The GMC’s Workforce report 2025 makes a blunt point: postgraduate training places have nearly doubled in a decade, but demand has grown too — and outcomes are diverging sharply by where doctors qualified.

Key takeaways

• Non‑UK PMQ applications for CT1/ST1 rose from 5,326 (2018/19) to 18,857 (2023/24) — more than tripling (Part 1, p11).
• The proportion of non‑UK applicants receiving an offer fell sharply to 23% in 2023/24 (p11–12).
• UK graduates’ offer rate also declined over time, but remains far higher: 69% in 2023/24 (p12–13).
• Some programmes (notably GP) combine low competition ratios with high non‑UK representation, raising questions about how the system allocates opportunity and meets service need (p14).

What’s happening: demand is exploding, supply is constrained

The report shows a steep rise in non‑UK PMQ doctors applying to enter the first year of specialty or core training (CT1/ST1). The non‑UK applicant count more than tripled between 2018/19 and 2023/24 (p11).

But offers didn’t rise at the same pace. The result is a collapse in the success rate for non‑UK applicants: from a peak where just over half received offers (2019/20) to under a quarter in 2023/24 (p11).

Meanwhile, UK graduate applicant numbers have been comparatively stable, and UK offer rates declined more gradually, from a higher starting point (p12–13). In 2023/24, the report highlights the contrast: 23% non‑UK vs 69% UK (Foreword p2; p12–13).

Why offer-rate comparisons are powerful — and also dangerous

Offer rates are attention-grabbing because they feel like a judgement: “who is good enough?”

But the report itself cautions indirectly by focusing on offers, not acceptances, and noting doctors may apply to multiple posts (p11; p15). That matters because offer rates can reflect system structure as much as candidate quality.

What offer-rate gaps can reflect (without proving discrimination)

• differential access to portfolio-building opportunities
• differences in NHS experience or referees
• familiarity with UK recruitment norms and scoring
• self-selection into more or less competitive programmes
• number of programmes applied to (doctors can submit multiple applications)

So the right question isn’t “why are non‑UK doctors worse?” It’s:
What does the recruitment system reward, and do all candidates have fair access to those signals?

This is especially important because the UK increasingly relies on doctors who trained abroad — not just for service posts but for training pipelines that feed future consultant/GP supply (p14–17).

Programme-level detail: the system isn’t uniform

The report goes beyond overall offer rates. It shows that in 2023/24, UK graduates had higher offer proportions across programmes, but the gap varies (p13). In general practice, for example, the report highlights 79% of UK applicants receiving an offer compared with 23% of non‑UK applicants (p13).

Then the report adds a second lens: competition ratios and non‑UK representation. Some programmes have relatively low competition ratios but high non‑UK proportions in the early stages (p14). General practice stands out not because it is uniquely “easy,” but because it shows how workforce needs, candidate preferences, and programme popularity interact.

The implication is uncomfortable but necessary: some of the programmes the NHS depends on most are becoming disproportionately filled by international doctors.

That’s not a problem in itself — international doctors are not a “stopgap.” But it becomes a policy risk if leaders attempt to reduce non‑UK participation without growing the overall pipeline or addressing why UK graduates apply elsewhere.

The “locally employed → training” pipeline is now part of the model

The report makes an important point that should reshape how we talk about training access: many non‑UK doctors apply for specialist training after several years in locally employed (LE) roles (p11; p17). In other words, the system increasingly functions like this:

1. doctor joins via a route like PLAB
2. works in LE roles for years
3. applies into training, often in programmes with lower competition ratios and fewer UK applicants

This is not a fringe pathway. It is now a structural feature of how the NHS fills gaps and staffs services.

So if training access becomes less realistic for non‑UK doctors, you don’t only affect individuals; you potentially remove a major motivator for doctors to come to the UK at all (p17).

What should the system do with this insight?

If your goal is a sustainable workforce, there are three strategic options — and pretending you can get sustainability without trade-offs is the biggest risk.

Option A: Expand training places further

The report shows offers have already grown over the decade (Foreword p2), but demand is outpacing supply. Expanding training numbers is expensive and requires educator capacity — but it is the most direct way to reduce pressure.

Option B: Improve fairness and transparency of recruitment

If outcomes differ sharply by PMQ, leaders should ask:

• Are recruitment criteria clear and consistently applied?
• Do candidates have equal access to portfolio opportunities and feedback?
• Are there avoidable barriers for doctors who didn’t train in the UK?

The report’s language about fairness and transparency isn’t limited to employment; it applies to the whole pathway (p10; p17).

Option C: Treat LE and SAS roles as genuine career structures, not waiting rooms

Part 2 shows the scale of doctors not on GP/specialist registers and not in training (p30–36). If training is bottlenecked, those doctors still need progression, stability, and development — otherwise retention suffers.

The patient impact is the point

Workforce debates often become tribal: UK vs non‑UK. But the report’s underlying message is pragmatic: the NHS is already dependent on international doctors, and policy choices must consider service delivery reality (Foreword p3; p14–17).

A training system that becomes a dead end for large numbers of doctors will not just frustrate careers; it will weaken retention, reduce future supply, and raise the risk of rota fragility.

In workforce planning, bottlenecks are never neutral. They push pressure elsewhere — usually onto patients, supervisors, and overstretched teams.

Source: GMC Workforce Report 2025