ArticleJournal of the Royal Society of Medicine2026
Competition and equity in NHS specialty training, 2021-2024: longitudinal cohort analysis of protected-characteristic outcomes.
Article in Journal of the Royal Society of Medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo evaluate recruitment equity for NHS specialty training posts between 2021-2024, characterising demographics, quantifying appointment disparities by protected characteristics and assessing temporal trends.
designLongitudinal cohort study using national recruitment data via annual Freedom of Information requests.
settingNational Health Service, UK.
participantsAll medical and surgical specialty training applications to NHS England (2021-2024).
main outcome measuresApplication success by protected characteristics.
resultsOf 214,893 applications, 52,998 (24.7%) were appointed. Annual success rates fell from 12,419/37,971 (32.7%) in 2021 to 13,929/81,189 (17.2%) in 2024. Competitiveness increased but non-UK graduate applications did not reduce successful UK graduate numbers. Gender segregation persisted: surgical specialties had the highest proportion of male applicants, whereas for females this was observed in obstetrics and gynaecology. Female applicants had higher success rates than males (27.5% vs 22.2%; Δ5.3%, 95% CI 4.95-5.70,
conclusionsInequities persist in NHS specialty recruitment. Gender segregation remains and disparities disadvantage pregnant/maternity-leave applicants. Disparities impacting minority ethnic UK graduates have widened. While data constraints preclude adjusting for confounders, these consistent trends require continuous monitoring and targeted interventions to ensure equitable access.
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