NHS Deaneries Guide

Many international medical graduates begin their NHS careers with non-training posts. After some time, many decide to take up a speciality training post to get on the specialist register. This route makes sense, as it’s a way of progressing your career and eventually taking on more responsibilities and earning a higher salary.

If you’re an IMG curious about speciality training, you’ve likely come across the term ‘Deaneries.’ So, what are they, and why are they important for medical training? Read on to find out more.

What Are NHS Deaneries?

Deaneries are the organisations responsible for NHS postgraduate medical training. If you are researching speciality training you will meet the word constantly, so it is worth knowing exactly what it refers to today.

In England the deaneries no longer exist as separate organisations. Postgraduate medical education is delivered through NHS England’s Workforce, Training and Education directorate and its regional local offices, a function that previously sat with Health Education England before the two merged in April 2023. In practice, though, the old word has stuck. NHS England publishes its own guidance on a page titled ‘Local Office and Deanery information’, and the process for moving between regions during training is still formally called an Inter-Deanery Transfer. You will hear doctors, trusts and recruiters use both terms interchangeably.

Scotland, Wales and Northern Ireland were never part of the English restructure and keep their own national arrangements. So when someone asks which deanery you are in, they are asking which region and local office is responsible for your training.

These NHS deaneries set training standards, monitor training programmes, manage the recruitment of speciality training programmes, provide educational supervision, and more. They oversee the whole training process. To do this, they get advised by the Speciality Training Committee, which consists of senior consultants who provide expert advice.

The Purpose of Deaneries

NHS Deaneries deliver postgraduate education and training to doctors, ensuring those who want to continue their professional development can do so. It’s all about allowing the same amount of opportunity and helping doctors reach their full potential. In turn, patients receive the best possible care from doctors.

Plus, with the presence of NHS Deaneries, the speciality training process is far more organised and monitored, which is essential. In the end, it’s up to the Deaneries to decide if a doctor has shown enough progress in their training programme. Here are just a handful of the crucial tasks that the Deaneries undertake:

• Appointing specialist registrars
• Advising international doctors
• Performing hospital inspections (specifically to ensure the fulfilment of educational contracts)
• Providing guidance and management courses

As you can see, Deaneries have a huge responsibility and play a big role in your career development in the NHS. With Deaneries, every doctor working in the UK gets the opportunity to pursue a speciality.

List of UK Deaneries

England is now covered by twelve NHS England local offices rather than the old deaneries, while Scotland, Wales and Northern Ireland run their own national arrangements. The current list is published on the NHS England local office and deanery information page. Here is how the structure looks across the UK:

England

• North East and North Cumbria
• North West
• Yorkshire and the Humber
• East Midlands
• West Midlands
• East of England
• London
• Kent, Surrey and Sussex
• South West (Peninsula)
• South West (Severn)
• Thames Valley
• Wessex

Northern Ireland

• Northern Ireland Medical and Dental Training Agency

Scotland

• NHS Education for Scotland, which runs training through its East, North, South East and West regions

Wales

• Health Education and Improvement Wales (HEIW)

Choosing a Deanery

It’s not so much about choosing a Deanery as it is about picking the region. However, some Deaneries offer particular specialities, so make sure the Deanery you choose for your training offers your chosen speciality. Some rarer, more niche specialities might only be covered in certain regions. That might mean you must choose to live in a specific area to pursue that speciality.

Speciality Training

So, as an IMG, when will you do the speciality training that gets managed by Deaneries? Speciality training is the most common route for getting on the NHS specialist register, so you likely want to know how to pursue it.

The first type of training for resident doctors is the UK foundation programme (UKFP), which lasts two years and covers levels FY1 and FY2. However, this training programme will not apply to you if you have already completed an internship – something many IMGs do while overseas.

The route we recommend for getting on a speciality training programme includes first completing a year or two in a non-training post to familiarise yourself with the NHS before applying for a speciality training programme (usually ST1 or ST3, depending on your experience and speciality). To apply, you can use the online Oriel portal, which will allow you to view training vacancies, book interviews, manage offers, and more – all in one place.

The reason we recommend doing a non-training post before speciality training is that these programmes are now both extremely competitive and legally prioritised. Under the Medical Training (Prioritisation) Act 2026, UK and Irish graduates, doctors with settled immigration status and doctors already in relevant UK training are offered posts ahead of everyone else. As an IMG, you might not feel confident and ready enough to jump straight into such a competitive programme. By spending a couple of years in a non-training post, you can get used to the NHS and gain experience before applying for the ideal training programme for your career goals. Once you have this experience on your CV, you are also more likely to get the training post you wish. These positions are very competitive so the more help you can get the better.

Rotations Within a Deanery

Did you know you can rotate between hospitals while training under a single Deanery? As Deaneries cover a specific region with multiple hospitals, you can often rotate your shifts so that you work in multiple clinical settings during your training. That might involve a couple of months in one hospital before moving to the next, or it may mean just a few short weeks in each hospital before rotating. To make this work, many IMGs choose to live in a central location in between these hospitals to commute to each one. Another option is moving around as you go. Both can work!

The benefit of NHS rotations is that you’ll gain exposure to a wide range of specialities and healthcare settings. This broad experience will teach you a lot, as every hospital will have something new to offer. You’ll establish strong relationships in multiple locations while also learning more about particular specialities. It might even help you figure out your future as an NHS doctor!

In Summary

Deaneries, and the NHS England local offices that replaced them in England, oversee NHS speciality training. Their responsibilities are great – not only do they offer educational support and advice to international doctors, but they also ensure that every doctor taking a speciality programme shows enough progress to continue and gain the qualification. This ensures every speciality doctor gains the necessary experience to practice in their role, which, in turn, creates better care for patients.

If you’re hoping to pursue a long term career in the NHS then training might be your next step. For many the first step is securing their non-training role to gain some experience and that’s where we can help. Get in touch to find out all about the latest vacancies across the NHS.