Medical Training (Prioritisation) Bill

Layla Moran Excerpts

Tuesday 27th January 2026 Commons Chamber

[Wes Streeting]

I absolutely give the hon. Member that assurance—the Bill covers medical graduates from the UK and Ireland, for very obvious reasons. I welcome the broad support that the Bill appears to have across the House, because for the changes to benefit applicants in the current round—for posts starting this August—it must achieve Royal Assent by 5 March. Any delay will risk vacancies in August and disrupt planning in NHS trusts, which rely on their new trainees to deliver frontline care. Doctors also need sufficient time to find somewhere to live, sort childcare and arrange other aspects of their lives before their posts start. I am grateful that Parliament has agreed to expedite the Bill’s progress, and confident that we will be able to work at pace with our majority in this House, and with cross-party support in the other place.

[Layla Moran (Oxford West and Abingdon) (LD)]

I sense that the Secretary of State is about to reach the end of his remarks. We are keen to start the debate, but it would be helpful to get clarity on one thing before we begin. When will we see the workforce plan? It has been delayed a couple of times. We wrote to the Department in November asking for an explanation as to why it has been delayed and when we can expect it. Can the Secretary of State give us some clarity, because that is the context in which the narrow technical measure that we are discussing needs to happen?

[Wes Streeting]

That is a fair question from the Chair of the Health and Social Care Committee. We are taking longer than I would have liked with the workforce plan. I hope it reassures the hon. Member and the House that we have taken more time because that is what the royal colleges, trade unions, and clinical and NHS leaders asked us to do. Their strong urging was to get it right, rather than rush according to a political timetable, which I thought was a fair challenge. It will be published this spring.

--- Later in debate ---

[Layla Moran (Oxford West and Abingdon) (LD)]

I broadly welcome this common-sense Bill. I am left rather flummoxed that we got to this point, but here we are. It is self-evident that if we pay to train doctors, they should be prioritised and encouraged in all manner of ways to stay in the UK. I understand why we must expedite the measures: talks with the BMA are ongoing and we want to avert strike action. I sincerely hope that the BMA and all resident doctors hear this debate and see that Parliament is listening to them, and that, together, we can avert industrial action, which does nothing to help the recovery of the NHS—fingers crossed that this works.

I will talk about the fears that I have heard about in my postbag. We are here in part because of the lack of a big joined-up workforce plan. We have been talking about such a plan for many years, but the previous one was clearly flawed, no matter which way one looked at it. It is in that context that we are bringing forward this very specific and quite technical point.

However, for resident doctors—formerly known as junior doctors—and for medical students, this is not technical at all; it affects their lives. Marco, an Oxford medical student, wrote to me last year to say that he was

“particularly concerned about the prospect of unemployment from being unable to secure a training position.”

He pointed out that countries such as Canada, the US and Australia already have structured approaches, while England has fallen behind.

Yasmin, another constituent, said:

“I studied for six years and graduated with over £70,000 of debt. I completed my foundation programme in a crumbling district general hospital, where I was routinely overworked and trying to care for patients in corridors under conditions that felt increasingly unsafe. I worked extremely hard to provide the best possible care despite these circumstances. Yet now, after two exhausting years, I find myself unemployed.”

Yasmin told me that many of her colleagues had been forced to take non-medical jobs—in administration, hospitality and other sectors—simply to survive. Some will never return to medical practice at all.

If our brightest and most committed young doctors are worried about unemployment, or are leaving the profession altogether, the system is clearly fundamentally broken and needs reform, so the Bill is a necessary step. Notwithstanding the good reasons to support the Bill, we must be mindful that it may well have unintended consequences if it is not implemented fairly. I am particularly concerned about the impact on overseas doctors who have already made significant life decisions based on the current rules.

Lamia, one of the many medical graduates in my postbag this week, said:

“Over the past two years, I have organised my professional life around the UK’s published requirements, completing examinations, securing GMC registration, and investing significant personal and family savings, even incurring debt. I also declined a stable job opportunity abroad to focus on the MSRA based on the rules at that time.”

She feels that to suddenly change things retrospectively is an injustice. The Government must clarify what “significant experience” means, because this will have an effect on people’s life choices. Perhaps the Minister could indicate that today—are the Government looking at one year, two, five or 10?

There is also the issue of British universities’ overseas campuses, which we have heard about from a number of Members. Graduates of institutions such as Newcastle University Medicine Malaysia, Queen Mary University of London in Malta and St George’s in Cyprus are excluded from the Bill. The vice-chancellor of Newcastle University, Professor Chris Day, wrote to me to say:

“these graduates complete the same medical degree, receive the same accreditation, and the majority then go on to train and work in the UK.”

As these students studied in English to UK standards, they transition into the NHS as quickly and effectively as home-based counterparts. He makes the point that they are incredibly effective very quickly within the NHS.

The Secretary of State explained why these students are being excluded: the Government cannot determine how many overseas campus places these universities will provide. However, to flatter my friend on the Health and Social Care Committee, the hon. Member for Chelsea and Fulham (Ben Coleman)—he is not here, but I know he will appreciate the flattery—he is absolutely right that the Minister could include a tightly drafted exemption for those who have already started those courses. I heard what the Secretary of State said about the fact that the terms and conditions on the website never guarantee a post, but we all know how this works. If we buy a product, understanding that for years and years it has worked a certain way, it cannot suddenly change halfway through. It would only take a year or two for this to wash through the system, so that we do not exclude those who have made the commitment and spent huge amounts of money in good faith, thinking that it would help. There could be some movement here, for a relatively small number of people. I hope the Government are listening to those voices. I am not sure it is a necessary battle, and it could be sorted in future regulations.

The other concern I have, which I have raised with the Minister and with the Secretary of State when he made a statement on the strikes before Christmas, is the signal that the Bill is sending to our overseas doctors. The more that we can all say this, the better: they are absolutely critical to our NHS. The chief executive of the GMC, Charlie Massey, gave evidence to the Health and Social Care Committee last week, and he was clear: doctors who qualified overseas make up around 42% of the medical workforce. Of course, we are not talking about that number, but if even a small proportion now might not want to work in our system, it will leave gaps that we simply cannot fill. Any conversation about prioritising UK graduates should explicitly recognise the immense contribution they make.

I want some concrete answers on this issue. We can keep talking about it, but will any measures be put in place? How will we show our appreciation? We must bear it in mind that these are highly mobile individuals to have come here in the first place. I understand the mantra that this is prioritisation, not exclusion, but if they find themselves excluded from some of the more popular specialisms, they may decide that they would rather leave the country and pursue that specialism elsewhere than stay in this country. We need them. There are potential unintended consequences in the short term. Has any modelling been done of how this might feed through the system? If the impact is negligible, what does that mean in concrete terms? Our Committee’s concern is that losing even a small number could have adverse consequences down the line.

My final point is on the workforce plan. I am confident that the Committee’s letter to the Minister is on her desk, and I hope it will be expedited soon. It would be better to flesh out some of the detail. The Secretary of State set out what the delay is and said the plan will be published in spring. I know that these things change, but we need to know exactly what is happening behind the scenes, so that we can get an understanding of the issues that are now being incorporated that were not there before. I agree we have to get this right. It was not right first time, and we have already had so many workforce plans that I understand why there is scepticism among the Royal Colleges and elsewhere that this one will work. Let us get it right—absolutely—but in the interim, by making such changes without the bigger picture, I fear we will end up doing more damage. England has 3.2 doctors per 1,000 people, but the OECD average is 3.9, and it is 4.5 in countries like Germany. The BMA estimates that we need another 40,000 additional doctors, so the 4,000 places announced by the Secretary of State do not even begin to get there.

The other issue, of course, is the leaky bucket: retention. Every time I meet anyone in the sector they say, “How do you solve the workforce issue?” I understand why the Government focus on training—it is an issue they can dial up when they can—but the thing that really matters is retention. Having a conversation about training places and inputs is essentially turning on the drip of a tap when we have a big hole at the bottom of the bucket. For GPs, we had a session on the shift to community, and if we are going to deliver that, boy do we need home-grown doctors as part of it—I totally get that. According to a survey by the Royal College of General Practitioners, one-third of GPs might leave in the next five years, with stress being the leading factor, and with 44% citing unmanageable stress, and 73% saying that patient safety as a result of the high work load was causing them moral injury. That is mimicked across all the different specialisms, and it is something we need to address. I appreciate that it is not an issue for this Bill, but it has a material effect on whether these measures will solve the problems that the Government say they will.

In conclusion, I welcome the Bill and urge the Government to think again about overseas campuses, even in a short, time-limited, tight way. Let us also say again how much we value our international doctors, and how much we want them to stay. I am looking forward to hearing more from the Minister than just the warm words that I am sure she will provide. What else could we do to ensure that doctors believe that the NHS is a place where their career can thrive, not just make it slightly more bearable than it was before? We all want the NHS to succeed; I am sure they do too and that they want to stay and be part of it.