On 5 March 2026, the Medical Training (Prioritisation) Act 2026 became law. In simple terms, it gives priority for UK medical training posts to certain groups, especially UK medical graduates and some other defined groups.
For IMGs, this is a big deal. It does not mean IMGs are shut out of the NHS. It does not mean IMGs cannot get jobs in the UK. And it does not apply to every doctor post. But it does mean that getting into foundation training and specialty training is now harder for many IMGs, especially those applying directly from abroad or those without meaningful NHS experience. NHS England has been clear that applicants are not excluded from applying, but they will not all be prioritised in the same way.
This matters because a lot of IMGs do not just come to the UK for registration. They come hoping to build a career here. And for most doctors, that means eventually getting into training. So the honest question is no longer just, “Can I pass PLAB and get GMC registration?” It is also, “What are my realistic chances of getting into training afterwards?” That is the question this article is really about.
1. Why this law was brought in
This law did not appear out of nowhere. It came in because competition for UK training posts has been rising sharply. Parliament’s briefing and NHS England’s own material both point to the same issue: more pressure on training places, more UK graduates coming through medical school, and more people applying overall.
The government’s argument is fairly straightforward. If the UK is increasing the number of people it trains in medical school, it should also give those graduates a better chance of progressing into NHS training. That is the workforce and political thinking behind the Act.
Whether people agree with that approach or not, that is the direction of travel. And for IMGs, it means one important thing: the route into training now needs more planning than before.
2. What the Act actually changes
Foundation training
For the Foundation Programme, priority must first go to UK medical graduates and to certain people in a defined priority group. That priority group includes graduates from certain institutions in Ireland, Iceland, Liechtenstein, Norway and Switzerland, under the terms set out in the legislation and the briefing documents. The key point is that this is mainly about where the primary medical qualification was obtained, rather than simply nationality.
Specialty training
For specialty training starting in 2026, prioritisation applies at the offer stage. The priority groups include:
- UK medical graduates
- members of the defined priority group
- doctors who have completed, or are completing, a relevant UK training programme
- for 2026 only, some applicants with certain citizenship or immigration statuses, used as a temporary stand-in for meaningful UK health service experience.
From 2027 onwards, immigration status is not supposed to be used in that same automatic way. Instead, the law allows regulations to define other priority groups, and NHS England has said this is expected to include doctors with significant NHS experience. It is also intended that, from 2027, prioritisation will affect not just offers but earlier stages too, such as shortlisting and interview selection. That would make the impact even stronger.
What it does not change
This is a very important point. NHS England has said this legislation applies to foundation and specialty training posts only. It does not apply to:
- locally employed doctor posts
- SAS posts
- consultant posts.
That distinction really matters. For many IMGs, the practical message is not, “You cannot work in the UK.” It is more, “You can still work in the UK, but the route into formal training is tighter than before.”
3. Does this mean IMGs cannot get into training?
No. IMGs can still apply. IMGs can still be appointable. IMGs can still get posts. But the competition is no longer on the same footing.
In practice, many IMGs will now be competing for the places left after prioritised groups have been considered, especially in 2026. And if future regulations do give weight to significant NHS experience, then IMGs who are already working in the NHS may be in a much stronger position than those applying straight from overseas.
So the honest message is this:
PLAB is still a route to GMC registration and NHS work. PLAB remains an important route into GMC registration and NHS work, but doctors should see it as the beginning of a wider career journey rather than a guaranteed direct route into specialty training.
4. The reality before this Act: what happened after the RLMT ended in 2020?
Before 2020, the Resident Labour Market Test (RLMT) formed part of the immigration framework for sponsored jobs. In broad terms, employers often had to show that no suitable settled worker could fill the role before sponsoring a migrant worker. In the UK’s 2020 points-based immigration reforms, the government expressly abolished the RLMT for the Skilled Worker route.
For doctors, the removal of the RLMT mattered because it reduced one of the immigration barriers that had previously favoured settled workers or UK-based applicants in sponsored roles. By 2020, official recruitment pages were already stating that doctors were exempt from RLMT requirements when applying for foundation and specialty programmes.
5. Did RLMT affect non-training jobs too?
Yes. And this matters.
RLMT was not a training-specific rule. It was part of the immigration sponsorship system. So it affected non-training sponsored jobs as well, not just formal training posts. The whole idea was that an employer might need to show they could not fill the role with a settled worker before sponsoring someone from overseas.
That means the old RLMT world was broader than the new Act. It could affect training jobs, but it could also affect non-training jobs that needed sponsorship.
6. So how is the new Act different from RLMT?
This is the key distinction.
The old RLMT was an immigration and sponsorship rule. It was about whether an employer could sponsor someone from overseas for a job.
The Medical Training (Prioritisation) Act 2026 is something different. It is not a general immigration rule. It is a rule about who gets priority for UK medical training places.
So in one way, the new Act is narrower than RLMT because it does not affect every doctor job. But in another way, it is more direct for doctors, because it targets the bit of the system that matters most for long-term career progression: entry into foundation and specialty training.
That is why comparing the two too loosely can be misleading.
A simple way to put it is:
- RLMT was mainly an immigration barrier
- The new Act is mainly a training access barrier
7. The biggest misunderstanding many IMGs may still have
A lot of IMGs understandably think:
“If I pass PLAB, I should be able to get into training fairly soon.”
That was never guaranteed, but for a while the UK looked more open because sponsorship barriers had eased and NHS jobs felt more accessible. The problem is that this could make PLAB look like a direct bridge into specialty training, when in reality that was already becoming less true because competition was rising fast.
8. What about non-training jobs?
This is where the picture is more reassuring, but it still needs honesty.
The Act does not apply to locally employed doctor posts, SAS posts, or consultant posts. So yes, IMGs can still apply for non-training NHS jobs.
That includes things like:
- trust grade jobs
- junior clinical fellow posts
- trust registrar posts
- clinical fellow jobs
- SAS roles later on
For many IMGs, this is likely to remain one of the most practical and valuable routes into the NHS:
This has already been a common pathway for many overseas doctors. The difference now is that it is even more important to understand how valuable that experience can be when building a longer-term career in the UK.
Non-training jobs can still be very valuable. They can give you:
- NHS references
- experience with NHS systems
- audit and QI opportunities
- teaching experience
- better understanding of UK practice
- stronger evidence of commitment to a specialty
9. Which specialties are more realistic for IMGs?
No specialty is truly “easy”, so it is better to talk about what is more realistic and what is much harder.
Very broadly:
- More realistic: GP, Internal medicine training (IMT), some emergency medicine routes, paediatrics
- Possible but getting harder: anaesthetics, obstetrics and gynaecology, clinical radiology
- Nearly impossible for newly arriving IMGs: neurosurgery, ophthalmology, community sexual and reproductive health, cardiothoracic surgery
10. Should IMGs still take PLAB?
That depends on what the person actually wants.
If the goal is GMC registration and getting an NHS job, PLAB may still make a lot of sense.
If the goal is quick entry into a competitive training programme, then the decision needs much more caution.
PLAB still makes sense for doctors who:
- are open to non-training jobs first
- are realistic about timing
- are flexible about specialty choice (e.g. willing to go into GP)
- are willing to build NHS experience before pushing for training
PLAB is a riskier choice for doctors who:
- only want one very competitive specialty
- do not want non-training work
That does not mean they should not come. It just means they should be making the decision with their eyes open.
Final thoughts
The Medical Training (Prioritisation) Act 2026 does not shut the door on IMGs. But it does force a more honest conversation.
It is also worth remembering that the UK is not unique in this approach. Many countries already prioritise their own graduates in different ways:
- In countries like Australia and New Zealand, local graduates and permanent residents are typically prioritised for training posts, and IMGs often need local experience before being competitive.
- In the United States, entry into residency is heavily influenced by the local system, with US graduates generally having an advantage, and IMGs needing strong exam scores and US clinical experience to compete.
So while this change may feel new for the UK, it is actually more in line with what many other countries already do.
In that sense, this Act is less about closing the system and more about reshaping expectations. It pushes the UK towards a model where getting into training is not just about passing an exam, but about building experience within the system first.
If anything, greater transparency may ultimately be a good thing. It means fewer IMGs come with false expectations, and more come knowing exactly what they are signing up for. That may reduce disappointment, but it also allows for better decisions.
For the right doctor, the UK remains a valuable and rewarding place to build a medical career. The key is to come with a clear understanding of the pathway, realistic expectations, and a plan for the steps after PLAB.