SophierFor international medical graduates (IMGs) and aspiring doctors, navigating the pathway to practising medicine in the UK can seem overwhelming. One of the most critical steps in this journey is obtaining General Medical Council (GMC) registration - a mandatory requirement to ensure that doctors meet the high standards of competence and professionalism expected in the UK.
Whilst the PLAB route is one of the most well-known pathways, it is far from the only option. Depending on your medical qualifications, training, and career goals, several alternative routes may be more suitable for you.
This guide explores the key differences between the PLAB route and other pathways to GMC registration, helping you make an informed decision about your journey into the UK healthcare system.
What is GMC Registration?
GMC registration refers to the process in which a medical professional, such as a doctor, is officially registered with the General Medical Council (GMC) in the United Kingdom. This registration is a legal requirement for doctors who wish to practice medicine in the UK, and ensures that doctors are qualified, competent, and fit to practice medicine safely. Throughout their career, doctors must regularly revalidate their registration, by demonstrating continued competence and adherence to ethical standards, to continue practising medicine legally in the UK.
Types of GMC registration
There are 3 different types of GMC registration, depending on a doctor’s (or medical student’s) level of training and qualifications. These are:
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Provisional registration: For doctors in their first year of medical training (Foundation Year 1).
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Full registration: Which allows doctors to practice unsupervised, usually after completing the first year of training.
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Specialist or GP registration: Required for those practising as specialists or General Practitioners (GPs) within the UK.
Do I need PLAB for GMC registration?
The PLAB route is just one of the many routes medical students and international medical students (IMGs) can take to obtain GMC registration - there are other options, depending on your specific qualifications and the country in which you obtained your medical degree.
Routes to GMC registration
Along with the PLAB route (which we discuss below), there are various different routes you can take to obtain GMC registration in the UK. Here’s a breakdown of all the different routes to GMC registration:
1. PLAB route
The PLAB route to GMC registration is one of the more well-known routes, designed to assess whether IMGs have the knowledge and skills equivalent to a UK-trained doctor starting Foundation Year 2.
In order to take the PLAB route, IMGs must have a primary medical qualification (gained outside of the UK, European Economic Area (EEA) or Switzerland) and proof of English language proficiency (either through the IELTS or OET).
The PLAB exam structure consists of two tests:
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PLAB 1: Multiple-choice exam testing clinical knowledge (which can be taken outside the UK).
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PLAB 2: OSCE-style practical exam (held in the UK).
This route to GMC registration provides full GMC registration to IMGs without postgraduate qualifications or specialty training.
2. UK medical degree route
For UK-trained medical students, taking a UK medical degree is the most direct route to GMC registration. UK graduates automatically qualify for provisional GMC registration to begin Foundation Year 1 and full registration is granted after the successful completion of their final year exams.
If you are an IMG, this route to GMC registration can be obtained by studying medicine within the UK, or by transitioning to a UK undergraduate medical program.
3. UK Medical Licensing Assessment (UKMLA) route
In 2024/25, the GMC will replace PLAB with the UK Medical Licencing Assessment (UKMLA) for IMGs seeking GMC registration. UK medical students will also need to take a similar exam, known just as the Medical Licencing Assessment (MLA). This change will allow a standardised assessment for both UK-trained and international doctors, as outlined in the MLA learning outcomes.
Like with the PLAB route, IMGs must have a primary medical qualification (gained outside of the UK, European Economic Area (EEA) or Switzerland) and proof of English language proficiency (either through the IELTS or OET). However, UK-trained medical students will complete this exam as normal during their final exams.
The UKMLA exam structure consists of two different assessments:
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Applied Knowledge Test (AKT): Similar to PLAB 1, a multiple-choice exam testing core medical knowledge (which can be taken outside the UK).
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Clinical and Professional Skills Assessment (CPSA): Similar to PLAB 2, an OSCE-style practical exam (which must be taken in the UK).
Like PLAB and UK medical training, this route to GMC registration provides full GMC registration to IMGs and UK medical students without postgraduate qualifications or specialty training.
Worried that the UKMLA will be harder than PLAB? We have a blog post that breaks down both exam structures and content. We also have a full guide to the UKMLA, providing you with everything you need to know about the new exams.
4. Recognised EEA or Swiss qualification route
Doctors with medical degrees from countries in the European Economic Area (EEA) or Switzerland can apply for GMC registration, as these qualifications are recognised under EU directives.
Post-Brexit, some EEA qualifications are still accepted, but doctors may need to provide additional evidence of skills and training. However, this can still be an ideal route to GMC registration for IMGs who cannot study medicine in the UK, but are able to in these areas.
5. Sponsorship route
Some GMC-approved organisations, such as NHS Trusts and Royal Colleges, can sponsor IMGs and international doctors for full or specialist GMC registration, based on their skills and experience. This often requires significant clinical experience and relevant postgraduate qualifications, and is often linked to specific job offers in the UK.
This can be an ideal route tailored to experienced doctors seeking direct employment within the UK healthcare system. However, there tends to be less availability for IMGs and those early in their medical careers.
6. Medical Training Initiative (MTI) route
The Medical Training Initiative (MTI) is a program designed to provide IMGs without UK medical training with the opportunity to work and train in the UK’s NHS for a fixed period (generally up to two years) and obtain temporary full GMC registration. It is aimed at enhancing skills and knowledge of IMGs in a structured environment before they return to practice in their home country. However, it does provide a stepping stone for those wishing to reapply for GMC registration later in their careers.
Throughout the MIT, doctors are placed into supervised training posts within NHS Trusts, typically at equivalent levels to junior or middle-grade doctors. Sponsorship for GMC registration is provided by a Royal College, a deanery, or another GMC-approved sponsoring body.
To get onto the Medical Training Initiative, IMGs must have:
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A primary medical qualification recognised by the GMC.
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At least two to three years of clinical experience (post-internship).
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English language proficiency.
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Support from the relevant Royal College, which oversees the training placement.
This route to GMC registration is very similar to the sponsorship route, where IMGs will need a sponsorship letter from a Royal College or other GMC-approved organisation.
7. Acceptable postgraduate qualifications (PGQs) route
Acceptable postgraduate qualifications (PGQs) are recognised UK-based and international qualifications that demonstrate medical knowledge and expertise, allowing IMGs to obtain specialist GMC registration without PLAB or UKMLA. UK-trained doctors can take this route to obtain specialist GMC registration.
Examples of recognised PGQs include Royal College qualifications, such as:
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MRCP (Membership of the Royal College of Physicians).
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MRCS (Membership of the Royal College of Surgeons).
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MRCPCH (Membership of the Royal College of Paediatrics and Child Health)
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MRCOG (Membership of the Royal College of General Practitioners).
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MRCEM (Membership of the Royal College of Emergency Medicine).
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FRCA (Fellowship of the Royal College of Anaesthetists).
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FRCR (Fellowship of the Royal College of Radiologists).
International equivalents include:
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American Board of Medical Specialties (ABMS) certifications.
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Fellowship of the College of Physicians and Surgeons of Canada.
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Australian or New Zealand specialist training qualifications.
8. Certificate of Eligibility (CESR and CEGPR) route
The Certificate of Eligibility route allows experienced international doctors to gain specialist or GP GMC registration without completing UK speciality training, equivalent to a UK Certificate of Completion of Training (CCT). This can create a direct pathway to higher roles within the UK healthcare system.
There are two different certificates of eligibility that international doctors can apply for:
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Certificate of Eligibility for Specialist Registration (CESR): For doctors seeking specialist GMC registration in their chosen field.
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Specialist registration allows eligibility for consultant posts in the UK.
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Certificate of Eligibility for General Practice Registration (CEGPR): For doctors who want to work as GPs but have not completed UK GP training programs.
To apply for a Certificate of Eligibility, doctors must submit a detailed application submitted to the GMC, demonstrating that their training, qualifications, and experience match the standards of UK CCT programs, and include evidence of work experience, case logs, audit reports, teaching activities, and CPD (Continuing Professional Development).
Key differences between PLAB and other routes
Here is a table summarising the key differences between the various routes to GMC registration:
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How to choose the right route to GMC registration
Choosing the right route to GMC registration as an IMG depends on your qualifications, experience, and career goals. Here's a step-by-step guide to help you determine the most suitable pathway:
1. Assess your medical qualification
Where did you complete your medical degree?
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UK degree: The UK medical degree route is the most direct option.
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EEA/Swiss qualification: Use the recognised EEA or Swiss qualification route.
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Outside UK/EEA/Switzerland: Consider PLAB, UKMLA (starting 2024/25), or other alternative routes.
2. Evaluate your training and experience
Minimal or no UK medical training?
PLAB or UKMLA (after 2024/25) may be your best option, especially if you're an IMG seeking GMC registration without recognised medical qualifications.
Considering postgraduate training?
If you hold acceptable postgraduate qualifications (e.g., MRCP, MRCS, FRCR), you can apply via the PGQ route and skip PLAB/UKMLA.
Extensive experience?
If you’ve completed equivalent specialist or GP training abroad, consider the CESR or CEGPR route for direct specialist or GP registration.
3. Consider sponsorship opportunities
Do you have a job offer or sponsorship?
If an NHS Trust, Royal College, or deanery sponsors you, the Sponsorship Route might be the easiest path.
Looking for short-term training?
If you want temporary GMC registration for structured NHS training, the MTI Route may suit you.
4. Check your language proficiency
Do You Meet English Proficiency Standards?
All routes require proof of English language skills (IELTS/OET). Plan to meet this requirement before proceeding.
5. Align with your career goals
Long-term practice in the UK?
PLAB/UKMLA or PGQ routes provide full registration for ongoing practice.
Short-term training/experience?
The MTI route is ideal for those aiming to return to their home country after NHS training.
Specialist or GP roles?
If you aim to work as a consultant or GP, CESR/CEGPR is the most direct route.
6. Seek guidance
Consult medical associations
Reach out to professional bodies within the UK, including the General Medical Council, for guidance based on your qualifications and goals.
Networking
Connect with peers or mentors who have gone through the process and take advice from their experience and expertise.
Have you decided which route to GMC registration to take? Preparing for your upcoming medical school exams can be a stressful time. Be sure to check out our medical revision blogs and med school revision resources for support in your qualifying years.