Medical Training (Prioritisation) Bill

Lord Patel Excerpts

2nd reading & Committee stage
Wednesday 4th February 2026 Lords Chamber

[Lord Patel (CB)]

My Lords, when there is such a short Bill, there is a temptation to repeat what has already been said in great detail, because it has not been said by me. I will not succumb to that temptation but will briefly point out the areas where I agree with what has been said, particularly by the noble Earl, Lord Howe, the noble Lord, Lord Clement-Jones, and the noble Baroness, Lady Finlay.

In the many letters and emails—hundreds of them—that I have received, two things stood out. One was the grievance felt by people who were already in the process of applying for the jobs; they now feel as if they have been thrown to the wolves. The other lot were the people who are British citizens who trained overseas and cannot now access training in our programmes. There is one other minority group: those who felt that they have had some experience in the NHS, but it is not as yet defined how much of their experience, starting in 2027, will be counted. The noble Lord, Lord Clement-Jones, referred to the immigration requirements which may or may not be counted, but that produces another. These are the groups that feel disadvantaged. What I felt on receiving these letters was that we are making people who have serviced our NHS for decades feel they are no longer required and are to be abandoned. I hope we do not give that impression.

Having said that, I recognise that, in principle, the idea that UK medical graduates should be prioritised for jobs in our NHS is correct, because it is not right that they cannot get the jobs they apply for, particularly in foundation and specialist training. On the foundation programme in Clause 1, I am concerned that British citizens who may have trained in GMC-approved institutions with the same kind of curriculum described by the noble Lord, Lord Clement-Jones, cannot be considered for that. I have already made the point about specialist training programmes and those who have gone through the process of applying in good faith. We do not as yet know what experience will be counted from 2027 onwards, so I hope the Minister can comment on that.

Clause 4 refers to a “UK medical graduate”, and says:

“‘UK medical graduate’ means a person who holds a primary United Kingdom qualification”.


It does not say a “UK citizen” who is qualified. Does that mean that an overseas student attending medical courses in our universities, who is therefore a graduate of our universities, qualifies or not? I might be wrong in my interpretation. The clause continues:

“but does not include a person”

with

“a majority of their … training for that qualification outside the British Islands”.

Some of our universities run joint courses. I am a professor emeritus of the University of Dundee, which, for instance, runs one course for Malaysian students. They do part of their training in Malaysia and finish their clinical training in the UK, at Dundee. The Bill refers to a majority of their training but, in a five-year course, if the overseas student does three years in a UK university, does that count as a majority of their training in the United Kingdom?

I am glad that the Minister alluded to refugee status and was pleased to hear what she said. That was to be one of my points, because I have had representation from Ukrainian refugees who are already working in the NHS, and whose status would otherwise have been removed.

Clause 4(5) says:

“‘primary medical qualification’ means a qualification that is treated by the General Medical Council as equivalent to a primary United Kingdom qualification within the meaning of the Medical Act”.

There are lots of institutions which the GMC recognises as equivalent, but we do not regard their graduates as UK graduates, although they do the same curriculum. Universities such as Newcastle have already been mentioned several times. They have been encouraged by the education department to open campuses, as other universities have been, and to provide the same curriculum. There are then graduates of Queen Mary University, Newcastle University or Dundee University. Their status is not quite clear.

I am concerned about these issues and hope that we will be able to have greater clarification. But I accept that, in principle, prioritising postgraduate medical training for UK graduates is correct.

Medical Training (Prioritisation) Bill

Lord Patel Excerpts

Committee stage
Thursday 12th February 2026 Lords Chamber

Moved by

[Lord Patel]

1: Clause 1, page 1, line 4, after “must” insert “first”
Member’s explanatory statement
This amendment, and others in the name of Lord Patel, seeks to ensure that UK medical graduates are prioritised above other categories of eligible applicants.

[Lord Patel (CB)]

My Lords, my name is also attached to Amendments 3, 6, 7, 8, 12, 13 and 14, which are consequential, so I will not speak to them. This may be the briefest of introductions to any amendment.

My amendment tries to prioritise—which is the main theme of the Bill—UK medical graduates for training in UK programmes. The Bill’s Long Title says it is to:

“Make provision about the prioritisation of graduates from medical schools in the United Kingdom and certain other persons for places on medical training programmes”.


In Clause 1, this therefore also includes

“persons in the priority group”.

In Clause 2, it includes person not only in the priority group but also, in subsection (2), persons who are

“a British citizen … a Commonwealth citizen who has the right of abode in the United Kingdom … an Irish citizen who does not require leave to enter or remain in the United Kingdom … a person with indefinite leave to enter or remain … a person who has leave to enter or remain in the United Kingdom”

and so on. Similarly, Clauses 3 and 4 describe the priority group as including not only UK medical school graduates but many others, including those from countries with which the UK has made a trade deal.

All those priority groups will be able to apply for the same jobs as UK medical graduates. Add to that—several amendments on this are coming later—that the graduates of UK universities that have overseas campuses will also be included in the priority group. They are not all in the amendments today, but if these amendments are accepted, there are other universities not listed which have overseas campuses, such as the two I know—Dundee, for instance—although I did not table an amendment on that.

My amendment is because of the enormous number of emails that we have had, both from UK graduates and overseas graduates who cannot find jobs. I know there are subsequent amendments coming later about those international graduates who are now stuck in a bottleneck for this year, but that is a separate issue. My amendment does not refer to that; it refers to UK medical graduates.

We heard a story on the BBC about Emma, who was one of the 1,000 graduates who cannot get a two-year foundation slot so she cannot progress at all. She cannot find a locum job because they are all full. We heard of people who cannot enter the specialty training programme at years 1 and 2 because the competition for the specialty training programme is four applications for one job. We have 50,000 international medical graduates applying for a job for 2025, for 10,000 slots. If we cannot get UK graduates to find jobs in training programmes, that is scandalous. We could cut the number of medical students—but on the other hand, we are going to increase the number of medical students, and that will compound the issue for future applications for training.

By the way, I am not saying that others in the priority group in these clauses are not to be considered for a job. All I am saying is that UK medical graduates should be prioritised. The definition says “UK medical graduates”, but there are international students who go to our medical schools and therefore they are UK medical school graduates, so we include them. They are about 7% of the total medical graduates of UK universities. My amendment only seeks to prioritise UK medical graduates, who should be considered first—not that the others will not be considered or get jobs in whatever they come to do. This includes the subsequent amendments about overseas campuses and other universities.

I hope that the Opposition Benches will agree that UK medical graduates ought to be the first priority. I doubt that the noble Baroness the Minister will accept my amendment—the Government want this Bill to go through as an emergency Bill and not to be held up because, otherwise, it will run out of time—but I hope that, at the Dispatch Box, while not accepting the amendment, she will recognise that UK medical graduates must have priority above others for training slots. I beg to move.

[Baroness Coffey (Con)]

My Lords, I have tabled Amendment 2. The clerks suggested changing the wording to what is now there. It is a probing amendment, and like those of the noble Lord, Lord Patel, it could be applied to other clauses as well. It is about the principle. My strong view is that we have opened up medical schools and made more placements because we want to make sure that we have an ongoing workforce. I am delighted to see the noble Lord, Lord Darzi, in his place. He will have done work not only for Health Secretary Wes Streeting recently but previously in making sure that we have a strong workforce pipeline.

I am conscious that many medical schools, by way of survival, by way of diversity, have opened up a number of places. Admittedly, this is still quite small compared with the number of UK citizens going to medical school. However, as the noble Lord, Lord Patel, said, we have a curious definition in this legislation—that a UK medical graduate is simply somebody who went to a UK medical school. I do not think that is what the public would think that this is about. From a lot of the emails, I do not think that it is what a lot of doctors appreciate either—although I appreciate that it is the position of the BMA, which does not want to differentiate in that regard.

We have young people taking on debt by investing in their own education and several billion pounds being put in by the UK Government, by the UK taxpayer, to have this pipeline. Therefore, it is vital to have what my amendment seeks—a set prioritisation in this legislation and not, as the Minister said the other day, a “just one group and then no more” kind of prioritisation. It is vital that UK citizens are given priority.

It is important to look at some of the analysis. It is not the case that all training posts could be filled by UK citizens who have trained to be doctors—far from it. We would not have GPs coming through. According to the 2024 analysis, only about half of the GPs going on the ST1 or CT1 were from UK medical schools. There is a whole series of issues, and we are seeing this in different elements including psychiatry and paediatrics—very few UK medical students, it seems, want to do paediatrics. I could go on with the series, but the point is clear: this is not about excluding people from the rest of the world coming to work in this country or to fill key roles in the NHS; it is about ensuring that our investment is prioritised on UK citizens.

There is a certain peculiarity, which will come up in other groups, about what then happens with the Republic of Ireland and similar. I am not seeking to get into that debate; perhaps we will a bit later.

I want to get a sense of this from the Minister. One thing that is clear in the statistics, and which the Minister and the Department of Health should be seeking to understand more, is that for quite a wide range of the training courses UK students are turning down the opportunity, once they have been offered placements. Why is that? For general practice, I think that only 57% are accepting. I am conscious that people might get posted around the country, but that needs careful scrutiny as well.

I do not wish to suggest in any way that we are not welcoming people from different parts of the world, but it should go back to trying to make sure that we are addressing particular gaps in our NHS workforce, now and in the future, not squeezing people out, and recognising the work that has been done to increase the potential numbers in home-grown talent.

Those of us who spoke at Second Reading have, in the last week, had a lot of emails coming in. I completely understand that there are different stories. For a brief time, when I was Health Secretary, a by-line suggested that I thought everybody should disappear to Australia—far from it. We cannot stop people leaving this country to go to Australia or elsewhere in the world, but we should be making sure that the reason they are choosing to go elsewhere is not because they cannot get a training place here when they have been deemed appointable. Ideally, they would be offered a role. That is something we can fix with this legislation. I hope the Government will rethink their approach to this during the passage of the Bill.

I apologise to the Committee that I will not be here to deal with my amendment later on, but I know that the Front Bench will do so. The time is pressing to get this right. I had not realised quite how soon a variety of decisions need to be made: I believe they need to be made before, or certainly within a few days of, Easter. It is critical that the Government think again. I am sure that, with encouragement from the Committee and from very distinguished medical practitioners, current and past, they will do so. That is why I commend my amendment to the Committee.

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[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, I am most grateful to all noble Lords for their helpful contributions to this debate. Amendments 1, 3, 6 to 8 and 12 to 14, tabled by the noble Lord, Lord Patel, seek to create tiered categories of prioritisation for the UK foundation programme and specialty programmes. Taken together, they would require places to be allocated to UK medical graduates in the first instance, and then to applicants in the other prioritised categories specified in the Bill. As noble Lords have observed, the Bill sets clear priority groups, but it does not make rankings within these groups, and that is what we are looking at.

I welcome my noble friend Lord Darzi, not least because the review that he undertook for the Government in 2024 recommended that we should prioritise medical training, for all the reasons given by the noble Lords who support it. I will return to this whole area when we debate a later group, but on the point made by the noble Lord, Lord Darzi—this will perhaps also be helpful to the noble Earl, Lord Howe—alongside UK graduates, we are prioritising in the Bill graduates from Ireland and the EFTA countries. This reflects the special nature of our relationship with Ireland—specifically, our reciprocal rights of movement and employment—and our obligations under international trade agreements with the EFTA countries, which the noble Earl, Lord Howe, referred to, that require consistent treatment of these graduates in access to medical training. The amendments that we are looking at would mean that we could not honour these agreements. That, by its nature and definition, would create huge difficulties.

On specialty training, these amendments would also mean that we could not effectively deliver on our policy intention to prioritise applicants with significant NHS experience who understand how the health service works and how to meet the needs of the UK population. It might be helpful if I summarise this by saying that the Bill sets out what I would regard as a binary system where applicants are either prioritised or not. Clearly, once that prioritisation has happened, the normal processes will apply to establish who the appointable applicants are, to fill the posts, and so on.

Amendment 2, tabled by the noble Baroness, Lady Coffey, seeks to create tiered categories of prioritisation for the UK foundation programme and to prioritise UK medical graduates who are British citizens above all other applicants. The Bill as drafted prioritises all UK medical graduates who meet the criteria, regardless of their citizenship status. It might be helpful to the noble Lords, Lord Mohammed and Lord Clement-Jones, to restate that what matters is where a doctor is trained, not where they are born. UK-trained medical graduates have undertaken curricula, clinical placements and assessment standards aligned to the NHS, and are therefore best prepared to move directly into NHS practice.

The Government are committed to prioritising those doctors who have already spent a significant part of their education within the NHS and understand how the health service works and how to meet the needs of the UK population, not least because—this is an issue that we have discussed many times—these doctors are more likely to remain in the NHS for longer, supporting the sustainable medical workforce for the future that we are all looking at.

As I set out in relation to the previous set of amendments tabled by the noble Lord, Lord Patel, this amendment would also mean that we would not be honouring the special nature of our relationship with Ireland and obligations under trade agreements with EFTA countries. I emphasise again in the Chamber today that prioritisation does not mean exclusion. All eligible applicants will still be able to apply and will be offered places if vacancies remain after prioritised applicants have received offers, which we expect to be the case particularly in certain areas.

My noble friend Lord Winston raised a question about the Bill in respect of highly skilled overseas doctors and particularly referenced clinical academics. As I have said, it is not exclusion from applying—it is prioritisation. It may be helpful more broadly for me to emphasise that there are likely to be opportunities in specialties such as general practice, core psychiatry and internal medicine, because historically they attract fewer applicants from the groups that we are prioritising for 2026. I understand the point that my noble friend is making, but we have to focus on the core purpose of the Bill. With that, I hope that noble Lords will feel able not to press their amendments.

[Lord Patel (CB)]

Obviously, the Minister is not accepting my amendment, but she makes the point that all the priority groups will be treated in the same way—whatever the definition is of people in the priority group, they will all be grouped together as a priority, and that would include UK medical graduates. What assessment have the Government made of the effect that it will have on UK medical school graduates to include all the others in the priority group? What disadvantage will that put UK medical graduates to? Will it be minimal, medium or a lot?

[Baroness Merron (Lab)]

We do not anticipate that that is going to cause a problem. The noble Lord did not specifically refer to the EFTA countries, but I should like to. Some of them will not produce any suitable people who are likely to be included, so in our modelling we do not anticipate that there will be a problem. What matters is patient care and getting people with the right training who understand what the NHS is about, understand the culture of the NHS and provide as best as they can. That is what the whole Bill is directed at doing and prioritising.

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[Baroness Merron (Lab)]

I shall be very pleased to do that.

[Lord Patel (CB)]

My Lords, I thank all noble Lords who have spoken today, no matter which amendment they spoke to, and I am grateful to the noble Earl, Lord Howe, for his strong support for my amendment. More importantly, he said that UK medical graduates need to be prioritised and should not have to enter into competition with others whose graduation is not from this country. I know that the Minister was not able to say that UK graduates would be seen to be prioritised; I understand that. Of course, these debates help, because the outside world is interested in what is said here. I hope that particularly those who make decisions about interviewing or selecting for interview for training programmes will get the message, take note of this debate and bear in mind what it was all about. I beg leave to withdraw my amendment.

Amendment 1 withdrawn.

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the past year, and that more than a third of radiology departments were subjected to a ban on hiring clinical radiologists. Given what needs to happen to improve cancer outcomes in line with the new cancer plan, we clearly want an end to the restrictions placed on hiring for these crucial specialists.

[Lord Patel (CB)]

My Lords, I support the amendments in the name of the noble Lord, Lord Stevens of Birmingham, to which I have added my name. I am not going to repeat much of what he said, but I support it because when, in 2026, both the UK and overseas graduates are further down the process of applying—and some have even been asked to come for interview—they will now not be able to continue. That seems morally and ethically wrong, so I support the amendments. I also support the amendment in the name of the noble Earl, Lord Howe. He made his points very strongly.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare my role as a pro-chancellor of Cardiff University, and that I have until recently been an observer on the Medical Schools Council; I am still in touch with it.

This group of amendments seems incredibly important for our international reputation for fairness and consistency in what we commit to, but also in wanting excellence in our NHS. Therefore, there needs to be a sophisticated way of prioritising. One of those important areas is the contribution to the NHS, especially during Covid and major events, when some have gone way above what is normally expected and come back from holiday or maternity leave, or whatever, to deal with a major incident, while others have perhaps not always been quite so flexible.

We certainly have a crisis and must deal with it, so this is not in any way to say that we should not be doing this, but the timing is the worry. I will come on to the other degrees in the next group. Can the Minister explain whether the Oriel system itself is a block to incorporating the flexibility that these amendments ask for? There is a real worry among some that the Oriel system is a rate-limiting step, rather than being flexible enough to be rapidly reprogrammed appropriately to allow the intention of these amendments to be incorporated at great speed, and therefore redress the accusation of unfairness.