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Policy Briefing · 2026

The Medical Training
(Prioritisation) Act 2026

What IMGs should know before choosing PLAB and the UK

A clear, structured breakdown of how the new law affects training pathways, competition, and career planning for international medical graduates.

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About This Resource

Written by Plabable

Plabable helps international medical graduates prepare for the PLAB exam and build successful careers in the UK healthcare system.

But passing PLAB is only one part of the journey. The landscape around training access has changed significantly, and we believe every IMG deserves clear, honest guidance before making major career decisions.

This resource was created to help you make informed, realistic decisions early — so you can plan your path with confidence, not assumptions.

Key Insight

This Act does not stop IMGs from working in the UK.
It changes how access to training works.

The Legislation

What Changed

A breakdown of the key structural changes introduced by the Act and where they apply.

Foundation Training

  • Priority given to UK graduates first
  • Defined priority groups receive preference
  • IMGs may apply but are ranked after priority cohorts

Specialty Training

  • UK graduates receive first priority
  • Defined priority group (visa/settled status)
  • Doctors with existing UK training experience
  • Transitional 2026 criteria applicants

What the Act Does Not Apply To

  • Locally employed doctor (LED) posts
  • Specialty and Associate Specialist (SAS) posts
  • Consultant posts

These roles remain accessible to all qualified doctors regardless of background.

Impact Assessment

What This Means for IMGs

The Act restructures competition — it does not eliminate opportunity.

IMGs can still apply

Applications remain open to all qualified doctors.

IMGs can still get NHS jobs

Non-training roles are unaffected by the Act.

Competition is now structured differently

Training selection follows a tiered priority framework.

PLAB is no longer a direct bridge into training — it is the first step in a longer pathway.

Historical Context

Then vs Now

How the new Act compares to the previous RLMT system.

Before 2020

RLMT System

  • Immigration-based barrier to employment
  • Affected many job types across healthcare
  • Required employers to prove no local candidates
  • Broad scope across roles and levels

2026 Act

New Prioritisation

  • Training access barrier, not immigration
  • Focused specifically on training posts
  • Uses a tiered priority ranking system
  • Non-training roles remain unaffected

Narrower in scope, but more directly impactful for long-term career progression.

Career Planning

The Realistic Pathway

The typical route from PLAB to a training position in the UK.

01 PLAB
02 GMC Registration
03 Non-training NHS Job
04 UK Experience
05 Portfolio Building
06 Training Application

What you will need along the way

NHS References
Clinical Experience
Audit & QI Projects
Specialty Commitment

Specialty Guide

Specialty Realism for IMGs

A general guide to competition levels. Individual outcomes will vary based on portfolio, timing, and experience.

More Realistic

Accessible with Planning

  • General Practice (GP)
  • Internal Medicine Training (IMT)
  • Emergency Medicine
  • Paediatrics

More Competitive

Requires Strong Portfolio

  • Anaesthetics
  • Obstetrics & Gynaecology
  • Radiology

Highly Competitive

Very Limited Positions

  • Neurosurgery
  • Ophthalmology
  • Cardiothoracic Surgery

Decision Framework

Should You Still Take PLAB?

An honest assessment to help you decide.

Makes Sense If You…

  • Are open to non-training jobs initially
  • Are flexible with specialty choices
  • Are thinking long-term (3–5 year horizon)
  • Want UK clinical experience regardless

Higher Risk If You…

  • Want immediate entry into a training programme
  • Are only interested in highly competitive specialties
  • Cannot commit to a multi-year pathway
  • Expect PLAB alone to guarantee a training post

Next Steps

Plan Your UK Medical Career Properly

Understand your realistic pathway before committing time, money, and effort to a career-defining decision.

Start PLAB Preparation

Final Thoughts

The Bottom Line

The UK remains a viable and rewarding path for international medical graduates.

Expectations must be realistic and aligned with current policy realities.

Similar prioritisation models exist in other countries globally — this is not unique to the UK.

Success depends on strategic planning and sustained commitment, not just passing exams.