This follows a policy passed by the UK resident doctors committee (UKRDC) on 4 March 2025. You can download UKRDC’s briefing and watch officers discuss the policy in this webinar recording.
Please note that the BMA does not set policy for training and recruitment in the NHS. The motion passed by the representative body sets out a position, which the BMA will advocate for UK health departments and relevant bodies to adopt.
Why did the BMA 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 particularly concerning to resident doctors and medical students, 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 BMA 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?
In July 2025, we published a survey which found that half of foundation year 2 (FY2) doctors had no job to go in August.
Some 4,401 doctors were asked whether they have substantive employment or regular locum work from next month. Of the 1,062 FY2 doctors who responded, 52 per cent said they did not. Overall, a third (34 per cent) of the doctors who responded did not.
The results of the poll led UKRDC to ballot foundation year 1 (FY1) doctors, to bring specialty training into a new, linked dispute with government.
It’s also important to note that some FY2s with job offers may not be going into training, having instead found 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 BMA chosen to lobby for prioritising UK graduates over international graduates?
The BMA 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 studied 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.
The BMA 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 BMA’s position.
IMGs have always played a crucial part in our health service and are valued colleagues. If the BMA’s policy were implemented by the UK government in full, those IMGs working in the NHS before 5 March 2025 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 BMA set a date after which IMGs would be deprioritised for UK medical training programmes?
To ensure fairness for those IMGs who are already working in the NHS, we believe it is right to prioritise NHS doctors over those who have yet to practise in the UK.
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 applicants in the first round of specialty training 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.
| Year | 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 |
Source: freedom of information request data in response to a question asking for the unique number of UK and international medical graduate applicants for round one of specialty training in 2023, 2024 and 2025.
When do we want prioritisation to come into place?
At our special representative meeting in September, members voted for a motion calling on the government to introduced UK medical school graduate prioritisation for foundation and specialty training programmes in time for the 2026 round 1 recruitment cycles. This is to address the backlog of un- and underemployed doctors as quickly as possible.
How many training posts would need to be created to ensure fair ratios?
NHS England’s 10 year plan commits the government to creating ‘1,000 new specialty training posts with a focus on specialties where there is greatest need.’
It is unclear how the NHS arrived at 1,000 posts or how ‘specialties where there is greatest need’ will be determined. The upcoming 10-year NHS Workforce Plan needs to include modelling of the NHS’s future workforce requirements, including projections of the future need for individual medical specialities, so that the number of training places leads to the health service having the GPs and specialists it needs to support current and future patients.
To prevent bottlenecks and unemployment in the future, expansions of undergraduate education must not go ahead unless 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 BMA will further consider the specific cross-border working implications between Northern Ireland and the Republic of Ireland when developing this policy.
BMA policy
Whilst international medical graduates (IMGs) are a valued part of the UK’s medical workforce, this meeting is concerned by exponentially increasing competition ratios for speciality training, driven primarily by overseas recruitment. This meeting therefore condemns the Government’s failure in workforce planning which has left many medical students and residents in the UK in the untenable position of facing unemployment in the near future. We therefore call on the four nations statutory education bodies and the Department for Health & Social Care to:
i. guarantee all UK medical school graduates a foundation programme post for all future recruitment cycles and prioritise UK medical school graduates in the preference informed allocation ranking for UK Foundation Programme recruitment;
ii. introduce a process for medical speciality training recruitment where UK medical school graduates are offered posts first before any unfilled posts are opened to all other applicants;
iii. Introduce an exception to part ii for IMGs who are GMC registered and practicing in the NHS/HSC on or before the 5th of March 2025 and who have two years or go on to gain two years of NHS/HSC experience;
iv. expand foundation programme and speciality programme posts to match increases in UK medical school places with the appropriate workforce planning for expansion of GP and consultant posts. (ARM 2025)
That this meeting notes the commitment in the NHS 10-year plan to expand specialty training places and prioritise UK graduates for foundation and specialty training, and to prioritise other doctors who have worked in the NHS for a significant period for specialty training. However, it is concerned that the proposed expansion will not adequately address issues with postgraduate recruitment nor create a sustainable medical workforce, and condemns the current mass unemployment of doctors across the UK. Therefore, this meeting calls upon Governments to:
i. implement UK medical school graduate prioritisation (as per associated policy passed in ARM 2025) for the UKFP26 and specialty training 2026 round 1 recruitment cycles;
ii. expand foundation and specialty training places in line with medical school growth, pausing further medical school expansion until this is achieved;
iii. create a long-term workforce plan to model the number of senior doctors required in the future and fund the corresponding number of medical school, foundation and specialty training places. (SRM 2025)
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.