UK Specialty Training for International Medical Graduates: The 2026 Route

What does GMC registration with a licence to practise actually get you in 2026?

It gets you the right to work as a doctor anywhere in the United Kingdom, and nothing else. The General Medical Council registers and licenses. It does not employ, and it does not allocate training posts. Registration is the entry condition for every route below, including those that never touch a training programme.

The General Medical Council's fee schedule effective 1 April 2026 sets full registration with a licence at £481, with a discounted rate of £184 for doctors within five years of their primary medical qualification; annual retention mirrors those figures. Below the published income threshold — £38,500 for 2026, up from £37,000 in 2025 — a half-fee discount applies. PLAB Part 1 costs £283 and Part 2 £1,036 in 2026.

One 2026 change matters more than any fee. NHS England now requires full registration at the point of application to specialty training and Academic Clinical Fellowships. It used to be something you could still be completing while your form sat in review. It is now a precondition of submitting it. That timing is new.

Does an international medical graduate need the Foundation Programme?

Usually not — but you do need the competences it certifies. UK graduates finish a two-year Foundation Programme and receive a Foundation Programme Certificate of Completion. Doctors who trained elsewhere evidence the same standard through the Certificate of Readiness to Enter Specialty Training, known in every trust corridor as the CREST form.

NHS England's rules on who may sign it are the most underestimated item on the route. The signatory must be a consultant or equivalent — a definition covering general practitioners, clinical directors, medical superintendents, academic professors, locum consultants on the specialist register, and Specialty and Specialist doctors acting as educational supervisors. That person must have worked with you for a minimum continuous period of three months whole-time equivalent, within the three and a half years before the post's advertised start date.

Clinical attachments and observer posts cannot evidence it. That rule explains why an unpaid observership, however prestigious the hospital, does not move you toward a training number. You need a paid job with a named supervisor. Paid, supervised, documented. Either the 2023 or the September 2024 version of the form is accepted for the 2026 rounds, and a consultant outside the United Kingdom can sign it.

How does Oriel work, and what changed for the 2026 round?

Oriel is the single online recruitment platform for UK postgraduate medical training. Every specialty, every deanery, one account. Applications open in autumn for posts starting the following August; the 2026 cycle opened on 23 October 2025, and 2 October 2025 for Academic Clinical Fellowships.

Two structural changes landed for 2026. The registration requirement is one. The second is a cap of five Round 1 applications, set after volumes rose roughly 60 per cent in 2025; the average applicant was submitting 2.37, so the cap ends scattergun strategy rather than ordinary applying.

Oriel does not interview you. It collects the application, longlists against the published person specification, then hands you to the specialty's recruitment office. Decline an offer and you re-enter the pool.

Who counts as a priority applicant under the Medical Training (Prioritisation) Act?

The Act came into force in March 2026 and applies to posts starting from August 2026. NHS England's guidance prioritises four groups: doctors qualified in the United Kingdom or the Republic of Ireland; doctors qualified in the European Free Trade Association states of Iceland, Liechtenstein, Norway and Switzerland; doctors who completed qualifying UK training programmes; and doctors holding specified immigration statuses — British citizens, Commonwealth citizens with the right of abode, Irish citizens, indefinite leave to remain, and residence scheme rights.

Read that last group again. NHS England states that for 2026, eligibility "has been defined using specified immigration statuses as a proxy for significant NHS experience". Settlement, not birthplace, is the operative variable. A doctor who trained in Belgrade, Cairo or Lagos and later obtains indefinite leave to remain enters the priority group on the same footing as a UK graduate.

Two mechanics follow. For 2026 prioritisation applies at the offer stage only; from 2027, at shortlisting and offer. And from 2027 "significant NHS experience" is to be defined in regulations rather than by status. Public Health Medicine is excluded entirely.

What is the difference between core and run-through training?

Run-through means one successful application carries you from day one to a Certificate of Completion of Training without re-competing. General Practice, Paediatrics, Obstetrics and Gynaecology, Clinical Radiology, Neurosurgery and Ophthalmology work this way. Core — also called uncoupled — splits the journey: Internal Medicine Training and Core Surgical Training run two or three years at CT level, then you compete again at ST3 or ST4.

Study the second gate. NHS England's 2025 competition ratio data records Emergency Medicine ST3 through Acute Care Common Stem at 0.82 applications per post and Genitourinary Medicine ST4 at 1.02, the same year Cardiothoracic Surgery ST1 ran at 73.70. The 2025 England fill rates, correct at 27 May 2025, show 10,413 accepts against 10,862 posts — 95.87 per cent.

Competition ratios per post, Round 1 entry, published by NHS England for the 2025 recruitment year. Ratios describe applications received, not offer probability for an individual.

Is the Medical Training Initiative still open in 2026?

Not to new applicants. The Medical Training Initiative let doctors from low- and middle-income countries take a fixed clinical placement in a National Health Service organisation for up to 24 months on a Temporary Work – Government Authorised Exchange visa, with General Medical Council registration granted through royal college sponsorship rather than the PLAB examinations. The Academy of Medical Royal Colleges administered it.

The Academy closed it to new participants at 12:00 noon on 31 March 2026, with a grace period to 30 June 2026 for applications already in progress with a royal college. NHS England had concluded it was no longer consistently meeting its objectives. Around 1,600 doctors on placement continue unaffected, sponsorship intact. No replacement is confirmed.

Its economics are worth recording: the Royal College of Physicians charged £1,020 in scheme fees plus a Government Authorised Exchange visa at £298, the cheapest supervised entry into UK hospital medicine. Its closure is why the Locally Employed Doctor route now carries the traffic.

What is a Locally Employed Doctor post, and why do most doctors start there?

A Locally Employed Doctor post — advertised as trust grade, clinical fellow, junior clinical fellow, or specialty doctor at the senior end — is a substantive National Health Service job outside the training structure. The trust employs you directly. No deanery, no training number, no automatic progression, but a salary, a rota, a named clinical supervisor and a Certificate of Sponsorship.

Four reasons stack up behind it. It is the only realistic way to accumulate the three supervised whole-time-equivalent months a consultant needs before signing your CREST form. It generates the audits, teaching, quality improvement projects and logbook any Oriel application or portfolio file is built from. It is sponsorable on the Health and Care Worker visa. And time in it counts toward the five years of continuous residence leading to indefinite leave to remain — a qualifying status under the 2026 rules.

Trust posts are advertised on NHS Jobs and individual trust sites year-round, and rotational schemes generally build a stronger portfolio than a single fixed post. Medschool Experts has placed over 500 study places in medicine and dentistry, and the pattern our team sees is that the first post decides the next three years, not the last exam result. Our advisers map that step against your qualification in a free consultation.

Can you reach the specialist register without a training number?

Yes. A training number ending in a Certificate of Completion of Training is one route onto the General Medical Council's specialist register. The other is the Certificate of Eligibility for Specialist Registration, applied for through the process the General Medical Council renamed the portfolio pathway.

The mechanism is evidence, not competition. Rather than being appointed to a programme and progressing through annual reviews, you assemble a portfolio demonstrating knowledge, skills and experience equivalent to the whole approved UK curriculum for your specialty, and the General Medical Council assesses it with advice from the royal college's Specialty Advisory Committee. No cap, no ratio, no round, no closing date. No prioritisation rule either: the Act governs recruitment, not registration.

The 2026 fee schedule prices a portfolio pathway application at £1,974, up from £1,902 in 2025. What it demands instead is documentation over years — consultant-level responsibility in appraisals, logbooks, audits, teaching records, management activity and multi-source feedback, mapped against the curriculum. Slower than a training number in most cases. Not competitive in any of them.

Which royal college examinations matter, and what do they cost in 2026?

Three families sit under the specialties most international medical graduates enter: MRCP(UK) for physicianly specialties, MRCS for surgery, MRCGP for general practice. Not licensing exams — the General Medical Council licenses, the colleges examine — but progression requirements inside training and weighted evidence inside a portfolio file.

MRCP(UK) is run by the Federation of the Royal Colleges of Physicians of the United Kingdom. From the 2026/03 diet, after a rise from 1 July 2026 tracking the 3.6 per cent UK Consumer Prices Index rate, Part 1 and Part 2 Written each cost £520 for UK candidates and £696 for international candidates; PACES costs £742 in the United Kingdom and £1,358 internationally. MRCS is intercollegiate: the Royal College of Surgeons of England lists Part A at £670 and Part B, an objective structured clinical examination, at £1,212 for the January and February 2027 sittings.

MRCGP catches people out. The Royal College of General Practitioners states that its regulations apply to doctors training in UK general practice specialty training programmes — the Applied Knowledge Test and Simulated Consultation Assessment are components of GP training, not open examinations you sit to qualify for it. From September to November 2026 they cost £481 and £1,207.

Sources: General Medical Council registration fee regulations effective 1 April 2026; Federation of the Royal Colleges of Physicians fee notice, 2026/03 diet; Royal College of Surgeons of England and Royal College of General Practitioners examination fees, 2026; Home Office immigration fee schedule, 2026. Dashes: no comparable 2025 figure published.

Skilled Worker visa or Health and Care Worker visa — which one?

For a doctor sponsored by a National Health Service trust, the Health and Care Worker visa. It is a subcategory of the Skilled Worker route rather than a separate scheme, and the eligibility difference is the job, not the person: an eligible health occupation with a licensed health or care sponsor. The money gap is wide.

Under the Home Office fee schedule for 2026, a Health and Care Worker visa costs £324 for a grant of up to three years and £628 for longer, inside or outside the United Kingdom. The equivalent Skilled Worker application from overseas, on the schedule in force from 8 April 2026, is £819 and £1,618.

The Immigration Health Surcharge separates the routes properly. The standard rate is £1,035 per person per year, and Health and Care Worker visa holders are exempt, as are their dependants. Sponsors of these roles also escape the Immigration Skills Charge, otherwise £1,320 for a medium or large sponsor's first year; the Certificate of Sponsorship costs the employer £525. One further change: from January 2026 the route's English requirement rose to CEFR level B2.

What does the recruitment year look like, month by month?

It repeats annually, and the shape holds even when dates move. Posts start in August, and everything upstream is scheduled backwards from that — which is why a doctor arriving in September is really planning for the August nearly two years away. Recurring phases, not filing dates.

• Late summer to early autumn — person specifications published. Read yours first.
• Autumn — Round 1 opens on Oriel; the 2026 cycle opened 23 October 2025. Registration in place, CREST signed.
• Late autumn to early winter — applications close, longlisting runs. Documents missing here are missing for the year.
• Winter — assessment centres and interviews, mostly January and February.
• Late winter to early spring — offers cascade through the ranked list, on clocks measured in days.
• Spring — Round 2 opens for unfilled posts, where under-subscribed specialties and locations appear.
• Late spring to summer — pre-employment checks, Certificate of Sponsorship, visa.
• August — posts begin nationally, on one changeover.

Locally Employed Doctor recruitment ignores this calendar. Trust posts are filled all year.

What does the first two years actually cost?

The arithmetic for a single doctor with no dependants, on published 2026 figures, taking the PLAB route to registration and a Locally Employed Doctor post on a three-year Health and Care Worker visa.

Two substitutions move that total. Sitting MRCP(UK) Part 1 abroad before arrival costs £696 rather than £520, taking it to £2,707 — £176 for the same paper outside the United Kingdom. A standard Skilled Worker visa replaces £324 with £819 plus three years of Immigration Health Surcharge at £1,035, or £3,924, pushing the two-year figure to £6,131. The visa category is the largest controllable line in the budget.

Not included: English testing, translation, travel to examination centres, the employer-paid Certificate of Sponsorship at £525, or relocation. Salary sits on the other side of the ledger.

What does thin coverage on this subject usually leave out?

Three things. The first is that the Act operates on immigration status in 2026, not nationality or place of qualification — indefinite leave to remain puts a doctor in the priority group whatever passport or diploma they hold. From 2027 that proxy is due to be replaced by regulations defining significant NHS experience, which a doctor accumulates by working.

The second is the CREST supervisor clock. Three months whole-time equivalent, continuous, within three and a half years of the post start date. Most accounts mention the form; far fewer mention that the window expires, so a CREST signed in a home-country post in 2023 will not support a post starting in 2027. Timing that block is a planning decision, not paperwork.

The third is that the portfolio pathway runs in parallel the whole time, outside every competition described above. A doctor building a specialist portfolio in senior service posts reaches the same register, at £1,974 in 2026, without entering Oriel. That is a different game, not a harder version of the same one.

Which applies depends on your qualification, specialty and immigration position, and that combination is individual. Medschool Experts assesses the case directly rather than guessing from a category — see how we work on our services page, read student stories, or bring your file to a free individual consultation.