Government warns of tough competition for trainee posts next year after Appeal Court ruling

BMJ 2007; 335 doi: (Published 22 November 2007) Cite this as: BMJ 2007;335:1066
  1. Lynn Eaton
  1. London

    The Appeal Court's ruling against the Department of Health's plan to restrict the number of medical graduates from outside the European Union who can apply for UK training posts will mean an average of three doctors applying for each post in 2008, government officials say.

    The health department plans to appeal against the judges' ruling on the case, which was brought by the British Association for Physicians of Indian Origin (BAPIO) (BMJ 2007;335:1009, 17 Nov doi: 10.1136/bmj.39398.720012.DB). But this could take several months. Meanwhile the status quo will prevail—and department officials say that this will be the case until the 2009 intake at the earliest.

    The Appeal Court's ruling means that medical graduates who gained their degree overseas—including many doctors from the Indian subcontinent and Africa who are already working in Britain—will still be able to apply in the next recruitment round, which starts in January.

    Additionally, an unknown number of non-EU medical graduates who are not currently in the UK could also apply for training posts.

    The Modernising Medical Careers team announced in October not only that recruitment in 2008 would be carried out locally by individual deaneries but also that more than one recruitment round would take place next year (

    The main recruitment round will still be for posts starting in August, but up to two further recruitment rounds will occur, by specialty. The first round begins in January. Doctors appointed from this round will not normally start until August, says NHS Employers.

    A health department official could not confirm reports that as many as 2000 additional training posts will be created for the January round.

    “We are in the process of working out the numbers likely to apply, so we can work out what will happen,” stated the spokesman, who said an announcement was due “very shortly.”

    It is understood that the department is working with the Home Office to see how the current immigration rules might be amended from 2009 to ensure that trainee doctors from the UK face less competition in future.

    By January around 3000 doctors who failed to secure a training post this summer are going to be trying again for such posts. They will currently be in either staff posts or fixed term specialist training appointments. Furthermore, anyone who has been in a staff post for some time could apply for a training post, and no one knows how many doctors will be in this group. Another unknown quantity is the number of international medical graduates who, despite all the problems caused by too many doctors competing for too few posts in 2007, might still want to try for a training position in the UK.

    Additional applicants will be those in supernumerary posts created to fulfil the employment guarantee given to doctors who could not secure posts. This guarantee ends on 31 December. However, the health department expects that fewer than 100 such doctors will have failed to obtain a post by that date.

    The recent health department consultation on how to handle the issue of international medical graduates is on hold pending the outcome of the department's appeal. In the short term the answer is to create more training posts, said Ramesh Mehta, president of BAPIO.

    “Changing the visa ruling is going to create a lot of problems,” he said. “In three or four years' time this will all be sorted out as the excess number of doctors on the HSMP [highly skilled migrant programme] visa are absorbed into service posts or staff jobs. The health department needs to put in a few more training posts for the time being. That should help.”

    The whole dispute involving doctors who trained outside the EU began when the health department, realising it had enough UK medical graduates, announced in March 2006 that it planned to change the immigration status of training posts, upgrading them to employment posts. In doing so it would have raised the immigration threshold for non-EU graduates and reduced the level of competition for UK graduates ( It would have required non-EU graduates to have an appropriate work permit for these jobs, and they could have been appointed to a post only if the post could not be filled by an EU graduate.

    Although the department dropped this proposal as a result of BAPIO's legal challenge, most non-EU doctors who were already working in the UK switched to the highly skilled migrant programme, giving them equal status to an EU graduate. After five years they have the right to stay indefinitely in the UK.

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