The Royal College of Physicians has this week criticised 2027 specialty training rules that will keep immigration status, rather than years of NHS work, as the extra test for interviews and posts.

Regulations laid before Parliament on 14 September 2026 retain the immigration categories used in 2026. The college had pressed for a three-year NHS service definition instead of that proxy.

College Warns Proxy Leaves Long-Serving Doctors Behind

The Medical Training (Prioritisation for Specialty Training Programmes) Regulations 2026 were made on 10 September 2026 and come into force on 1 January 2027.

Extra applicants must be offered interviews and places first if they are British citizens, certain Commonwealth citizens with the right of abode, Irish citizens who do not need leave, people with indefinite leave, or people with leave under EU settlement scheme rules.

Professor Mumtaz Patel, RCP president, said: 'The RCP is disappointed that the regulations will continue to use immigration status, rather than significant NHS experience, as the basis for prioritisation in specialty training recruitment from 2027.'

The college supported a three-year NHS work test. Doctors already on the UK Foundation Programme or the next UK specialty stage remain prioritised under the parent Act.

How 2027 Specialty Training Will Differ From This Year

The Medical Training (Prioritisation) Act 2026 received Royal Assent on 5 March 2026. For 2026, immigration status was used only at the offer stage.

From 2027, the specified immigration statuses will also be used when prioritising applicants for interview. NHS England says the categories are intended as a proxy for applicants likely to have significant experience working in the NHS.

It adds that this is not a direct measure of NHS experience, though such applicants are more likely to stay.

UK medical graduates, the statutory priority group and doctors completing a relevant UK programme remain first in line, with further priority determined by specified immigration status. Other eligible applicants may still apply and can receive posts left over after priority candidates have been considered.

NHS England reported in June 2026 that 33,953 appointable applications competed for 9,315 specialty posts, a ratio of four to one, falling to two to one among prioritised candidates.

Priority candidates filled 98 per cent of posts, against 72 per cent in 2025.

Trust Grade Years Still Count for Little on Paper

Dr Leah Ajayi, an international medical graduate in acute medicine, wrote on X that 'working for several years in trust-grade or locally employed posts does not, by itself, confer priority'.

She said the rules may affect who reaches the interview as well as who receives a post. The RCP says many international medical graduates have built NHS careers and a long-term commitment to patients.

It welcomes a pledge to keep reviewing competition ratios and equality impacts. Expanding training numbers still needs trainer capacity and protected learning time.

The regulations do not bar non-prioritised doctors from applying. Offers can still go to them if places remain after prioritised applicants have been considered.

Ministers say the immigration proxy for 2027 specialty training will stay while later recruitment rounds produce more evidence on whether another test should replace it.

The 2027 cycle will therefore still sort a large group of applicants by right to remain, not by how long they have already worked in NHS posts. That leaves the promised shift to a direct test of significant NHS experience postponed for another recruitment year.

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