AlphaMED Resources · https://alphamedicine.uk/Resources/cases/medical-training-act
Medical Training (Prioritisation) Act 2026
A new law puts UK medical graduates first for foundation and specialty training posts. It became law in March 2026 as applications for those posts grew sharply, and doctors trained abroad who already work in the NHS say it treats them unfairly.
- Government publishes the impact statement on the Bill
- Royal Assent on 5 March, and the sections take effect on 6 March
- First foundation allocations issued on 12 March
- Final foundation reserve allocations on 12 August, with 188 applicants still unplaced
- Regulations for the 2027 specialty round laid on 14 September
Summary
- The Act sets the order in which training posts are offered. Foundation training is the first stage after medical school, and specialty training leads to becoming a consultant or GP.
- Applications for specialty training rose from 12,000 in 2019 to nearly 40,000 for 2026. NHS England estimated 3.8 applicants per post before prioritisation and 2.1 with it.
- The Act requires UK medical graduates and a priority group to be offered places first, and other applicants only after them. The priority group includes graduates of Irish schools unless they trained mainly outside Ireland, and of schools in Iceland, Liechtenstein, Norway and Switzerland.
- The BMA says the aim is to restore specialty competition ratios to more reasonable levels. Doctors' Association UK says changing the criteria now "feels unfair and unethical" for doctors who joined the NHS under the earlier rules.
- International medical graduates made up 42% of the medical workforce in the regulator's 2025 report, and 23% of overseas qualified applicants secured specialty posts, against 69% of UK graduates.
- By 24 August 2026, 98% of eligible foundation applicants had been allocated a place, with 188 still unplaced. The 2027 regulations use nationality and immigration status to set priority.
Dig deeper
- Specialty priority in 2026 applied to offers under section 2 of the Act. From 2027, priority applies at both shortlisting and offer stages, according to NHS England.
- The 2027 regulations, made on 10 September 2026, prioritise British citizens, some Commonwealth and Irish citizens, and people with indefinite leave or Withdrawal Agreement residence leave. They give no route for NHS service, and NHS England says it does not yet have enough evidence to define NHS experience in regulations.
- BAPIO, the body for physicians of Indian origin, calls this a two tier system. It has begun talks with public law specialists on the Public Sector Equality Duty and is considering legal options.
- A placeholder is a foundation place that confirms the school but not the hospital. The BMA says placeholders fell significantly in 2026. No count of 2026 specialty offers by group has been published.
Ethical issues
| Principle | How it applies here |
|---|---|
| Beneficence | Training posts decide how many doctors the NHS will have later. A rule that narrows access for international medical graduates, who make up 42% of the medical workforce, bears on who staffs services. |
| Non maleficence | A placeholder leaves a doctor without a hospital until a place opens. Doctors' Association UK points to harm from changing the rules after doctors had committed to NHS careers. |
| Justice | Section 1 sets a legal order: UK graduates and the priority group come first, "before offering places to any other eligible applicants". The conflict is between fair access for home graduates and fair treatment of doctors who joined under earlier rules. The 2027 regulations order applicants by nationality and immigration status, and NHS service has no route. |
Interview questions
- What do you know about the Medical Training (Prioritisation) Act 2026?
- What did the Act change for foundation and specialty applicants in 2026?
- You are a doctor trained overseas who has worked in an NHS hospital for five years. A new rule puts UK graduates ahead of you for a specialty post. What would you say to your managers?
- Why might a government want its own graduates to come first for training posts, and what could that cost patients?
- Is it fair to change the rules for doctors who have already committed to NHS careers?
- Should a training place depend on where a doctor qualified, or on how long they have served in the NHS?
- Why does the number of applicants per post matter for the quality of training?
Sources
- nhsemployers.orgnhsemployers.org/…/medical-training-prioritisation-act-2026-enters-law
- NHS Englandengland.nhs.uk/…/medical-training-prioritisation-bill-information-for-applica
- legislation.gov.uklegislation.gov.uk/…/7
- British Medical Associationbma.org.uk/…/what-the-new-law-means-for-uk-graduate-prioritisation
- dauk.orgdauk.org/…/response-to-medical-training-bill-announcement
- British Medical Associationbma.org.uk/…/imgs-increasingly-relinquishing-medical-licences-finds-gmc
- UK Foundation Programmefoundationprogramme.nhs.uk/…/ukfp-2026-reserve-allocation-update-3
- legislation.gov.uklegislation.gov.uk/…/made
- legislation.gov.uklegislation.gov.uk/…/2
- bapio.orgbapio.org/…/bapio-raises-concerns-over-specialty-training-regulations-an
Photo: Stethoscopes, CC BY-SA 3.0, via Wikimedia Commons, colour altered.
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