The Medical Training Prioritisation Act

The Medical Training (Prioritisation) Act 2026

The Medical Training (Prioritisation) Act 2026 is a UK law, in force from 6 March 2026, that gives UK and Irish medical graduates (plus certain EEA/Swiss nationals and doctors embedded in the NHS) priority access to foundation and specialty training posts. It does not ban IMGs from applying, but they are considered only after the priority group.

Why was this bill introduced?

• In 2025 alone, 15,723 UK-trained doctors and 25,257 overseas-trained doctors were competing for just 12,833 available round 1 and round 2 speciality training posts.

• This meant that thousands of UK medical graduates were being left without speciality training places

• The government's core argument was one of public investment

• Health Secretary Streeting stated publicly that the UK spends over £4 billion every year training medics, and it made little sense for UK graduates to then be left unable to secure training posts.

which IMGs already working in the NHS keep priority status from 2027?

"significant NHS experience", because this is the criterion expected to determine which IMGs already working in the NHS keep priority status from 2027.

significant NHS experience

• this phrase had not been given a precise definition in regulation

• For 2026, the Act uses immigration status as a practical proxy for being embedded in the system, rather than a fixed number of years worked

• The BMA has argued that any future definition should protect IMGs with at least two years of NHS practice

• The government has indicated that detailed regulations will follow, but until they are laid, IMGs cannot assume a specific length of service will guarantee priority

For specialty training, the priority group includes

UK and Irish graduates, graduates from Norway, Iceland, Liechtenstein, and Switzerland (owing to reciprocal professional agreements), doctors who have already completed a UK foundation programme or core training, and those holding certain immigration statuses such as indefinite leave to remain, EU settled status, or British or Irish citizenship

Key Takeaway

The priority group is broader than just UK graduates. It includes Irish graduates, certain European nationals under reciprocal agreements, and IMGs who have already embedded themselves in the NHS through foundation or core training. However, IMGs who have not yet worked in the UK and do not hold a qualifying immigration status are not prioritised

Ethical Tensions

• Justice and Fairness

• Brain drain from low-income countries

• Discrimination concerns

• Procedural fairness

Justice and Fairness

• The four pillars of medical ethics include justice, which concerns the fair distribution of resources and opportunities

• On one hand, it could be argued that it is just to protect the investment made in UK-trained doctors and ensure they have reasonable access to training.

• On the other hand, IMGs who have already been working in the NHS and contributing to patient care may feel they are being disadvantaged despite building careers here in good faith.

Brain drain from low-income countries

• LMICs fund the expensive public education and training of their doctors, only for wealthy nations like the UK to reap the clinical and economic benefits

• Countries already suffering from critical physician shortages (often defined by the World Health Organization as fewer than 4.45 health workers per 1,000 people) lose senior specialists, teachers, and consultants, worsening public health crises

• In one reading, the Act reduces this ethical harm by reducing the pull factor drawing international doctors away from healthcare systems that need them far more than the UK does.

Discrimination concerns

• the policy will likely have a disparate impact on applicants of certain ethnicities, nationalities, and religions, given the demographic composition of IMGs versus UK graduates

• This raises questions under the Equality Act and human rights legislation, with some commentators drawing parallels to the BAPIO v Secretary of State legal challenge of 2008 - Their visas became useless: They had spent thousands of pounds passing exams and moving to the UK under the promise of a career path, only to find the door suddenly shut

Procedural fairness

Many IMGs had already paid for and sat exams such as PLAB, submitted applications, and made significant life decisions based on rules that applied at the time. Changing those rules mid-cycle raises questions about legitimate expectation

What does the Act mean for the NHS and Future Medical Workforce?

• The Act does not create new training posts

• while the legislation was a step forward, the total number of training places still falls far short of what is needed.

• Reducing the competition ratio from roughly 4:1 to approximately 2:1 for speciality training is meaningful progress, but it does not resolve the underlying shortage.

Statistic to show that this act has worked

Early data from the 2026 recruitment round suggests prioritisation has had a marked effect at the offer stage: NHS England reported that around 98% of posts were filled by priority candidates (up from roughly 72% in 2025), and only a small fraction of accepted offers in round 1 went to non-prioritised applicants

Long-term workforce sustainability

• The government has stated an ambition to reduce NHS reliance on international recruitment from around 34% of new recruits today to below 10% by 2035

• This depends on a substantial and sustained increase in domestically trained doctors, which in turn requires expanded medical school places, foundation posts, and speciality training capacity working in alignment.

Summary

The Act improves competition ratios and job prospects for UK graduates but does not resolve the fundamental shortage of training posts. Sustainable workforce planning requires substantially more posts, not just a reordering of who fills the existing ones

Why did the prioritisation legislation appear?

• Many junior doctor strikes

• Many doctors had argued for years that the specialty training bottleneck was driving talented UK graduates abroad

Specific Specialty shortages

• Competition is fiercest in popular hospital specialties, yet some frontline areas still depend heavily on international recruitmen

• IMGs make up over half of all first-year GP trainees

• NHS GP Shortage: cutting the IMG pipeline too quickly, without a credible domestic replacement, could deepen shortages in exactly the areas patients struggle to access

• Abruptly reducing that pipeline without a credible domestic replacement carries its own patient safety risks.

• tension between protecting UK graduates and maintaining safe staffing

BMA’s View

• The BMA welcomed the legislation in broad terms, describing it as recognition of the scale of the bottleneck facing UK-trained doctors

• However, the BMA's position had consistently been that IMGs already working in the NHS with at least two years of experience should also sit within the priority group.

• The Act does not go that far for 2026, instead using immigration status as a proxy for NHS experience, a distinction the BMA publicly criticised.

Key Takeaway

The medical community broadly supports the direction of the Act while raising important reservations about its scope, particularly for experienced IMGs already contributing to the NHS who are not fully protected under the current provisions

Practice Questions

The UK government has introduced legislation to prioritise UK medical graduates for NHS training posts. Do you think this is the right decision?

• Complex issue with legitimate arguments on both sides

• Principles of justice and sustainable workforce planning

• UK invests heavily in training its own doctors, and it seems reasonable that those graduates should have a reliable pathway into the profession they have prepared for

• From a systemic perspective, building a stable domestic workforce is probably better for long-term NHS resilience than depending heavily on international recruitment

• UK doctors are leaving due to lack of career progression

• Brain drain from lower income countries = unethical

• Many international doctors have already contributed years of service to the NHS, often in roles and locations where it has been difficult to recruit domestically - it would be unfair and against NHS values of equality to disadvantage them

• I think they should ensure that there are enough posts for both domestically trained and experienced internationally trained doctors to have a fair pathway forward."

How would you explain the Medical Training (Prioritisation) Act 2026 to a patient who asks whether there are now fewer international doctors in the NHS?

• Briefly explain the Medical Training Prioritisation Act and its impacts

• State that it affects formal specialty training paths, it does not affect general NHS employment