Medical Training (Prioritisation) Bill

Lewis Atkinson Excerpts

Tuesday 27th January 2026 Commons Chamber

[Lewis Atkinson (Sunderland Central) (Lab)]

I welcome the Government bringing forward this legislation, and not just in response to the significant concerns that doctors currently have about access to training places, but as an important part of a reset, with a longer-term approach, to ensure that we have an NHS workforce that is fit for the future.

I am going to go off script and respond to some comments that the shadow Secretary of State, the right hon. Member for Daventry (Stuart Andrew), made. He rightly pointed out that the Bill is about prioritisation, not immediate capacity. However, in week one or two of NHS manager school, one of the core techniques that is taught is about capacity and demand modelling. A fundamental assumption about the capacity of our workforce going forward is retention—how long they will work over the course of their careers. The GMC is absolutely clear that an international medical graduate will, on average, work for a shorter period of time in the UK than a UK medical graduate—they are more likely to leave.

I suggest that it is entirely sensible that the Government are bringing in the legislation now, in advance of their NHS workforce planning, because the Bill fixes a core assumption of that plan. To give an example, I have managed cancer waiting lists and, knowing that I have a list of patients I am responsible for, feared that the lower gastrointestinal oncologist who is getting on will announce their retirement without a clear succession plan, as lower GI oncologists are in short supply. This Bill is not just the right thing to do but provides the absolute clarity around medical capacity that will allow the Government to do the proper demand work that is necessary to build the NHS of the future.

Turning to the immediate situation, I have heard the views clearly expressed by medical graduates in Sunderland and across the country about the bottlenecks they face when trying to secure foundation and specialty training places. Many are left in prolonged periods of uncertainty, unable to progress despite years of study.

When we talk about trainees, we risk giving the impression that the contribution made by these talented young people will all be in the future, but of course, in reality, people in training positions provide a huge contribution of direct service to the NHS today, forming the core of the medical workforce in hospitals up and down the country. When I was an NHS operational manager, I had to get to know the new rotation of core, foundation and specialty training doctors every time as they rotated around. Meeting those inspiring and motivated young people was not just a lovely thing to do but a hugely important one, as the day-to-day care of the patients in the specialties I was responsible for was largely provided by the people on those training courses.

That experience also highlighted to me how, over a decade under the previous Government, there was a total failure to put in place a proper care framework for those foundation and specialty doctors, which left UK-trained doctors competing in increasingly crowded pools. We have heard some of the numbers already from the Secretary of State: in 2025, there were more than 30,000 doctors competing for just 9,500 training posts. That is not a system that shows proper regard for the commitment of medical graduates or for their wellbeing, let alone a system that is designed to meet the future needs of the country or the NHS. We invest hundreds of thousands of pounds training each medical student, but too often we fail to retain them. That represents a loss not only of talent, but of public investment.

However, I think it is important, as others have done, to put on the record our recognition of the enormous benefit brought by medical professionals who have chosen to come to the United Kingdom and dedicate their careers to the NHS. I know that will continue even after this legislation is passed. As I always say, healthcare is a team sport, and in my experience, when a team is working together under significant operational pressure, the commitment of everyone in going the extra mile, no matter which country they trained in and what nationality they are, is always exemplary. That is the case throughout the NHS that I know.

The contribution of international medical and wider clinical staff to our NHS is invaluable, and it must never be diminished or forgotten. I know that will continue. It is important, therefore, that the discussion of the Bill is not interpreted as a slight on their contribution or commitment.

In aggregate, as I have said, the GMC has been clear that while international graduates are essential to the functioning of our health services, they are statistically more likely to leave the UK workforce within six years of joining compared with those who train here. That reality makes clear the risk of overreliance on a system that is unpredictable and, ultimately, unsustainable. This Bill is about balance, not exclusion; it is about ensuring that the significant public investment we are making in training doctors in this country translates into a stable and sustainable workforce for the years ahead.

[Jim Shannon (Strangford) (DUP)]

As others will know, I have raised this matter a number of times in the Chamber. In Wales, for example, the health service pays students’ fees and trains them, and students then have an obligation to stay with the Welsh health service for a period of time. One of my constituents, whom I know well, did just that. She went there, received training and stayed there. What happened, of course, is that she met someone in Wales who she fell in love with, and now she wants to stay there, so we will lose her in Northern Ireland. The point I want to make is this: if paying the fees retains the staff in Wales, should we not also do that in Northern Ireland, Scotland and England? We could do so in this Bill.

[Lewis Atkinson]

There is some merit in the hon. Gentleman’s proposal, not just for medical training but across the clinical workforce. As Members have acknowledged, we pay significant sums of public money training clinical staff, but the graduates incur significant student debt. If a UK-trained undergraduate student decides to work abroad, the UK taxpayer will have invested a significant amount in their training, and that is then lost. It strikes me that there is an opportunity for the Government to think about the sort of incentive that the hon. Gentleman describes as part of wider workforce planning.

That is pertinent to my next point about the importance of the medical workforce reflecting our wider society, particularly the working class communities of the north-east of England. I want to ensure that a young person doing well at a state school in Sunderland has as much encouragement and access as anyone else in the country to study medicine and, crucially, progress through the ranks to the highest grades. We have heard some talk of international medical schools, but I can absolutely assure Members that there are not state school-educated kids in Sunderland thinking that they will pay privately to study in Grenada or anywhere else.

As the Secretary of State rightly pointed out, there have been welcome improvements on diversity in the NHS, but we often fail to consider socioeconomic background in that. The first line of the NHS constitution states:

“The NHS belongs to the people.”

But sometimes it can feel like it is staffed by a pretty unrepresentative slice of the people, particularly in medical roles.

In that spirit, I recognise the excellent work of the University of Sunderland medical school, which has placed widening access at the heart of its mission. Building on a 100-year history of wider clinical training, the school opened in 2019, shortly before the covid-19 pandemic—a period that starkly exposed our over-reliance on overseas recruitment and underlined the importance of growing our own workforce. By 2022, 47% of the University of Sunderland’s intake were local students, and it now ranks sixth in the UK for student satisfaction.

However, it is no good universities like Sunderland in my constituency doing excellent work on widening participation at recruitment stage if when we get to foundation training and specialty training those students are disadvantaged in competition. In my view, the Bill will help to ensure that talent nurtured by institutions like the University of Sunderland is retained and prioritised for the benefit of our NHS.

I highlight that medical schools such as Sunderland are increasingly placing a huge emphasis on training their medical students in a multidisciplinary environment alongside the trainee nurses and trainee pharmacists of the day, so that they are prepared to work in the multidisciplinary environment that our NHS rightly demands. I am not sure that all international undergraduate courses are always so advanced, so it is right to prioritise this UK-based training approach for the multidisciplinary ethos of the NHS in the future.

Other Members have mentioned the wide variation in specialist training fill rates, and GP recruitment has been mentioned as part of that. It is also worth saying that the national statistics about specialty training mask significant regional variations. The GP specialty training fill rate has been as low as 62% in the north-east of England, and as we have heard, over 73% of applicants for GP specialty training in 2023 were international. That has a disproportionate effect in regions like mine. My constituents want to have the confidence that there will be a stable GP workforce as part of our community for the long term. I cannot tell them in all candour that the status quo delivers that, so we must make changes of the type that the Bill sets out.

I hope that by introducing effective, regulated training pathways, the Bill will improve retention and strengthen workforce planning in our communities, including in areas such as women’s health, where training provision has not kept pace with rising demand. When I look at the shape of the NHS elective waiting list, it is no coincidence that some of the trickiest waiting time problems are in specialties such as gynae, where we have had recruitment and training challenges in recent years.

To close my remarks, I re-emphasise the link between capacity and demand, which I hope the Minister will touch on in advance of the workforce plan. Will she also say a little about the medical training review and the phase 1 report for NHS England and how the Government will work with that?