Government to prioritise UK medical graduates for training places

• Substantial offer put to BMA in bid to end resident doctors strikes once and for all
• Includes bringing forward emergency legislation to fix choked recruitment system that overlooks UK graduates, benefitting this year's applicants
• BMA refusing to call off Christmas strikes despite an unprecedented government offer to extend their mandate.

The government has put an offer to the BMA which would put in place emergency legislation for UK and Republic of Ireland medical graduates and doctors who have worked in the NHS for a significant period of time to be prioritised for specialty training, tackling bottlenecks through an overhaul of recruitment for medical training. Should the BMA accept this offer, the government will accelerate plans to prioritise these medics, addressing the current system which has led to soaring competition ratios – with current applicants set to benefit from the 2026 intake.

Other measures in the offer include:   

• Creating 4000 more specialty training places, with 1000 of these brought forward to this year.
• Cost related measures, such as reimbursement for exam fees, to address the unique costs that resident doctors face. 
• Increasing the less than full time allowance by 50% to £1,500.   

Strikes suck up time, resources, and energy, with each round costing the NHS around £250 million. As a result, enacting this emergency legislation is contingent on the BMA and its members accepting this offer, and the government will not be able to deliver its offer of 4000 more training places if strikes continue.

The government also offered to extend the BMA's strike mandate if exchange for cancelling their damaging Christmas strikes, which are designed to cause maximum disruption to the NHS. This would have allowed the BMA to hold a formal referendum on the offer, with enough time to rearrange the cancelled strikes for the end of January should it have been rejected. It is deeply disappointing that the BMA leadership has refused this generous compromise, creating untold anxiety for patients across the country. Latest data shows that at the end of November, there were 1,649 beds occupied by flu patients, which is up 55.6% from this time last year. 

The BMA will now conduct a short, informal survey before making a decision on the offer next week.

Secretary of State for Health and Social Care, Wes Streeting said:   

Doctors asked me to deliver on jobs, especially unfair competition from overseas, and this comprehensive offer will deliver - providing resident doctors currently applying with more jobs, prioritising UK-trained graduates, and putting money back in the pockets of resident doctors. It builds on a 28.9% pay rise which has already been delivered.

We have been working around the clock to prepare emergency legislation to prioritise our homegrown talent and halve the competition for jobs that resident doctors currently face - that is now on the table. But it can only happen if resident doctors vote to accept the deal and end these strikes.

This offer will now go to BMA members, but the BMA have chosen to continue holding the spectre of strikes over the NHS next week. This was entirely avoidable as I offered to give the BMA the chance to reschedule strikes in January after the vote has taken place so that they could cancel the Christmas strikes, which are timed for the most damaging period of the year.

 I am astounded that the BMA's leadership rejected this. It means their NHS colleagues will this week be cancelling Christmas plans to cover shifts, and patients will have their operations cancelled, as the NHS prepares for the worst. I cannot understand the wilful casualness with which the BMA's leadership have chosen to inflict this pain on patients, other staff and the NHS itself. It is one of the most shameful episodes in the long history of the BMA.

I am appealing directly to Resident doctors, who now have an opportunity to vote for more jobs, better career opportunities, more money in their pockets, and to end the strikes. I urge them to vote for this deal.

There are currently record numbers of doctors working in the NHS, but training bottlenecks are at all-time high, with UK graduates facing record competition for places due to rising numbers of international applications, and in many cases being left without a job to go into. 

The last Government scrapped the Resident Labour Market Test, which required employers to check first if they can find an acceptable locally trained person to do the job. Medical school places were also expanded in recent years without also expanding postgraduate training, leading to increased competition for jobs.  This has seen NHS-trained doctors forced to compete on equal terms with doctors from around the world for NHS jobs.   

Competition ratios for postgraduate places have increased by 150% since 2019 - from 1.4 applicants per place in 2019, to 3.5 per place in 2025. There were around 12,000 applicants for 9,000 places in 2019, which has soared to over 30,000 applicants for near 10,000 places in 2025.   

Government reforms requiring GMC registration at the point of application and limiting applicants to five specialty training applications have already reduced applications by 11% this year.

However, the system is still currently hostage to the previous government's changes allowing increased overseas applicants – as a result whilst applications are down, overall applicant numbers are still 16% higher than last year, making recruitment even more competitive than this year.   

UK and Republic of Ireland graduates would also be prioritised for foundation training. These reforms would be delivered through emergency primary legislation to be introduced in the New Year, so that those applying in this current round are able to benefit from the changes.   

The plans will not exclude internationally trained staff who will still be able to apply to the roles and continue to bring new and vital skills to the NHS. The UK is fortunate to have exceptional internationally trained graduates, and the NHS will always benefit from their experience. We will be continuing to support and attract talented overseas staff that want to dedicate their time, energy and skills to the health service. That's why, the reforms will also prioritise doctors who have worked in the NHS for a significant period for specialty training.    

However, at a time when competition for medical staff globally has never been fiercer, we want to ensure we have a sustainable workforce fit for the future that is not overly reliant on international graduates. Taxpayers spend £4.3 billion in training medics every year, and we want to better protect this investment.

Further details on the changes that will be made to the recruitment system will be set out if the BMA decide to accept the offer put to them.