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 this is not a final figure for the year, but the effect was already severe enough to change plans built around work, exams and a life in the UK.
For a non-priority applicant, 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 starts at shortlisting.
What the Act changed
The Medical Training (Prioritisation) Act became UK law in March 2026. As NHS England's information for applicants explains, it covers specialty recruitment across the UK, with ST1 Public Health as the exception. For 2026 entry, it was introduced at the offer stage. Applicants went through selection and received a rank, then posts were offered to the priority group first. Someone outside that group 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 describes a broader category than the statutory priority group. On the statutory measure, and across all specialties rather than GP alone, 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, which makes the overall ratio a poor personal probability. The offer figures show the practical effect more directly. A non-priority applicant can score well and still miss out where posts are taken before recruitment reaches that group.
Why 2027 is different
For 2027 entry, prioritisation runs from shortlisting through to offers. A non-priority applicant may therefore be filtered out before interview, where a specialty has an interview, instead of waiting to discover the effect at the offer stage. Priority status will be determined automatically from the information entered on the application form.
Round 1 applications close on 19 November 2026. The published deadline for requesting a review of your priority status is 17:00 UK time on 24 November. Read the questions carefully, keep the evidence that supports your answers, and check the status Oriel gives you. The NHS England prioritisation page is the live source to use if anything changes after this page's update date.
Who is in the priority group?
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.
In 2026 there was another route based on immigration status. It covered British and Irish citizens, people with Commonwealth right of abode, indefinite leave to remain, and status under the EU Settlement Scheme. Do not assume that route carries over unchanged into 2027. The additional 2027 group is one of the parts still waiting for regulations.
Your nationality alone does not settle priority status. NHS England applies the published categories to each application, while IMG is an informal umbrella term covering 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; its 2027 form remained unsettled on 3 August. Your own answer has to come from the published categories.
The regulation that is still missing
The government has the power to create an additional 2027 priority subgroup based on "significant NHS experience" and/or immigration status. The regulations are due in early autumn 2026 and had not been published at the time of writing.
No published rule yet says how many years will count, whether trust-grade or locally employed doctor work will qualify, or what evidence Oriel will ask for. The BMA is lobbying for five years of NHS or HSC experience. Five years is its proposal, not the law.
There is another open question: offers could operate as sequential tiers, or the additional group could be blended into the existing priority arrangements. That mechanism was also unconfirmed on 3 August. Anyone giving you a confident answer before the regulations appear is filling a gap with a guess.
This is not the Resident Labour Market Test returning
The Resident Labour Market Test was abolished in 2020. The Act did not bring it back. 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.
What this means if you are a UK graduate
You have a material advantage in 2027 recruitment if your qualification meets the UK primary medical qualification rule. That advantage starts at shortlisting. It is still not a training number.
There were about two prioritised applications for every 2026 post, and competition is much sharper in some specialties. You still need to meet the person specification, submit a sound application and perform well in the selection process. 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's wording is useful here: "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 an application considered earlier.
What this means if you are an IMG
Start by matching your circumstances to the published categories. Some IMGs will be prioritised because of a recognised programme route, and the pending regulations may add others. If you are not prioritised, the 2026 results say your chance of an offer is much lower, 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, or may meet the additional route once the regulations appear. If you are clearly non-priority and GP is your only acceptable specialty, use the published GP figures before committing 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 is not yet guaranteed to satisfy the coming "significant NHS experience" rule. Compare another country's pathway now if it suits your aims and finances better. Money already spent on the UK route is not a reason to spend more.
The timing asks doctors to prepare before every rule is known. Check your documents and likely status now, then set a limit on what you are willing to spend before the regulations appear. If the application still makes sense, the MSRA score is the part you can influence.
Preparation is worth paying for only after the application itself makes sense. If yours does, start with ProMSRA's free trial; the member pricing is set out here.
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 shortlisting and 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?
Nobody knows yet. The regulations defining the additional group were due in early autumn 2026 and were still unpublished on this page's update date.
Does "significant" mean five years?
No regulation currently says five years. That figure comes from the BMA's proposal for a five-year threshold based on NHS or HSC experience; the government hasn't adopted it.
Will I get an interview in 2027 if I am not prioritised?
Possibly, but it cannot be assumed. Because prioritisation now applies at shortlisting, a specialty may filter 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?
Do not rely on the university's name alone. The published rule excludes a UK primary medical qualification where all or a majority of training took place outside the British Isles. Check your exact course 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.