After an NHS Job Offer: Conditional Offers, References and Pre-Employment Checks Explained

You've been offered an NHS job. Congratulations. But the email you got is a "conditional offer", and the start date is blank. For many IMG doctors, the weeks between offer and start date are the most frustrating part of the whole process, mostly because nobody explains what's happening or why it's taking so long.

Quick answer: after an NHS job offer, the Trust sends a conditional offer, usually through Trac, and starts its pre-employment checks. Under the NHS Employment Check Standards, these cover identity, right to work, professional registration and qualifications, employment history and references, criminal record (DBS or overseas police certificates) and occupational health. References usually need to cover the last three years. If you need a visa, the Trust also assigns a certificate of sponsorship. Some Trusts aim to finish checks within about 20 days, but referees, overseas police certificates and visas often take longer. Don't resign from your current job until the Trust confirms all checks are complete.

Conditional offer vs unconditional offer

A conditional offer means the job is yours if your checks come back satisfactory. An unconditional offer (or "clearance") comes once everything is done, and that's when you agree a start date. The conditional offer letter usually lists the checks needed and links to the forms.

The six NHS pre-employment checks

1. Identity

You'll need a passport and sometimes proof of address. UK-based doctors usually attend an ID appointment; overseas doctors may do it online or on arrival.

2. Right to work

Your visa status, or a share code if you're already in the UK. If you need sponsorship, the Trust will assign a certificate of sponsorship (CoS) so you can apply for a Health and Care Worker visa.

3. Registration and qualifications

The Trust checks your GMC registration and licence to practise, and may ask for your degree certificate and any qualifications listed as essential in the person specification.

4. Employment history and references

This is the check that causes the most delays. Trusts usually need references that cover the last three years of employment or training. If you've worked in several places in that time, you may need one from each. Referees should have supervised you, ideally a consultant or senior clinician.

5. Criminal record checks

Doctors need an enhanced DBS check if they've lived in the UK. If you've lived abroad, you'll usually need police certificates from the countries where you've lived, often for any period of 12 months or more in the last 10 years. Overseas certificates can take weeks, so start early.

6. Occupational health

An online health questionnaire and evidence of vaccinations and immunity, such as hepatitis B, MMR, varicella and TB screening, depending on the role. Exposure-prone procedure posts, such as surgery, need extra blood tests.

References: what IMGs need to know

• Warn your referees before you apply. Tell them a UK Trust will contact them, usually by email, and ask them to reply quickly.

• Use official email addresses where you can. Personal emails such as Gmail may need extra verification and can slow things down.

• Cover every post in the last three years. If you had a gap, such as time studying for PLAB, explain it and offer an alternative referee or evidence if asked. Our career gap guide helps.

• Chase politely. If a referee hasn't replied within a week, remind them, and let the Trust know you're chasing.

• A UK reference helps. A consultant who supervised your clinical attachment can sometimes provide a character or supporting reference.

How long do pre-employment checks take?

It varies. Some Trusts aim to complete checks within about 20 days of the conditional offer, but for IMGs it's often longer, because of:

• Referees overseas who are slow to reply

• Overseas police certificates

• Visa processing after the certificate of sponsorship

• Missing occupational health or vaccination records

Doctors who prepare documents before the offer (police certificates, vaccination records, referee details) usually start much sooner. Our NHS job application documents checklist lists everything to gather.

Before your start date

• Check your contract, pay point, rota and any relocation package

• Make sure your GMC licence to practise is active

• Book accommodation and plan travel

• Complete any mandatory e-learning the Trust sends

• Ask about induction and shadowing days

If your GMC licence lapses or you relinquished it, see our guide on restoring your GMC licence after a job offer.

Still looking for that offer?

If you're not getting shortlisted yet, our £35 NHS CV review and £35 supporting statement service help IMG doctors get to the interview stage. And when you are, our list of NHS interview questions for IMGs will help you prepare.

Frequently asked questions

What is a conditional offer in the NHS?

An offer that depends on satisfactory pre-employment checks. Once all checks are complete, the Trust confirms clearance and agrees a start date.

How many years do NHS references need to cover?

Usually the last three years of employment or training. You may need more than one referee if you've had several posts in that time.

Can I use an overseas referee?

Yes. Most IMGs do. Give a professional email address and warn your referee to expect the request.

How long do NHS pre-employment checks take?

Some Trusts aim for about 20 days, but for IMGs it's often several weeks or more, mainly because of references, overseas police certificates and visas.

Should I resign before my checks are complete?

No. Wait until the Trust confirms all checks are satisfactory and you have an agreed start date.

Can a conditional offer be withdrawn?

Yes, if checks are unsatisfactory, if you don't provide what's needed, or if information on your application turns out to be inaccurate. Be honest and complete on your application form.