However, DAUK is concerned that the Medical Training (Prioritisation) Bill announced by the Government risks being unfair, and ineffective in addressing the causes of the crisis.

The shortage of training opportunities is the direct result of poor workforce planning under successive governments, despite repeated warnings from DAUK and others in the profession.

Specialty training posts

The number of medical graduates has grown for years without a corresponding increase in specialty training posts.

The consequence is a widening gap between applicants and available places, one that this Bill does nothing to close.

Dr Pushpo Hossain, DAUK IMG lead, said: “It is concerning that international medical graduates (IMGs) are being implicitly framed as part of the problem, when they are not to blame.

“IMGs often bear the greatest risk within the system. Many have invested thousands of pounds in PLAB examinations, GMC registration, relocation, and visa applications and renewals.

International medical graduates

“IMGs often cannot walk away if the rules change as they are financially, professionally, and personally tied into the UK system.”

A BMJ investigation found English hospitals trusts recruiting doctors from abroad as ‘cheap labour’ as part of fellowship schemes in which they were paid less than trust-employed doctors and had fewer benefits.

A recent follow up investigation by the BMJ found a £40.5m programme to train doctors from overseas at a Midlands NHS trust failed to ensure they were paid fairly, among other issues.

This prompted calls for all national programmes involving international training fellows to be paused pending an review of employment conditions to identify and prevent exploitative practices.

PLAB examinations

The GMC’s most recent published accounts show that PLAB examinations generated £25m.

Dr Matt Kneale, DAUK co-chair, said: “That reinforces that there are strong system incentives driving the recruitment of IMGs with a matching expansion in training capacity.

“The concern is that some IMGs have been encouraged to come to the UK in good faith, incurring significant costs, only to find themselves locked into insecure roles with limited progression.”

DAUK also questions the fairness of changing prioritisation criteria midway through the process.

NHS workforce

Doctors who have entered the NHS workforce did so on the basis of the current rules, and changing the criteria now feels unfair and unethical.

Therefore, we call for provisions within the Bill to protect any doctor who has already commenced the application for the 2026 training cycle in good faith. This would have the effect of preventing their de-prioritisation under new rules.

Dr Hossain said: “We are concerned the Bill will result in many IMGs leaving the NHS and deter others from entering it.

“The NHS is on its knees and we need doctors, whether they are a UK graduate or an IMG, to staff the hospitals safely, reduce waiting times and provide quality care.

“UK medical graduates are not leaving the NHS because IMGs are taking their jobs, it’s due to a number of factors including years of pay erosion, poor work conditions, lack of work-life balance, and workforce planning by the government.”

Non-doctor roles

It’s also important to recognise that at the same time the Government and NHS bodies have facilitated the expansion of a range of non-doctor roles, which are replacing doctors. This includes the poorly planned introduction of physician associates and anaesthesia associates, which has generated significant patient safety concerns, professional confusion, and personal cost to people who pursued these careers in good faith, based on assurances given at the time.

The Bill fails to address one of the core issues, that there are no new training posts being created.

Without meaningful investment in additional training numbers, the gap between applicants and places will remain, competition will intensify, and patient care will suffer.

Dr Hossain said: “We’re also concerned by the narrative that risks pitting UK-trained medical graduates against IMGs. Both groups overwhelmingly want the same outcomes which are to work, to train, to staff hospitals safely, and to treat patients.

Workforce strategy

“Understaffed hospitals, rota gaps, and long waiting lists harm everyone, and won’t be fixed by dividing the profession.”

A fair and effective workforce strategy must be based on long-term planning, expansion of training posts, and policies that treat doctors with consistency and respect.

We are ready to engage on solutions that strengthen the NHS workforce and improve care for patients.

We are a non-profit campaigning and lobbying organisation led by frontline doctors, for frontline doctors. We are volunteers and our collective aim is to give frontline workers a voice to be heard.

Please support our work by contributing to our crowd funder.

Dr Victoria Zaslona said it had been ‘painted as the fault of IMGs’ when the problem was a result of years of poor workforce planning.

She was speaking on national radio during a discussion on the news UK medical graduates are to be given priority access to specialty training jobs in the NHS.

Training places

The Government has announced it will prioritise UK medical graduates for training places from 2026. It is part of its efforts to end industrial action by resident doctors.

Dr Zaslona, speaking on LBC, said: “One important thing to be really clear about is that junior doctors want training places.

“They don’t want international medical graduates to not have jobs or not be given training. It’s just that they want to be able to have training places.

“This is the government’s way of painting the issue of no training places as IMGs’ fault.

Medical training

She said that poor workforce planning over many years led governments to make short-term decisions to plug rota gaps, rather than invest strategically in medical training.

This resulted in large numbers of IMGs being recruited into locally employed doctor roles. These are posts often offering little training, limited support, and insecure terms.

“They’ve made very quick decisions about trying to fill rota gaps and opened up schemes to bring IMGs to fill those gaps,” she said.

“They want to come to the UK. They’ve heard how good the training schemes are. And then IMGs have aspirations, as many doctors do.

IMGs not to blame

“This problem has been created by the government itself, and now it’s being painted as the fault of IMGs.”

Dr Zaslona warned that political rhetoric risked scapegoating IMGs and perpetuating racist narratives, rather than addressing structural failures.

Citing the GMC workforce report, she noted that doctors outside formal training schemes now make up a growing proportion of the workforce.

This, she said, was another illustration of how ‘training schemes are no longer fit for purpose’.

Fit for purpose

She said: “But no one yet is really talking about re-wiring or dismantling and rebuilding the system.”

Listen to Dr Zaslona’s interview in full on the DAUK YouTube.

Workforce planning

This is a massive failure of workforce planning. Despite the clear need, hundreds of doctors coming through UK medical schools and IMGs already practising in the NHS are being denied opportunities because of underfunding by successive governments, which have failed to increase the numbers of specialty training places. Dr Matt Kneale, DAUK committee member and former chair, said: “We recognise that there are real issues with specialty training places that need nuanced solutions that are both pragmatic and lawful. “It’s difficult to justify leaving UK-trained doctors unemployed while training numbers remain static. “These graduates could be contributing to the NHS workforce rather than being underutilised, especially given the public investment in their education. “It’s also worth questioning the fairness of continuing to recruit IMGs through costly PLAB exams when many face limited prospects of NHS employment.

International medical graduates

“This risks setting unrealistic expectations and could leave some IMGs feeling misled about their opportunities.” Dr Pushpo Hossain, DAUK’s IMG lead, said: “As an IMG myself, I had more than two-and-a-half years of NHS experience before applying for training jobs. “If an IMG has worked in the NHS for two years, they should be able to apply for training posts under the same criteria as a UK graduate. “This would strike a fair balance and recognise their experience within the NHS.” Tax payers’ money is increasingly being spent pushing non-doctor roles, such as physician associates, despite concerns over their training, scope of practice, and patient safety.

Non-doctor roles

The expansion of non-doctor roles is another factor impacting resident doctors and IMGs and limiting their opportunities. Patients want to see a doctor, and patient outcomes are significantly improved when they do. Dr Ellen Welch, DAUK vice-chair, added: “We need to look at why doctors are out of work, while rotas are understaffed and waiting lists still stretch into the millions. “We need our government to fund job opportunities for both UK and international graduate doctors instead of paying less qualified non-doctors to cover doctor roles.” Please support our work by contributing to our crowd funder or by becoming a member.

NHS Employers has published an FAQ in response to the changes to the immigration system announced by the Government.

A DAUK spokesperson said the changes caused “confusion, concern and heartache” among NHS staff and their families when they were announced by Home Secretary James Cleverly.

The spokesperson said the announcement was lacking in important detail and the language being used around the policy change has impacted international medical graduates (IMGs) already living and working in the UK, and those thinking of coming here.

In the announcement, the Government said it would “tighten the Health and Care Worker visa, which has seen a significant number of visas granted to care workers and their dependants, by preventing overseas care workers from bringing their dependants to the UK”.

NHS Employers said that these changes will only affect the care sector and not the NHS.

The Government also announced an increase in the minimum salary required for skilled workers from overseas – from £26,200 to £38,700 – and the more than doubling of income required for family visas – from £18,600 to £38,700.

These increases in salary thresholds do not apply to the Health and Care Visa route, NHS Employers said.

It also said that Health and Care Visa holders will continue to be exempt from paying the Immigrational Health Surcharge (IHS).

Read the NHS Employers changes to the UK immigration policy FAQs.

The DAUK spokesperson said: “We’re grateful for NHS Employers for clarifying many of the issues around the Government’s new immigration policy and what it will mean for people working in the NHS on a Health and Care Worker Visa.

“The Home Secretary’s announcement lacked important details about what it would mean for them and caused a lot of confusion, concern, and heartache.

“There’s no doubt that the language being used and that lack of information has had an impact on IMGs already living here and working in the NHS, and it’s bound to make people think twice about coming here in the future. 

“This at a time when there’s a staffing crisis in the NHS. There are thousands of vacant healthcare roles, and waiting lists continue to grow.

“We’re neither training enough staff nor retaining enough staff and our international colleagues are delivering vital care to people who need it.

“Without them things would be a lot worse.”

Home Secretary James Cleverly has announced:

• A ban on health and care workers bringing family dependants to the UK
• A hike in the minimum salary required for skilled workers from overseas from £26,200 to £38,700 from spring
• More than doubling the minimum income required for family visas from £18,600 to £38,700 from spring
• The scrapping of the shortage occupation list and employers being able to pay workers 20% below the going rate for jobs 
• A review of the graduate immigration route by the Migration Advisory Committee.

Dr Pushpo Hossain, DAUK’s international medical graduate (IMG) lead, said: “We have a huge number of vacancies in our National Health Service and immigration is delivering vital care to people who need it.

“The plans announced by the Government are cruel and inhumane and will only make the staffing crisis in the NHS even worse.

“We’re not training enough healthcare staff as it is, and we’re not retaining enough either with UK-trained staff already leaving in their droves because of pay and working conditions.

“This announcement will make it even harder for the migration of health workers to the UK, decimating recruitment and placing an even greater strain on the NHS.

“The current pay scale for many doctors and nurses wouldn’t meet the minimum salary threshold. Why would anyone work in a system that’s underpaid, understaffed and overstretched and accept they won’t be able to bring their families to be with them and to help them decompress at the end of a gruelling shift?

“It will also destroy family lives, causing misery for many people working in the NHS and could force them to leave.

“It will not only affect healthcare workers who were planning to come to the UK, but also the morale of IMGs, like myself, who feel targeted by inflammatory statements towards International healthcare professionals from this Government.”

“In short, the essence of the plan is a systematic destruction of the NHS.”

he BBC’s adaptation of Adam Kay’s best-selling book This is Going to Hurt, which shows the stark reality of how it feels to work in the NHS, aired last week.

The seven-parter is loosely based on Kay’s time working as a junior doctor – health workers across the UK have praised the show, saying it shows the racism, trauma and burn-out doctors and nurses experience while working in the health service.

The first episode played out a horrific racist moment in which a patient screamed ‘Get that P*** off my baby’. As an international graduate, it sadly reflects my experiences of racism within the NHS where comments such as ‘Why don’t you go back to where you came from?!’ or ‘I want to be seen by a white doctor!’, are all too common.

I joined as a doctor from my home country of Bangladesh in January 2020 – just before the pandemic hit the UK. I’d always wanted to become a part of the legacy of the NHS, to contribute to an institution that provides almost all services to patients for free.

Nothing is more rewarding than knowing you can provide your people with the best healthcare without handing them a bill at the end. This is what attracts so many international staff to the NHS every year. But little did I know that following my dream to treat patients for free had a huge price tag – just because I’m not British.

Almost 200 different nationalities are represented within the NHS. And the majority of these are at the mercy of yearly hospital contracts to get their visa renewed.

To legally reside and work in the NHS, visas typically must be renewed on an annual basis, which can cost up to £500 per applicant, per year. Their fate is almost always tied to obtaining a card called the Biometric Residence Permit. To put this into context, without this permit staff are unable to work, open a bank account, apply for a license to drive or even rent an apartment. Travel outside the UK for incidents such as a family emergency is avoided – as without the BRP one cannot re-enter the UK.

After five years in the UK, we then become eligible to apply for an Indefinite Leave to Remain, which means we are then a permanent resident. Despite working on the frontlines of the pandemic, there is no guarantee of getting this application accepted, and the rejection rates are alarming even after submitting a perfect application. Each application comes with a huge price tag of around £2400 per applicant.

What’s more, the state of the NHS depicted in This is Going to Hurt has only got worse. Since Kay wrote the bestseller, we’ve seen ten years of austerity, severe staff shortages and the pandemic – yet as an international medical graduate, I’ve had to run an extra mile to prove that I’m worthy to live in the UK.

On top of this, in order to avail NHS services myself, I had to pay an international health surcharge of around £400 before being granted a visa to work in the UK. This charge was scrapped thanks to campaigning by Doctors’ Association UK. Since I joined the NHS, I have paid my taxes religiously but I don’t have any recourse to public funds should I become sick or unable to work.

Sometimes I wonder if it is worth it at all, to stay away from my home and the life I knew so well to come and live in the UK where immigration rules seem so hostile.

I’ve worked side by side with my British colleagues and cared for all the patients’ as if they were my own family – but when the storm of the pandemic calmed down – I was made to feel disposable. I watched as other countries recognised the contributions of their international workers and, at times, I feel I’ve chosen badly. It’s a likely prospect that I’ll make the difficult choice to leave my NHS dreams behind for a better opportunity somewhere else.

Until the authorities acknowledge the contributions of international healthcare workers in the NHS and establish measures to retain staff, the quality of care and patient safety will suffer – and that is going to hurt.

Dr Pushpo Babul Hossain, International Medical Graduate Lead with the Doctors’ Association UK

On Friday March 4, the  DAUK celebrate Overseas NHS Workers Day  with a showing of the Hostile documentary, to raise awareness of the extra pressures faced by international staff, and support Indefinite Leave to Remain for Overseas NHS Staff 

Over the years I’ve had several longish spells in hospital and quite a few visits to clinics. The NHS has mended my nose, picked me up off the road having been knocked down, knitted my pelvis together, taught me how to walk, spotted my auto-immune disease, stitched up hernias and, most recently, saved my life from Covid. My parents too, of course especially in their last years.

As I write this, I’m still seeing doctors and nurses every two weeks or so.In all this time, going back to the 1950s, I can remember time and time again, I have been looked after by doctors and nurses who were born overseas: Jamaica, Denmark, Brazil, Uganda, India, Pakistan, the Philippines, Grenada, Ireland, Trinidad, China, Australia…apologies to people and places I’ve missed out – but I’m matching people to places, as I write this list.

And I don’t want to overlook the people who did the scans and x-rays, taught me how to walk – twice! – cooked and brought me food, cleaned the wards, did the laundry and 100s of jobs I didn’t see. One way for me to look at this is to see my well-being and survival resting on the work of 100s of people, many of whom were born in other countries. Of course, in their careers they have looked after 1000s of other people, but through my telescope thinking of them, they are for a moment just looking after me!

And it seems almost miraculous that people who started out life many, many miles away from me could have arrived next to my hospital bed and done all that care, skill and attention which has enabled me to carry on.

Gratitude doesn’t really express how I feel about this. It feels much more than saying thank you to someone for doing a kind thing. It was this but it also involves application of knowledge with a devotion that goes beyond that.

I can’t bear to think that there have been times when people in this huge army of workers have felt under-valued or under-appreciated. I for one know that all NHS workers make huge sacrifices to do this work. It can take a heavy toll on personal and social life.

Right now, in this tribute, I’m also thinking of the kinds of sacrifice that people born overseas make too. Leaving home, with all its tugs of family, friends, familiar places, familiar foods can be a hard struggle. I know that look on people’s faces when they remember loved ones, loved places ‘back there’.So – in four huge words – a huge thank you! “

Michael Rosen

The pandemic has demonstrated how vital the contribution of international staff is for the NHS. 1 in 7 healthcare workers is from overseas. They have carried out their jobs in extremely difficult conditions, risking their lives during this crisis despite being on temporary visas. The government made a promise that bereaved families would get permanent residency status if these workers were to die due to COVID-19. Such a bereavement scheme is hurtful for the overseas workers who have fought so bravely. These workers bring highly specialised and sought after experience in addition to contributing to our economy through their taxes, investment in property etc.Currently indefinite leave to remain (ILR) is granted to the families of healthcare workers if they die. This sends a message that these heroic people only deserve recognition in the event of their dying in service, which is simply not in keeping the British Values of Fairness. These heroes deserve the right to call the UK their home and should not have to die to have this recognised. The French have granted citizenship to key workers – the UK cannot be seen to lag behind! On 5th March 2021 we are set to celebrate NHS Overseas Workers to recognise the efforts of ALL our international staff –  which is not limited to doctors and nurses but includes huge numbers of vital clinical, laboratory, clerical and estates staff. We invite Sunday Times readers to join us in acknowledging this extraordinary group of people.

Dr Pushpo Hossain, Doctors’ Association UK

As featured in The Sunday Times

Find out more about Overseas NHS Workers Day and how you can get involved here

Scroll down for Press Resources for the Day

Overseas NHS Workers Day on Friday 5^th March is a recognition of the extraordinary contribution that people who have migrated to the UK have made in the fight against COVID-19.  The Doctors’ Association UK, with support from UNISON, The Hospital Consultants and Specialists Association, British Association of Physicians of Indian Origin, Royal College of Physicians, British International Doctors Association, Egyptian Doctors Together and the NHS Arab Doctors in the UK support group.

“DAUK is proud to lead an initiative to celebrate the diversity, companionship and strength our international staff bring to the NHS by observing the first ever ‘Overseas NHS Workers Day’” said organiser Dr Pushpo Hossain. 

“We want to applaud the contribution of our overseas colleagues during the pandemic and raise awareness of some of the issues they face as international staff.”

Sign this petition to offer Indefinite Leave to Remain to all NHS and social care workers

Resources for NHS Trusts and Journalists:

Our press release outlining the activities planned for the event can be downloaded here along with our posters, logos and letter to NHS trusts