IMG Careers Guide

How the NHS Job Market Has Changed

Why has it become so difficult to get an NHS job?

Updated: 1 September 2026

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Training posts
Non-training posts

The UK medical job market has become much more competitive in recent years. Training and non-training posts have both been affected, but for different reasons.

Training posts

The current bottleneck largely stems from government measures to recruit more overseas doctors to tackle immediate NHS staffing shortages, without adequate planning for the resulting increase in demand for training posts. More specifically, Foundation and specialty training capacity was not expanded sufficiently to keep up with the larger medical workforce that followed.

In 2019, the Shortage Occupation List (which gave immigration advantages to jobs in shortage) was widened to include more medical roles, making it easier for employers to recruit overseas doctors across a wider range of roles.
In 2020, COVID put more pressure on NHS staffing, leading to emergency visa extensions for overseas healthcare workers. The Health and Care Visa, which had already been planned to address pre-existing staff shortages, was launched in August 2020, making it quicker and cheaper for overseas doctors to work in the UK.
- By 2022, the effects of these changes became more apparent. PLAB 1 candidates more than doubled (from 10,431 in 2021 to 21,916 in 2023), while PLAB-route registrations increased by 60% in 2022 alone. Meanwhile, the number of IMGs applying for CT1/ST1 training more than doubled (from around 6,900 in 2021 to 14,850 in 2024).
- By 2025, competition for training posts had increased significantly. In that year, 15,723 UK-trained doctors and 25,257 overseas-trained doctors competed for just 12,833 Round 1 and 2 specialty training posts. The government’s impact statement for the Medical Training (Prioritisation) Bill described UK-trained doctors being unable to secure formal training posts as a “growing problem”.
In March 2026, the Bill passed into law as the Medical Training (Prioritisation) Act, giving UK-trained doctors priority for Foundation and specialty training. For the 2026 intake, all prioritised Foundation applicants were allocated a place, while prioritised applicants filled 98% of specialty training posts. In Round 1 specialty training, the proportion of accepted offers going to non-prioritised applicants fell from 28% in 2025 to just 1.8% so far in 2026.

While this has eased the training bottleneck for UK graduates, it has made direct entry into training highly unlikely for non-prioritised IMGs. With significant NHS experience expected to become a new route to priority status from 2027, building this through non-training posts such as locally employed doctor roles is likely to become the main feasible route into training for many IMGs.

Non-training posts

Financial pressures and cost-cutting have reduced the number of non-training opportunities, especially locum work. At the same time, more doctors being unable to secure training posts has increased competition for the remaining roles.

As more doctors remained outside training, the non-training workforce expanded rapidly. The number of locally employed (LE) doctors in England and Wales increased by 75% from around 21,000 in 2019 to 36,831 in 2023, rising again to more than 38,000 in 2024. However, this growth was not enough to meet demand: by July 2025, 34% of resident doctors surveyed by the BMA had no substantive job or regular locum work lined up for August, rising to 52% for FY2 doctors.
- The effect on newly registered IMGs can also be seen directly in GMC data. Among doctors joining the register through the PLAB route, the proportion connected to a designated body within six months of registration fell from 26% for the 2021 and 2022 cohorts, to 20% in 2023 and just 13% in 2024. The GMC uses connection to a designated body as a strong indication that a doctor has found employment. In its November 2025 Workforce Report, the GMC described the overall position as a “clear worsening of the UK job market for newly arrived non-UK-qualified doctors”, with subsequent GMC research indicating that these employment difficulties have continued.
During periods of severe staffing shortages, Trusts became heavily reliant on agency and locum doctors to fill rota gaps, often paying substantially higher rates for equivalent clinical shifts. As financial pressures increased, the NHS began cutting temporary staffing spend. Agency spending fell from around £3.5 billion in 2022/23 to £2.1 billion in 2024/25 and £1.2 billion in 2025/26. This has reduced locum opportunities and placed wider pressure on recruitment to locally employed posts, including Trust Grade and Clinical Fellow roles.

For newly registered IMGs, this creates a particularly difficult position: non-training roles are the main route for non-prioritised IMGs to gain the NHS experience to progress into training, but these roles have become less available and more competitive.

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