UK graduates legally prioritised for medical training as law comes into effect

A bill prioritising UK medical graduates for foundation and specialty training will become law tomorrow (6 March). 

The Medical Training (Prioritisation) Bill, introduced to prioritise UK graduates and others in a select ‘priority group’ for places before other eligible applicants, received Royal Assent today after it was first introduced to Parliament in January. 

It follows the Government’s pledge to prioritise UK medical graduates for specialty training in the 10-year health plan last year, promising to ‘reorientate’ away from its dependency on international recruitment.

For both foundation training and speciality training places, the priority group includes UK citizens, and applicants with a primary medical qualification from a medical school in Ireland, Iceland, Liechtenstein, Norway and Switzerland. 

For speciality training places only, the priority group includes people with indefinite leave to enter or remain in the UK; and those with leave to enter or remain which was granted by virtue of residence scheme immigration rules.  

From 2027, ‘persons who … have significant experience of working as a doctor in the NHS’ may also be prioritised for speciality training places, though the interpretation of this will be left to ‘the opinion of the appropriate authority,’ it says.

More than 2,000 doctors, including GPs, had signed a petition urging the House of Lords to explicitly add ‘international doctors’ with ‘two or more years of continued medical practice’ in the NHS to the priority list.  

However, the bill passed through the House of Lords unamended before receiving Royal Assent. 

Health secretary Wes Streeting said the legislation will mean UK graduates and doctors who have been in the NHS ‘for a significant period’ would get ‘first dibs’ on training places from this year. 

Mr Streeting said the bill is the result of the Government having ‘listened’ to resident doctors’ ‘legitimate concerns about their working conditions’. 

He said: ‘We invest over £4bn every year in training medics in the UK, yet thanks to years of poor workforce planning, UK trained medical graduates have been forced to compete with ever increasing numbers of internationally trained medics. 

‘This Government has strained every sinew to pass fast-tracked legislation to prioritise homegrown graduates and others with significant NHS experience for training posts. It has progressed through parliament in a matter of months – and will now become law. 

‘UK graduates and doctors who have worked in the NHS for a significant period will benefit from this year – getting first dibs on available places – and British taxpayers will in turn see a fair return on the investment they put into training the doctors of the future.’ 

‘International talent is crucial to our NHS and will continue to play a valued and important role in the NHS, but this is an essential step towards putting an end to the fierce competition that has been stifling homegrown talent and supporting a sustainable medical workforce that meets the health needs of the population. 

‘Resident doctors have raised legitimate concerns about their working conditions and I’ve listened, taking this significant action to address absurd training bottlenecks, and delivering a record pay increase of 28.9% over the last three years. But I know there’s more to do, which is why I’m committed to continuing to work together with resident doctors and all NHS staff to build an NHS fit for the future.’ 

The Government ‘consulted’ both the RCGP and BMA on how NHS experience would be recognised in the legislation.

Responding to bill’s passing into law, Dr Jack Fletcher, chair of the BMA’s UK resident doctors committee, said: ‘This Act marks an important step toward fixing the jobs crisis for doctors. The legislation recognises, at last, the scale of the bottlenecks that have left too many UK-trained doctors struggling to find posts despite years of public investment in their education and training.

‘It is also positive for medical students, too many of whom have been offered only placeholder positions when starting their first year as a doctor, not knowing their location until the last minute. This legislation will at least reduce this regrettable practice.

‘Prioritising UK medical graduates for NHS training places has the potential to reduce the number of doctors who are left without work. But it will require swift implementation. We will not accept delay in England as part of negotiating tactics from the Government; this legislation is too important for that. We need to see reductions in doctors unable to find work this year, or risk seeing them lost to the NHS forever.

‘While there are some protections in this Act for internationally trained doctors already working the NHS, we must redouble our efforts to improve their working lives, which at present are all too often unstable and poorly rewarded. The contracts of locally employed doctors must be brought in to line with the protections of those on permanent contracts, assuring them of stability and career progression.

‘It has been a hard road to get this legislation across the line, and it should never have needed our strike action to prompt it. Nevertheless, when the Government makes a correct move we are always willing to recognise it.’

The Department of Health and Social Care has estimated the bill will halve overall competition ratios for training places, from 4:1 to 2:1. 

The competition ratio for GP specialty training posts reached a record high last year, with almost five doctors vying for each post in the first recruitment round for 2025. 

Royal College of Physicians president Professor Mumtaz Patel said:  ‘We welcome the Medical Training (Prioritisation) Act receiving Royal Assent and becoming law.

‘Escalating competition ratios have been a major factor in early career doctors’ growing uncertainty about their future in medicine. Through our next generation campaign, we’ve consistently raised these concerns, and we’re pleased that government has listened and acted.

‘As we have said throughout our campaign, the vital contributions of IMGs to the NHS must be recognised. The focus must now be on working with the sector to define ‘significant NHS experience’ so that the necessary regulations can be put in place by the government without delay, in good time for the 2027 recruitment round.’

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