“And because of the quite, quite meaningless limits set on what people can earn, we can't attract junior doctors from around the world because they won’t actually earn enough to meet the minimum income requirements”.
Maggie Chapman, 25 January 2018
A junior doctor’s basic salary during their first year is below the minimum required to get the relevant visa to work in the UK—unless they’re aged under 26, in which case the minimum salary is lowered. Junior doctors who’ve completed their first year will usually earn more than the minimum requirements.
However, in recent months, the amount junior doctors have needed to earn to be eligible for a visa has been unusually high due to a combination of high demand for visas and the government’s cap on skilled immigration from outside the EU. In December 2017 the threshold was effectively £55,000, and it was £50,000 in January this year—more than is typically earned by a junior doctor at any point.
Non-EEA students who graduate from a UK medical school, and then extend their visa to study as a junior doctor, are not subject to these visa requirements.
What are the earnings limits?
The Scottish Green Party pointed us to these guidelines from the BMA, which explain the salary requirement for doctors on a Tier 2 visa.
A Tier 2 (General) visa is required for people from outside the European Economic Area who have been offered a skilled job in the UK. Skilled jobs include “medical practitioners”—the category to which junior doctors belong.
A junior doctor is someone who has completed their medical degree and is now in further training, which normally takes 3-8 years. Although they cannot practice medicine independently, they make up almost half of NHS doctors, and could give you diagnosis or put you under anaesthetic.
As well as meeting the skills criteria, in order to get a Tier 2 (General) visa an applicant must be paid a minimum of £30,000 a year, or the appropriate salary for their job, whichever is higher.
The appropriate salary for a junior doctor (as set out by the Home Office) varies according to which year of training they are in. In the first year of training, the appropriate salary is £26,350—but a first-year junior doctor on a Tier 2 visa would have to earn £30,000. From the second year of training onwards, the appropriate salary for a junior doctor is higher than the £30,000 threshold.
Similarly, the NHS says that the basic starting salary for a junior doctor in their first Foundation year is £26,614, rising to £30,805 in the second year. A junior doctor starting specialist training (after a two-year Foundation Programme) has a basic starting salary of £36,461, rising to £46,208.
So a non-EEA individual applying to start the two-year Foundation Programme would not be expected to earn enough to be granted a Tier 2 visa.
However, those aged under 26 are subject to a reduced earnings threshold of £20,800 if they are sponsored for a Tier 2 (General) visa of no more than 3 years. The Foundation Programme told us that a Tier 2 visa would initially be granted to a Junior Doctor for the 2 years of their foundation training, and they would then extend their visa after applying for specialist training. This means junior doctors under 26 would be eligible for the lower income threshold.
Oversubscription automatically excludes Tier 2 applicants
Even if we assume they pass the earnings threshold, the limited number of Foundation Programme places available puts another limit on non-EEA junior doctors.
Health Education England (HEE) told us that historically the Foundation Programme has been oversubscribed, and they said this means Tier 2 visa applicants would fail the resident labour market test. This test asks the recruiting organisation to first assess whether the “settled workforce” can fill vacant posts, before it offers positions to workers from outside the EU. As the Foundation Programme was oversubscribed, those on Tier 2 visas would not have been considered.
However, HEE said that there has been undersubscription over the last two years, meaning that applicants requiring Tier 2 visas would have be considered more recently. But it’s unclear whether these applicants would be able to successfully apply, given the ambiguities about the earnings threshold.
The earnings threshold was effectively £50,000 in January
The £30,000 threshold has also effectively been inflated by quotas on the number of Tier 2 visas set by the Home Office.
Each year the Home Office puts a limit on the number of skilled workers who can come to the UK from outside the EU. These workers need to apply for a visa and have a sponsoring employer in the UK lined up. The employers themselves need to apply to the Home Office beforehand for certificates that allow them to sponsor workers who they want to employ.
The Home Office limits this kind of immigration by restricting how many certificates it gives out. In 2017/18, this limit was set at 20,700. Some immigrant workers—such as those earning £160,000 or more—aren’t capped in the same way.
Each month a limited number of certificates are allocated. If the number of applications is too high for that month, a points system determines who gets the certificates.
So if there are a high number of applications in a single month, the number of points you need is likely to be higher too. In December 2017, around 1,500 certificates for visas were granted, and applicants had to score a minimum of 55 points to make the cut—higher than the usual 21.
Points are awarded according to the type of job and salary level of an applicant. In terms of job type, most junior doctors will score 20 points unless there is considered a shortage in their specific occupation. This is the score awarded if an applicant’s proposed employer determines that there is no “settled worker” able to fill their role.
That means that in December a junior doctor would have needed to score at least 35 points on the salary scale—so they must have been in line to earn at least £55,000. This is higher than a junior doctor salary at any level.
In January 2018 the points score needed was 46. This means that most junior doctors would have to be in line to earn at least £50,000 to get a visa.
The other way to score points is if a visa applicant’s proposed job is suffering from a shortage of workers—this is worth 135 points, and so will virtually guarantee making the cut in any given month. Some trainees in emergency medicine and psychiatry are currently included on the shortage occupation list, but all other junior doctors are not (even though the Foundation Programme has been undersubscribed in the past two years).
Additional visas may be granted in in “compelling” circumstances such as there being an urgent need for an applicant to begin immediately (for instance to perform life-saving surgery). The number of visas granted for this reason was exceptionally high in December 2017, but we don’t know who they were granted to.
Thinking beyond just junior doctors, the government estimates that a third of Tier 2 visas go to the NHS. A spokesperson for Cambridge University Hospitals is reportedas saying that “Cambridge University Hospitals, which is proud to have more than 84 nationalities working at the trust, was disappointed to learn that visas for three overseas doctors due to join us in February have been declined because they do not meet a criteria that includes a salary threshold of £55,000.” We don’t know if any of these individuals were junior doctors.
Yet 17% of junior doctors are non-EEA nationals
Despite all this, 17% of NHS England junior doctors were non-EEA nationals at the end of September 2017. Based on the full-time equivalent figure it’s 18%. That’s a slightly higher level than the for all NHS England doctors, which is 16% based on both headcount and full-time equivalent.
How is this the case if they do not earn enough to enter the Foundation Programme?
It’s because non-EEA junior doctors who received their medical degree in the UK are not subject to the same immigration criteria. They can apply to extend their existing Tier 4 visa instead, which is not subject to the same earnings thresholds. Non-EEA students who have completed their studies in the UK will already be on a Tier 4 visa, and they can have their leave to remain extended if they successfully obtain a place on the junior doctor Foundation Programme.
The Foundation Programme told us that, over the last five years, an average of 520 doctors a year begin the Foundation Programme on a Tier 4 visa. So the majority of non-EEA junior doctors are likely to be on Tier 4 visas, having completed their medical degrees in the UK. The BMA suggests that it is "very rare" for non-EEA individuals to be sponsored for Tier 2 Visa for the junior doctor Foundation Programme.