4 February 2026

The UK relies on foreign medics, but we must take care of home-grown talent

Most overseas recruits come from less developed nations that can ill afford the brain drain

An unusual piece of legislation is making its way through parliament. The Medical Training (Prioritisation) Bill will enshrine a specific discrimination into law in order to curb the burgeoning competition for training jobs in the NHS from international medical graduates (IMGs).

The UK has always relied on overseas talent to help staff the health service, but following the lifting of visa restrictions in 2020, the number of applicants from abroad has soared. To compound matters, previous governments increased UK medical school places, producing more home-grown doctors, but failed to expand postgraduate training capacity to match. The result has been a perfect storm. Last year, more than 25,000 IMGs were vying alongside 15,700 UK graduates for 12,800 training posts – almost four doctors for every available place. As recently as 2019, the competition ratio was less than half that. If the bill becomes law, training places will be offered first to applicants whose primary medical qualification is from the UK or Ireland (or, by dint of an intriguing post-Brexit idiosyncrasy, a clutch of non-EU European nations including Liechtenstein and Iceland). IMGs will only get a look-in on any posts that remain unfilled.

While this will make the UK a far less attractive destination for international medical talent, the legislation is viewed by government as a crucial part of its bid to resolve the long-running industrial dispute with resident doctors. The current blight on career prospects for UK graduates is having a corrosive effect on morale. It is common for a UK medical student to accumulate around £100,000 of student debt to fund a medical degree; the state invests around twice as much again. The increasing number of disillusioned doctors leaving the NHS – or medicine entirely – represents a colossal waste of money, to say nothing of the damage being done to dedicated young people’s lives.

There is also a moral case for scaling back our dependence on international recruits: the majority come from less developed nations that can ill afford the brain drain. And there are practical concerns, too. The influx of IMGs has given rise to the concept of the “NHS-naive” doctor. It is hard to overstate the challenges of practising in an entirely new healthcare system, populated by patients with often unfamiliar patterns of diseases. Many IMGs require extensions to their training to enable them to adjust, yet failure rates in postgraduate examinations remain significantly higher than among UK-educated graduates.

The global shortage of medical practitioners has created fierce competition for them. Countries such as Australia and Canada (where I am practising at the moment) offer better remuneration and more sustainable working conditions, but already prioritise their own graduates for training. IMGs are much more likely to be able to move to these countries if they have a postgraduate qualification from the UK. Anecdotally, the NHS is at the centre of a medical churn in which many IMGs capitalise on the relative ease of entry to gain higher qualifications, then use them to move on to more desirable locations. Meanwhile, demoralised UK graduates are being lost to the health service in increasing numbers.

The danger with the proposed legislation is that it creates a “hostile environment” for international medical talent, which the NHS will continue to require for the foreseeable future. To attempt to mitigate this, the legislation proposes in its second and subsequent years to include in the priority group IMGs who have gained substantial NHS experience. An IMG dedicated to developing a career in the UK could still progress after a few years working in purely service-delivery roles. Whether the bill achieves the right balance – nurturing home-grown talent while still attracting sufficient overseas recruits – remains to be seen. But it is a sorely needed step towards sorting out the mess that previous governments have made of UK medical careers.

[Further reading: How to eat like a Roman emperor]