Competition for specialist training programmes in the NHS: Sector views and the government’s plans for resident doctor training posts

Approximate read time: 12 minutes

On 17 July 2025, the House of Lords will debate the following question for short debate:

Lord Lansley (Conservative) to ask His Majesty’s Government what assessment they have made of the ratio of medical training posts in each specialty relative to the number of foundation year medical students choosing that specialty.

1. Training as a doctor in the NHS

Future doctors go to medical school for five or more years.^[1] Graduates then do two years of foundation training, completing placements in different specialisms.

Doctors can then apply for specialist training posts, including core training in internal medicine or surgery, or for general practice training, to become a GP. Not all doctors go straight into specialty training posts, some do ‘locally employed doctor’ (LED) or locum jobs after their foundation years.

The General Medical Council (GMC) has noted that doctors not in training posts have a higher rate of leaving the profession that those who are.^[2]

Most specialist recruitment is organised at a national level: doctors put in an application for a particular specialty in which they state their preferences for geographical locations.^[3] Doctors can apply for more than one specialism.

Specialist training is either:^[4]

• ‘run-through’: a person applies once at the start of the programme for the duration of specialty training or,
• ‘uncoupled’: a person completes core training and then applies for higher specialist training.

Run-through specialties include general practice and ophthalmology. Uncoupled specialist training begins with a broader focus and then narrows. For example, a doctor could do core surgical training, then later specialise in a type of surgery.

Doctors in their foundation years and in training posts are known as ‘resident doctors’, formerly ‘junior doctors’.^[5] Training programmes vary in length and structure according to specialism. Individuals may also spend different lengths of time in training due to factors like how quickly they achieve the required competencies to proceed and whether they work part time.^[6]

When doctors have completed full medical training in a specialised area of medicine, they can apply for consultant positions.

2. What does competition look like for different specialisms?

The NHS publishes the ratios of applicants to posts for entry to training programmes.^[7]

The latest data available, set out in table 1, is for 2024. The lowest rate of applicants to available posts was for oral and maxilla facial surgery (1.89 applicants per post), and the highest rate of applicants to available posts was for general practice and public health medicine (112.13 applicants per post).

The number of posts varies between specialisms. For example, in general practice and public health medicine, there were 1,794 applicants for 16 posts (there were also 4,096 posts in pure general practice). For oral and maxilla facial surgery there were 34 applicants for 18 posts.

Table 1. Competition for training posts for second year foundation students to apply for to enter a specialism 2024

For higher specialist training, ratios ranged between 0.53 (for genitourinary medicine) and 10 (for allergy).

Figures 1 and 2 illustrate how competition has changed over time for two specialties. The charts show increases in the ratios of posts to applications, particularly from 2019 and 2020 onwards.

Figure 1. Number of applications and number of posts for core surgical training

Figure 2. Number of applications and number of posts for emergency medicine

Further analysis by the British Medical Association (BMA) found that the ratio of unique applicants to total available posts is two to one.^[8] The BMA observed “specialty training places have been oversubscribed since publicly available records began in 2013, but never at such high levels”.

The BMA has also noted an increase in doctors in ‘locally employed doctor’ (LED) or locum jobs after their foundation years, rather than in training posts. The GMC has assessed that 75% of doctors in their second foundation year in 2022 did not immediately enter core or specialty training in 2023.^[9] Doctors told GMC researchers that they were doing LED roles for a range of reasons, including needing a break from the training environment and for their health and wellbeing. In 2011, just 34% of doctors completing their second foundation year did not immediately enter core or specialty training the next year.

3. What have stakeholders said about competition for training posts?

The BMA’s resident doctors committee passed a motion in March 2025 to condemn “the persistent failure of UK and devolved nation governments to significantly expand medical specialty training posts”.^[10] It said that this year “around 20,000 applicants are expected to miss out on specialty training due to a lack of formal training places”. The committee called for:

• a specialty training recruitment process that prioritises medical graduates from UK medical schools
• equal access to specialty training for international medical graduates (IMGs) who are practising in the UK on or before 5 March 2025, but deprioritisation after that date
• increased funding for the expansion of postgraduate training posts and subsequent consultant and GP posts
• reform of recruitment practices so LEDs can use evidence of the experience and skills they gain in these roles when applying for future roles in the same way a person in an equivalent training post can

In the BMA publication, ‘The Doctor’, some practitioners said that changing conditions for IMGs was not the answer, because international doctors are crucial to “keeping the NHS afloat”.^[11] However, commenters generally agreed on the necessity of tackling the training ‘bottleneck’ with improved planning, strategy and capacity.

GMC data shows that in 2023 “record growth” (up 23% on the previous year) in the number of licensed doctors in the UK was driven by joiners from abroad, often taking up LED roles.^[12] Over two thirds of doctors joining the UK register (68%) in 2023 had got their primary medical degree abroad. This group grew from just under half (47%) of joiners in 2017. Doctors were added to the shortage occupation list after a Migration Advisory Committee recommendation in 2019.^[13]

Before 2020, employers had to apply the resident labour market test, which prioritised workers from the UK and European Economic Area countries for roles. Now that the test is no longer in place, international medical graduates can apply for specialty training places on an equal footing with UK-trained candidates.^[14]

While the number of doctors in the NHS has increased overall in recent years, the BMA has stated that the rate of growth is lagging behind the demand for care, and staffing numbers are much lower than in comparable countries. The BMA has said that the NHS “would not be able to function without international medical graduates”.^[15] However, concerns have also been raised, from organisations such as the Nuffield Trust, that the NHS is having a negative international impact by recruiting doctors from countries which have significant healthcare staffing shortages.^[16]

The GMC has also pointed to competition from increased UK graduates. It assessed that increases in medical school places will mean there will be 6,213 more UK graduates entering the profession each year by 2034.^[17] The previous government’s 2023 NHS long term workforce plan included an ambition to double the number of medical school training places, taking the total number of places up to 15,000 a year by 2031/32.^[18]

It also aimed to increase the number of GP training places to 6,000 by 2031/32. In 2024 there were 4,096 training places in general practice and 16 in general practice and public health medicine (totalling 4,112).^[19]

The GMC also noted that infrastructure to train and support doctors “is struggling to keep pace with their increasing numbers” with supervisors reporting “unsustainably high workloads” and high risk of burnout.^[20] It expressed concerns about capacity to cope with further increases.

The Doctors’ Association UK, a campaigning group of doctors and medical students, has warned that some medics fear unemployment due to high competition for places in their chosen specialisms.^[21] It has described how portfolios are built to apply for certain specialisms, leaving applicants ill-equipped to apply for other placements outside their area of interest.

The Royal College of Physicians has also expressed concerns about the competition ratios and adequacy of training positions.^[22] While it is supportive of the pledged increases in medical school places, it has emphasised that they must be accompanied by a plan to increase specialist training provision. The co-chairs of the college’s resident doctor committee said:

Ever-increasing competition ratios for entry to internal medicine and higher specialty training are driving distress and despair for applicants. Many resident doctors will rightly be wondering how good candidates can fail to qualify for interviews to training programmes, whilst working daily on understaffed wards and struggling to access educational opportunities due to poor staffing.

It is now clear that radical reform of postgraduate pathways is unavoidable. The next generation of physicians are increasingly struggling to progress into core and specialty training, despite vacant consultant posts across the country.

The college called for a review into postgraduate medical training in November 2024.

4. How has NHS England responded to concerns about training posts?

In February 2025 NHS England launched a review into postgraduate training for medics.^[23] The review is led by National Medical Director Professor Sir Stephen Powis and Chief Medical Officer Professor Sir Chris Whitty. NHS England said “resident doctors who currently work in the NHS have made it clear that they have concerns and frustrations with their training experience” and acknowledged “there is much more the NHS and our partners can do collectively to improve their learning and working experience in the NHS”. Following a programme of engagement, a phase one report is expected to be published in July 2025.

5. What does the new NHS 10 year plan say about training posts for doctors?

In the 10 year plan for the NHS, published 3 July 2025, the government said it would “tackle bottlenecks in medical training pathways”.^[24] It said undergraduate medical places had been expanded without expansion in postgraduate training places, “compounded by the 2020 decision to open competition for postgraduate medical training to international trainees on equal terms with UK-trained graduates”.

The government said it would work to “prioritise UK medical graduates for foundation training, and to prioritise UK medical graduates and other doctors who have worked in the NHS for a significant period, for specialty training”.

It also aimed to “over the next 3 years, create 1,000 new specialty training posts with a focus on specialties where there is greatest need”.

The government also said it would publish a 10 year workforce plan “later this year”.^[25] It said the previous government’s 2023 long term workforce plan focused on assuming growth in the number of staff required based on the current model of care. It said the forthcoming plan would not require the same increase in clinicians, because it would take into account the use of digital technology and automation to free up clinical time:

While there will be fewer staff in the NHS in 2035 than projected by the 2023 workforce plan, those staff will be better treated, have better training, more exciting roles and real hope for the future—and so they will each achieve much more.^[26]

6. Read more

• Ben Ireland, ‘Specialty training squeeze’, The Doctor, 17 April 2025
• Tomas Ferreira, ‘Escalating competition in NHS: Implications for healthcare quality and workforce sustainability’, Postgraduate Medical Journal, June 2024, Vol 100, Issue 1184, pp 361–5

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Cover image by freepik