Doctors’ Association UK (DAUK) recognises the intense pressure on medical training and employment in the NHS and the genuine anxiety felt by doctors at all stages of their careers.
However, DAUK is concerned that the Medical Training (Prioritisation) Bill announced by the Government risks being unfair, and ineffective in addressing the causes of the crisis.
The shortage of training opportunities is the direct result of poor workforce planning under successive governments, despite repeated warnings from DAUK and others in the profession.
Specialty training posts
The number of medical graduates has grown for years without a corresponding increase in specialty training posts.
The consequence is a widening gap between applicants and available places, one that this Bill does nothing to close.
Dr Pushpo Hossain, DAUK IMG lead, said: “It is concerning that international medical graduates (IMGs) are being implicitly framed as part of the problem, when they are not to blame.
“IMGs often bear the greatest risk within the system. Many have invested thousands of pounds in PLAB examinations, GMC registration, relocation, and visa applications and renewals.
International medical graduates
“IMGs often cannot walk away if the rules change as they are financially, professionally, and personally tied into the UK system.”
A BMJ investigation found English hospitals trusts recruiting doctors from abroad as ‘cheap labour’ as part of fellowship schemes in which they were paid less than trust-employed doctors and had fewer benefits.
A recent follow up investigation by the BMJ found a £40.5m programme to train doctors from overseas at a Midlands NHS trust failed to ensure they were paid fairly, among other issues.
This prompted calls for all national programmes involving international training fellows to be paused pending an review of employment conditions to identify and prevent exploitative practices.
PLAB examinations
The GMC’s most recent published accounts show that PLAB examinations generated £25m.
Dr Matt Kneale, DAUK co-chair, said: “That reinforces that there are strong system incentives driving the recruitment of IMGs with a matching expansion in training capacity.
“The concern is that some IMGs have been encouraged to come to the UK in good faith, incurring significant costs, only to find themselves locked into insecure roles with limited progression.”
DAUK also questions the fairness of changing prioritisation criteria midway through the process.
NHS workforce
Doctors who have entered the NHS workforce did so on the basis of the current rules, and changing the criteria now feels unfair and unethical.
Therefore, we call for provisions within the Bill to protect any doctor who has already commenced the application for the 2026 training cycle in good faith. This would have the effect of preventing their de-prioritisation under new rules.
Dr Hossain said: “We are concerned the Bill will result in many IMGs leaving the NHS and deter others from entering it.
“The NHS is on its knees and we need doctors, whether they are a UK graduate or an IMG, to staff the hospitals safely, reduce waiting times and provide quality care.
“UK medical graduates are not leaving the NHS because IMGs are taking their jobs, it’s due to a number of factors including years of pay erosion, poor work conditions, lack of work-life balance, and workforce planning by the government.”
Non-doctor roles
It’s also important to recognise that at the same time the Government and NHS bodies have facilitated the expansion of a range of non-doctor roles, which are replacing doctors. This includes the poorly planned introduction of physician associates and anaesthesia associates, which has generated significant patient safety concerns, professional confusion, and personal cost to people who pursued these careers in good faith, based on assurances given at the time.
The Bill fails to address one of the core issues, that there are no new training posts being created.
Without meaningful investment in additional training numbers, the gap between applicants and places will remain, competition will intensify, and patient care will suffer.
Dr Hossain said: “We’re also concerned by the narrative that risks pitting UK-trained medical graduates against IMGs. Both groups overwhelmingly want the same outcomes which are to work, to train, to staff hospitals safely, and to treat patients.
Workforce strategy
“Understaffed hospitals, rota gaps, and long waiting lists harm everyone, and won’t be fixed by dividing the profession.”
A fair and effective workforce strategy must be based on long-term planning, expansion of training posts, and policies that treat doctors with consistency and respect.
We are ready to engage on solutions that strengthen the NHS workforce and improve care for patients.
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