For years the route was well worn: pass PLAB, get GMC registration, sit the MSRA, enter GP training. Thousands of international medical graduates followed it, and most advice you will find online still describes it as if nothing has changed.
Something has changed. In March 2026 the UK passed a law that reshapes who gets into specialty training, and GP training felt it immediately. If you are an international graduate planning a UK career in general practice, you need the current picture, not the 2024 one. This guide gives it to you straight: how selection works, what the new law says, what actually happened in this year's recruitment, and the routes that genuinely remain open.
What GP training is
GP specialty training is a three-year programme (ST1 to ST3) combining hospital rotations with placements in general practice. Along the way you sit the MRCGP assessments, and on successful completion you receive a Certificate of Completion of Training, entry to the GMC's GP Register, and the right to practise as a GP in the NHS.
It is one of the largest training programmes in the country, with thousands of posts each year across every region. That scale is why it has historically been the most popular first target for international graduates entering the UK system.
How selection works
Recruitment is run nationally. You apply online through Oriel, the UK's application portal for postgraduate medical training, during defined recruitment rounds. The first round for 2026 entry opened on 23 October 2025.
Selection for GP training rests on one assessment: the Multi-Specialty Recruitment Assessment (MSRA), a computer-based exam sat at test centres in the UK and internationally. It has two papers:
- Professional Dilemmas, a situational judgement paper testing how you prioritise and respond in realistic workplace scenarios.
- Clinical Problem Solving, testing applied clinical knowledge across common presentations.
There is no interview stage for GP. Offers and deanery locations are ranked on MSRA performance, which makes it one of the most transparent selection processes in UK medicine: your score is your application. For 2026 there were two sittings, in January and February, with the February window reserved for applicants to general practice and core psychiatry.
What you need before you can apply
Three things, and each takes time to obtain.
- GMC registration with a licence to practise. For international graduates this usually means the PLAB route, which the UKMLA is progressively replacing. The 2026 person specification required full registration at the point of application, a tightening from earlier years when provisional or pending registration could be completed later in the process. Our step-by-step guide to getting a job in the UK as a doctor covers the registration journey in detail.
- Evidence of foundation competence. Either completion of the UK Foundation Programme, or a Certificate of Readiness to Enter Specialty Training (CREST) signed by a consultant who has supervised you in a clinical post over a sustained period of recent practice. Applications for August 2026 entry required the 2024 version of the form. Note what this means: CREST comes from supervised clinical work, in the UK or overseas. An observership cannot generate it, and you should be sceptical of anyone who implies otherwise.
- English language evidence, typically IELTS or OET at the GMC's required grades, unless you qualify for an exemption.
What changed in March 2026
The Medical Training (Prioritisation) Act 2026 became law on 5 March 2026 and applied to recruitment for training programmes starting from 2026. Its stated aim is to restore competition ratios in UK training to sustainable levels. Its mechanism is blunt: applicants in defined priority groups are considered first, and other applicants are considered only for whatever remains.
You are in the priority group if any of the following applies:
- Your primary medical qualification is from a UK or Republic of Ireland medical school.
- You graduated from a medical school in Iceland, Liechtenstein, Norway or Switzerland.
- You have completed, or are currently on, a relevant UK training programme.
- You meet specified immigration criteria: British citizenship, Irish citizenship, Commonwealth citizenship with right of abode, indefinite leave to remain, or status under a residence scheme such as the EU Settlement Scheme.
Two details are easy to miss. A British citizen with an international medical degree is in the priority group for specialty training. And an international graduate who completes a relevant UK training programme moves into the priority group for subsequent applications.
The effect on GP recruitment was immediate. In the first round run under the Act, every one of the 4,364 GP ST1 places went to priority-group applicants. The majority of people who applied, 57 percent, were outside the priority group, and none of them received an offer. In the equivalent round a year earlier, priority-group applicants had filled 62 percent of places. It is now 100.
So can an international graduate still get into GP training?
Legally, yes. You are not barred from applying, and NHS England is explicit about that. Practically, an application made from overseas with no UK footprint now has close to no chance while demand from the priority group exceeds the number of posts, which it currently does by a wide margin.
That is a hard sentence to read, and we are not going to soften it, because planning around a false picture costs you years. What it does mean is that the way in has changed. Three positions change your standing:
Priority through status
If you hold British or Irish citizenship, right of abode, indefinite leave to remain, or EU Settlement Scheme status, the Act treats you as a priority applicant regardless of where you studied medicine. Check this before you assume anything about your chances; many graduates qualify without realising.
Priority through UK training
Completing a relevant UK training programme brings you into the priority group for what follows. This is the long route, and entry to that first programme is itself competitive, but it compounds: each stage completed inside the system strengthens your position for the next.
Employment outside the Act
The legislation governs recruitment into training programmes. It does not govern NHS employment. Trust-grade posts, clinical fellowships and other non-training jobs are filled by hospitals the ordinary way, on merit, and remain fully open to international graduates with GMC registration. Doctors in these posts build UK experience, collect the supervised practice that CREST requires, and in time may qualify for settlement, which itself confers priority. For most international graduates reading this, that employment route is now the realistic spine of a UK general practice career.
Where NHS exposure fits, honestly
Here is where we declare an interest: arranging NHS observerships and electives is what we do. So read this section as advice from people with a stake, and judge it on whether the logic holds.
UK clinical exposure has never been a formal requirement for GP training, and the MSRA does not award marks for it. What changed in 2026 is where the competition actually happens. If the realistic route now runs through non-training NHS jobs, then the competition that matters is shortlisting for those jobs, and there, familiarity with the NHS is a genuine advantage: employers can see you have watched UK medicine at close range, understood how its teams and referral pathways work, and still want the job. An observership is the accessible way for a graduate to build that familiarity, and a general practice week is the version aimed at exactly the setting this post is about.
Know its limits with equal clarity. An observership carries no clinical responsibility, so it does not produce CREST evidence, does not count as clinical experience on a person specification, and guarantees nothing. Anyone selling it as a ticket into training is misleading you. It is context, credibility and a working knowledge of the system you intend to join, and in a market this competitive those are worth having, provided you know exactly what you are buying.
What to do from where you stand
- Still at medical school? Your elective is the strongest NHS exposure available to you, and it closes at graduation. Check whether you fall into a priority category by status before making assumptions about training routes.
- Graduated, not yet GMC-registered? Registration first. English test, then PLAB or UKMLA. The route map sets out the order and timescales.
- GMC-registered? Target non-training NHS posts, build supervised UK experience towards CREST, and treat training applications as something your position will support later, not this year's plan.
- In the priority group by status? The classic route remains open to you: MSRA preparation is the highest-value work you can do.
Whatever stage you are at, you can register with us to see the placements currently open to you.
Sources and verification
The facts in this post were checked in July 2026 against NHS England's guidance for applicants on the Medical Training (Prioritisation) Act, the BMA's analysis of the legislation, the government's published impact statement, and NHS England's GP recruitment pages. Recruitment rules change annually and this Act is new; before acting on any specific figure, confirm it against the current national recruitment guidance for your entry year.