Locally Employed Doctors

Locally Employed Doctors (LEDs) are growing at a very fast pace and as indicated in the GMC's 2024 report on The state of medical education and practice in the UK Workforce, a substantial proportion have a non-UK primary medical qualification (PMQ). The Faculty of Intensive Care Medicine (FICM) values the contributions of LEDs who play a vital role in delivering high-quality patient care. LEDs encompass a diverse group of doctors, from clinical fellows and trust doctors to teaching and research fellows, who bring varied skills and experiences to the NHS.  

We recognise the importance of offering LEDs equitable access to educational opportunities, career support, and supervision. One guiding principle we strongly endorse is that ‘all doctors are in training’ - whether they are on a formal national training pathway or working within locally employed structures. In addition to effectively integrating LEDs into workplaces, there must be an equitable and open career pathway for them that will result in better job satisfaction along with improvement in retention rates.

Recommendations:

• NHS Employers: Employers should clearly identify the level and responsibility of an LED role with a salary that reflects the duties and responsibilities
  and is in line with national terms and conditions for the equivalent career grade of a doctor in a national training programme[NB1] [MW2] . Employers should ensure that supervisors are given appropriate renumeration and time in their job plans for supervising LEDs and that appraisers are available to carry out annual appraisals.
• Professional Development: LEDs deserve access to high-quality education, leadership opportunities, pastoral support and structured supervision to foster career growth and enhance patient care outcomes. LEDs should have a nominated clinical and educational supervisor with regular, scheduled supervision meetings.
• Educational Opportunities: LEDs should have access to the same local teaching and educational opportunities as Intensivists in Training.
• Induction and Orientation: For those new to the NHS, particularly international medical graduates (IMGs), we support tailored induction programmes and guidance to help them navigate NHS systems effectively (Link to FICM IMG). LEDs should have completed trust induction, departmental induction, and mandatory training before starting the first day of clinical work. A regular pastoral support and mentors to be offered during the appointment.
• Equity and Inclusion: LEDs should not face disadvantages in their career development due to their contractual arrangements. Access to study leave, regional and national examination courses and flexible working and career advice are critical components of their progression.

Resources & Support 

We are committed to connecting LEDs with tools and resources to help them thrive:

• For LEDs who may also be International Medical Graduates you may find the guidance and resources on our IMG pages useful
• Educational supervision and mentoring opportunities
• CPD resources and regional events to build skills
• Access to guidance on achieving key career milestones like CREST sign-off and specialty training applications

References:

• The state of medical education and practice in the UK Workforce, GMC 2024: https://www.gmc-uk.org/-/media/documents/somep-workforce-report-2024-full-report_pdf-109169408.pdf
• Educational and career support for locally employed doctors (LEDs) and international medical graduates (IMGs) Guidance for doctors and employers, RCP 2024: https://www.rcp.ac.uk/media/tfkj52qc/educational-and-career-support-for-locally-employed-leds-and-imgs.pdf