IMG guide to UK practice 2026: from PLAB/UKMLA to first NHS job

Key takeaways

The pathway to practising medicine in the UK as an IMG involves: (1) confirming eligibility and applying for GMC registration, (2) passing the required exam (PLAB or UKMLA), (3) demonstrating English language proficiency (IELTS or OET), (4) completing an acceptable internship pattern, and (5) finding and starting your first NHS role.
The UKMLA is replacing PLAB as the primary licensing assessment for the UK. The GMC is transitioning from the two-part PLAB exam to the UKMLA, which will be the single assessment for both UK graduates and IMGs. Check the GMC website for the latest transition timeline.
Alternative pathways exist: Doctors who have passed the USMLE, MCCQE, or AMC exams may be eligible for GMC registration without taking PLAB, subject to specific conditions (exam pass dates, internship requirements).
iatroX was built by an immigrant doctor who understands the challenges of navigating a new healthcare system. It provides free, UK-guideline-grounded clinical reference (Ask iatroX), differential diagnosis support (Brainstorm), and adaptive exam preparation (iatroX Quiz) for UKMLA, PLAB, MRCP, MRCGP AKT, and other UK exams — all grounded in NICE, CKS, and BNF guidelines.
The biggest challenge for most IMGs is not the exam itself — it is adapting to UK clinical practice: different guidelines (NICE vs what you learned), different clinical systems (EMIS/SystmOne), different prescribing (BNF), and different cultural expectations. The tools and resources in this guide are designed to smooth that transition.

Step 1: Check your eligibility for GMC registration

Before anything else, confirm that your primary medical qualification (PMQ) is recognised by the GMC.

Requirements for full GMC registration:

An acceptable primary medical qualification from a recognised medical school
An acceptable pattern of postgraduate clinical experience (internship)
English language proficiency (IELTS Academic with minimum 7.0 in each band, or OET with minimum B in each component)
Passing the required licensing assessment (PLAB or UKMLA) — unless you qualify for an exemption

EPIC verification: Your primary medical qualification must be verified through the GMC's EPIC (Electronic Portfolio of International Credentials) process. Start this early — it can take weeks.

Alternative routes (USMLE, MCCQE, AMC): The GMC accepts results from the USMLE, MCCQE, and AMC for consideration of full registration, subject to specific conditions including exam pass dates and completion of an acceptable internship. If you have passed Step 1, Step 2 CK, and Step 2 CS (before its discontinuation in March 2020) via the USMLE route, you may be eligible. Check the GMC's international registration pages for the current requirements.

Step 2: Pass the exam — PLAB, UKMLA, or alternative

PLAB (Professional and Linguistic Assessments Board)

PLAB has been the traditional licensing exam for IMGs:

PLAB 1: A written exam (180 single best answer questions, 3 hours). Tests applied medical knowledge.
PLAB 2: An OSCE (Objective Structured Clinical Examination) with 16 stations. Tests clinical and communication skills.

UKMLA (UK Medical Licensing Assessment)

The UKMLA is the GMC's new unified licensing assessment, designed to replace both PLAB (for IMGs) and medical school finals (for UK graduates). It consists of:

Applied Knowledge Test (AKT): A written test of clinical knowledge, similar in format to PLAB 1 but aligned with the MLA content map.
Clinical and Professional Skills Assessment (CPSA): An OSCE-style clinical exam, similar in format to PLAB 2.

Transition: The GMC is in the process of transitioning from PLAB to the UKMLA. Check the GMC website and the iatroX PLAB vs UKMLA guide for the latest timeline and which exam you should sit.

Preparing for the exam with iatroX

iatroX Quiz provides adaptive, curriculum-mapped question banks aligned with the UKMLA/PLAB blueprint. The system uses spaced repetition and adaptive difficulty to target your weakest areas — exactly the kind of efficient, personalised preparation that IMGs need when studying alongside work or other commitments.

Key features for IMGs:

Questions grounded in UK guidelines (NICE, CKS, BNF) — not US or international guidelines. This is critical because the exam tests UK-specific knowledge.
Brainstorm mode for practising clinical reasoning with UK-appropriate differentials and management plans — excellent preparation for the OSCE/CPSA stations.
Ask iatroX for checking guidelines between study sessions — "What is the NICE-recommended first-line for X?" is exactly the kind of question you will face.
Free: No subscription barrier. This matters for IMGs who may be studying while managing finances in a new country.

Other exam resources: Passmedicine (for PLAB 1 and AKT), Quesmed, PLABable, and Pastest are all established UK exam resources. See our detailed comparison to choose the right combination.

Step 3: English language proficiency

You must demonstrate English proficiency through either:

IELTS Academic: Minimum 7.0 in each of the four components (Speaking, Listening, Reading, Writing), achieved in a single sitting. Overall score of 7.5.
OET (Occupational English Test): Minimum grade B in each of the four components, achieved within a six-month window.

Practical advice: Many IMGs find OET more accessible than IELTS because it uses medical scenarios and healthcare-specific language. However, both are accepted by the GMC. Start your English language preparation early — retakes add cost and delay.

Step 4: Internship and clinical experience

The GMC requires an acceptable pattern of clinical internship/experience for full registration. The requirements vary depending on your route:

If you have completed an acceptable internship in your home country: You may be eligible for full registration directly.
If you have not completed an acceptable internship: The GMC may offer provisional registration, which allows you to work only in Foundation Programme (UKFP) training posts to complete the equivalent of internship.

Check the GMC's internship criteria carefully. This is one of the most common points of confusion for IMGs.

Step 5: Finding your first NHS job

Foundation Programme (UKFP)

If you receive provisional registration, the UK Foundation Programme is the standard route. Apply through the UKFPO (UK Foundation Programme Office) during the annual application cycle.

Specialty training

For IMGs with full registration who want to enter specialty training (e.g., GP training, medical or surgical specialties), applications go through the relevant national recruitment processes (GPNRO for GP, MSRA for many specialties).

Non-training roles (Clinical Fellow, Trust Grade, Locum)

Many IMGs start in non-training NHS roles:

Clinical Fellow / Trust Grade posts: Fixed-term hospital roles. Search on NHS Jobs.
Locum GP: For IMGs with full registration and GP experience. Platforms like Lantum connect you directly with practices — see our Locum GP Toolkit for the full guide.
Staff & Associate Specialist (SAS) roles: For experienced IMGs who want to work outside the formal training pathway.

Where to search

NHS Jobs (jobs.nhs.uk): The official NHS recruitment portal.
BMJ Careers: Medical job listings including NHS and private.
Lantum: For GP locum work specifically.
Medical recruitment agencies: Many Trusts use agencies for hard-to-fill posts.

Step 6: Your first week — adapting to UK practice

This is where the real challenge begins. You have passed the exam, secured the job, and arrived at the hospital or surgery. Now you need to function effectively in a system that works differently from what you trained in.

Clinical systems: EMIS and SystmOne

UK general practice runs on two main clinical systems: EMIS Web and SystmOne (TPP). Hospitals use various EPR systems (Epic, Cerner, etc.). You will need to learn the specific system used by your employer. Ask for a dedicated induction session — most practices and Trusts provide this.

UK guidelines: NICE, CKS, BNF

This is the single biggest knowledge gap for most IMGs. UK clinical practice is governed by NICE guidelines (covering diagnosis, management, and referral thresholds), NICE CKS (concise primary care summaries), and the BNF (prescribing formulary). What you learned in your home country — even if it was evidence-based — may differ from UK recommendations.

iatroX was designed with this challenge in mind. The platform is built by an immigrant doctor who experienced this transition firsthand. It provides:

Ask iatroX: Ask any clinical question and get the answer according to UK guidelines — not the guidelines you learned in medical school. This is your daily safety net.
iatroX Knowledge Centre (iKC): A curated front door to NICE, CKS, SIGN, and BNF — navigate directly to the right guideline page without Googling.
Brainstorm: When you encounter an unfamiliar presentation, Brainstorm generates a UK-contextualised differential diagnosis and next-step plan.

Prescribing: the BNF

UK prescribing follows the BNF (British National Formulary). Drug names, doses, and protocols may differ from what you learned. Always check the BNF before prescribing an unfamiliar medication. The BNF is available free online via NICE and as a mobile app.

Communication and professional culture

UK medical practice places particular emphasis on:

Shared decision-making with patients
Documentation standards (clear, contemporaneous, defensible notes)
Multidisciplinary teamwork (working closely with nurses, pharmacists, allied health professionals)
Safeguarding awareness (child protection, vulnerable adults)
GMC Good Medical Practice — the professional standards framework that governs all UK doctors

Mandatory training

You will be required to complete statutory and mandatory training (safeguarding, infection control, fire safety, information governance, etc.) through NHS e-Learning for Healthcare (e-LfH). Register with your NHS email address at e-lfh.org.uk.

The IMG-specific toolkit

Need	Tool	Cost
UK guideline reference	iatroX (Ask, Knowledge Centre)	Free
UKMLA/PLAB exam prep	iatroX Quiz + Passmedicine + PLABable	Free (iatroX) / Paid (others)
Clinical reasoning practice	iatroX Brainstorm	Free
OSCE/CPSA preparation	iatroX Brainstorm + Geeky Medics + OSCE Stop	Free / Paid
Prescribing reference	BNF (via NICE)	Free
English language prep	OET practice materials / IELTS prep	Varies
Job search	NHS Jobs + BMJ Careers + Lantum (GPs)	Free
Mandatory training	NHS e-LfH	Free
PLAB vs UKMLA guidance	iatroX Academy	Free
CPD and appraisal	iatroX CPD + FourteenFish/Clarity	Free / Paid

A note from the founder

iatroX was created by Dr Kola Tytler — a GP who knows what it is like to navigate a new healthcare system as an immigrant doctor. The platform was built with the specific challenges of IMGs in mind: the need for reliable UK-specific clinical guidance, the pressure of high-stakes exams, and the daily reality of practising in an unfamiliar system where the guidelines, the drugs, and the cultural expectations are all different from what you trained in.

If you are an IMG reading this, know that iatroX is free for you — always has been, always will be. It is our contribution to making the UK healthcare system more accessible, more equitable, and more supportive for every doctor, regardless of where they trained.

Welcome to the UK. You belong here.