‘Deprioritising IMGs is a policy the Government will regret’

Dr Margaret Ikpoh argues that deprioritising international medical graduates for foundation and specialty training may ease short-term pressure, but will not prevent the next GP workforce crisis

I give it five years – maybe less – before the Government decides to ‘take a moment to reflect’. This familiar ritual is usually triggered not by foresight, but retrospectively by another workforce crisis. When it comes, the reflection will focus on the Medical Training (Prioritisation) Bill and its most efficient outcome, which has been the systematic deprioritisation of International Medical Graduates (IMGs). You may know them as the very doctors who have quietly sustained general practice for decades.

This policy has been framed as strategic. UK medical school places were expanded (rightly so) and it is only correct that we ensure jobs and training opportunities for our home-grown graduates.

But expanding undergraduate numbers without a matching increase in training posts or specialty capacity does not solve a workforce problem; it simply displaces it. This resulting bottleneck in which we find ourselves was entirely predictable to the point where it could have been sketched during my coffee break between meetings. We created competition without capacity, which in turn has led to scarcity without strategy.

Throughout this, IMGs have remained faithful to a system that repeatedly failed them. They navigated PLAB costs, visa hurdles, disproportionate referrals to regulators, prolonged uncertainty, and delay. Many have settled permanently and gained indefinite leave to remain (ILR). Nearly all of them continued to staff rota gaps, underserved areas, and overstretched practices until they were quietly deprioritised in the name of workforce planning.

As an IMG, I recognise the uncomfortable truth that under today’s rules, I might never have become a GP in the UK. Not for lack of my ability or commitment; but because the door that I entered through, narrow as it was, is now closing. This is not workforce planning, it is retrospective exclusion and will not fix a GP workforce in which over half trained overseas.

General practice does not suffer from a supply problem alone, but from poor retention, limited progression, low morale, and the ongoing absence of a credible workforce plan. Prioritising one group of doctors without addressing these fundamentals does not stabilise the workforce; it merely reshuffles who is disappointed first.

In that context, the more likely future looks like this: by 2030, many more newly-qualified GPs – including those the system has worked so hard to prioritise – will have left the UK. They will be actively recruited by healthcare systems offering clarity and opportunity. The UK will have succeeded, not in retaining its doctors, but in training them for export

And so, the cycle continues. A crisis, followed by reflection, followed by regret. When the next workforce emergency arrives, the call will return: Please come back. Once again, it will be addressed to IMGs, faithful still, perhaps, but understandably hesitant this time.

Dr Margaret Ikpoh is a GP in Holderness, East Yorkshire. You can find her on X @docmagsy