Every IMG faces this fork within weeks of passing PLAB 2 or gaining GMC registration. Apply for a trust-grade post now, or hold out for a national training number? There is no universally right answer, but there is a right answer for your circumstances.
What each one actually is
A trust-grade post — clinical fellow, trust registrar, senior clinical fellow — is a job with a single NHS trust. It is not part of a national training programme. It does not, on its own, lead to a CCT. It is advertised year round, recruited locally, and can move from application to start date in six to ten weeks.
A training post is a national training number. It runs on an annual recruitment cycle with fixed windows, structured rotations, a named educational supervisor and a defined route to the specialist register.
The case for starting trust grade
For most international medical graduates, the first NHS job should be a trust-grade post. Three reasons:
- Speed. You can be earning, on a visa and building UK references within two to three months of registration.
- UK experience is the currency. Training recruitment scores UK-based clinical experience, audit, teaching and references heavily. Six to twelve months in an NHS department transforms a training application.
- You learn the system before you are assessed on it. Electronic prescribing, escalation policies, the ward round rhythm, how to bleep a registrar at 3am. Learning that while also being formally assessed is unnecessarily hard.
The strongest training applications we see almost always come from doctors who spent a year in a trust-grade post first.
The case for going straight for training
Go straight for training if you already have substantial UK experience, you are close to the upper end of the competition ratio for your specialty, or your visa situation makes a longer route unattractive. If you have already passed the relevant royal college exams and hold UK audit and teaching evidence, waiting for the next round can be the faster path to CCT overall.
The differences that actually matter day to day
- Recruitment. Trust grade: year round and local. Training: fixed national rounds.
- Time to start. Trust grade: six to ten weeks. Training: six to twelve months.
- Progression. Trust grade: negotiated locally. Training: defined, with ARCP.
- Study leave. Trust grade: varies by trust. Training: protected.
- Pay. The same national grade scale for both.
Pay is the surprise for many people. A clinical fellow at ST3-equivalent level is paid on the same pay scale as a trainee at that level. The difference is structure and progression, not money — the detail is in our NHS doctor salary guide.
How to choose a good trust-grade post
Not all are equal. Before accepting, ask:
- Is there a named educational supervisor and protected teaching time?
- Is the post recognised for training in your specialty, even partially?
- What is the rota — full shift, on call frequency, how many gaps?
- Will the trust support study leave and exam fees?
- Do previous fellows in this department go on to training numbers?
A department that answers those five well is worth more to your career than a slightly more prestigious trust that answers them badly.
Making the switch later
Nothing about a trust-grade post prevents you applying to training. Apply in the next round while working. Use the year to complete a closed-loop audit, teach regularly, sit the relevant college exam and collect two strong UK references. That is exactly the profile training panels reward.
Dates and fees
Which exams you need depends on which route you take. Compare the two exam routes in PLAB vs MRCP, check current costs on the exam dates and fees page, and use the cost calculator to see what the first year in the UK really costs.
If you are unsure which fork fits you, our free pathway quiz takes about three minutes and gives you a personalised route.