Medical Training (Prioritisation) Bill

Baroness Gerada Excerpts

Committee stage
Thursday 12th February 2026 Lords Chamber

Moved by

[Baroness Gerada]

15: Clause 4, page 3, line 2, at end insert “, unless they hold a primary UK medical qualification issued by a UK registered institution, operating on the date of 1 January 2026, which is identical in character to a qualification undertaken in the British Islands and recognised as such by the UK General Medical Council.”

[Baroness Gerada (CB)]

My Lords, I shall speak to Amendments 15, 16 and 19. I want to disclose an interest that I did not have at Second Reading: I am now co-chair of the Malta APPG—and I remain of Maltese heritage.

Amendment 19, in my name and that of the noble Lords, Lord Clement-Jones and Lord Mendelsohn, seeks to add Malta to the list of countries in Clause 4(4). It is precise and proportionate, and it would correct a narrow but serious unintended consequence in the Bill, as I will explain. Of course I acknowledge the need to prioritise UK graduates for training but, as the Minister of Health and Active Ageing of Malta put it in a letter to the Secretary of State for Health and Social Care, the Bill risks

“undermining two centuries of proud tradition and the dissolution of a strong bilateral relationship in healthcare, care, and the training and specialisation of Maltese graduates”.

At Second Reading, I spoke about the unique medical training partnership between the UK and Malta, which dates back two centuries. For example, Maltese surgeons have held licences from our own royal colleges since the 1830s. This is therefore not a recent convenience but a deep historic alignment. It is a relationship that has shaped both systems for generations, creating an instinctive alliance in training, practice, standards and expectations.

The Maltese education system is modelled on the UK system and aligned to British clinical and ethical standards. Training is delivered in English, and the Maltese healthcare system closely mirrors the NHS. That is why my father was able to come to this country in 1963 and devote his working life to serving patients in the east of England, and why others from Malta have done the same, performing well above their weight in serving patients in this country.

Furthermore, postgraduate membership and fellowship remain aligned with the British royal colleges, reflecting a deep and enduring professional loyalty. Indeed, many of these doctors have become trainers, educators and examiners, helping to uphold the quality of UK postgraduate education—some have had daughters who became presidents of royal colleges. Malta and the UK are therefore historically, culturally and educationally linked.

I turn to the comparison of the Malta foundation programme, an affiliated programme to the UK foundation programme, and I shall reflect on the free trade agreements that the UK holds with the countries in Clause 4. Government documentation for the UK’s free trade agreement with these countries requires regulators to

“recognise qualifications or relevant experience of a professional who applies for recognition and possesses comparable professional qualifications”.

The language in that documentation, which recognises reciprocal arrangement, strongly aligns to the UK-Malta affiliate programme and, on that basis, it should be treated no less favourably than these other nations.

Since 2009, our foundation programmes have been formally aligned, sharing the same curriculum and e-portfolio. This alignment was renewed in 2024, confirming that the Malta programme met the same standards and outcomes as the UK foundation programme. To the best of my knowledge, no other country anywhere in the world has that level of mutual recognition.

At the centre of this is Queen Mary University of London’s campus in Malta, a UK public university delivering an identical UK GMC-approved MBBS degree to that which it delivers in its east London campus in Tower Hamlets. The students follow the same curriculum, complete the same statutory mandatory training, take the same UK national qualification exams and graduate with the same UK primary medical qualification. They are registered by the GMC as graduates of Queen Mary University of London.

During Second Reading, the Minister, the noble Baroness, Lady Merron, addressed Malta as a distinct case, and indeed it is. The QMUL training programme is a UK programme delivered overseas under a framework recognised by and supported by the UK Government. More than half the students are UK citizens. The equivalence of training between the UK and Malta is complete, not approximate. It is not close; it is identical. Even the patient profile is the same. Malta’s population, diversity, healthcare system and disease patterns share extraordinary similarities with the UK, particularly compared with any other international training environments. Moreover, most students undertake NHS attachments during their training. These graduates enter the UK workforce fully prepared for UK foundation training, trained at no cost to the UK taxpayer.

The impact of a medical school goes beyond the students. QMUL has made a not insubstantial professional and financial investment in the campus and the Government of Malta have invested in the school’s construction. This aligns with the UK Government’s wider objective of developing international UK university campuses, as outlined in the recent strategy document from the Department for Education. This Bill, if not amended, puts this at risk.

The numbers are small, as the foundation years are capped at between 50 to 70 graduates. This is less than 0.6% of the UK foundation programme places. This is simply no workforce threat, no substitution effect or planning distortion. There is, however, a real risk of unfairness in the Bill as it stands. These students have a legitimate expectation, grounded on 15 years of consistent government practice, and the experience of all preceding QMUL medical graduates, that they should be treated comparably with other holders of UK primary medical qualifications. The Bill as drafted removes that status and places these graduates behind Norway, Iceland, Liechtenstein and Switzerland—jurisdictions whose graduates do not hold a UK primary medical qualification, do not sit the medical licensing or prescribing exams and are not trained on an NHS-aligned curriculum. This is difficult to explain, let alone to justify. This amendment simply corrects this anomaly. It protects a uniquely successful partnership, anchored in history, quality and equivalence.

Going beyond foundation years, a few Maltese doctors come to the NHS every year to fill gaps in their own medical training—so-called finishing school. These are in non-numbered posts. Malta provides 70% of their pay and these doctors are contractually required to return to Malta. This is not a pipeline of overseas doctors displacing domestic graduates. It is a small group, maybe 30 or 40, who meet our standards, all of whom have been examined and trained specifically in UK practice.

Finally and briefly, I turn to Amendments 15 and 16 again in my name and the names of the noble Lords, Lord Clement-Jones and Lord Mendelsohn. These suggests a carefully defined exception in Clause 4 for UK universities operating overseas campuses that deliver an identical UK-approved medical degree as in the British islands. These are exceptionally narrow amendments confined, to the best of my knowledge, to only two programmes in the world—Queen Mary University of London’s campus in Malta and Newcastle University Medicine Malaysia.

At Second Reading, the Minister referred to

“almost 300 applicants from … overseas campuses”,—[Official Report, 4/2/26; col. 1679.]

and noted that the Government need to control this number to “avoid opening the floodgates”. I stress, as I have already said, that the number of QMUL graduates applying for UK jobs is capped by the University of Malta at between 50 and 70, with around 120 from Newcastle University Medicine Malaysia bringing the total to 190. These caps would enable the Government to control the number of overseas applicants.

I also want to make clear my support of the amendment in the name of noble Lord, Lord Forbes, which provides a similar solution. Only institutions operating overseas campuses that meet the criteria set out in the amendments and that are in operation at the time the Act is passed should be included. I beg to move.

--- Later in debate ---

[Baroness Merron (Lab)]

I am happy to set it out in a letter, but I can say immediately that graduates of the Royal College of Surgeons in Ireland’s Bahrain campus are not necessarily prioritised just because part of their programme takes place in Ireland. The Bill is clear that prioritisation applies to graduates of Irish medical schools who complete the majority of their medical education in Ireland, but I am happy to add to that in my letter.

[Baroness Gerada (CB)]

I am grateful to the Minister for the care with which she has addressed my amendments. I will be very brief. I must say I am disappointed, and I have a few points.

I will address Malta first. These are not international medical graduates; these are UK-trained doctors training in a UK university, albeit overseas. As I said, they are trained for the NHS. The Minister mentioned several times that it is not exclusion, it is prioritisation. I have already had emails from two doctors, one of whom is being excluded from applying for a postgraduate examination until the UK cohort has applied. I will not say their specialty, because it might identify them, but it means that the tiny island of Malta will not have this particular specialty because this doctor cannot finish his training until he does that. They are already being excluded from fellowship posts that have been long standing over decades—that is of last week.

Given the fact that the Bill is being taken through the House at such pace, as well as writing a letter—which I understand we will get in our post next week—would the Minister be willing to meet me and several Peers who have already raised some amendments so that we can explore this in more detail and work constructively towards a solution? I am sure these issues will be considered further on Report but, in the light of the Minister’s reply today, I beg leave to withdraw the amendment.

Amendment 15 withdrawn.