The debate about prioritisation for medical training has been one of the most difficult and emotive discussions we have had as a profession in recent times. I understand why. It goes to the heart of who gets opportunity, how we value different routes into medicine and how we plan properly for the future of the NHS.
I come to this discussion with more than one perspective. I am an IMG (international medical graduate). I know what it means to build a career in the UK after training elsewhere and I know the contribution IMG doctors make every day to patients, services and colleagues across the NHS. I am also a parent of UK medical graduates and I have seen first-hand the anxiety felt by those who have trained in the UK but face increasingly intense competition for the next stage of their careers.
Those perspectives are not in conflict. They both matter. They are why I believe we need to explain the BMA’s policy carefully, honestly and with respect for all members affected by it.
The ARM’s decision
At this year’s BMA annual representative meeting, delegates elected by the membership agreed IMGs should need five years’ NHS or HSC experience to be considered for prioritisation for training places under the Medical Training (Prioritisation) Act.
This was not an easy decision. The motion passed by a small margin after a lengthy and emotional debate. Many members spoke powerfully against it. Their concerns were heard, and they deserve to be acknowledged. However, the ARM is the BMA’s sovereign policy-making body. Once a decision has been made, even narrowly, it becomes BMA policy and we will now lobby the Government to accept the definition agreed by our representatives.
Why our members voted for prioritisation
The purpose of this policy is not to criticise IMG doctors. IMGs are essential to the NHS and to the BMA. The issue we are trying to address is a workforce planning failure that has built up for many years. Successive governments have expanded medical school places without ensuring there are enough foundation and specialty training places to allow doctors to progress. The result is a system in which too many doctors are competing for too few training opportunities.
For UK graduates, this creates a particular problem. Their education has been publicly funded and designed around NHS practice, GMC standards and UK clinical environments. Yet many now face a real risk of being unable to progress into the training needed to become the future consultant, GP and specialist workforce the NHS depends on.
KOCHHAR: The ARM's decision is final
That does not mean the answer is to close doors to colleagues who trained overseas. It means we need a more sustainable and fair system, alongside a major expansion of training places. The BMA will continue to press the Government to increase training capacity so doctors are not set against one another by artificial scarcity.
UK citizens with international medical degrees
ARM also considered whether the Medical Training (Prioritisation) Act should go further, with specific protections for international medical graduates who hold UK citizenship. Delegates voted against adopting those protections. Those speaking against the motion argued the BMA’s policy should be based on where a doctor trained because UK medical degrees are designed around the NHS and because workforce planning is based on the number of UK medical school places.
I recognise this is especially difficult for UK citizens who trained overseas. Their position is not the same as that of UK graduates under BMA policy or the Government’s legislation but the concerns they raised about progression routes into NHS practice are important. The BMA will continue to listen to members in this situation and explore how they can be better supported.
Our work for IMGs
Nothing in this policy changes the BMA’s commitment to IMG doctors. IMG members bring a wide range of skills, experience and perspectives to medical practice in the UK. We know IMG doctors face a combination of structural, cultural and practical barriers, including poor induction, limited access to training and career progression, visa and employment insecurity and difficulty navigating NHS systems, contracts and workplace rights. These challenges are often compounded by discrimination, bias, isolation and differential attainment in exams and training.
The NHS could not function without IMG doctors and our union must continue to support them. That support includes practical help for doctors coming to the UK, including free membership for the first year and resources to help IMGs settle into the NHS and life in the UK. It also includes work to reduce the barriers created by the immigration system and help for members facing immigration-related concerns.
We will also continue to campaign for locally employed doctors, many of whom are IMGs, to be employed on the right national contract. Doctors should have secure, fair terms and conditions, which recognise their expertise, reduce exploitation and support career development.
What happens now?
The real failure here is not the presence of IMG doctors, nor the aspirations of UK graduates. The failure is a workforce system that has not created enough opportunities for doctors to train, progress and serve patients. The BMA’s priority must be to challenge that failure while representing all parts of the profession with honesty and respect.
As chair of the representative body, my role is to uphold the decisions made by ARM and to make sure our democratic processes remain open, fair and inclusive. I also want members to know that disagreement within the BMA does not mean disregard. We can hold difficult policy positions while continuing to listen to one another, support one another and fight for a better system for every doctor.
This policy will now guide the BMA’s lobbying of relevant health bodies on the definition of significant NHS experience. At the same time, we will continue to campaign for more training places, fair treatment for IMG doctors, stronger protections against exploitation and a medical workforce plan that gives doctors confidence in their future.
Uniting against discrimination
While the vote at this year’s ARM was close, one thing is clear. This policy must not and will not be used to fuel anti-migrant rhetoric nor to imply IMGs are responsible for successive governments’ poor workforce planning.
IMGs are our members, they are our colleagues and they are an essential part of the NHS workforce. The BMA will continue to stand against racism, xenophobia and discrimination in all forms while campaigning for fair treatment, better support and properly planned training pathways for all doctors.