Short answer: The UK’s Medical Training (Prioritisation) Act, which became law on 5 March 2026, gives priority for Foundation Programme and specialty training places to graduates of UK universities. Graduates of overseas campuses of UK universities, including Queen Mary University of London’s Malta campus, are classed as international medical graduates and allocated only through a reserve pool. The university says its Malta students take the identical course, the same examinations and the same qualification as its London students, all regulated by the General Medical Council. The government has declined to amend the Act, though the Secretary of State retains a power to add further groups to the prioritised category.
If you are an international medical graduate planning a route into the NHS, the Malta row is worth understanding. It is not just a dispute between one university and the government. It is a live test of what the 2026 prioritisation rules mean in practice: who counts as an IMG, who does not, and how much weight geography carries against qualifications.
What did the Medical Training (Prioritisation) Act change?
Before 2026, entry into the UK Foundation Programme was broadly open: graduates of UK medical schools had the strongest position, but international graduates competed for the remaining places through national allocation. In January 2026, the government announced emergency legislation to prioritise UK medical graduates in the allocation of Foundation Programme and specialty training posts. The Medical Training (Prioritisation) Act became law in early March 2026.
The stated aim was workforce planning: with competition for training places running at record levels, the government wanted British-trained doctors to have first claim on British training posts. The Act does not ban international medical graduates from applying. It changes the order in which applicants are considered, with prioritised groups taking the first places and everyone else allocated through later rounds and reserve pools. For the 2027 recruitment cycle, the government has confirmed that the interim 2026 arrangements will roll over for another year, with immigration status used as a proxy for significant NHS experience for specialty training applicants, according to the BMJ’s reporting of the regulations.
For a detailed walkthrough of the Act itself, I wrote an explainer when the law passed: Medical Training Prioritisation Act 2026: what IMGs must know. The Malta row picks up where that explainer left off, with the first cohort to be sorted by the new rules.
Who counts as prioritised under the Act?
The priority groups under the Act are, broadly:
- Doctors who graduated from a medical school in the United Kingdom or the Republic of Ireland.
- IMGs who studied in Iceland, Norway, Liechtenstein or Switzerland, who are treated the same as UK graduates under reciprocal arrangements.
- Doctors who have completed, or are completing, the UK Foundation Programme or the relevant earlier stage of a UK specialty training programme.
The Secretary of State for Health and Social Care also has a power to bring further groups into the prioritised category. That power is now the focal point of the entire row, because one group of graduates, trained by a British university to British standards, sits outside the priority list.
Why are Malta graduates treated as IMGs?
Queen Mary University of London runs a five-year MBBS programme on a campus in Gozo, Malta, taught by its own Faculty of Medicine and Dentistry. According to the university, the Malta students follow the identical course to students in London, sit the same examinations at the same time, including the UK medical licensing assessment, and are regulated by the General Medical Council. Since welcoming its first cohort in 2017, more than 200 medical students have graduated from the campus.
Yet under the Act, these graduates are designated as international medical graduates, not UK graduates, as the university’s own placements guidance confirms. The distinction is geographic, not academic: the campus is overseas, so its graduates sit in the reserve pool. Queen Mary has stated publicly that the government was not prepared to accept any amendment to the primary legislation, though ministers are sympathetic to the students’ cause and there may be scope for subsequent modification. The university continues to press for its graduates to be included in the prioritised category.
QMUL Malta is not the only affected campus. Newcastle University also runs a medical campus in Malaysia, and The Times reported that none of the 184 foundation year applicants from the affected overseas campuses was accepted by the NHS in the first allocation round this year. The same reporting noted that around 150 British students a year study a British medical qualification at an overseas campus, many because they were not offered a place at home and because it can be cheaper than international fees at a UK campus.
What has the government said?
The government’s position, as relayed by Queen Mary, is that the primary legislation will not be amended for these graduates, but ministers have expressed sympathy and pointed to the Secretary of State’s power to add groups to the priority category later. For now, no such addition has been made.
Analysis by Pulse Healthcare has been blunt: the law judges these graduates by geography rather than merit, creates a two-tier system that contradicts the Act’s stated goal of equitable workforce planning, and excludes a ready-made pool of qualified doctors at a time when NHS trusts are reporting serious junior doctor vacancies. Those are the analysts’ words, and the staffing argument is the one that travels furthest outside medicine: it is hard to explain why doctors trained to UK standards are unavailable to the NHS that trained them while rota gaps are filled by expensive temporary staff.
What happens to the Malta cohort now?
The immediate picture for the affected graduates is uncertain. They remain eligible to apply for the UK Foundation Programme and may secure posts in subsequent allocation rounds, since some prioritised candidates decline offers each year. But the time frame is unconfirmed, and they sit below prioritised applicants on the waiting list.
There is a Malta route. The Maltese government has confirmed flexibility in the allocation of its own Foundation Programme jobs this year. Completing Malta’s two-year foundation programme is recognised as equivalent academic experience to the UK programme, including full GMC registration at completion. The catch, for those still set on the UK, is that the Malta programme does not confer prioritised status for UK specialty training applications later on.
Are the Malta graduates challenging the decision?
Yes. According to the graduates’ own campaign, a group of 17 Malta graduates is pursuing a judicial review against the Secretary of State for Health and Social Care, arguing that students who enrolled under one set of rules should not be retrospectively punished when the rules change. The campaign states that a High Court hearing is underway and that it is raising 130,000 pounds to cover legal costs.
This is the part of the story worth watching, whatever its outcome. If the court grants relief, the most likely remedy would be a grandfathering arrangement: current students and recent graduates who enrolled before the rule change would be protected, while the Act’s forward-looking prioritisation survives. A grandfathering clause is also what Pulse’s analysts have called for, as the minimum corrective that preserves the Act’s workforce-planning aims without rewriting the law.
What does this mean for IMGs planning a UK route?
Four practical lessons, stated plainly:
- Check where you sit in the priority order, not just whether you can apply. Eligibility and prioritisation are now different things. You can be eligible to apply and still sit in a reserve pool.
- Overseas campuses of UK universities are not a UK route. The qualification may be GMC-accredited and the teaching identical, but the allocation system reads the campus location. If you are choosing where to study, weigh this explicitly.
- Track the 2027 arrangements. The interim rules roll over into 2027 with immigration status as a proxy for significant NHS experience at specialty level. The rules are still bedding down; check current NHS England guidance before you commit to a timeline.
- Build a portable career. My framework for choosing a country as an IMG applies here: diversify destinations, keep licensing exams current, and document your portfolio from day one. My guide to building a specialty training portfolio covers the audits, quality improvement and teaching evidence that matters whichever system you enter.
I want to be careful with the tone here. This is an identity site, and the temptation with a story like this is outrage. The honest version is more measured: the Act does what the government intended it to do, which is prioritise graduates of British universities. The problem is the boundary. A graduate whose degree is awarded by Queen Mary University of London, examined to the same standard, and regulated by the GMC, is, in every sense that matters for patient safety, a product of British medical education. Drawing the line at geography rather than at qualification equivalence looks like an administrative shortcut, and the people paying for it are the ones who trusted the rules as written when they enrolled.
Frequently asked questions
Are QMUL Malta graduates really IMGs under the 2026 Act?
Yes. Queen Mary has confirmed that its Malta graduates are now designated as IMGs under the Medical Training (Prioritisation) Act 2026, despite the identical course, examinations and GMC regulation shared with its London students.
Can Malta graduates still get UK Foundation Programme posts?
They remain eligible to apply and may secure posts in subsequent allocation rounds, since some prioritised candidates decline offers. But they sit below prioritised applicants on the waiting list, and no time frame has been confirmed.
Does the Malta Foundation Programme count towards UK training?
Completing the two-year Malta Foundation Programme is recognised as equivalent academic experience to the UK programme, including full GMC registration. It does not, however, give prioritised status for UK specialty training applications.
Is the government changing the law for Malta graduates?
Not currently. Queen Mary says the government was not prepared to accept amendments to the primary legislation, though the Secretary of State has the power to add further groups to the prioritised category and ministers have said they are sympathetic.
Which other campuses are affected?
Newcastle University’s Malaysia campus is the other named programme. Around 150 British students a year study a British medical qualification at an overseas campus, according to The Times.
What should IMGs do if they are considering a UK route?
Check your place in the priority order, not just your eligibility; treat overseas campuses of UK universities as non-UK routes for allocation purposes; follow the 2027 arrangements as they develop; and keep your options and portfolio portable across destinations.