Starting your first NHS job: 10 things I wish I'd known

Hi, we are Nowrin and Abhishek, IMGs from Bangladesh and India, and NHS practising doctors. In today's blog, we will guide you through some important aspects of joining the NHS and share tips on how to make your transition as smooth as possible.

'I started to work in the NHS after working for almost 6 years in my home country, that is India. After the initial euphoric phase, reality hit me hard. I started to realise the massive difference in work between the NHS and the rest of the world. I started to learn things, sometimes the hard way. So I would be putting down basic things which I should have known before even starting my job.' - Abhishek

A big congratulation on your success!

Getting your first NHS job is very exciting for newly GMC registered doctors. It feels like all hard work pays off. At the same time, it brings some fear of the unknown. Adapting to a new environment, weather, culture and work in a completely different system. Initially, I felt like I was swimming in a pond and all of a sudden I was thrown into an ocean. However, knowing things beforehand can make things a bit easier. I would try to share some of the tips which can help us to save your time and to adapt the system early.

1. Relocation Fee

After accepting the job offer, check with the authority whether you will be allocated for the relocation fee from the trust. Relocation fee covers ticket fare, TB test cost, COVID test (if required), visa application fee, taxi or bus fare to come to the hospital or accommodation for the first time. But you need to keep all the receipts of these both as hard and soft copies. After starting your job, you will have to fill out a form and submit all documents, so that the trust could reimburse you the money within 3 - 4 weeks' time.

2. BRP collection and opening bank account

After coming to the UK, aim to collect BRP as soon as possible and open your bank account, because you can only start your job after completing these things. Opening a bank account can be done online but you need to provide a BRP copy, proof of residence (your address), and a letter from the hospital mentioning your contract period and salary.

3. Shadowing period

Always ask for a shadowing period of at least 2 weeks before signing the contract. Furthermore, do not start on-call duty in the first month. Before starting on-calls, always ask for on-call shadowing for at least 4 weeks otherwise it would be very stressful.

'Read up on the cases you have seen in the ward on that day. This is a good practice and would help you grab the clinical bits faster.' - Abhishek

4. Your time management

Try to come and leave on time. Don’t think that if you overstay, your consultants will praise you and think you work hard. If most of your team is staying behind to finish jobs that’s fine, but if it's only you then hand over. Otherwise again it raises serious questions about your time management skills. You also need to rest to return to duty the next day morning.

'You are expected to be in at the right time. Not even a minute less. If the morning board meeting starts and you enter after, you are late. Being late here raises serious questions about your punctuality. Try arriving 5 mins early, that’s what most of the juniors do.' - Abhishek

5. Your clinical skills

Blood sampling and cannula: Initially, almost all IMGs struggle to some extent to do blood sampling and insert a cannula, as in other countries these things are done by phlebotomists and/or nurses. To gain some experience, you can go to the OP phlebotomy section in your hospital during your shadowing period and explain to them that you are new and want to practise blood sampling and cannulas. Most of the time they are very friendly and provide initial training.

To-take-out medications: Make sure TTOs are done pretty much quickly, discharge summaries could be done later in the day. TTOs need to be screened by pharmacies and medications dispensed. Controlled drugs like opioids take time and thus this step is a serious delaying factor for patient discharge. It’s a good practice to prep it the day before, remember patients in Nursing homes and care homes cant be discharged without these two and have to be discharged timely so that they can enter the home before 4 pm. Later than this, they cannot be accepted and end up staying in the hospital for another day.

Read up on the cases you have seen in the ward on that day. This is a good practice and would help you grab the clinical bits faster.

6. Education Supervisor, Clinical Supervisor and Portfolio

After starting your job, find out who your Educational supervisor and Clinical supervisor are by contacting medical staff. Initially, ES and CS could be the same person. Arrange an initial meeting with your supervisor and ask them to help you get access to your portfolio. Usually, doctors who are in training (trainees), use the NHS portfolio for free but trust grade doctors would need to pay a fee. That is why for trust grade doctors some trusts provide access to Horus portfolio. In the beginning, it can be a bit difficult to understand what we need to do in the portfolio. There are some abbreviated things like Mini-CEX, CBD, DOPS but with time you will get an idea of what to do, and also can ask for help from your ES and CS.

7. Good communication with colleagues

Try to maintain good communication with your colleagues, doctors, nurses, health care workers and other specialities. Know the names of the nurses and address them by their names and always politely ask for things instead of giving an order. If you can establish a good rapport, they will help you and will make things easier for you.

Go through the case in detail before speaking with microbiology for advice or radiology cons for the vetting of scans. They ask for a lot more information about the current clinical condition of the patient and if you are not able to say it, the encounter becomes less friendly.

'Make sure you engage with the consultants and registrars on rounds. Ask questions and show that you are keen to learn. That way they will understand that you are keen and want to learn. Present your patients during the morning board rounds the next day, that way your voices would be heard, your face and name recognized. Remaining silent is seen as non-engagement.'- Abhishek

8. Documentation

Documentation is very important in the NHS. You have to document all and everything that you have done. If you don’t document, that means you have not done it. Any phone call you get or any conversation you have with the patient or their family needs to be documented with the names of the people and details of your conversation.

9. ESR Account and Payslip

Ask your HR or medical staff about your ESR (Electronic staff record) account details and log in there. You will find some free courses and your monthly payslip in your ESR account. Take time to understand your payslip. It is very important to know how your salary is calculated. For example, if you take one or two days of sick leave but HR is not aware of it, it may result in your salary being cut in half, simply because your HR thought you had been on sick leave for a month. Read more about NHS doctor's payslip in our blog NHS doctor's payslip: a guide to understanding your salary

10. NHS discount and Blue light card

As an NHS worker, you can get lots of discounts but you need to ask for that. You can take a blue light card online by spending £5. You will get the blue light card on your phone and also they will send you the card by post. You can buy your essentials by using this card as in the beginning you need to buy loads of things. Also in some places, public transport allows some discounts for NHS workers, so check locally whether these discounts are available.