Medical Training (Prioritisation) Bill

Ben Spencer Excerpts

2nd reading
Tuesday 27th January 2026 Commons Chamber

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

I will start with what is now a traditional declaration: I am a non-practising doctor and my wife is a doctor. I thank the Secretary of State for his comments, and for thinking through the content and merits of my new clause 2, on allocation based on merit. I hope that, as the Bill proceeds through this place and the other place, he continues to focus on that, because it is a very important point. For my Second Reading speech, I am not going to focus on the details of new clause 2—I will hold that back for Committee. Instead, I want to make some general comments.

In a sense, the Bill treats the symptoms of what has been happening in the medical workforce. I do not think it is a cure for the fundamental disease or the problems we have had over the years, which are in part down to a creeping de-professionalisation of the medical profession. I also think they are down to the way we have approached doctors’ appointments to placements, and how we assess their skills and CVs, and how that then leads to different appointments and places. Doctors are thrown from pillar to post, subject to the whims of a computer or a training programme. It has been shown time and again that one of the most important things in people’s eyes, or at least what gives most work satisfaction, is autonomy.

Unfortunately, we have sleepwalked into a situation, in pursuit of a weird type of fairness in the allocation of jobs, that works towards equality of outcome as opposed to equality of opportunity. Doctors have found themselves unable to compete or have control over their lives. Where they are allocated to their foundation school or their specialty training has a real, material impact. Crucially, within allocations, the geographical regions are huge. That means uprooting: moving your family and your social network. In the training scheme there really is no power that a doctor can exert in terms of choice or preference. My understanding—I am a creature of the Nursing and Midwifery Council and the Medical Training Application Service, when I was coming through and applying for posts—is that we just used to let doctors competitively apply for different posts and put together a sort of portfolio CV. That has all changed.

There is now the allocation to training programme schemes and national contracts, which is something I have been campaigning about for quite some time. Do not get me wrong: I think the way the BMA has behaved is absolutely appalling. I categorically and unreservedly condemn the approach that it has taken, and not just under this Government but under previous Governments over various disputes concerning junior doctors. But the fact that doctors have found themselves in a situation where they need to have a militant trade union is a consequence of the training schemes, programmes and national contracts not treating doctors as professionals when it comes to applying for jobs.

It also means that the training providers, the trusts and the integrated care systems, cannot provide options that doctors might want to compete for. They cannot say, “Well, we’re a really good research unit, so we’re going to have an offering that pursues a certain type of doctor who wants to go down the academic pathway.” We do not have trusts or regions that can say, “Actually, this is an area where there is quite a lot of social and economic deprivation, so we want doctors who are interested in certain specialties.”

For all sorts of different reasons, there are parts of the country that are oversubscribed and parts that are undersubscribed. We cannot use what we use in every other walk of life, which is changing remuneration to encourage people to go to other places. We cannot say, “You know what? Let’s look at flexible working arrangements.” As part of my medical school rotations, I was in Barnstaple. I can only imagine that if the trust for Barnstaple had recruitment challenges—I do not know if it does or does not—then it could look at whether people are into surfing or ensuring they could get involved in other activities outside of medicine. Dare I say, as a former doctor, that medicine is important but there are more important things than people’s careers, in particular their work-life balance. We have a system that does not enable that to happen. The behaviour of the BMA is, in a sense, a consequence of dismantling the normal human experience in the approach to the selection and allocation of jobs.

That has real consequences locally. Ashford and St Peter’s, my local trust, struggles to recruit because of the proximity to London, which has London weighting. Since we are on the border of London, to look at it purely financially—if that is the main priority—it makes more sense to pop into London and work than it does being employed in my area. Runnymede and Weybridge, by the way, has house prices and a cost of living that are equal to a big chunk of London, but there is no approach to regionalisation.

I am really glad that the Secretary of State is in his place to hear my contribution. I will say to him something that I have said to many previous Secretaries of State. When he is in those difficult negotiations with the BMA and hears from doctors about the workforce experience challenges that they have, would it not be better if we trusted doctors—and, for that matter, anyone who is subject to a national contract—to make decisions for their own lives, and that we devolve decision around pay and terms and conditions to some form of regional unit? For medicine, the obvious solution would be the integrated care systems, but there could be different solutions and ways of approaching it.

I think ICS devolution would make the most sense, but there are other opportunities to do it. That way, it moves from the Government essentially getting stuck in the middle of doctors, who are making difficult decisions about their careers and having to balance and judge different T&Cs of work, and the employers, which are different NHS trusts, being unable to use the normal mechanism that any other employer would use to recruit and incentivise people. If we do not do that, unfortunately the consequence is a Bill like the one we are debating: ever-increasing state intervention to try, in the absence of a market system, to impose a command economy.

The Secretary will have seen the issues dealing with local doctor prices. The fact that we have struggled with high locum payments for so long is because we do not allow the doctor employment market to resolve itself for adjustments in contracts. The system would save a huge amount of money overall if, rather than having a huge amount of money going to locums and a national contract system for doctors, we let the market sort it out. I will support the Bill, but I see it more as palliation than the definitive treatment that we need to solve the workforce problems for the NHS going forward.

Medical Training (Prioritisation) Bill

Ben Spencer Excerpts

Committee of the whole House
Tuesday 27th January 2026 Commons Chamber

In conclusion, amendments 2, 3, 4 and 5—which stand in my name—would strengthen parliamentary scrutiny by replacing the negative procedure with the affirmative procedure, ensuring that any future changes to eligibility receive proper examination. Amendment 5 would also ensure that devolved nations also give consent before any changes are laid before Parliament. Amendments 6 and 7 would ensure the fairness of the process in the current year, and new clause 1 seeks to ensure that the Bill meets its objectives of lessening the workforce crisis by specialty. These changes would not undermine the Bill, but strengthen it. They protect fairness, protect parliamentary sovereignty, and protect the NHS workforce from unpredictable and disruptive changes. As such, although we support the Bill, we urge the Government to adopt these amendments, which would ensure that the legislation works for patients, staff and the long-term strength of our NHS.

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

As always, Mrs Cummins, it is a pleasure to serve under your chairmanship. I rise to speak to new clause 2, which stands in my name and is supported by many other Conservative Members. I declare again that I am now a non-practising doctor and my wife is a doctor.

I believe that ambition should be encouraged, and success should be dependent on the talent and hard work of the individual. However, in a vocation where we really want to encourage and support the brightest and the best, the signal being beamed out by the NHS and its various arms and quangos is unfortunately quite different. We have already seen this over the years in how the NHS treats competence and excellence among doctors—someone could be the best doctor in the world and be treated exactly the same as someone who is just about competent. No other operation would approach employment, and celebrating and supporting success, in that way.

I do not think, though, that I have ever seen as egregious and extreme an example of completely ignoring talent and merit as the preference informed allocation system. The shadow Minister, my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), has laid out some of the details behind that system, but I encourage Members across the Committee to read about how preference informed allocation works—about the soulless, computerised, algorithmic method by which it allocates human beings a random number. That random number is then the sum total of those people’s dreams, hopes and ambitions when it comes to placements as they take their first steps into their medical career. To me, PIA looks better suited to the dystopian sci-fi programmes that I enjoy watching—better suited to “Logan’s Run” or “The Prisoner”, in which people are allocated numbers. It is not the way that we should be treating people in this country, and it is outrageous that such a system has been brought into force. We in this House should stand up for merit, and I really hope the Minister will affirm from the Dispatch Box today that the Government will dismantle this awful scheme.

[Karin Smyth]

I am grateful to Members for their contributions to the wider debate at this hour and for their considered amendments. I will respond briefly to their points and the amendments that have been tabled.

Amendment 6 and 7 would widen the scope of who is prioritised for specialty training starting in 2026 by prioritising applicants who worked as a doctor in the health service on 13 January. Although we welcome the intention to recognise the importance of internationally trained doctors, we cannot accept the amendments at this time. They would mean that the Bill was ineffective in delivering on its intention to tackle bottlenecks and ensure that we have a sustainable medical workforce that can meet the needs of the population.

I remind the Committee again that the Bill does not exclude anyone. In particular, there are likely to be opportunities in specialties such as general practice, core psychiatry and internal medicine, which historically attract fewer applicants from the groups we are prioritising for 2026. International medical graduates also continue to have opportunities in locally employed doctor roles. That could lead to NHS experience that might count towards future prioritisation as we look to make regulations to set criteria for what is considered “significant” NHS experience from 2027.

Amendment 10 would ensure that members of the armed forces are not excluded from prioritisation due to having undertaken medical training while on posting outside the British islands. We cannot accept that amendment as we believe it is not necessary. That is because medical cadets do not spend time outside the British islands as part of their UK medical degree. While cadets undertake their elective with the military, which may be overseas, that is no different from other civilian medical students, many of whom undertake electives overseas. As such, we do not believe that medical cadets are disadvantaged by the Bill.

Amendment 9 would include all British citizens within the priority groups so that British citizens will be prioritised for the purposes of the foundation programme and specialty training from 2027 onwards. It has no effect for 2026 specialty training, as British citizens are already prioritised by virtue of their immigration status. We therefore cannot accept the amendment. To do so would risk a significant increase in the pool of prioritised doctors who would compete with UK-trained doctors. The amendment would incentivise the expansion of the market for overseas medical schools, including medical schools working with foreign Governments to grow the overseas campus sector. That could offset any increase in postgraduate training places and undermine workforce planning. While British citizens will be prioritised for specialty training places in 2026, this is a proxy that is necessary for practical reasons. From 2027 we want to prioritise applications with experience and training based in the NHS.

Again, prioritisation does not mean exclusion. International medical graduates who are not prioritised will still be able to apply and will be offered places if vacancies remain after prioritised applicants have received offers. However, it is important that we do not incentivise actions that will undermine the Bill. This Bill will reduce competition for places for UK-trained doctors so that home-grown talent can become the next generation of NHS doctors.

Amendment 8 would limit the definition of a UK foundation programme in clause 5 to include programmes only where the majority of training has occurred within the UK. Although I understand the desire to do that, the number of doctors on a foundation programme within the meaning of the Medical Act 1983, but where the majority of training occurs outside the UK, is very small. Indeed, we understand that there is only one such active training programme. There are fewer than 25 doctors on that programme this year, of which fewer than five applied to continue their training in the UK. As such, there is no material impact on the Bill, so we do not think amendment 8 is necessary. However, we will keep the situation under review.

Amendments 2, 3, 4 and 5 would change the procedure for making regulations to set additional priority groups for specialty training from 2027. The regulations would prioritise additional groups based on criteria indicating that a person is likely to have significant experience of working as a doctor in the health service or by reference to their immigration status. To be clear on our intention, the Bill sets out the groups of people who are to be prioritised for specialty training from 2027 onwards. The delegated power is limited to adding to that list by reference to their having

“significant experience of working as a doctor in the National Health Service”,

or immigration status. Although I am sympathetic to the desire for more parliamentary scrutiny, as outlined by the hon. Member for North Shropshire (Helen Morgan), we believe that, due to the limited scope of the power, the negative procedure is justifiable. I therefore encourage her not to press those amendments to a Division.

Amendment 1 would change the commencement of the Bill—from being commenced by regulations to being commenced automatically on Royal Assent. As my right hon. Friend the Secretary of State outlined, the commencement clause is important, and I have addressed that point. It is a failsafe that, given the tight timeline for introducing the Bill, will ensure that we are not in a position where a law is enacted that we cannot implement effectively for whatever unforeseen reason.

As I have said, there is also the question of whether it is even possible to implement prioritisation if, for example, the strikes are ongoing, given the strain that they put on resources and the impact that could have on delivery of the Bill. Because our objective is not just to move quickly but to get this right, these considerations are key to the commencement of the Bill, which is why the Government believe that we need to be able to commence the Bill when it makes sense to do so. For those reasons, we cannot accept the amendment.

We do not think that new clauses 1 and 3 are necessary, because the data is already published, or, as we have said, we would be seeking to monitor the impact. New clause 2 would require the allocation of individual candidates to foundation and specialty training places on merit, once the requirements to prioritise certain applicants had been met. We consider the new clause to be unnecessary at this time because existing systems for recruitment to foundation and specialty training already assess the applicants on many of the merits outlined by in it. The Bill does not alter that; it simply ensures that UK medical graduates and other eligible applicants are prioritised.

[Dr Spencer]

Will the Minister give way?

[Karin Smyth]

I am coming to the hon. Gentleman’s point. We will keep the current system under review—I think the Secretary of State was clear about that—but we think that any change is best made through established guidance rather than through legislation.

Many Members raised the issue of our relationship with Malta and Queen Mary, and the work that is done there. That relationship is clearly important. We have a great deal of work ongoing with Queen Mary, in the medical field as well as others. We are not excluding anyone. We are making sure that the prioritisation works in the best way possible, and we will of course keep all that under review. I thank hon. Members for their constructive debate on this important legislation.

Question put and agreed to.

Clause 1 accordingly ordered to stand part of the Bill.

Clauses 2 and 3 ordered to stand part of the Bill.

Clause 4

“UK medical graduate” and “the priority group”

Amendment proposed: 9, page 3, line 3, after “are” insert

“a British citizen or are”.—(Stuart Andrew.)

This amendment would require British citizens to be prioritised for places on UK Foundation programmes and for interviews and places on speciality training programmes from 2027 onwards.

Question put, That the amendment be made.