NHS England's provisional Round 1 figures put accepted non-priority offers at 163 to date, against 2,168 in the comparable 2025 round. That is a fall of more than 92%. Round 2 was due to close on 10 December 2026, so the figure does not cover the full year.
The change was already large enough to affect plans built around work, exams and a life in the UK.
If you are outside the priority group, those figures change the calculation. Applications remain open to IMGs and the MSRA still sets selection performance, but the Act decides whose application is considered first. In 2027, that order applies from the offer of an interview.
The Act changed the order of recruitment
The Medical Training (Prioritisation) Act became UK law in March 2026. NHS England's information for applicants says it covers specialty recruitment across the UK, with ST1 Public Health as the exception. For 2026 entry, prioritisation began at the offer stage. You went through selection and received a rank, then posts went to the priority group first. If you were outside that group, you could receive a post after the available prioritised applicants had been considered.
Selection performance produced the rank; priority status affected when that rank could lead to an offer. The 2026 priority group was a flat tier with no further order inside it. The Act did not add or remove MSRA marks.
The first national results are now available. NHS England's impact publication reports 33,953 applications that successfully met the required appointable level for 9,315 posts in 2026, roughly four appointable applications per post. Among prioritised applicants, the ratio was about two to one. It also says that "100% of GP training places were accepted by UK graduates or applicants working in the NHS", compared with 62% in 2025. That wording covers a broader category than the statutory priority group. On the statutory measure across all specialties, 98% of posts were filled by priority candidates, compared with 72% in 2025. The 163 accepted non-priority offers at the top of this page are provisional Round 1 figures only.
Doctors can make more than one application, so the overall ratio is a poor estimate of your own chances. The offer figures show the effect more directly. You can score well and still miss out if posts are taken before recruitment reaches the non-priority group.
In 2027 priority applies from the interview offer
For 2027 entry, NHS England applies priority at two stages: the offer of an interview and the offer of a place. If you are outside the priority group, you may be passed over for interview where a specialty has one. Academic Clinical Fellowship recruitment in 2027 Round 1 applies priority at the offer stage only, and ST1 Public Health is still excluded. Holding a visa as a partner or dependant does not bring priority.
Your status is worked out automatically from the application form and shown in Oriel the day after applications close. Round 1 closes on 19 November 2026, and the deadline for requesting a review of your status is 17:00 UK time on 24 November. A second review window, from 19 to 26 February 2027, comes before offers are made. Your answers, the evidence behind them and the status shown in Oriel will determine whether a review is needed. The NHS England prioritisation page is the live source if anything changes after this page's update date.
Qualification, training and immigration-status routes are all set for 2027
The established routes into the priority group depend on the level at which you are applying. They include:
- a UK primary medical qualification, unless all or a majority of that medical training took place outside the British Isles;
- a primary medical qualification from Ireland, unless all or most of that training took place outside Ireland;
- a primary medical qualification from Iceland, Liechtenstein, Norway or Switzerland;
- for CT1 or ST1 recruitment, completion of or current enrolment in the UK Foundation Programme; and
- for relevant ST3 or ST4 recruitment, completion of or current enrolment in the UK Foundation Programme or a relevant UK training programme that is an entry route for the specialty. This can include core training or a Locum Appointment for Training; NHS England gives Paediatrics as an entry-route example for Haematology.
The remaining route is immigration status. For 2027 it is set by the Medical Training (Prioritisation for Specialty Training Programmes) Regulations 2026, and the list matches 2026: British citizens, Commonwealth citizens with the right of abode, Irish citizens, people with indefinite leave to remain and people with leave under the EU Settlement Scheme.
Your nationality alone does not settle priority status. NHS England applies the published categories to each application, while IMG is an informal umbrella term for doctors with different routes. An overseas graduate may qualify through a programme route. A British citizen with an overseas primary medical qualification relied on the immigration-status route in 2026 and can rely on it again in 2027. Your status comes from the published categories.
The 2027 regulations add no NHS-experience route
The Act let the government add a 2027 priority group based on "significant NHS experience" and/or immigration status. The regulations, SI 2026/1019, were made on 10 September 2026, laid before Parliament on 14 September and come into force on 1 January 2027. They define the added group by immigration status alone. They set no NHS-experience test, and so no qualifying length of service or cut-off date.
In the ministerial statement published with them on 15 September (HCWS350/HLWS358), the government said it did not yet have the evidence to set an NHS-experience threshold "at this stage" and would gather evidence for future years. The BMA had lobbied for five years of NHS or HSC experience; no threshold of any length was adopted for 2027.
Years in trust-grade, locally employed doctor or SAS posts therefore bring no priority by themselves in 2027. That could change for 2028 entry if the evidence-gathering leads to a threshold.
Wales has made its own Specialty Training Prioritisation Regulations 2026. According to the Welsh Government's written statement of 15 September 2026, they continue the 2026 interim arrangements for a further 12 months.
The Act is separate from the Resident Labour Market Test
The Resident Labour Market Test was abolished in 2020 and the Act did not restore it. The old test concerned an employer's ability to recruit a worker from overseas; this Act controls priority within medical training recruitment. The Health and Care Worker visa remains available to doctors, and service posts such as trust-grade or clinical fellow jobs remain separate from specialty training offers. Visa eligibility and training priority are different questions.
UK graduates still compete within the priority group
You have a material advantage in 2027 recruitment if your qualification meets the UK primary medical qualification rule. That advantage starts at the offer of an interview, but it does not guarantee a training number.
There were about two prioritised applications for every 2026 post, and competition is much sharper in some specialties. The person specification, your application and your selection performance still decide your position within the group. Where the MSRA determines shortlisting or ranking, your score still matters. For GP and Core Psychiatry it is the sole ranking tool; other specialties use it as part of shortlisting or alongside later stages.
NHS England states: "Prioritisation does not affect the rank applicants receive following interview; ranks are based on performance in the selection process only." Selection performance still earns the rank, even when priority gets your application considered earlier.
IMG options depend on priority status
Some IMGs will be prioritised through a recognised programme route or their immigration status. Matching your circumstances to the published categories establishes where you currently stand. If you are outside the priority group, the 2026 results show a much lower chance of an offer, especially where nearly all posts are taken within the first tier. Across all specialties, 98% of posts were filled by priority candidates, and in GP every accepted place went to NHS England's broader UK-graduate-or-NHS-worker category.
For an IMG outside the priority group, a high MSRA score may still fall short of an offer. It improves the selection rank but cannot guarantee that recruitment will reach that group.
Whether to sit the MSRA depends on the application you can make. Preparation remains sensible if you meet a priority route. If you are clearly outside the priority group and GP is your only acceptable specialty, the published GP figures are the basis for deciding whether to commit months of study. You may apply, but the evidence does not support confidence about an offer.
One recruitment result does not settle the value of GMC registration or UK clinical work. Trust-grade, clinical fellow and SAS posts remain open, although time in them does not count towards priority in 2027. Another country's pathway may suit your aims and finances better. Money already spent on the UK route does not make further spending worthwhile.
The 2027 rules are now complete, so your documents and likely status can be checked against them before Oriel opens at 10:00 on 22 October 2026. If you sit outside the priority group, a spending limit protects you from paying for preparation that recruitment may never reach. If the application still makes sense, the MSRA score is the part you can influence.
Once you have checked your likely 2027 priority status, you can decide how to prepare for the MSRA: try ProMSRA free / see pricing.
Questions doctors are asking now
Is UK specialty training completely closed to IMGs?
No. IMGs can apply, some qualify for priority through an established route, and non-priority offers still occurred. NHS England's provisional Round 1 data recorded 163 accepted non-priority offers to date, against 2,168 in the comparable 2025 round. Across all specialties, 98% of posts were filled by priority candidates, and in GP the separate UK-graduate-or-NHS-worker category accounted for 100% of accepted places.
Does the Act stop a non-priority doctor from applying?
No. It changes priority at the interview-offer and place-offer stages; it does not create a general ban on applications. You must still meet the ordinary eligibility and person-specification requirements.
Is GP training now closed to non-priority applicants?
There is no legal ban. NHS England reports that 98% of posts across all specialties were filled by priority candidates in 2026, compared with 72% in 2025. It separately says that 100% of GP training places were accepted by UK graduates or applicants working in the NHS, compared with 62% in 2025. Those categories are different, and the 2027 outcome cannot be promised in advance.
Will my trust-grade or LED years count as significant NHS experience?
Not for 2027. The regulations made in September 2026 contain no NHS-experience route, so trust-grade and LED years do not count on their own. The government has said it will gather evidence on a threshold for future years.
Does "significant" mean five years?
No regulation sets five years or any other length. Five years was the BMA's proposal, and the 2027 regulations contain no NHS-experience threshold.
Will I get an interview in 2027 if I am not prioritised?
Possibly, but it cannot be assumed. Because priority now applies at the offer of an interview, a specialty may pass over non-priority applicants before interview. The result will depend on its process and how far recruitment reaches.
Does a UK university's overseas-campus medical degree count as a UK qualification?
The university's name alone does not settle this. The published rule excludes a UK primary medical qualification where all or a majority of training took place outside the British Isles. Your exact course needs to be checked against NHS England's current guidance.
Was PLAB, GMC registration or moving to the UK a waste?
The answer depends on what GMC registration and UK experience have opened for you outside national training. The Act has made direct entry much harder for many doctors, but non-training work and other career routes remain. Past spending should not force the next decision.
Is a high MSRA score still worth pursuing as an IMG?
Yes, if applying remains a reasonable choice for you. The MSRA still sets or contributes to rank in the specialties that use it. For a non-priority applicant it is necessary, but it cannot make recruitment move beyond a filled priority tier.
Should I abandon the UK for Australia, Canada, the Gulf or the US?
One headline is a poor basis for that decision. Compare entry rules, exams, costs, immigration position and the work you would accept in each country. A rushed move made from fear can be expensive.