What happens before your first day?
Every NHS employer must complete pre-employment checks set out in the NHS Employment Check Standards. They protect patients and they are not optional. A slow reply to the recruitment or medical staffing team can delay your start date, so answer emails quickly and keep copies of everything you send.
| Check | What it involves | Practical tip |
|---|---|---|
| Identity | Original passport or approved documents | Bring originals when asked; photocopies are usually not enough |
| Right to work | Share code or visa documents | If you are on a visa, check its conditions, including limits on extra work |
| Professional registration | GMC, NMC, HCPC or GPhC registration | Do not practise in a registered role until it is confirmed; check the register yourself |
| Criminal record check | DBS check in England and Wales, or the equivalent elsewhere in the UK | Overseas staff may also need certificates of good conduct |
| References | From recent employers, covering a set period | Warn your referees and give correct contact details |
| Occupational health | Health questionnaire and immunisation evidence | Find vaccination records early; some blood tests take weeks |
Doctors also need indemnity arrangements suitable for their role. NHS employers provide indemnity for NHS work, but many doctors also join a medical defence organisation for advice and support beyond that, and the BMA recommends bringing your certificate to induction.
How do you get IT access and complete mandatory training?
Almost everything runs on computer systems: results, electronic prescribing, notes, rotas and email. Ask early how to get your logins. In England you may also need an NHS Smartcard for national systems such as the Summary Care Record, which usually needs an in-person identity check. Starting a ward shift without a working login is one of the most common and stressful problems for new staff.
Mandatory and statutory training usually covers safeguarding adults and children, infection prevention, information governance, fire safety, moving and handling, basic life support and equality. Many trusts in England follow the Core Skills Training Framework, so some certificates from a previous NHS employer may transfer. Do e-learning you are sent before you start and keep the certificates.
What does NHS induction involve?
Most organisations run a corporate induction for all new staff and a local induction in your ward or department. Corporate induction covers values, policies and systems. Local induction is where you learn how your area actually works, and it is the one that keeps you and your patients safe on your first shifts.
- Where the resuscitation trolley, anaphylaxis kit, controlled drugs cupboard and fire exits are.
- How to put out an emergency call and the switchboard emergency number.
- Who is in charge each shift and how to reach seniors out of hours.
- The IT systems for notes, results, prescribing and handover.
- Policies you will use daily: deterioration and escalation, sepsis, medicines.
- Your rota, how to request leave and how to report sickness.
- Who your supervisor, preceptor or educator is and when you will meet.
Many new starters have shadowing or supernumerary time. Foundation doctors usually have a paid shadowing period, and newly registered nurses, midwives and allied health professionals often have supernumerary time within preceptorship. Doctors new to UK practice can also use the GMC's free Welcome to UK practice programme. Use shadowing actively: practise the systems, write notes and prescriptions under supervision, and keep a list of questions.
Who will support you?
Titles vary between organisations, so ask at induction who fills each role for you.
| Role | How they help you |
|---|---|
| Line manager | Rota, leave, sickness and employment matters (often the ward manager for nurses; a rota coordinator or clinical lead for doctors) |
| Clinical supervisor | Oversees day-to-day clinical work and gives feedback |
| Educational supervisor | For doctors in training, supports overall progress and annual review |
| Preceptor | For newly registered nurses, midwives, nursing associates and many AHPs, a registered colleague guiding a structured preceptorship |
| Practice or clinical educator | Runs training and signs off competencies |
| Freedom to Speak Up Guardian | Supports staff to raise concerns about safety or the working environment, where your organisation has one |
| Occupational health | Vaccinations, needlestick injuries and adjustments for health conditions |
| Staff networks and unions | International staff and other networks; unions and professional bodies such as the BMA, RCN, RCM, CSP and Unison |
The NMC's Principles of preceptorship describe the support newly registered nurses, midwives and nursing associates should receive. Many employers also offer preceptorship for internationally educated nurses in their first UK post. It is support, not an extra test of your registration. Ask how long your programme lasts and what it includes, and book your first supervision meeting in week one or two.
How do NHS teams work and communicate?
NHS care is delivered by multidisciplinary teams: doctors of different grades, nurses, nursing associates, healthcare assistants, pharmacists, therapists, dietitians, social workers, discharge coordinators and ward clerks. Staff from more hierarchical systems are often surprised by how flat UK teams feel. Nurses and therapists are expected to challenge a plan if they are worried, and doctors are expected to listen. Many teams use first names, but follow local custom.
Many organisations use SBAR (Situation, Background, Assessment, Recommendation) for urgent escalation, especially by phone.
Hi, it's the nurse on ward 7. Mrs D's not right, her obs are a bit off. Can you come and see her at some point?
This is Grace, staff nurse on ward 7, about Mrs D in bed 12, aged 78. Situation: her NEWS2 has risen from 2 to 7 in an hour. Background: admitted yesterday with a urinary infection, on IV antibiotics. Assessment: RR 26, sats 91% on air, BP 92/58, HR 118, newly confused. I'm worried about sepsis. Recommendation: please review within 30 minutes. I've started oxygen and taken blood cultures. Anything else you'd like before you arrive?
The strong version gives a name, a patient, the numbers, a concern, a clear request with a time frame and an offer to help. Repeat back any instructions you receive. At handover, always include unwell patients, outstanding tasks, results to chase and resuscitation decisions.
Which professional expectations surprise new starters?
- Consent and capacity: adults with capacity make their own decisions, including ones you disagree with. Families do not decide for them. When an adult lacks capacity, decisions are made in their best interests under the Mental Capacity Act 2005 in England and Wales, with separate laws in Scotland and Northern Ireland.
- Confidentiality: only access records of patients you care for, never discuss patients in lifts, canteens or messaging groups, and ask before sharing with relatives.
- Openness: when something goes wrong you must tell the patient, apologise and explain what happens next. Report incidents through the local system; the NHS aims for a just and learning culture.
- Raising concerns: speak to your line manager or supervisor first, then use your organisation's speaking up policy or seek advice from your union.
- Working within competence: all UK regulators expect you to recognise your limits. Asking for help is expected and respected.
Samuel is a physiotherapist in his first NHS post after working abroad, where physiotherapists rarely questioned surgeons. In his second week, a patient told to walk on day one after surgery is dizzy with low blood pressure on sitting. He tells the nurse in charge, documents his findings and calls the surgical doctor using SBAR, recommending review before mobilising. The patient turns out to be anaemic and needs a transfusion. At his preceptorship meeting, Samuel reflects that his clinical judgement is expected to shape the team's plan.
Pay, contracts and wellbeing
Most NHS nurses, midwives, allied health professionals and pharmacists in England are on Agenda for Change terms, paid by band and pay point. Doctors are on separate national contracts that differ across the four UK nations. Check your band or grade, pay point and first payslip carefully, because early errors are common and easier to fix quickly. Ask HR, medical staffing or your union if anything is unclear. Most staff are automatically enrolled in the NHS Pension Scheme; understand what it offers before opting out.
The first months are tiring, especially if you are also arranging housing, bank accounts, schools and transport in a new country. Take your breaks, avoid saying yes to every extra shift, and find out about your employer's staff support services. If you are struggling with your mental health, your GP, occupational health and NHS Practitioner Health (for many NHS clinicians in England) can help, and Samaritans are available on 116 123 at any time.
A 90-day plan for your first NHS job
- Week 1: Complete induction, get IT access working, learn emergency procedures, meet your supervisor or preceptor and agree your first goals.
- Weeks 2 to 4: Build confidence with everyday tasks and systems. Keep a question list and use it. Start a learning log and write one short reflection a week.
- Month 2: Review goals with your supervisor, ask for feedback from colleagues in different roles, and choose one skill to develop.
- Month 3: Complete competency sign-offs, check mandatory training is current, reflect on what still feels hard, and agree a plan for the next stage.
Everyone was new once. The most confident colleague on your ward once had to ask where the blood bottles were kept. If you would like a structured walk-through of checks, induction, supervision and UK professional expectations, with worked examples and a reflective exercise for your CPD record, the Your First NHS Job: Induction and Expectations course covers this ground. Your First Week on the Ward and How the NHS Works: Structure and Roles go into the practical and organisational detail.
Frequently asked questions
How long do NHS pre-employment checks take?
It varies with the employer and how quickly documents, references, DBS and occupational health clearance come back. International recruits may also wait for visas and overseas police certificates. Reply to recruitment emails promptly, warn referees in advance and find vaccination records early, as these are the most common causes of delay.
What should I bring on my first day in an NHS job?
Bring photo ID, your contract or offer letter, registration confirmation, and any documents HR or medical staffing asked for, such as originals of qualifications and immunisation records. Doctors should bring proof of indemnity or defence organisation membership. Bring bank details for payroll, and a notebook for bleep numbers and logins.
What is preceptorship and who gets it?
Preceptorship is a structured period of support for newly registered nurses, midwives and nursing associates, described in the NMC's Principles of preceptorship. Many employers extend it to internationally educated nurses and allied health professionals starting in the UK. A named preceptor supports you; it is not an extra assessment of your registration.
Do international doctors get an induction to UK practice?
Employers must provide a corporate and local induction. The GMC also runs a free Welcome to UK practice programme for doctors new to UK practice, covering ethics, consent, confidentiality and how the NHS works. Many trusts run extra support programmes for international doctors; ask your medical staffing team what is available.
Is it normal to call consultants by their first name in the NHS?
In many NHS teams, yes, especially among doctors, nurses and therapists working closely together. Customs vary between departments and individuals, so follow what colleagues do or simply ask. Using first names does not mean less respect for seniority or expertise. With patients, use whatever name and title they prefer.
What if I am asked to do something I have not been trained for?
Say so politely and ask for supervision or training. All UK regulators expect you to work within your competence, and refusing to guess is safer for patients and for you. Record the conversation if needed, and discuss training gaps with your supervisor or preceptor.
Can I transfer my mandatory training from my previous NHS job?
Often, yes. Many trusts in England follow the Core Skills Training Framework, which allows some training to be recognised between organisations if it is in date. Your new employer decides what it accepts, so send certificates early and ask which modules you still need.
Related courses
Your First NHS Job: Induction and Expectations
This course is a practical guide to your first weeks in an NHS job, written for newly qualified staff and for professionals who trained outside the…
Your First Week on the Ward
This course is a practical survival guide for doctors and nurses starting on a UK hospital ward. It explains how ward rounds, jobs lists, bleeps and…
How the NHS Works: Structure and Roles
This course explains how the NHS is organised, how primary, secondary and community care fit together, and who does what in the teams you will join.…
Sources and further reading
- NHS Employment Check Standards. NHS Employers.
- Welcome to UK practice. General Medical Council.
- Principles of preceptorship. Nursing and Midwifery Council.
- Being an international resident doctor in the NHS: what you should know before you start. British Medical Association.
- The NHS Constitution for England. Department of Health and Social Care.
- Good Medical Practice 2024. General Medical Council.
- The Code: professional standards of practice and behaviour for nurses, midwives and nursing associates. Nursing and Midwifery Council.
Practitioner Insight is an independent education provider. It is not affiliated with or endorsed by the GMC, MPTS, NMC, HCPC, GPhC or any NHS organisation, and this information is not legal advice. If you have been referred to a regulator, speak to your defence organisation, trade union or legal representative.
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