Overseas fully qualified post-FRCR Fellows will be appointed to unfilled consultant radiologist posts, but as ‘Global Fellows’ at top of the range of ‘staff grade/SAS grade’ salaries.
These Global Fellows will only be expected to work six full unsupervised direct clinical care (DCC) programmed activities (PAs) doing the type of work which they are already comfortable performing independently, such as plain radiographic reporting, general ultrasound, general body and head CT. They will not be expected to take multidisciplinary team meetings (MDTMs) as most will never have done so in their home countries.
In their remaining four PAs (‘self-training PAs’) they will be enhancing their specialisation in self chosen areas of radiology. It is radiological specialisation that such overseas radiologists are unable to achieve in their home countries, and this will enable them to obtain a better job when/if they decide to return to their home countries after three years in the UK. We appreciate that overworked consultant radiologists in currently understaffed departments will only have limited time for training these Global Fellows.
Therefore, it is suggested that the Global Fellows can achieve such specialisation during their 'training PAs' by attending MDTMs relevant to their chosen specialty areas (gradually being delegated cases to present at these MDTMs under the supervision of the consultant radiologist in charge of that MDTM); self-learning using RCR, European Society of Radiology (ESR) and other online material; and writing provisional reports for specialist studies in their chosen specialty area. So, for example, a Global Fellow wishing to specialise in gastrointestinal radiology might write provisional reports on MR studies of the small bowel, fistula-in-ano, rectal carcinoma and so on. Their provisional reports would be checked and amended by the existing consultant radiologists with a gastrointestinal specialty interest. The contribution that the Global Fellows make to the general service work reporting in the department during their six unsupervised DCCs should allow the extant consultant radiologists sufficient time to be able to correct and sign off the specialist reports issued by these Global Fellows (in the same way that one would for a trainee radiologist).
It is hoped that every Global Fellow can also be allocated a 'pastoral mentor' either from the radiology department to which they are appointed, or online from other consultant radiologists now resident in the UK, but originally from the same country of origin as the Global Fellow. This should help give the Global Fellows support as they adapt to the British/NHS way of life.
Appointing Global Fellows will ultimately help to increase capacity within struggling services, but the success of the scheme is reliant on the support of our Fellows and members in providing the (limited) supervision these already experienced radiologists need to develop their specialised expertise. Clearly this will work best if a cohort of overseas Global Fellows can be appointed together to fill all the consultant vacancies in one hospital, so that the impact they have in performing their unsupervised service DCC work will be immediately evident.
The College recognises that this Global Fellowship appointment scheme will not supply any hospital with specialist radiological expertise where this is already lacking due to unfilled consultant posts, and will only – after training of the Global Fellows – provide more of the same specialty expertise already present, but we would argue this is still much better than having the vacancies.
In order for the RCR’s matching scheme to work, Clinical Directors must submit to the Clinical Radiology Project and Development Officer the number of funded consultant radiologist vacancies they have, and the specialty interests of the consultant radiologists they currently have on their staff. Then we will be able to direct potential Global Fellows to the various hospitals for skype/facetime interview where the radiological specialisation they seek is available.
It is essential that Radiology Clinical Directors wishing to engage with the Global Fellowship scheme contact the head of their Human Resources department to agree a change in the job description from locum/consultant to 'Global Fellow' (SAS/Staff Grade doctor). The reduction in salary compared with a locum consultant should allow a realistic relocation package to be offered to the Global Fellows. (Overseas radiologists, who generally do not have their Certificate of Eligibility for Specialist Registration [CESR] from the General Medical Council, cannot be appointed to substantive consultant posts). The incentive for overseas radiologists to take up these Global Fellowships, rather than applying for more lucrative locum consultant posts is twofold: firstly they will have the opportunity in their job plan to obtain some radiological specialisation; and secondly, they will not be given responsibility beyond their experience, including not having to take MDTMs.
Other reasons why Clinical Directors need to engage with their Human Resources departments are: first, to gain their support for setting up virtual interviews for these potential Global Fellows; and second, to get them to be very proactive in supporting the appointed Fellows to gain their Tier 2 visas (especially now that the cap on these has been lifted for doctors coming to work in the UK).
It would be advisable that as soon as Global Fellows are in post, part of their mentorship should include preparing them to be able to apply for their CESR, so that in time they will be in a position to apply for substantive consultant posts in the NHS, should they so wish. This will include giving them two audit projects to perform a year, keeping a log book of any procedures they perform and advising them to keep anonymised copies of a selection of reports they author or co-author in all modalities, to help them prove the equivalence of their training to that of a UK-trained trainee radiologist.
For Indian radiologists with their full FRCR wishing to apply for a Global Fellowship, Health Education England (HEE) are working with the private hospital chain Apollo Healthcare in Hyderabad to provide training in clinical governance issues, RIS/PACS/speech recognition usage, familiarisation with the process of MDTMs and coaching for passing the Overseas English Test (OET), prior to these Indian Radiologists applying for a Global Fellowship in the UK to prepare them for work in the NHS.