A workforce can grow and still fail patients if the workforce is in the wrong places. 

The GMC’s Workforce report 2025 brings that into focus by tracking doctors at three career stages: 

1. after graduating from medical school 
2. after completing foundation training (F2) 
3. after completing specialty training (CCT) 

The results show stark differences between the UK nations and a particularly serious challenge for Wales at the earliest stages. 

This blog explains what the report shows about geographic retention and movement, why early-career retention is the bottleneck, and what the ScotGEM rural-medical-education case study suggests about designing “stickiness” into the pipeline. 

 

The first movement shock happens right after graduation 

For doctors who graduated in 2020, the report tracks the proportion who remained licensed and in the same UK country by 2024. 

By 2024: 

• England: 81% remained in England 
• Scotland: 51% remained in Scotland 
• Northern Ireland: 44% remained in Northern Ireland 
• Wales: 31% remained in Wales  

That means Wales retains under a third of its medical graduates in the same country five years later. 

This is not “a small leak.” It’s a structural outflow. 

The report frames this as movement for the first foundation post (F1) being a key point where many graduates move across borders.  

 

Foundation helps, but Wales still loses close to half by five years 

The report then examines doctors who completed F2 in 2019 and tracks their retention in the same country through 2024. 

By 2024: 

• England: 88% 
• Northern Ireland: 75% 
• Scotland: 61% 
• Wales: 54%  

So retention improves after foundation compared with post-graduation, but: 

• Wales still retains only 54% of that cohort after five years, 
• Scotland retains 61%, 
• England is much higher at 88%. 

This suggests a critical policy truth: 

If you lose doctors immediately after graduation, foundation can’t fully repair the pipeline. 

The “capture point” for retention is earlier than many plans assume. 

 

CCT retention is strong, which reveals where the real problem is 

At the third stage (CCT), retention is higher across all countries. 

For doctors who gained a CCT in 2020, by 2024 the share still licensed and in the same country was: 

• England: 93% 
• Northern Ireland: 93% 
• Scotland: 86% 
• Wales: 84%  

This is the report showing you where the system performs better: once doctors complete specialty training, most remain. 

So if you want to improve geographic distribution, the biggest leverage is not necessarily late-career “golden hellos.” It’s: 

• how doctors choose (or are allocated) to foundation and early training locations, 
• how experiences in those locations shape attachment and future choices, 
• and how credible long-term pathways are in those regions. 

 

The Wales lesson: retention is a pipeline design issue, not a loyalty issue 

It’s tempting to interpret “Wales retains 31% of graduates” as an individual loyalty problem. 

But workforce data almost never supports that framing. More likely explanations include: 

• availability and distribution of foundation and specialty posts 
• partner employment opportunities 
• training pathway availability in desired specialties 
• perceptions of service pressure and support 
• geographic ties and housing affordability 
• the “gravity” of larger training centres elsewhere 

The report doesn’t test these causes directly. But it does something more useful: it shows the pattern clearly enough that leaders can no longer deny it or treat it as minor. 

 

Rural workforce: what ScotGEM suggests about building retention into education 

The report includes a case study on the Scottish Graduate Entry Medicine (ScotGEM) programme, designed to attract and retain doctors in rural and remote areas by incorporating rural living and study placements from the second year onwards.  

Key early outputs: 

• 155 ScotGEM graduates have joined the UK workforce since the programme began producing qualified doctors in 2022. 
• By 2024: 
  • only 2 doctors (1%) had left 
  • 133 (87%) were working in Scotland 
  • 19 (12%) were working in England 
  • 1 (1%) was working in Wales  

The report notes that 87% in Scotland after 1–2 years is higher than the 70–71% retention after 1–2 years for the 2020 Scottish medical student cohort (from the national retention data).  

It also reports early evidence that larger proportions of ScotGEM graduates were working in more rural boards such as Tayside, Highland, and Dumfries and Galloway compared with the distribution for all doctors in training and all licensed doctors working in Scotland.  

This is early-stage evidence, but it points to a practical principle: 

If you want doctors in rural areas, you may need to educate and socialise doctors in rural areas. 

Not as a short placement. As a meaningful part of professional formation. 

 

Critical interpretation: ScotGEM is promising, but don’t overclaim 

It’s important not to turn early data into certainty. 

Limitations include: 

• small cohorts (155 graduates is meaningful but not large) 
• short follow-up time (1–2 years post-qualification is not the same as 10 years) 
• multiple confounders (student selection, rural background, programme identity, cohort culture) 

The report itself frames this as “very early evidence.”  

But early evidence is still useful for design thinking: it suggests that retention and rural distribution can be influenced, not merely “hoped for.” 

 

What workforce leaders should do with this data 

The report implies three policy directions that are hard to escape: 

1. Fix early-career retention before you obsess over late-career retention 
   • CCT retention is already comparatively strong. The biggest losses occur earlier, especially for Wales. 
2. Make training pathways geographically credible 
   • If doctors have to leave a country to access desired training or progression, they will. Workforce planners should map where training opportunities are scarce and which specialties drive outflows. 
3. Invest in place-based medical education models 
   • ScotGEM offers a model of how education design can increase geographic attachment. The report notes similar initiatives in Northern Ireland (Ulster University) and Wales (Swansea and Bangor) aimed at rural/remote exposure.  
   • The strategic goal isn’t simply “rural placements.” It’s place-based professional identity. 

 

Conclusion: retention is not one problem, it’s three different problems at three stages 

The report shows: 

• big movement after graduation (especially Wales) 
• improved but still leaky retention after foundation (again, Wales and Scotland) 
• strong retention after CCT across all countries 

So the workforce question becomes clearer: 

What would it take to make doctors’ first choices and early experiences align with where the system needs them most? 

If leaders can answer that, the later-stage workforce becomes easier. If they can’t, no amount of late-stage incentives will fully compensate for losing doctors at the start of their careers. 

Source: GMC Workforce Report 2025