ARM debates prioritisation on specialty training programmes

Doctors have voted to prioritise graduates from UK medical schools for roles on specialty training programmes ahead of those who trained overseas.

A motion held in a special open debate session at the BMA’s annual representative meeting in Liverpool this week also calls for an exemption for international medical graduates (IMGs) who registered in the UK by 5 March 2025 and gain two years of NHS experience. 

The policy, which condemns a ‘failure’ in government workforce planning, also calls for all graduates of UK medical schools to be guaranteed a foundation programme post for their first jobs as doctors. 

And it insists on an expansion of both foundation and specialty programme posts to match increases in UK medical school places with the appropriate workforce planning for expansion of GP and consultant posts.

The issue has seen fierce internal debate among members since the association’s resident doctors committee (RDC) began working on a similar motion, which it passed in March this year.

The open debate session, which lasted for an hour and twenty minutes, saw queues of doctors line up to speak to two separate motions; the one that passed prioritising UK medical graduates, and another which opposed any restrictions on specialty training applications based on country of primary medical qualification, which fell as a result of the other motion passing.

While many foundation year 2 doctors spoke of the fear they could be left unemployed as a result of poor government workforce planning and a lack of training posts, opponents of the motion argued that prioritising those who studied medicine in the UK would create a two-tier system that penalises some colleagues over others.

Tabling the motion, Callum Williams, deputy co-chair for education and training on the BMA medical students committee, said: ‘The foundation programme is broken.

We haven’t got enough posts for the number of applicants. 

‘If you trained in one of the UK’s medical schools, we are saying you should have priority. Because you require it for full registration, you cannot legally work in another job, other than a foundation year one post. This is in line with what a lot of other countries do. Australia, New Zealand and Ireland all have a similar system.’

Mr Williams noted that health secretary Wes Streeting has indicated publicly that he favours prioritisation of UK medical graduates, adding: ‘This motion gives us the best chance to influence policy on your behalf, to make sure all our members are protected.’

Melissa Ryan, co-chair of the BMA’s resident doctors committee, said the specialty training bottleneck crisis is a ‘multi-factorial problem’ caused by failures of successive governments and poor workforce planning.

‘The situation is absolutely not the fault of those who want to come to the UK, it lies squarely at the feet of the government who left training numbers essentially static for years.’

Dr Ryan noted current competition ratios for specialty training posts and how some 20,000 doctors (both UK graduates and IMGs, some of whom will apply from overseas) are unable to secure a training place, as well as fears among foundation year two doctors that they will be left without a job at all when their foundation programmes come to an end. ‘It’s appalling that this situation is rearing its head,’ she said.

She said the clause to protect IMGs who already work in the NHS showed how highly valued the cohort is among the BMA, adding: ‘The BMA has been the only organisation calling for this among stakeholders discussing how to tackle the bottleneck crisis.

‘We urgently need a solution that acts to reduce the bottlenecks now before they worsen and doctors lose their jobs.’

GP Gaurav Gupta, an IMG, spoke against the motion. He said it feels like ‘the clock is turning back 20 years’ as he recalled similar bottlenecks in the 2000s when he first moved to the UK.
‘I applied for 800 jobs before I got my first job. I faced a long spell of unemployment,’ he said. 

Dr Gupta said he ‘completely supports’ resident doctors and medical students in their fight for sufficient training places, saying ‘we are on the same side.’ But he also said the BMA ‘should never treat its fee-paying members unfavourably’.

He called out the GMC’s use of PLAB exams, noting how they raise £25 million a year for the regulator’s coffers, up from £20 million in 2023, while not guaranteeing IMGs passing the tests work in the UK.

Dr Gupta called for a limit to the number of PLAB (Professional and Linguistic Assessments Board) exams, so that doctors applying to work in the UK from overseas are not given false hope or travelling to the country to be left ‘abused, worrying and jobless’.

Lucie Olivova, a resident doctor and IMG, noted how the UK is 40,000 doctors down against what it would have if it had the average number of doctors per population of other OECD countries.

She said: ‘Even doubling the training numbers wouldn’t be enough. We should be asking to increase doctor posts, and training posts, massively.

‘So why are we fighting each other [over prioritisation] instead of fighting the enemy, which is the government? We need to do the right thing and not point the finger at the IMGs.’

The debate heard from supporters saying that those who have invested in the UK university sector, either as UK citizens or as international students, often taking on large debts while doing so, should be repaid for that through prioritisation – and that increasing training places alone will not fix the problem of doctor unemployment.

On the other hand, opponents argued that IMGs are already at a disadvantage because they often have to compete for places in their second language, and in unfamiliar systems – and said many may leave for other countries such as Australia if the environment becomes more hostile, which could involve uprooting families who have made the UK their home after years of NHS service.

It was also noted that the issue has a unique challenge in Northern Ireland, where doctors with the right to work and train in both Northern Ireland and the Republic of Ireland are at heightened risk of leaving the NHS for more competitive pay and opportunities south of the border. In response, RDC co-chair Dr Ryan said a solution to this was being worked on.

And concerns were also raised about what this policy might mean for UK citizens completing medical school overseas.

As well as asking delegates to vote on the motion, Latifa Patel, chair of the BMA’s representative body, ran a series of indicative polls during the debate to try and help fill gaps in the association’s policy on specific elements of the debate.

The results showed that members were highly dissatisfied with the way recruitment to the foundation programme (through the PIA system)  is currently working , and that the specialised foundation programme (SFP) should be allocated competitively, rather than via PIA.

Representatives also responded to questions about postgraduate recruitment, which showed there were concerns about the broad use of the MSRA (multi-specialty recruitment assessment) for judging suitability for specialty training programmes and a belief that the recruitment process should include an interview component.

And the representative body also agreed, but less conclusively, that every doctor should have the opportunity to join a specialty training programme.