Please note that UKRDC does not set policy for training and recruitment in the NHS. The motion passed by the committee sets out a position, which UKRDC will advocate for UK health departments and relevant bodies to adopt.
Why did the UKRDC decide to pass this motion now?
Data have shown a significant year-on-year increase in the number of applicants for specialty training places (particularly among international medical graduates, or IMGs), without a commensurate increase in the number of places available. This is concerning to many resident doctors, who fear this increased competition for places will negatively impact their ability to progress their careers. Instead of training to become consultants or GPs, many may find themselves stuck in fixed-term, zero-hours or insecure employment.
What is the underlying issue here?
The UK has far fewer doctors than equivalently wealthy countries, and successive governments have failed to adequately undertake workforce planning for the NHS. This means that there aren’t enough specialty training places available to develop the senior medical workforce the UK will need in the future.
The UKRDC will continue to lobby the government to significantly expand the number of medical specialty training posts, while also addressing the immediate problem facing UK graduates currently applying for specialty training places amid increasing competition.
UK graduates are already more likely to get into training, why do they need to be prioritised?
Although a smaller proportion of IMGs who apply for speciality training are usually offered places when compared to their UK graduate peers, the high competition levels still result in many UK graduate doctors unable to access specialty training.
Should resident doctors be concerned about unemployment? Do we know how many may be unemployed in August?
We don’t know how many doctors may face unemployment in August, because some of those who do not access training may find jobs as locally employed doctors (LEDs, or Clinical Fellow, Trust Grade doctors). While these jobs are often fixed-term and insecure, if doctors are unable to access training, competition for LED posts may increase – risking medical unemployment in the future.
However, it’s imperative that - considering the workforce shortages and the backlog in the NHS – LEDs are not devalued and used as an inexpensive way to plug up gaps created by systemic issues like the specialty training bottlenecks.
Why has the UKRDC chosen to lobby for prioritising UK graduates over international graduates?
UKRDC believes it is essential that doctors trained in UK medical schools should be able to progress their careers in the UK. This applies regardless of a doctor’s nationality. This policy calls for priority for doctors who have settled in the UK for at least four years of medical school, know the NHS systems, and who have received investment from UK taxpayers and the NHS. UK graduates also face barriers to training in many other countries, where graduation, citizenship or residency requirements vary.
UKRDC recognises that there are many international graduates in the UK who are also currently settled and working in the NHS. This policy aims to ensure that this select group is also prioritised.
What does this motion mean for IMGs working in the NHS today?
This motion doesn’t establish any government policy. It does, however, set out the UKRDC’s position.
IMGs have always played a crucial part in our health service and are valued colleagues. If UKRDC’s policy were implemented by the UK government, those IMGs working in the NHS before 5 March 2025 (if the government implements the policy in full) would still be able to apply for training on the same basis as UK graduates if they have two years of NHS experience (or in the future once they have completed two years of service).
Why has UKRDC set a date after which IMGs would be deprioritised for UK medical training programmes?
To ensure fairness for those IMGs who are already settled and working in the NHS, we believe it is right to prioritise NHS doctors over those who have yet to practise in the UK.
While we understand that, should the government implement our policy, a different date would be set. We included a date in our motion, as we believe that it will be important for the government to do the same, so that new rules are clear to doctors applying to specialty training from overseas.
What wider work is the BMA doing to support IMG members?
IMGs bring a diverse range of skills, knowledge and experience to their medical practice in the UK, which has been hugely beneficial to patients and the NHS.
We offer IMGs a year of free membership when coming to the UK, and provide lots of resources to assist in settling into the NHS and the UK.
We are also committed to breaking down the barriers with the UK immigration system. We have lobbied extensively on visa issues, provide legal support to our members through our immigration advice service, and can help individual members.
On the ground, our staff and members are campaigning for doctors within LED roles, many of whom are IMGs, to get the right national contract (usually a SAS contract). Getting on a substantive and agreed contract reduces exploitation, visa difficulties, and can help ensure terms and conditions adequately reflects a doctor’s expertise and commitment, including improving opportunities for career development.
Do you have data for how bad the competition ratios in specialty training have become?
Yes. We have data showing rising numbers of applications across 2023, 2024 and 2025 – with particular rises among IMGs. We know, for instance, that in 2019 the ratio was just 1.9 applications per post – this increased significantly to 4.7 last year, and we expect it to be much higher this year. Since 2019, the number of applicants has increased by 68% in just three years.
| UK graduate | International medical graduate (IMG) | Total | |
|---|---|---|---|
| 2023 | 9,273 | 10,402 | 19,675 |
| 2024 | 10,628 | 14,868 | 25,496 |
| 2025 | 12,305 | 20,803 | 33,108 |
How many training posts would need to be created to ensure fair ratios?
In the upcoming review of the Long Term Workforce Plan, NHS England must prioritise a review of the number of training places, so that the health service has the GPs and specialists it needs to support current and future patients. While past versions of plan made a welcome commitment to expand medical school places, the same attention was not given to speciality training places.
To prevent bottlenecks and unemployment in the future, expansions of undergraduate education must be matched by equivalent increases in training places and consultant and GP jobs thereafter.
How would you campaign for this policy? Would you enter dispute with the Government if they cannot increase training places?
We will be engaging with the relevant bodies to ensure that UK medical graduates can progress in their careers without fear of unemployment.
What are the circumstances in Northern Ireland that mean the policy would have to be delivered differently there?
For many years, doctors in Northern Ireland have studied at medical schools in the Republic of Ireland and then returned to further training and work in Northern Ireland. These doctors are classed as international medical graduates as they have graduated outside the UK. The UKRDC and NIRDC will further consider the specific cross-border working implications between Northern Ireland and the Republic of Ireland when developing this policy.
UKRDC policy
This committee condemns the persistent failure of UK and devolved nation governments to significantly expand medical specialty training posts and resolves to
i. demand that UK and devolved nation governments, NHS/HSC bodies, and statutory education bodies implement a specialty training recruitment process that lawfully prioritises medical graduates from UK medical schools.
ii. ensure equal access to specialty training for those international medical graduates (IMGs) who are already GMC registered and practising in the UK on or before the 5th of March 2025 who have completed or go on to complete two years of NHS/HSC experience or NHS/HSC funded care working as a medical doctor (grandfathered IMGs). Any IMG doctor starting medical practice in the UK on or after 6th March 2025 will be deprioritised for the purposes of specialty training applications compared to UK medical graduates and IMGs meeting the grandfathering criteria previously mentioned. Work will be undertaken to consider how this policy could be delivered across the 4 nations recognising the different circumstances presented by cross-border working in Northern Ireland and the Republic of Ireland.
iii. demand that UK and devolved nation governments, NHS/HSC bodies, and statutory education bodies provide increased funding for the expansion of postgraduate training posts and subsequent consultant/GP posts to meet the growing demand for specialty training, significantly reduce competition ratios, prevent unemployment amongst doctors, and help provide the medical workforce the UK population needs.
iv. work robustly towards reform of trust/board recruitment practices so resident doctors in locally employed posts are free from exploitation, career uncertainty, risk of excessive financial burdens, and are able to seamlessly evidence the experience they gain in these posts against equivalent experience in training.