Medical Training (Prioritisation) Bill

Katie Lam Excerpts

Tuesday 27th January 2026 Commons Chamber

[Katie Lam (Weald of Kent) (Con)]

The NHS has a deeply unusual set-up when it comes to its workforce. The Government set the rules for who can qualify as a medical professional, decide how many medical training places to offer and control the flow of medical graduates into the NHS. They decide how much to charge medical students and under what conditions and since the NHS is by far the country’s primary employer of medical professionals, the Government also have effective control over the pay and conditions of those who qualify, and are responsible for deciding where medical trainees go and when. As a result, the health service workforce is not subject to the same labour market conditions as other organisations. The Government control both the supply of and the demand for its own workforce.

It is welcome to see this legislation before us, which rightly gives priority to British-trained doctors for NHS training posts, particularly at the early stages of their career. Those who decide to practise medicine in this country should have reasonable confidence that, if they wish to do so, they can build a career here. The Bill goes some way towards addressing the current situation in which British-trained doctors are being squeezed out of the system in favour of overseas recruits, despite the Government’s control of both the supply of new British graduates and the number of training places.

In 2025, 15,723 British-trained doctors were set to compete for 12,833 NHS training posts. This is already a competitive environment. However, the NHS’s focus on overseas recruitment meant that those British-trained doctors were also forced to compete with another 25,257 overseas trainees. It is clearly absurd that the British Government should restrict the number of training places offered, while also increasing demand for those places through a policy of overseas recruitment, having spent hundreds of thousands of pounds to train each medical student in this country.

That is particularly true when we know that doctors trained overseas are two-and-a-half times more likely to be referred to the GMC by their employer than doctors trained here. Many overseas recruits are hard-working and well-meaning, and many are excellent at the work that they do. Yet we must be honest about the fact that relying on overseas recruits instead of training more medical professionals in this country is not always a like-for-like swap.

Both medical trainees and patients would benefit from a system that trains more doctors here and ensures that those British-trained doctors are given a reasonable chance at moving quickly into an NHS training post. The system should also reward ability and allocate training posts based on merit. The current system of random allocation not only fails to reward our most talented medical graduates but creates profound uncertainty for those at the start of their careers.

Last summer, one of my constituents qualified as a doctor. He graduated with one of the very highest marks in the year—he was in the top three—from one of the most competitive medical schools in the country. He is clearly an outstanding student and will make an incredible doctor. In any sane system, he would have been placed immediately and been able to choose his location and specialism to keep him incentivised and happy within the NHS and to make the most of his obviously considerable talents. Instead, because of the mismanagement of places and the lottery system, he was not placed at all in the first round of allocations. He was not placed in the second, the third or even the fourth round. With fewer than four weeks to go, he still had no placement and no sense of where he would spend the next few years of his life, including whether he might be able to live close to his partner, who was also a doctor and graduating with him.

That is an insane way to treat our most brilliant graduates. I hope the Government will change their mind and amid their other good changes accept the amendment tabled by my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer), to which I have added my name, to ensure that training places are, in future, allocated on the basis of merit. If the Bill aims to provide certainty to British-trained doctors that they will be able to build a career in this country, which is a noble aim, it should also recognise that the current system of randomly allocating training places is one of the biggest causes of uncertainty in our system. It would be far better for doctors and patients to have a system that instead prized excellence, providing a clear basis on which medical trainees could be allocated and creating a system that rewarded the most talented graduate doctors. It is right that the health service prioritises British-trained doctors. It is also right that, across every area of the public sector, we reward talent, effort and merit.