Training by geography, not merit: the Medical Training (Prioritisation) Act 2026 and the NHS workforce.

The Medical Training (Prioritisation) Act 2026 provides preferential access to specialty training for UK and Irish medical graduates, graduates from certain European countries, and some internationally qualified doctors with specified immigration status. The policy has been introduced in response to the considerable pressure on specialty training: in 2025, 40,965 unique medical applicants applied in rounds 1 and 2 for 12,833 positions, as compared with 22,248 applicants applying for 11,579 positions in 2021. This article contends that while prioritisation redistributes access to limited training opportunities, it does not address the fundamental constraint on training capacity. To make this case, the article first examines the selection environment and the Act's equity aspects, then examines training capacity and workforce dependency, and finally considers what is needed for sustainable expansion and alternative pathways to progression. Recent evidence from the GMC also indicates that UK graduates still receive considerably more offers for postgraduate training than do non-UK graduates. The Act does not prevent internationally trained doctors from working in non-training roles or from pursuing other paths to become specialists. The central concern is therefore differential access to structured career progression. A lasting solution needs both prioritisation and more funding for training places, investment in educators and placements, and the creation of reliable alternative routes for career advancement.