The Medical Training Pathway For Doctors In The UK - GP & Hospital Consultants - 2025 Updates

Becoming a doctor in the UK follows a structured training pathway: medical school, the UK Medical Licensing Assessment (UKMLA), the Foundation Programme, then specialty training, all within the NHS. Each stage builds the practical skills, experience and knowledge needed to qualify as a GP or hospital consultant. From starting medical school it takes roughly 10 years to become a GP and 14 or more years to become a consultant, depending on the specialty.

In this article, you’ll learn about the stages of training required to become a hospital or community consultant doctor in the UK or a general practitioner (GP).

This is extremely useful to know, especially if you are applying to study medicine in the UK, as this can help you develop your answers during your medicine interview.

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Step 1: Medical School (5-6 Years) And The UKMLA

The UK Medical Licensing Assessment (UKMLA)

Since the 2024/25 academic year, all students graduating from UK medical schools must pass the UK Medical Licensing Assessment (UKMLA) before they can join the medical register. The UKMLA has two parts: the Applied Knowledge Test (AKT), a written exam, and the Clinical and Professional Skills Assessment (CPSA), a practical exam usually delivered as part of your medical school finals. There is no separate fee for UK students, as the cost is covered by your medical school.

The UKMLA sets a single, GMC-governed standard for safe practice. International medical graduates still sit PLAB, but since 2024 its content has been updated to align with UKMLA standards, so that everyone joining the UK register is held to the same benchmark.

Length: 4 - 6 years

The first step to becoming a doctor in the UK is to take an undergraduate or postgraduate medical degree at medical school. This is called Undergraduate Medical Training.

Students who have completed a previous degree before joining medical school may apply for a condensed 4-year Graduate Entry Medicine (GEM) course.

Some students may complete an additional year at the beginning of medical school, known as a foundation year, to develop their science-based knowledge. This will extend their degree to 6 years long.

The classical medical degree at university is a 5 year undergraduate degree.

Some universities have an optional or mandatory intercalation year which can extend training by one year. Mandatory intercalation occurs at some medical schools such as UCL, Cambridge, Imperial and Oxford.

This will consist of both:

1. Pre-Clinical Teaching - consisting of basic science, physiology, pathology, anatomy, biochemistry and molecular biology.
2. Clinical Teaching - consisting of practical skills, patient-based learning and application of pre-clinical knowledge.

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The Foundation Programme (FY1 and FY2): The First 2 Years As A Doctor

Length: 2 years

Medical School Graduates who are continuing to become doctors are entered into the Foundation Training Programme. This is where doctors are known as FY1 and FY2 doctors.

It is after the completion of FY1 that doctors receive full registration with the GMC.

This foundation programme consists of 2 years, where doctors will rotate around 6 different specialities in blocks of 4 months. This enables them to gain experience in both hospital and community medicine, from a range of different medical and surgical departments.

The skills learnt during the Foundation Training Programme constitute the Postgraduate Medical Training which is required to apply for jobs as a doctor in a particular speciality.

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Specialty Training: Run-Through vs Uncoupled Training Pathways

Run-Through vs Uncoupled Specialty Training Explained

Specialty training comes in two structures. In uncoupled training you apply twice: first for core training (such as Internal Medicine Training, Core Surgical Training or ACCS), then competitively again for a higher specialty training post at ST3/ST4 level. In run-through training you apply only once and, if accepted, are guaranteed progression all the way to your Certificate of Completion of Training, with no second national application. Run-through specialties include general practice, paediatrics, obstetrics and gynaecology, ophthalmology, clinical radiology, and community sexual and reproductive health. The structure matters because uncoupled pathways create a second competitive bottleneck at ST3.

Length: 3 - 8 years

There are over 60 different specialities which doctors can train in.

Different specialities will require different types of training programmes. Here are some of the common next stages of training:

1. Core Surgical Training (CST): lasting 2 - 3 years for careers in most surgical specialities such as general surgery, urology, orthopaedics and many more
2. Internal Medicine Training (IMT): lasting 3 years - for careers in general internal medicine such as cardiology, gastroenterology, nephrology.. and so many more!
3. Acute Care Common Stem (ACCS): lasting 3 - 4 years - for careers in anaesthetics, accident and emergency and intensive care.
4. General Practice Training (GPST): lasting 3 years - to become a general practitioner in the UK.

This is then followed by Higher Speciality Training which can last 3 - 5 years.

At several points in their training, doctors may be required to sit exams to continue in their training. The doctor will also have to apply for a higher speciality training post following their initial surgical core training, internal medicine training or ACCS training.

Some specialities may allow trainees to complete a form of training known as Run-through Training, whereby you are only required to apply once, and if accepted you are guaranteed a higher speciality training post.

Examples of specialities with run-through training posts include GP, clinical radiology, community sexual and reproductive health, obstetrics and gynaecology, ophthalmology and paediatrics.

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Certificate of Completion of Training (CCT): How You Become A Consultant

The Specialty Training Bottleneck: Record Competition In 2025

The biggest challenge in the UK training pathway today is not finishing training, but getting into it. In 2025, around 92,000 applications were made for just 12,833 specialty training posts in England, an average competition ratio of roughly 7:1, up from 4.7:1 the year before and just 1.9:1 in 2019. GP training alone saw nearly 21,000 applications for about 4,300 ST1 posts, leaving four in five applicants without a place that round.

This bottleneck is driven by a mismatch between a growing number of UK graduates, a surge in international applicants, and a training-post number that has not kept pace. In my experience as a GP, this is now the single most common worry I hear from junior colleagues: the medical degree no longer guarantees a smooth run to consultant or GP. Some specialties are extreme, with psychiatry, ophthalmology and clinical oncology among the most oversubscribed.

The Medical Training (Prioritisation) Act 2026 And IMGs

In response to this crisis, the Medical Training (Prioritisation) Act 2026 became law in early 2026. From the 2026 recruitment round it prioritises UK and Irish graduates (plus graduates from Norway, Iceland, Liechtenstein and Switzerland, and those with settled status or who have already completed a UK foundation programme or core training) over international medical graduates for specialty and foundation training posts. Prioritised applicants are considered first, and non-prioritised applicants are only offered places once that group is exhausted.

For 2026 the prioritisation applies at the offer stage, and from 2027 it is expected to apply at both the shortlisting and offer stages. IMGs can still apply, and routes such as the Medical Training Initiative (MTI), which offers time-limited NHS training placements for overseas doctors, remain open. For a fuller breakdown of the law and how to discuss it at interview, read our guide to the Medical Training (Prioritisation) Act 2026 and what it means for IMGs in the NHS.

At the end of their training and following completion of their final exams, a doctor is awarded their Certificate of Completion of Training (CCT), which allows them to practice as a consultant doctor in a permanent hospital or community role.

Speciality Doctors (SAS Doctors)

SAS doctors are doctors who have completed their core medical training, internal medicine training or ACCS as a minimum and have taken up a permanent staff job at the hospital.

This means that they are no longer working within the medical training pathway, and are not working towards a CCT.

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Working As A Doctor In The UK As An International Medical Graduate (IMG)

To gain full GMC registration in the UK, international medical graduates (IMGs) usually need to pass the PLAB exam (parts 1 and 2). Since 2024, PLAB content has been aligned with the UK Medical Licensing Assessment (UKMLA) so that UK and international graduates are assessed against the same standard. UK graduates now sit the UKMLA itself as part of their final degree, rather than PLAB.

IMGs must also evidence their English with the International English Language Testing System (IELTS) or the Occupational English Test (OET). Note that from the 2026 recruitment round, the Medical Training (Prioritisation) Act 2026 means UK and certain other graduates are prioritised over IMGs for specialty and foundation training posts, so securing a UK training place as an IMG is now significantly harder.

To apply for foundation training in the UK, IMGs need to:

1. Apply for eligibility checking one year in advance of when they wish to join the foundation training program.
2. Pass their medical school exams
3. Pass PLAB parts 1 and 2 (now aligned with UKMLA standards)
4. Apply for provisional GMC registration