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Navigating Your Early Days in the NHS: How to Lose the ‘Newbie’ Tag!

If you have aced your NHS job interview and ready to enter the healthcare system as a SHO, then give this blog a read.

Hey, I am Pragyan, an IMG from India. I have recently started my job as a SHO in Cardiothoracic Surgery at St Bartholomew’s Hospital in London. Being new at this job, I felt lost and hence decided to share a few tips based on my experience during my initial days in the NHS. In this blog I will be covering the following points:

  1. Shadowing period

  2. First month as Rot’ed in

  3. Formalities that need your attention soon after you join your trust

Congratulations! You made it into the NHS after years of hard work and dedication. Kudos to that!

Entering into a new healthcare system in a new country can be very overwhelming. In this blog, I am going to use the word “overwhelm” a lot because that aptly sums up my initial days in the NHS. Remember, we are handpicked for this job by a panel of consultants and management. We are perfect for the job. The only thing that we now need is time. With time, we will acclimatize and will be able to give our best with ease.

But what to do meanwhile? How to cope up with the first couple of months in the NHS?

Here are some tips which I learnt from my experience that can be applied to deliver a satisfactory embed. Additionally, I will also talk about a few formalities which should be done soon after you join your trust.

Shadowing period:

First 1-2 weeks (depending on your trust) will be a shadowing period when the new SHOs will be tagged along with other SHOs to observe and learn daily workflow. Make use of this cushioning period. Try to start doing jobs on your own with guidance from colleagues. Ask feedback to learn as you onboard into your role. Make sure to be a safe doctor.

Of course 1-2 weeks of shadowing is not enough and it might take 1-2 months to settle into your job. Rest assured that adequate support will be provided during this period to the new SHOs. Take things slow, stay curious!

First month as rota’ed in:

Overwhelmedness will be at its peak but trust the process. Everyone goes through the same path. Be happy that you have reached this far. Have a great 8+ hours with your colleagues.

Some helpful tips:

  1. It might help to come in early and get started with the day. It boosts confidence. I am not encouraging overtime at work, but as a new SHO, it helps getting a head start on the rest of the day.

  2. Know your patients. As you will be rota’ed into the same ward for at least a week, know your patients on the first day which makes your job easier for the rest of the week. Know the diagnosis, surgery, drugs and management plan for the patients and assist the registrars in making a plan during the ward rounds. This quality gets embedded into us spontaneously in a couple months.

  3. Effective time management is key. Prioritize tasks, stay organized, and adapt to the fast-paced nature of healthcare in the NHS. Everyone develops their own job-list format to achieve this. Construct yours during the shadowing period.

  4. Embrace continuous learning. Stay updated on teaching and training sessions happening around your trust and attend them to enhance your skills and stay confident.

  5. Book your annual leaves six weeks in advance. Every junior doctor is entitled to 27 annual leaves in a year. This is in addition to study leaves which can be taken to do taster weeks, take exams, attend conferences or courses. Courses like ALS, ATLS, BSS, CCrISP etc. need to be booked a couple months in advance. Make sure to plan your leaves and budget accordingly.

  6. Take your off days and annual leaves seriously. It’s a new city in a new country. There’s no greater kick than exploring the tourist places, markets, local pubs, and the nightlife. Do not get stuck with your work mails during off days. No one is expecting your replies right away.

Formalities that need your attention soon after you join your trust:

  1. Set up your ESR account: In order to get paid in the first month, you need to be on your trust’s payroll. Most often this needs to be done before the 5th day of the month. While most trusts assign their new doctors on their payroll without needing our help, some cases need our active involvement to get this done. We need to get an assignment number and register with ESR (Electronic Staff Record). Payroll team will guide you with the registration. You will be able to view your payslips on ESR a day before your payday which is on or before 27th of every month.

  2. Pay during shadow period: Beware that some trusts prefer not to pay the SHOs during the shadowing period. Most often this is negotiable. Make sure to approach your management before your joining date and get this clarified.

  3. Set up your bank profile with your trust: In order to do locum shifts and earn extra, you need to talk to your management and set up your bank profile. You will receive a second assignment number and a separate payslip for locum payments.

  4. Opt out of pension (if needed): Every month, an average of 9.8% will be deducted from your pay towards pension. While I admire the UK's workplace pension scheme, many would like to opt out of it at least for the first year in the NHS. This might help you get an average of additional GBP 300 into your pockets. To opt out, mail your payroll department and they will guide you.

  5. Apply for indemnity: This is necessary to protect you from clinical negligence related finances. Read more about medical indemnity here.

Take one step at a time, and you’ll find your footing in no time. Best of luck on your NHS journey.

Need more tips and advice?

If you have any questions related to my blog, I would be happy to answer them at You can register using this link. Find me as an ambassador and follow my profile – Pragyan Pratik to receive regular support and advice.


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