Why is the Government introducing this Bill?

Since the lifting of visa restrictions in 2020, UK-trained doctors have faced growing competition from overseas-trained doctors for specialty medical training posts, with applicants rising from 12,000 in 2019 to nearly 40,000 this year.

The number of eligible applicants for the Foundation Programme (FP) has also grown from 8,137 in 2019 to 11,205 in 2025 partly driven by an increase in applications from graduates from international medical schools. To ensure UK graduates achieve full GMC registration and strengthen the domestic workforce, all eligible applicants (UK and overseas) have so far been guaranteed a place.

In recent years, FP applicant numbers have exceeded available places, causing delays in FP allocations while extra posts are created or vacancies arise from withdrawals. Affected applicants are often placed in ‘placeholder’ positions, which confirm the foundation school but not the hospital. This information is frequently provided very late – sometimes close to the start date – creating significant stress for those involved.

The Medical Training (Prioritisation) Bill intends to implement the commitment set out in the 10 Year Health Plan for England to prioritise UK medical graduates for foundation training places, and to prioritise UK medical graduates and other doctors with significant NHS experience for specialty training places. In order to address the scale of the problem with the urgency it demands, the Government has decided to introduce emergency legislation so that prioritisation can be implemented during the current application process, securing the commitment for years to come.

The Bill is UK-wide and has been drafted in close partnership with the Scottish Government, the Welsh Government and the Northern Ireland Executive, creating a unified approach across the four nations.

Prioritisation will help build a sustainable medical workforce that meets population health needs, reduces reliance on an unpredictable international labour market, and maximises taxpayer investment in medical training. The Bill aims to secure a reliable supply of doctors for the future, ensuring those with a UK medical link are more likely to progress to consultant roles and continue their careers within the NHS.

Internationally trained doctors make a huge contribution and will continue to do so. If passed, the Bill will also enable us to prioritise internationally trained doctors with significant NHS experience, and we are not excluding anyone from applying for training places, they just won’t be prioritised.

For 2026 starts, prioritisation will be applied at the offer stage because shortlisting is already underway. In order to ensure successful candidates are able to take up their posts in August with sufficient notice, eligibility has been defined using specified immigration statuses as a proxy for significant NHS experience. 

From the autumn 2026 application round for 2027 starts, subject to the Bill’s passage, prioritisation will apply from shortlisting through to offers, and we will define “significant NHS experience” more precisely through regulations. Over the coming months, we will engage with key stakeholders across the UK to agree how NHS experience will be recognised from 2027 onwards.

What does the Bill do (subject to Parliamentary passage)?

• The Bill establishes rules for prioritising certain groups of applicants for foundation and specialty training places.
• The Medical Training (Prioritisation) Bill must go through the full parliamentary process, including debate, scrutiny, and approval by both Houses, before it becomes an Act. Even after that, the law does not take effect immediately; it must be formally “commenced” by the Government. This means the changes to how training applications are prioritised will only apply once the Bill has completed this process and commencement regulations are in place.
• For the UK Foundation Programme, the Bill requires that places are allocated first to applicants with a UK primary medical qualification, and other priority groups before being allocated to other applicants. Beyond applicants with a UK primary medical qualification, the other priority groups include applicants holding a PMQ from an Irish medical school and, in line with existing international agreements, those with a PMQ from Norway, Iceland, Liechtenstein or Switzerland.
• For specialty training the Bill sets prioritisation criteria from 2026 and gives us the ability to change how we define significant NHS experience from 2027.
• As the application process is currently live, for specialty training the Bill requires that for posts starting in 2026 onwards there must be prioritisation at the offer stage of UK medical graduates, individuals in the priority group and individuals who have completed the Foundation Programme or another relevant qualifying UK programme. For offers made in 2026 for specialty training only, it will also require prioritisation of individuals with certain immigration statuses.
• For specialty training posts starting from 2027 onwards, the immigration status category will not apply automatically. Instead, we will be able to make regulations to specify any additional groups who will be prioritised. For future years we want the power to define significant experience in a way that best delivers our policy intent to prioritise doctors with a better understanding of UK epidemiology and the healthcare system.
• Including those with significant NHS experience is crucial to delivering the policy intent of the Bill. The aim is to prioritise those applicants who have spent substantial time working here as a doctor; who have demonstrated long-term commitment to the NHS and who best understand the health needs of the UK population.
• For specialty posts starting in 2026 prioritisation will be applied at the offer stage. For training posts starting from 2027 onwards, prioritisation will apply at both the shortlisting and offer stages, which will enable more of the applicants we are prioritising to be offered posts.  In Foundation, prioritisation will be applied at allocation to Foundation School.
• The Bill includes a power to set out in regulations a programme which does not amount to a “UK Specialty Programme” for the purposes of the Bill. This will give the necessary flexibility to respond to future changes in recruitment, training and workforce needs. For example, if the number of applications for places on a specific training programme was to decrease in the future, the delegated power would allow Ministers to continue to ensure that there are reasonable levels of competition for places whilst balancing the need to prioritise UK graduates and others specified in the Bill.
• The Bill extends across the UK. Health workforce planning and access to medical training are devolved matters, with each nation’s health ministers responsible for their own area. However, the process of recruitment and allocation of foundation and specialty training places is undertaken on a UK-wide basis. The Bill establishes a statutory process for prioritising certain groups for training posts, without changing relationships between statutory bodies or eligibility for training

Questions and answers (subject to Parliamentary passage)

What stakeholders will be engaged on provisions for 2027 onwards?

Provisions for 2027 onwards will be set out in regulations, developed in partnership with the devolved nations, who must agree the content. We will be working to a short timeline so that regulations are ready for the application round opening in autumn 2026 for 2027 starts, subject to the parliamentary timetable.

We plan to undertake a listening exercise to gather views from key stakeholders. We will confirm who these stakeholders are in due course but would expect them to include the BMA, employers, regulators, Royal Colleges, the devolved administrations, organisations representing international medical graduates and others.

Changing the process every year would be disruptive for Resident Doctors. Can you confirm that is not your intention?

We recognise the importance of consistency and predictability and will change the scheme only when it is needed to ensure it delivers our aims of prioritising UK graduates effectively and filling all specialty training places.

The Bill as currently drafted provides for amendments to the scheme for posts starting in 2027 onwards and allows for further changes thereafter. After the Bill has been commenced, we would want to make changes for posts starting from 2027 to ensure that we are best delivering our policy intent to prioritise applicants with significant NHS experience. Thereafter we would expect to make changes only where necessary to ensure the scheme operates effectively.

Foundation Programme frequently asked questions

1. Which applicants will be prioritised for the foundation allocation?

The following groups will be prioritised:

• UK medical graduates
• Applicants with a primary medical qualification from an institution in Ireland
• Due to European Free Trade Association (EFTA), applicants with a primary medical qualification from an institution in:
  • Iceland
  • Principality of Liechtenstein
  • Norway
  • Switzerland

2. Are all UK Graduates guaranteed a foundation programme place?

We expect all eligible prioritised applicants for FP2026, including UK medical graduates, to get a place on the foundation programme. We will not be able to guarantee every applicant not in the prioritised group a place. This means that we should significantly reduce the number of ‘placeholder’ offers made, and the uncertainty and anxiety that can cause.

3. Will the allocation be delayed due to prioritisation in 2026?

Foundation allocation can only occur once the prioritisation bill receives Royal Assent and becomes an Act of Parliament.  Depending on this timing we may need to delay the foundation allocation by a week or two until March. We will update applicants directly when the revised timeline is confirmed.

4. Will there be placeholders in 2026?

This will depend on the number of eligible prioritised applicants and the posts available. If the Bill is passed and prioritisation is implemented, we expect that if any placeholders are required it will be significantly fewer than in previous years.

5. Will graduates from UK overseas medical school campuses be prioritised?

There is no provision in the Bill to specifically prioritise applicants from UK or Irish overseas medical school campuses. Applicants with a primary medical qualification from the UK and Ireland will be prioritised, but not if they have spent the majority of their training for that qualification outside of the UK.

6. How will pre-allocation work with prioritisation?

Applicants who need to be in a certain part of the UK for their Foundation Programme, due to their current personal circumstances, who meet one of the nationally agreed criterion, can apply for pre-allocation to a specific foundation school. We have had to delay pre-allocation outcomes and will announce outcomes when the Bill is launched in parliament. 

7. Will linked applications still be supported under prioritisation?

Linked allocations will only be honoured if both applicants are allocated at the same stage, during allocation to foundation school and if there are two available places at the point of allocating both applicants. The UKFPO will publish more detailed guidance on this process in due course.

8. Will prioritisation occur in standalone FY2 recruitment?

Yes, the same groups of applicants, as for the foundation programme, will be prioritised for standalone FY2 recruitment.

9. Impact of Foundation Priority Programmes

Due to the timing of the passage of the Bill, Foundation Priority Programmes will not be offered in 2026 in a separate recruitment process. Instead, these posts will be added to the main allocation round and allocated via Preference Informed Allocation (PIA).

Specialty training recruitment frequently asked questions

10. Exactly which applicant groups will be prioritised for specialty training?

For 2026 the following groups will be prioritised:

• Those with a primary medical qualification from medical schools in the UK or Republic of Ireland
• Those with a primary medical qualification from medical schools in Iceland, Principality of Liechtenstein, Norway, or Switzerland  
• Persons who have completed or are currently on the relevant qualifying UK training programme (e.g. Foundation for core training, core training for higher training)
• Those within the following priority groups:
  • British citizen,
  • a Commonwealth citizen who has the right of abode in the United Kingdom under section 2 of the Immigration Act 1971
  • an Irish citizen who does not require leave to enter or remain in the United Kingdom under that Act, Compare 5th January 2026 Medical Training (Prioritisation) Bill 1
  • person with indefinite leave to enter or remain in the United Kingdom
  • a person who has leave to enter or remain in the United Kingdom which was granted by virtue of residence scheme immigration rules within the meaning given by section 17 of the European Union (Withdrawal Agreement) Act 2020.

11. Is prioritisation occurring at core and higher training?

Prioritisation will be implemented both at core and higher specialty training. 

12. Will applicants who have completed core be prioritised for higher training?

Yes, applicants who have completed or currently on the relevant qualifying programme will be prioritised:

• Foundation Programme completers will be prioritised for core, (both those completing the two-year programme and 1-year standalone FY2)
• applicants who have completed core specialty training will be prioritised for higher specialty training in the relevant specialty. Completing a core programme in an unrelated specialty to the higher specialty training programme will not lead prioritisation (e.g. completing core psychiatry and applying for higher surgery)

Applicants who have previously completed the foundation programme will also be eligible for prioritisation and do not necessarily need to have completed the relevant core programme.

All applicants will also need to meet the relevant eligibility criteria in the relevant specialties’ person specification.

13. Are there any specialties that will not be included for prioritisation?

The only specialty currently excluded from prioritisation is Public Health Medicine (single CCT), due to the specialty being open to medical and non-medical applicants.

14. Are academic posts included in prioritisation?

Academic posts are included in prioritisation. As applicants to academic training need to be holding a NTN, they would have already been prioritised to enter specialty training.

The only exception is Public Health ACF posts in England where these vacancies will be open to current non-medical public health trainees.

15. Are Dental training posts to be included in prioritisation?

No dental posts are included in prioritisation. Oral and Maxillofacial Surgery (OMFS) is included in prioritisation, as this is a medical specialty despite the requirement for applicants to be dental qualified.

16. The Bill includes provisions to make regulations in future which can exclude certain specialty training programmes prioritisation. Why does Government want this power?

This power is intended to respond to any changes in applications for programmes in future.  For example, if applications for certain programmes, such as general practice or psychiatry fall significantly, as has happened in the past, the Government needs flexibility to respond. Adjusting prioritisation, can ensure reasonable levels of competition across specialties and avoid situations where some programmes struggle to fill places while others remain highly competitive. But our aim is to avoid this as much as possible, by attracting more UK graduates to the specialities where service need is greatest.

17. Is there a specific provision to prioritise refugees?

Refugee status is not a standalone priority group. Individuals with refugee status will be prioritised if they fall within another priority category, such as holding Indefinite Leave to Remain (ILR) or if they have completed the Foundation Programme etc. Refugees who do not meet priority criteria may still apply, although they will not receive prioritisation, and the Bill will not change their eligibility to apply for Locally Employed Doctor (LED) roles.

18. When will my prioritisation status/immigration status be confirmed in the recruitment process?

For applications that have already been made for specialty training places starting in 2026, prioritisation status will be determined based on the information provided in the application form at submission. For any future rounds, applicants will be able to update  if their information has changed. 

19. Will alternative training programmes be recognised for prioritisation?

No, alternative or mirrored programmes will not be recognised for prioritisation.  Only GMC approved training programmes will be considered.

20. Do the changes in legislation apply to applications for Locally Employed Doctor posts, Consultant roles, or SAS (Specialty, Associate Specialist, and Specialist) doctors?

No. If the Bill is passed, the changes will only apply to applications for foundation and specialty training posts. It does not affect IMGs who are already working in the NHS.

21. How are non-medical applicants into public health training being prioritised?

Due to the unique application process for Public Health training that accepts applicants from medical and non-medical backgrounds, public health has been excluded from prioritisation.

Annex 1: Timetable

The below diagram is a simplified recruitment timetable for 2026/2027 medical recruitment.

R1 – CT1/ST1 vacancies starting from August 2026
R2 – ST3/ST4 vacancies starting from August 2026
R3 – All levels of vacancies starting from February 2027

New Round – Additional round for recruitment for 1000 new training posts starting from August 2026.

Download the above timetable as a PDF document.

Note: The new recruitment round timetable has not yet been confirmed and is subject to change

Annex 2: Competition ratios – core training 1/specialty training 1

1. Baseline

• For 2026, c40,000 individual applicants made 74,000 applications at CT1/ST1
• For 2026, it is estimated that c10,000 training posts will be advertised, giving a competition ratio of 3.8 applicants to every training post, at a UK aggregated level.
• As applicants can make up to 5 applications, competition as measured by applications will be higher at an average of 7.4 applications per post (individual specialties will vary).
• However, with prioritisation,
  • Aggregate applicant levels will reduce to 2.1 per post (to 1.9 with 1000 additional posts).
  • Specialty applications level competition ratios will reduce to 3.8 per post on average, when comparing prioritised applications to advertised posts.

2. Prioritisation

With the delivery of prioritisation, the total number of prioritised applicants will be an estimated 21,000.  With the 410,000 advertised posts, this gives a competition ratio of 2:1 (Prioritised applicants v posts), almost halving the applicant pool.

3. Prioritisation and additional 1000 training posts

With Prioritisation and an additional 1000 training posts promised in the 10YP, this further reduces competition ratios, at applicant level. With the 21,000 prioritised applicants now competing for c11,000 training posts, which creates a competition ratio of 1.9:1.

4. Applications

However, competition will appear to be greater, when considered by the number of applications made for a specialty, as applicants are applying to up to 5 specialties. With competition on average at 3.8 across all CT1/ST1 specialties.

5. Offer stage

Competition will reduce at offer stage, as only appointable applicants will be considered, and applicants can only accept one training offer.

Annex 3: Potential impact of prioritisation on applicant pool at offer stage (R1 2025 Data)

• With the delivery of prioritisation, the total number of prioritised applicants will be an estimated 21,000. With the c10,000 advertised posts, this gives a competition ratio of 2:1 (Prioritised applicants v posts), almost halving the applicant pool.
• Competition ratios are highest at application, due to applicants making multiple applications.
• However, the competition ratios reduce as applications are progressed through recruitment. In 2025 Round 1, 28,000/80,000 applications were deemed appointable following assessment/interview*.
• Competition ratios are lowest at offer stage as not all appointable applications will be made an offer, as applicants can only accept one offer.
• In 2027, implementing prioritisation at shortlisting stage as well as offer stage will ensure more prioritised applicants will be assessed and reach offer stage.

* Appointable numbers exclude Public Health and Dual GP and Public Health vacancies.

Annex 4: Competition – all appointable applicants by specialty v posts in 2025

Annex 5: Competition – appointable UK Graduate applicants by specialty posts in 2025

• Despite lower competition ratios over 2000 appointable UK graduate applications did not receive an offer in R1 2025
• Those UK Graduates who were not offered were either out competed by non-UK applicants or only preferenced a small number of locations and would have been offered if they preferences a wider geographical preference.
• Despite lower competition ratios, applicants may still not get their first-choice specialty or geography due to the competition.
• There will aways be competition, with the highest quality applicants being appointed, especially for popular training programmes and/or geographies.