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The next item is an evidence session with the Cabinet Secretary for Health and Social Care and supporting officials on the Medical Training (Prioritisation) Bill legislative consent memorandum, LCM-S6-72, which was introduced in the Scottish Parliament by the cabinet secretary on 21 January 2026. The legislative consent process that is set out in chapter 9B of standing orders requires the Scottish Government to notify the Parliament by means of a legislative consent memorandum whenever a UK Parliament bill includes provision on devolved matters. Each LCM is referred to a lead committee to scrutinise and report on it before the Parliament decides whether to give its consent to the UK Parliament legislating in the manner proposed.
The Medical Training (Prioritisation) Bill was introduced in the House of Commons on 13 January 2026. The purpose of the bill is to introduce a system that gives graduates from UK medical schools and certain other groups priority for training places to become doctors. The bill has been introduced as emergency legislation, subject to an expedited timescale, to allow prioritisation to be implemented for live training programme recruitment rounds, and it would affect those receiving offers for training posts starting in August 2026.
I welcome to the committee Neil Gray, Cabinet Secretary for Health and Social Care, Lucy Gibbons, head of the health skills development and delivery unit, and Lucy McMichael, head of the branch social care legal services unit, Scottish Government. I invite the cabinet secretary to make a brief opening statement.
Convener, colleagues, thank you for inviting me to speak with you today. The committee will be aware that the bill passed through the House of Commons unamended on 27 January. Across the UK and here in Scotland, the dedication of our NHS staff continues to be remarkable, but we must be honest about the challenges that are facing our medical workforce. I thank those doctors who took part in phase 1 of the future medical workforce project and who shared their views on those challenges candidly.
We cannot ignore the increasing pressures within the UK medical training pipeline that are affecting our resident doctors. Demand for the foundation programme and specialty training posts has grown sharply. In 2025, 12,000 UK-trained and 21,000 internationally trained doctors competed for 9,500 specialty training places. That bottleneck threatens the progression and retention of doctors who have trained in the UK and who are most likely to stay and build their careers here.
To match the increase in the number of undergraduate places, the Scottish Government has created 252 foundation-year places since 2021 and will add a further 72 in 2026. Furthermore, in line with anticipated future workforce needs, approximately 850 additional specialty training posts across multiple specialties have been added since 2014. To address concerns about training bottlenecks this year, the draft Scottish budget provides an additional £14 million for specialty training posts. That will increase the number of available posts in 2026 by approximately 10 per cent.
Although the Scottish Government can take action in Scotland, the impact of that on the UK-wide pool of posts and, ultimately, the experience of resident doctors in Scotland is influenced by the actions of other Governments in the UK. It is against that backdrop that the Medical Training (Prioritisation) Bill is being enacted. It is right that training posts are determined by future workforce needs, but we cannot risk losing those whom we have trained in our world-class universities. Although Scotland experiences those pressures to a lesser extent than other parts of the UK, the reality is that we operate within a UK-wide recruitment system, so moving together on a four-nations basis is the only way to ensure that Scotland is not negatively impacted. If prioritisation were to apply without Scotland, we would experience displacement effects.
The bill provides a lawful and proportionate mechanism to prioritise UK medical graduates alongside other priority groups where limits are required. It also ensures that, from 2027 onwards, we can recognise and value internationally trained doctors who have made significant contributions within the NHS by enabling them to be prioritised through future regulations. The concurrent regulation-making powers with safeguards around Scottish ministers’ consent provide the necessary assurances that our devolved responsibilities are fully respected.
I stress that the bill will not prevent international recruitment. Indeed, international students will always be welcome in Scotland for their positive contribution to our campuses, our economy, our NHS and our local communities. The bill will support a sustainable and reliable future supply of doctors and ensure that those who have trained here have the opportunity to progress their careers. On that basis, and having considered the legal, financial and operational implications, the Scottish Government recommends that the Scottish Parliament grants legislative consent to the bill.
11:00
Thank you, cabinet secretary. We will move to questions.
I declare an interest as a practising NHS GP.
On 14 June 2025, at the Scottish Conservative conference, I announced that we would introduce pretty much the same policy as we are talking about here, so I obviously support the bill. However, given how quickly the bill passed through the House of Commons unamended, should we spend a bit more time considering it and taking evidence from, say, international medical graduates?
I recognise that there has been an expedited timetable, particularly in the House of Commons—as the convener set out, that was needed in order to meet this year’s recruitment rounds—but the Scottish Government has been discussing these matters with the UK Government for quite some time. As I said in my opening statement, we believe that the bill contains the most proportionate legal proposals that the UK Government has made and, critically, that the proposals are workable.
It is for the committee to determine its work programme—I cannot direct it—but I believe that the bill is balanced and the right course of action to take. That is why we recommend that the Parliament should give its legislative consent.
As I said, I very much support the bill and think that it is key. Graduates in Australia, for example, get the training places that they need, and then the places that are left go to people who have emigrated from, say, this country, so that they can get that experience.
I know that other members will ask about recruitment into roles that are harder to fill, so I will not touch on that. However, does the bill cover dentists?
No.
GPs have to go through specialty training programmes, so does the bill cover GP training?
Yes, it covers GPs.
Does the way in which the bill has been constructed mean that a number of people from, say, England will want to come up to Scotland to practise?
That opportunity will remain, and there might be expanded opportunities as a result of the prioritisation being on a four-nations basis. There will be reduced competition for UK-based medical graduates, and it will be proportionately harder for international medical graduates.
However, I reiterate that, given the issue that you mentioned relating to places that are harder to fill, international medical graduates will still be required and will still be very much valued by the Scottish Government. In our discussions with the UK Government, we were not comfortable with previous iterations of the policy because we felt that they would impinge on our ability to recruit internationally. I want to leave the committee in no doubt that the Scottish Government’s position is that we will still require international medical graduates, even under this policy.
It is important to state that, under the system, an international student who has come to study at, say, the University of Glasgow will be given the same prioritisation as anyone from this country who went to that university. Is that correct?
That is correct. Anyone who has started their medical education at a UK university will be treated as a UK-domiciled graduate. Anyone who has carried out their foundation year programme in the UK will be prioritised as a UK medical graduate, but the prioritisation will start in relation to those who are entering for the first time to take up a specialty position. That is where the difference lies.
Given that this is a UK-wide recruitment that prioritises people who have graduated in the UK over those who have graduated internationally, if a graduate of a Scottish university or a Welsh university chose to go to England for specialty training, they would not be ranked below somebody who graduated from an English university, or vice versa. Is that right?
That is correct.
Will what the bill proposes affect the allocation of graduates on the Scottish graduate entry medicine programme to foundation year 1 and 2 posts? As you know, I am interested in how successful ScotGEM has been in recruiting doctors for rural practice in NHS Dumfries and Galloway. Will the bill affect ScotGEM students?
I recognise Emma Harper’s long-standing interest in and advocacy for ScotGEM, so I understand her desire to ensure that ScotGEM is not impacted by the process that is proposed by the bill. I can confirm that ScotGEM will not be impacted by it.
Good morning, cabinet secretary. We all agree on the positive impact that international graduates, GPs and medical staff have on our NHS. At the moment in Scotland, we have a cap on home-based medical graduates. Will what the bill proposes necessitate a raising of that cap to allow more Scotland-domiciled graduates to get a training place? Will it change the perspective in that regard?
Are you asking about specialty training places?
Yes.
As I said in my opening statement, we have provided additional specialty training places, in recognition of the fact that it is a competitive landscape. I put on record that I think that it is right that it is competitive, as that serves to ensure that the best come through. People who receive their medical education and training in Scotland and the rest of the UK are held in very high esteem internationally. Therefore, we have incredibly high standards to ensure that the best come through into our system.
We review annually the number of specialty training places that are available. As I said in my opening remarks, we have allocated an additional £14 million to increase the number of specialty training places by 10 per cent. That matches proportionately what the UK Government is delivering. Obviously, we will keep under review the impact that the bill has on the delivery of the workforce supply that is required and whether we need to move that up or down in future years.
You said that you are increasing the number of specialty training posts in Scotland. How will you ensure that that increase reflects the demand that will be there now that the bill has been introduced?
That will be part of the discussions about recruitment that we have on a four-nations basis. NHS Education for Scotland has representatives in those discussions, which help us to determine what our need will be as regards specialty training and how many people should be recruited to that. As I said, there is a fine judgment to be made to ensure not only that the process is competitive but that it delivers the number of specialty training places that will allow us to fill the gaps in our supply that we need to fill.
The competitive nature of the process is totally understandable. It is right that it is so competitive. From a completely selfish point of view, we want people who emerge from that competitive process to choose to be here. How are you ensuring, in a four-nations context, that Scotland sits at the forefront in that regard and that access to specialty training is such that it makes it easy for people to make the choice to stay here?
A number of factors determine the attractiveness of Scotland, or any other part of the UK, as a place for people to live and work. There are a number of reasons why people should want to choose to live in Scotland and to work in the NHS in Scotland, which I am more than happy to put on the record. Through NES, we look to set out a competitive and supportive education programme and specialty programme. I have certainly not had any feedback to the contrary in discussions with either the British Medical Association resident doctors committee or the medical students committee.
There is concern from the BMA, which is why it has set out its support for the bill, although in some places that is qualified support. The bill will make it easier for UK-domiciled medical graduates to access specialty places. Everybody is aware of the issues that exist between the BMA and the UK Government at the moment. The bill is an attempt to resolve some of those issues.
Good morning. What impact could the bill have on vacancy gaps in areas such as rural Scotland, where places are hard to fill?
We are taking a number of measures to try to improve recruitment in rural and island areas. Emma Harper mentioned ScotGEM, which is an example of that. We have taken forward a number of programmes to provide rural and island communities with people to serve those services. The bill will not necessarily directly change the perspectives in that regard but, taken alongside some of those programmes, it has the potential to help us to meet the skills gaps in our rural and island communities.
What evaluation has been undertaken of the impact that the bill might have on specialist programmes that have historically had higher levels of non-UK graduates, such as general practice and psychiatry?
That relates partly to Dr Gulhane’s questioning. There will still be a need for international medical graduates for some specialties, where there is not the same popularity among UK-domiciled medical graduates. That will not change—I expect that we will still have that.
The dynamic that might change is that the more popular specialty places among UK-domiciled students might be harder for international medical graduates to come into. However, if those graduates continue to have a determination, as I hope that they will, to live and work in the UK—I want that to be in Scotland, but it could be other parts of the UK—they might have to choose other specialties to practise.
We talked about ScotGEM. Specialty training means that a GP could spend part of their time in a GP practice and part as a diabetes or rheumatoid specialist or something like that. Does the bill enable the continuation of supporting rural practice by allowing doctors to split their time between in-hospital specialties, following training, and a GP practice?
I will bring in Ms Gibbons in a second on the dynamic that is at play and the impact that the bill will have on the ability to have a mixture of practice and to diversify. In rural communities such as the one that Ms Harper is from and the one that I am originally from, it is incredibly important to have medical professionals with diversity in their practice. We understand the need for rural practitioners, whether they be medical practitioners or part of the wider multidisciplinary team, to have diversity in their portfolios. They need to be able to deliver a wider variety of services. I have seen evidence of that in my visits to rural and island communities where, because of capacity and what needs to be responded to, people are stepping into areas of specialism that would be delivered by specialists in the central belt.
It is important for us to consider the crux of the point that you are making and I will bring in Ms Gibbons to talk about the dynamic in the context of the bill.
11:15
The bill will not affect the curriculum or the way in which people undertake training in general practice or any other specialty, which will remain the same, but it will affect their eligibility to be prioritised at the point of initial application.
I am interested in the international medical graduates and how we are going to manage. You outlined that in your opening speech so, to follow up, I wondered whether we know how many locum appointments for training—I think that they call them LATs—and clinical fellow posts in Scotland are filled by international medical graduates. Was that group considered when you looked at how to implement the legislation?
I will need to write to the committee to give numbers, but I understand Ms Mochan’s point about the wider impact that international medical graduates have across the whole system, which is why I talk about the importance that I place on us being a welcoming nation not just to international medical graduates but international workers in our health and social care system in general. Ms Mochan and I have corresponded on that on a number of occasions. I will write back to the committee with the numbers that Ms Mochan is asking for, because I do not have them to hand.
Thank you. I think that you have addressed my next point. I know that we both think about making sure that Scotland continues to be an inclusive workplace for our international students, that we value them and that the bill continues to mean that we are fair and consistent in our approach. I do not know whether you want to add anything to what you said in your opening statement.
I very much share the concern that Ms Mochan puts on the record, which is why the Scottish Government is content with this approach as opposed to others that we discussed with the UK Government before this legislation was mooted. In my view, it achieves the inclusive and welcoming approach that we want to take and the legal and workable element that I mentioned in my opening remarks. From our perspective, the UK Government’s previous attempts to address the issue, which we heard about in our private discussions with it, did not pass that test. We are now in a much better place with the bill.
That is great. I have one last wee question. A couple of people have raised the issue of Ukrainian doctors. Have we got Ukrainian doctors working here, and is it easy enough for them to be part of the system?
Ms Mochan will recognise my ministerial background in that regard and my determination to do all that we can to ensure that we support displaced Ukrainians in the health and social care system and those who bring with them skills and qualifications that are much in demand across the public sector and wider economy. Discussions continue to be had about the sharing of qualifications and qualifications standards. I will need to provide Ms Mochan with the status of that. Because it is to do with regulation, some of it lies outwith our control here in Scotland.
In principle, I will say now what I have been saying for four years: we expect our Ukrainians who have been displaced to be able to work to their qualifications, because we need their skills and experience, and we can offer them an opportunity to rebuild their lives here in Scotland. I care deeply about that, and I will make sure that I provide a more formal update to the committee on the progress of those discussions.
Other committee members have covered most of the issues that I wanted to cover. Others have mentioned concerns relating to the need for international medical graduates, because they go into specialties that are not usually preferred by UK graduates. The British Association of Physicians of Indian Origin has raised concerns about the potential limitations for career development. What equality monitoring is the Government planning to undertake to detect any adverse consequences that the bill might have for international medical graduates working in the NHS in Scotland?
Such monitoring is carried out routinely through discussions among the four nations on the recruitment that is required. Given that I will be writing to the committee in response to Ms Mochan’s questions, I am happy to add a paragraph to provide the assurances that Ms Mackay is looking for.
Beyond the bill, what can be done to ensure that international graduates feel welcome here? There has been a lot of anti-migrant rhetoric across the UK recently, and the bill could be seen as adding to the idea of not wanting people to come to this country to work. I appreciate from what the cabinet secretary has said that that is very much not the Scottish Government’s position, so what softer measures can it put in place to ensure that international medical graduates are aware that they are still welcome and that the bill should not put them off coming to Scotland?
I very much recognise Ms Mackay’s concern. We wanted to ensure that the proposals were workable and legal and would not have an unfair detrimental effect on international medical graduates. That was our first point, and we fiercely guarded that principle. To be fair, other devolved Governments were in a similar position in wanting to ensure that that basic principle was adhered to.
The second point is about the culture and rhetoric in Scotland. We have heard from committee members that there is a welcome consensus on the need for us to recruit internationally and the value that we place on our international medical graduates. It is to our credit that that position has been expressed on a cross-party basis in the committee. I hope that that view will extend to the wider body politic and that our political discourse can return to one in which greater dignity is shown to our migrant workers in Scotland than has been shown of late, as Ms Mackay referenced.
Thank you.
A number of clauses in the bill confer powers on UK ministers that might be exercised in areas of devolved competence. Will you expand on how the regulation-making powers that are set out in the bill were decided? To what extent does the approach respect the devolution settlement?
I will bring in Ms Gibbons in a second to provide a bit more detail. In our negotiations, we secured a number of conditions, including Scottish ministerial consent, that will ensure that the devolution settlement is respected. For all the reasons that I set out in my opening statement, we recognise that operating on a four-nations basis on the issue is advantageous to us, because that will avoid unintended consequences and detriment to the Scottish system. I ask Ms Gibbons to provide additional information on how that was achieved.
The committee might wish to refer to the recent letter that Mr Gray sent to the Delegated Powers and Law Reform Committee, which details the four powers in the bill. Three of them are treated in the same way—that relates to the consent element to which Mr Gray referred. There is also an option for those powers to be concurrent, so Scottish ministers could exercise them by themselves if they wished to do so. The final power is slightly different and reflects the UK Government’s international trade obligations. In certain circumstances, that is a reserved power, so our involvement would not be required.
I thank the cabinet secretary and his officials for their attendance.
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