Paid Clinical Attachments in the UK: What Actually Exists for IMGs

"Paid clinical attachment UK" is one of the most common searches we see from IMG doctors. It makes sense: a clinical attachment costs money, takes weeks of your time, and many doctors are supporting a family while they wait for a UK job. So is there a version that pays you instead?

Quick answer: no. In the NHS, a clinical attachment or observership is always unpaid, and most Trusts charge you a fee to take part. If an advert offers a "paid clinical attachment", it's either a real job with a different name (such as a clinical fellow or trust grade post) or something to be careful about. The genuine paid routes into NHS experience are locally employed doctor (LED) and trust grade posts, clinical fellow posts, and bank or locum work once you're GMC registered. The Medical Training Initiative (MTI) used to be another paid route, but Royal Colleges report that new MTI sponsorship stopped from April 2026.

Why clinical attachments are unpaid

A clinical attachment is observation only. You don't treat patients, prescribe or take clinical responsibility, so it isn't employment and there's nothing to pay you for. That's also why many attachments are open to doctors who don't yet have a GMC licence to practise. Trusts charge a fee to cover supervision, honorary contracts, occupational health and admin. Fees range from nothing to about £1,600 for the larger London programmes; see our NHS clinical attachment directory.

Be careful with "paid attachment" offers

We regularly hear from doctors who've been offered "paid clinical attachments", "guaranteed placements" or "NHS internships" by agents or social media accounts. Be cautious if:

• The offer doesn't name a specific NHS Trust and supervising consultant

• You're asked to pay a large fee to an agent rather than to the Trust

• It promises a job, a visa or GMC registration at the end

• It describes hands-on patient care without GMC registration

You can always check with the Trust's medical education team directly. Genuine attachments are arranged with the Trust.

Paid routes into NHS experience

1. Locally employed doctor and trust grade posts

This is how most IMGs get their first paid NHS experience. They're real, salaried jobs, usually at FY2 or SHO level, advertised by individual Trusts on NHS Jobs and Trac. You need full GMC registration with a licence to practise. Pay usually follows the resident doctor scale; see our guide to NHS doctor grades and pay.

2. Clinical fellow posts

Salaried LED posts with protected time for teaching, research, QI or leadership. Junior clinical fellow posts are one of the most popular first jobs for IMGs. See our junior clinical fellow guide.

3. Bank and locum work

Once you're GMC registered and have the right to work, some Trusts and NHS Professionals take doctors onto their medical bank. It's paid by the shift. Many prefer doctors with some NHS experience, so it often works better after a first post, but it's worth asking.

4. Specialty doctor posts

If you have at least four years' postgraduate experience, including two in the specialty, you can apply directly for specialty doctor posts, which start at £63,696 in England in 2026/27.

5. The Medical Training Initiative (MTI)

The MTI let doctors from overseas train in the NHS for up to two years, in a paid post, sponsored through the Academy of Medical Royal Colleges on a Government Authorised Exchange visa. In 2026 several Royal Colleges said the NHS had stopped funding new MTI visa sponsorship from 1 April 2026, and some, such as the Royal College of Physicians of Edinburgh, are no longer accepting new applications. Check your College's website for the latest position before planning around the MTI.

So is an unpaid clinical attachment still worth it?

For many IMGs, yes, as long as it's in an NHS Trust, in your specialty, and timed before your job applications. It gives you UK examples for your supporting statement and interview, an understanding of how NHS teams work, and sometimes a UK reference. It doesn't replace a job, though, and the quickest route to paid work is usually a strong application for trust grade or clinical fellow posts.

• Not sure whether to do one? Read our clinical attachment guide and our comparison of clinical attachments and observerships.

• Ready to apply for paid posts? See how to get your first NHS job with no UK experience.

How we can help

If you want an attachment, our clinical attachment support service contacts hospitals for you and guides you through the checks. If you're ready for paid work, our £35 NHS CV review and £35 supporting statement service help you get shortlisted.

Frequently asked questions

Are clinical attachments paid in the UK?

No. NHS clinical attachments and observerships are unpaid, and most Trusts charge a fee.

Is there a paid alternative to a clinical attachment?

Yes: trust grade or locally employed doctor posts, clinical fellow posts, and bank or locum work once you're GMC registered.

Is the MTI scheme still open?

Several Royal Colleges reported in 2026 that NHS funding for new MTI visa sponsorship stopped from 1 April 2026, and some aren't accepting new applications. Check your College's website for the current position.

Can I work in the NHS without GMC registration?

Not as a doctor. You need GMC registration with a licence to practise for any paid medical post. Clinical attachments are observational, which is why many don't require it.

How much does a clinical attachment cost?

From nothing to about £1,600 for the larger London programmes, plus checks, travel and accommodation.