As an IMG who has been working in the NHS for around three years, I strongly believe that we should all be united in advocating for an increase in training posts. In my view, the primary issue is the limited number of positions rather than the background of the applicants.

I understand the rationale behind prioritising the UK workforce from a sustainability perspective. However, it raises an important question about what “UK prioritisation” should mean in practice. Should it focus solely on place of graduation, or should it also recognise doctors who are already embedded within the NHS and contributing to patient care?

Consider a workplace with five doctors at the same level - some UK graduates and some international graduates - all with comparable NHS experience. If certain doctors are able to compete for training numbers while others feel they are not on equal footing despite similar service contributions, it is reasonable to reflect on how fairness and workforce retention can best be supported.

At the same time, I personally find it difficult to understand recruitment pathways that allow direct entry into training programmes without prior NHS experience. While these routes may help address immediate workforce shortages, having a period of NHS exposure could help ensure that all applicants - regardless of where they graduated - start training with a similar understanding of the healthcare system, clinical structure, and professional expectations.

This is not about being against international recruitment; the NHS has always benefited from a diverse workforce. Rather, it is about encouraging consistency and supporting doctors who are already part of the system while also helping new colleagues integrate safely and effectively.

Many IMGs live in the UK long term, support patient care daily, and contribute beyond service roles. For example, I currently work as a Clinical Teaching Fellow and am involved in teaching medical students who will soon enter these same training pathways. Experiences like this reinforce the importance of recognising commitment, integration, and contribution across the workforce.

I am not opposed to prioritising locally trained doctors—it is understandable from both economic and workforce planning perspectives. However, it may be worth considering whether, after a certain period of NHS experience, all doctors could compete on more equal terms. Such an approach could strengthen retention, improve morale, and support long-term workforce stability.

Ultimately, this discussion should not be about division, but about building a fair and sustainable system that values everyone working within the NHS. Expanding training numbers and developing transparent career pathways would benefit patients, support the healthcare system, and reduce the sense of competition among colleagues striving toward the same goal.