On Thursday 5th March, the UK Government’s Medical Training (Prioritisation) Act officially became law. This legislation affects recruitment into specialty training and the foundation programme across the UK.
The aim is to restore competition ratios for specialty training programmes to more reasonable levels. The law will make progress on this by prioritising UK graduates and other groups, as listed below. The Act also introduces prioritisation for the foundation programme, which the government expects will result in significantly fewer ‘placeholder’ offers than in previous years.
The Act is UK-wide and was drafted by the Westminster government in consultation with the governments of the devolved nations. The BMA was involved in discussions about communication of the policy, but not on its content.
The Department of Health and NHS England have produced their own FAQs here.
Which groups of applicants will be prioritised?
For foundation programme places starting in 2026, the prioritised group includes:
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Those with a primary medical qualification from medical schools in the UK or the Republic of Ireland.
- Those with a primary medical qualification from medical schools in Iceland, Liechtenstein, Norway and Switzerland (as the UK holds trade agreements with these countries that require this to happen).
For specialty training places (core and higher) starting in 2026, the prioritised group includes:
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Those with a primary medical qualification from medical schools in the UK or the Republic of Ireland.
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Those with a primary medical qualification from medical schools in Iceland, Liechtenstein, Norway and Switzerland.
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Any doctor who has completed or is currently on the relevant qualifying UK training programme (for example, foundation doctors applying for core training or doctors who are completing or have competed core training applying for higher training).
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Those within specific priority groups based on immigration status, regardless of where their medical degree is from.*
*This includes:
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British citizens,
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Commonwealth citizens who have the right of abode in the United Kingdom under section 2 of the Immigration Act 1971
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Irish citizens who do not require leave to enter or remain in the United Kingdom under that Act
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people with indefinite leave to enter or remain in the United Kingdom
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people who have leave to enter or remain in the United Kingdom by virtue of residence scheme immigration rules within the meaning given by section 17 of the European Union (Withdrawal Agreement) Act 2020.
When did these changes happen?
The law came into effect for the 2026 application cycle for both specialty training and foundation programme allocation.
What did this mean for the 2026 recruitment rounds?
For specialty posts starting in 2026
Prioritisation was applied at the offer stage for specialty training, as shortlisting was already underway.
For training posts starting from 2027 onwards, prioritisation will apply at both the shortlisting and offer stage.
For foundation programme in 2026
Prioritisation was applied at allocation to the foundation school.
What does the Act mean for doctors who hold a degree from, or students who are studying at, a UK medical school’s international campus?
It depends on whether the majority of their medical degree was completed abroad or in the UK. If the majority of their medical degree was completed in the UK, then yes, that student or doctor falls into the prioritised group.
For example, if a medical student attended an international campus for the first two years of their degree and then completes three clinical years in the UK, they will be prioritised under the legislation. However, students who complete the majority or all of their degree abroad will not be prioritised. If you are a doctor with a medical degree from an international campus applying to specialty training, you may still have been prioritised if you fall into one of the relevant priority groups (for example, if you completed the foundation programme).
Does this mean that UK citizens with an international medical degree will be prioritised?
For the foundation programme in 2026
No, British citizens with international medical degrees were not prioritised.
For specialty training in 2026
Yes, as a British citizen, someone with an international medical degree is included in the prioritised group.
What is the BMA’s view on the Act and the definition on “significant NHS experience”?
BMA policy, set at the last annual representative meeting, called for UK medical graduates to be prioritised for specialty training, with protections for IMGs already working in the NHS before the 5 March 2025, who have or go on to get two years of NHS or HSC experience.
The Act itself doesn’t use cut-off dates – instead, anyone who comes to the UK and gains ‘significant NHS experience’ will, in time, be able to apply for training on an equal footing with UK graduates.
What ‘significant NHS experience’ means is still up for debate in 2027. But analysis from NHS England has projected that a two-year NHS experience threshold (as per original 2025 BMA ARM policy) would have minimal impact on reducing training bottlenecks over forthcoming recruitment years, negating the purpose of the Act.
Given the legislation is now live, and members need clarity about the BMA’s position, UK Council approved a request to defer the implementation of our existing policy until the July 2026 meeting of council or until new policy is formed by the annual representative meeting in June 2026. This request was submitted by the BMA medical students committee and BMA resident doctors committee. Both committees have passed motions that support five years of service becoming the definition of ‘significant NHS experience’. The Government consultation on what definition will be used from 2027’s recruitment round onwards is likely to open soon.
What is the BMA doing to support members in the non-prioritised group?
Some of our members will have been personally affected by this change in the law and have been in touch with us to express deep concerns and anxieties. The BMA is continuing our work to support our members who hold international medical degrees, by lobbying for job security and stability, substantive contracts, career progression in the NHS, and fully standardised national terms and conditions.
The foundation programme
Who was prioritised for the foundation programme in 2026?
In the 2026 round, UK graduates were prioritised for places on the foundation programme, alongside graduates from the Republic of Ireland and four other European countries that the UK holds agreements with (Norway, Iceland, Switzerland and Liechtenstein).
This means that people who hold a degree in medicine from an international medical school (including UK citizens) were not prioritised. Not being prioritised does not mean that international medical graduates could not apply, but that jobs will be allocated to those in the prioritised group first.
Graduates from UK medical schools who spent the majority of their degree at an international campus were not counted as UK graduates for the purpose of application to the foundation programme, as defined by the legislation.
What did this mean for timing of allocations for the 2026 round?
Allocation to the foundation programme was delayed, to allow time for the law to pass through Parliament. Applicants received their allocations on 12th March 2026.
What did this mean for linked applications?
With the introduction of prioritisation, 2026 has seen a significant reduction in the number of placeholders. As with previous years, those on placeholders are guaranteed a place in their allocated foundation school but their programme placement, which is managed locally by the foundation school, will take place later as withdrawals from the foundation programme create available spaces. The reduction in the number of placeholders should mean that, in general, those on placeholders are given programme allocations more swiftly than in previous years.
NHS England produced new FAQs on placeholders for 2026, while no specifically new guidance was issued for the other UK nations.
What does this mean for ‘placeholders’?
With the introduction of prioritisation, 2026 has seen a significant reduction in the number of placeholders. As with previous years, those on placeholders are guaranteed a place in their allocated foundation school but their programme placement, which is managed locally by the foundation school, will take place later as withdrawals from the foundation programme create available spaces. The reduction in the number of placeholders should mean that, in general, those on placeholders are given programme allocations more swiftly than in previous years.
NHS England produced new FAQs on placeholders for 2026, while no specifically new guidance was issued for the other UK nations.
What did this mean for UK nationals who studied medicine at an international university?
No international medical graduates (other than those with degrees from the Republic of Ireland, Lichtenstein, Norway, Switzerland or Iceland) were prioritised for foundation training, regardless of their nationality. This means that UK nationals with degrees from other international medical schools were not prioritised.
Will prioritisation occur in standalone FY2 recruitment?
Yes, the same groups of applicants were prioritised for standalone FY2 recruitment as for the foundation programme (i.e. FY1). There is more information on FY2 recruitment here.
What did this mean for foundation priority programme recruitment?
Due to the timing of the passage of the law, Foundation Priority Programmes were not offered in 2026 in a separate recruitment process. Instead, these posts were added to the main round and allocated via Preference Informed Allocation (PIA).
What does the law mean for refugee doctors who want to access the foundation programme?
As it stands, there are no specific provisions for refugee doctors to access training within the legislation. For the purposes of applying for training, they will be treated the same as other international medical graduates.
What does the law mean for international students studying at UK medical schools?
International students are considered UK graduates and so will be prioritised, regardless of their nationality or immigration status.
Specialty training
Who was prioritised for specialty training in 2026?
As above, during the 2026 recruitment round, the UK Government prioritised UK graduates, alongside graduates from the Republic of Ireland and four other European countries that the UK holds trade agreements with (Norway, Iceland, Switzerland and Liechtenstein), for places in core and higher training.
International medical graduates who have already completed the foundation programme or relevant core training were also prioritised. This means that applicants with an international medical degree were prioritised if they had completed the foundation programme. If a candidate had completed relevant core training, they were also prioritised for higher training (for example, if an international medical graduate had completed core psychiatry, they would be prioritised for an application for higher training in child and adolescent psychiatry. However, if they did not meet any other criteria, they would not have been prioritised for another core programme).
This change does not mean that international medical graduates could not apply for specialty training places, but that they were not prioritised for a place.
Does this mean that UK citizens with an international medical degree were prioritised for specialty training?
Yes, as a British citizen, someone with an international medical degree holds the relevant right to work so as to be included in the prioritised group. This is different to the foundation programme, where UK citizens with international medical degrees were not prioritised (unless they hold a degree from the Republic of Ireland, Norway, Iceland, Switzerland or Liechtenstein).
Were applicants who have completed core training prioritised only for relevant higher specialty training?
Yes. Applicants who have completed core specialty training were prioritised only for higher specialty training in a relevant specialty (for example, someone applying to general surgery ST3 following core surgical training would be prioritised). Applying to a programme unrelated to your core training programme did not lead to prioritisation (for example, if you have completed core psychiatry, you would not be prioritised in an application for core surgery) unless you met another criterion for prioritisation (such as having completed the foundation programme).
Are there any specialties that will not be included for prioritisation?
The only specialty currently excluded from prioritisation is Public Health Medicine (single Certificate of Completion of Training), as the specialty is open to medical and non-medical applicants.
Are academic posts included in prioritisation?
Academic posts are included in prioritisation.
The only exception is public health academic clinical fellow posts in England, where vacancies are open to current non-medical public health trainees.
Are dental training posts included in prioritisation?
No, dental posts are not included in prioritisation. Oral and maxillofacial surgery is included in prioritisation, as this is a medical specialty despite the requirement for applicants to hold a dental degree.
What does this mean for refugee doctors who want to access specialty training?
Refugee status is not a standalone priority group. Individuals with refugee status were prioritised if they fall within another priority category, such as holding Indefinite Leave to Remain (ILR) or if they have completed foundation or core training. The law does not change their eligibility to apply for Locally Employed Doctor (LED) roles.
Will the same groups always be prioritised from now on?
Legislation allows for the Secretary of State for Health and Social Care to make changes, through regulation, to who is prioritised for the foundation programme and specialty training. The government has said that 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, significantly drop, they can remove these specialties from prioritisation. However, they have said that their aim is to avoid this as much as possible, by attracting more UK graduates to the specialities where service need is greatest.