Should UK Medical Graduates be Prioritised Over IMGs?

Examining Wes Streeting’s call to put homegrown doctors back at the front of the queue

Doctors sat up in their chairs this week when Wes Streeting took his seat on GB News and said the following:

His message is simple — protect domestic investment, prioritise homegrown talent, prevent a ‘brain drain’. If we are to take his claim seriously however, we must go beyond words and examine the actual levers he may be reaching for…

“It’s a crazy situation for our country to be in… I am looking at the changes we need to make”

So, what ‘changes’ could he look into? Well there are a number of options at his disposal, but here we want to speak about the most commonly mentioned one - the reinstatement of the Resident Labour Market Test (RLMT):

The abolition of the Resident Labour Market Test (RLMT), as part of the UK's post-Brexit immigration reforms, removed the requirement for NHS employers to demonstrate that no suitable UK or settled workers were available before recruiting internationally. This change facilitated the direct recruitment of international medical graduates (IMGs) into NHS roles, including competitive training positions, without prioritising British-trained doctors.

Under the previous rules, NHS trusts and Health Education England were required to prove, typically through four weeks of advertising on specific job portals, that no suitable UK or settled candidate was available before offering a training or employment contract to an international medical graduate (IMG). In practice, the additional steps needed for a trust to demonstrate they had adhered to these protocols introduced a layer of bureaucratic delay and led to delayed appointments, discouraged some trusts from recruiting abroad altogether, and introduced an implicit hierarchy of preference that placed UK-trained doctors at the top of the queue, especially in oversubscribed specialties.

Critically, the RLMT wasn’t applied uniformly across all medical posts. Psychiatry and GP training posts were classified as shortage specialties and were often exempt from the test, whereas highly competitive specialties like Radiology, Dermatology, or Surgery enforced the RLMT more rigorously. This distinction is vital: RLMT wasn’t about banning IMGs — it was about prioritising access to opportunities based on workforce pressures and domestic training investment.

If Wes Streeting were to reinstate the RLMT — even in a targeted, NHS-specific form — it would represent a shift in priorities. It would acknowledge that the NHS is not merely a consumer of global labour, but a steward of public investment in domestic medical education.

Would reinstating the Resident Labour Market Test be a good idea?
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Can We Wake Up UK Clinical Research?

Once the envy of global academia, UK clinical research is now on shaky ground. According to The BMJ this week, patients being recruited into new clinical trials dropped 27% between 2018 and 2023.

A frequently cited cause is the lack of unity between academic centres and the place where trials are conducted - the NHS. While researchers dream up brilliant studies, the separate administrative departments in Universities and NHS sites work to increase bureaucracy and costs. Suggestions have been raised of working to strengthen ties between Trusts and Universities and perhaps directing government grants to centres that already show evidence of this.

Tom Keith-Roach, President of Britain’s largest pharmaceutical company, AstraZeneca, says the company has been forced to look oversees to host trials due to the difficulties recruiting patients into clinical trials in the UK.

The Doctor-Pinching Red Line: A Global Health Dilemma

The ethical argument against Doctor-pinching from around the globe…

In the post-Brexit era, Britain’s NHS is facing an uncomfortable truth: It is increasingly reliant on doctors and nurses from the world’s most healthcare-stressed nations. This is not just a policy problem, ’doctor-pinching’ is an ethical issue that should be considered.

In 2023, the World Health Organisation (WHO) updated its “Health Workforce Support and Safeguards List”—commonly referred to as the red list. It highlights 53 countries experiencing a critical shortage of health workers. These are nations where there are fewer than 4.45 doctors, nurses, and midwives per 1,000 people. The WHO recommends and urges high-income countries to not recruit from these regions, but as of March 2025, one in 11 (or 9%) of all doctors in England are now from red list states. Between 2021–2024, over 12,000 healthcare professionals arrived from Nigeria, Ghana, Pakistan, and Bangladesh—four of the most heavily affected red list nations.

Britain is a G7 nation, we have some of the finest academic institutions in the world to train doctors, and yet, we’ve somehow pulled off the magic trick of having too few training posts for UK doctors — and still needing to import thousands more.

An Ethical Tightrope

Now, let’s be fair: working for the NHS can be a huge opportunity for doctors from red list countries. The pay and training is better, and the CT scanners (usually) work. Many migrate willingly— and the idea of restricting that ‘freedom’ is uncomfortable for many. But let’s pause on that word: Freedom.

As Nobel laureate Amartya Sen puts it, “Even if you technically have a choice, that choice isn’t truly free if it’s made under pressure, constraint, or lack of alternatives.”

So imagine you’re a skilled doctor in Malawi. You want to stay, help your community and live close to family and friends, but your hospital can’t afford basic equipment. The power cuts out mid-surgery. Wages are just enough to get by.

Technically, you’re free to choose where you go. But is it really a free choice when the system back home gives you so few meaningful options? Where is the ‘choice’ in this?

The Deeper Question

So here is the ethical question: Should a wealthy country like the UK be relying on doctors who are leaving their own struggling healthcare systems?

Flip the script: imagine the NHS is on its knees (Yes we know this phrase already does the rounds, but imagine harder), and Australia starts recruiting thousands of our publicly trained doctors. The absolute majority of UK citizens would be infuriated. And yet, we do just that to countries whose healthcare systems are in even more dire states—countries that invested in these doctors only to watch them leave, just when they’re most needed.

Now, if we must recruit from red list countries, the very least we could do is show some accountability through, perhaps, offering compensation for the workforce loss, supporting healthcare infrastructure projects or funding training programmes in the source country - All recommendations that the WHO make.

“Can we all agree that Bupropion should be Buproprion? Propranolol needs to give its extra ‘r’ to buproprion”

“Created the ABC of General Surgery - Airways, Breathing, CT.”

“Being a doctor has topped the list of jobs teenagers want to be when they are older for a second year running according to the annual BBC bitesize careers surgery. In the same survey, when asked which company/organisation they’d choose if they could work anywhere in the world, the NHS was number 1 (above Google, Apple and NASA in 2nd, 3rd, and 4th respectively”

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Some things to review when you’re off the ward…

NHS to revise single-sex space policies following Supreme Court ruling that a woman is legally defined by biological sex. The Equality and Human Rights Commission warns that failure to comply could lead to enforcement actions. This presents both logistical and ethical challenges for the NHS - balancing the rights and protections of all individuals.​ (BBC News)

GP practices can claim £20 for each patient managed without hospital referral as part of an expansion of scheme to deliver care closer to home. This initiative aims to reduce NHS waiting lists by encouraging treatment in community settings. (The Guardian)

Dr Mumtaz Patel has been elected as the 123rd president of the Royal College of Physicians. The vote had a turnout of 36.3% which was the highest turnout in RCP elections since the presidential election in 2002.

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Mandatory Training Mayhem: A Long Overdue Remedy

For years, doctors rotating between NHS trusts (every 4/6/12 months) faced the redundant task of redoing mandatory training modules—ranging from data security, equality and diversity and human rights to fire safety—each time they moved, even if it was just a short distance away. This repetitive process not only consumed valuable time but led to led to endless frustration.​

Starting May 1, NHS staff can now transfer their statutory and mandatory training records between all NHS organisations in England. This change, brought about by the NHS Digital Staff Passport, is expected to save up to 100,000 staff days annually. While it's a significant relief, many know this is decades overdue and another symptom of how slow the cogs turn within the NHS.

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