Prioritisation in the 2027 specialty training round: what to expect

The 2027 round, which closes on 19 November 2026 at 16:00, is the second run under the Medical Training (Prioritisation) Act 2026, and the first where priority decides who is invited to interview as well as who is offered a post. The best guide to what that means is last year's results: NHS England's final Round 1 2026 prioritisation data, correct at 28 September 2026 and published on 21 October.

The short version. If you are in the priority group, your overall chance of a place probably looks much like last year, when about half of priority applicants accepted a post. But being found appointable is likely to be enough less often than it was, because more priority applicants will reach interview and compete with each other afterwards. Ranking well, not just passing, will matter more. If you are not in the priority group, 2027 is likely to be harder than 2026.

This post goes through who counts as priority, what happened in 2026, and what the interview change is likely to do to those numbers. The figures are interactive: hover or tap them for the details. They cover CT1 and ST1 programmes.

Who counts as priority

Under the Act, priority applicants are considered before everyone else. You are in the priority group if any one of these applies:

• you graduated from a UK medical school;
• you have completed, or are on, a relevant UK training programme (for CT1 and ST1, that is usually the UK Foundation Programme);
• you are a British or Irish citizen, or a Commonwealth citizen with the right of abode in the UK;
• you have indefinite leave to enter or remain in the UK, or status under the EU Settlement Scheme;
• your primary medical qualification is from Ireland, Iceland, Liechtenstein, Norway or Switzerland.

The groups are the same for 2027. Early in the Act's passage there were suggestions that the immigration routes would drop out; the 2026 regulations, in force from 1 January 2027, keep all of them. There is no ranking within the group: one route is enough, and a UK graduate is not ahead of a British citizen who trained abroad. Of last year's priority applicants who accepted a place, 76% qualified as UK graduates, 9% as British citizens without a UK degree or UK foundation training, 8% through a UK training programme and 4% through indefinite leave to remain.

Your priority status shows in Oriel the day after applications close. If it's wrong, NHS England's guidance says to challenge it by 17:00 on 24 November 2026. The Act does not apply to public health recruitment.

What happened in 2026

39,387 people applied for 10,682 CT1 and ST1 posts, the familiar 3.7 applicants per post. 19,908 of them were in the priority group, about 1.9 for every post.

10,242 priority applicants accepted a post: 51% of the group. For non-priority applicants it was 427 out of 19,479, or 2%.

The 49% of priority applicants without a place include everyone who wasn't found appointable in any programme they applied to, people who applied only to the most competitive programmes, and people who turned an offer down. So the more useful question is what happened to priority applicants who reached the appointable standard.

What "appointable" means

NHS England defines an appointable applicant as one who was "successful in the assessment/interview process". They could have been offered a post if they ranked high enough. It's a standard, not a ranking: it says you were good enough to train, not that a post was available.

Each specialty sets its own standard: a minimum interview score, a minimum score in each MSRA paper, or both, and some have a review or veto for serious safety concerns. Once you clear it, offers go out in rank order, with priority applicants first. So for a priority applicant there are two steps:

1. reach the appointable standard;
2. rank high enough among the other appointable priority applicants for the posts and regions you preferenced.

In 2026, appointable usually meant an offer

In most large programmes, nearly every priority application found appointable got an offer in that programme: 99% in internal medicine training (1,716 of 1,742), 97% in core surgery, 96% in paediatrics and in obstetrics and gynaecology, 95% in ACCS emergency medicine, 91% in histopathology and 89% in general practice and clinical radiology.

It was already tighter in anaesthetics (70%), ophthalmology (69%), neurosurgery (62%) and core psychiatry (61%). At the end of September anaesthetics still had 274 priority applicants on its reserve list, core psychiatry 601 and general practice 923: people who met the standard but ranked below the last offer.

These figures count applications, not people. Someone appointable in IMT and anaesthetics appears in both, and if they took IMT, the anaesthetics offer may have gone further down the list. Offers also include ones that were declined.

What changes in 2027: priority reaches the interview

In 2026, priority applied only when offers were made. Shortlisting ignored it, so non-priority applicants took a share of the interview places and many of them passed: at least 1,524 in internal medicine training, 124 in obstetrics and gynaecology, 117 in paediatrics, 70 in clinical radiology and 69 in histopathology. They then lost out at the offer stage.

From 2027, priority applicants are invited to interview first. In programmes that shortlist for interview, the places non-priority applicants held last year will mostly go to priority applicants who just missed the cut. More priority applicants will reach the appointable stage, competing for roughly the same number of posts. So the share of appointable priority applicants who get an offer should fall, and by most where non-priority applicants held the most interview places.

To get a sense of the size, imagine those extra priority interviewees pass as often as the non-priority applicants they replace, and posts and offers stay as they were in 2026:

On those assumptions, an appointable priority application in internal medicine training would get an offer about 60% of the time rather than 99%, histopathology would fall from 91% to about 54%, obstetrics and gynaecology from 96% to about 81%, clinical radiology from 89% to about 76% and paediatrics from 96% to about 85%. Core surgery, ACCS emergency medicine and anaesthetics barely move, because very few non-priority applicants were appointable there in 2026.

Treat this as closer to a worst case than a forecast. The extra interviewees ranked below last year's shortlisting cut, so fewer of them may pass. More or fewer priority applicants may apply, and post numbers change every year.

General practice and core psychiatry select on the MSRA alone, with no interview, so this change doesn't touch them: priority still applies only at offers. Oral and maxillofacial surgery interviewed every eligible applicant in 2026, so it isn't affected either.

Does that mean fewer priority applicants will get places?

Not by much. Posts, not applicants, set how many places there are, and priority applicants already took 96% of them in 2026. Even if every one of last year's 427 non-priority places went to a priority applicant instead, and the number of priority applicants stayed the same, the share with a place would only rise from 51% to about 54%.

What changes is where the competition happens. Last year a lot of it was settled at shortlisting, before priority mattered. This year more of it moves after the interview, among priority applicants who have all cleared the bar. Expect longer reserve lists of appointable priority applicants and a bigger gap between appointable and offered in the popular programmes. Two other changes push the same way: anaesthetics now needs at least 210 in each MSRA paper before shortlisting, and core psychiatry 186.

In practice:

• Aim above the pass mark. Clearing the appointable standard got almost everyone an offer in many programmes last year. This year your interview score and rank are more likely to decide it.
• Preference widely. More appointable applicants chasing the same posts means popular regions fill sooner.
• Check your priority status in Oriel the day after applications close, and challenge it by 24 November if it's wrong.

What it took to be appointable

These were the published standards for some programmes in the 2026 round, from our competition ratios research. Check the current guidance for your own cycle, because standards change between years.

• Anaesthetics CT1: at least 60 out of 100 at interview. Two of the lowest global ratings from both assessors in one station, or serious safety, probity or behaviour concerns, trigger a review that can lead to a veto. For 2027 you also need at least 210 in each MSRA paper before you can be shortlisted.
• General practice ST1: at least 186 in each of the two MSRA papers. A strong score in one paper cannot make up for a low score in the other.
• Paediatrics ST1: at least 88 out of 160 at interview, with a clinical review for serious concerns or very low station scores. This is unchanged for 2027.
• Oral and maxillofacial surgery ST1: at least 60% of the total interview score and at least 40% in every station.
• Neurosurgery ST1: 65% of the available marks, according to the 2026 handbook.
• Internal medicine training CT1: under the current guidance, no score of 1, no more than two scores of 2 and a raw interview total of at least 42 out of 70.
• Core psychiatry CT1: MSRA only, with no interview. For 2027 the threshold is at least 186 in each paper.

Pick a programme below to see its 2026 numbers at each stage, alongside its rule.

If you are not in the priority group

We would rather be straight about this. In 2026, 427 non-priority applicants accepted CT1 and ST1 posts, mostly in internal medicine training (243), paediatrics (40), ACCS emergency medicine (39), core surgery (34), general practice (33) and obstetrics and gynaecology (33). They were interviewed on equal terms and took posts left once appointable priority applicants had been offered.

In 2027, in programmes that shortlist for interview, priority applicants are invited first, so many non-priority applicants may not reach interview at all, and the number of places is likely to be lower than last year. First check carefully whether you qualify through any of the routes above. General practice and core psychiatry are unaffected by the interview change, because they have no interview.

The caveats

NHS England says its figures "should not be used to predict future recruitment outcomes", and the 2026 data may still change slightly through reserve lists and data checks. The 2027 numbers above are a reasoned illustration from last year's results, not a prediction: post numbers, how many people apply and the new MSRA thresholds will all move them. But the direction is clear enough to plan around. Priority will still get most applicants who clear the bar into training. It will no longer do so as reliably on its own.

If you have a DocFolio account, the competition ratios page has every programme with priority and non-priority figures side by side, sortable by stage.