UK Specialty Training Competition Ratios 2026: CT1/ST1 and Higher Specialty Training

• 2026 specialty-level figures are now available. NHS England has published application numbers, training posts and competition ratios for 22 Round 1 CT1/ST1 recruitment categories. The 2026 ratios for several major specialties are lower than in 2025.
• Applications are not individual doctors. In Round 1, 39,387 people submitted 78,735 applications for 10,682 posts. That equates to 3.69 individual applicants, but approximately 7.37 applications, per post overall. Specialty rows show applications per post.
• Prioritisation changes what the ratios mean. In 2026 it applied to offers; in most 2027 specialty recruitment it also applies to interview invitations. Priority status, ranking and location preferences can all affect the outcome.
• Good preparation still matters. The ratios describe demand, not your personal likelihood of appointment. Meet the eligibility requirements, maximise the marks available and prepare for your specialty's selection process.

A competition ratio tells us how many applications were received for each advertised specialty training post. A figure of 8:1 means eight applications for every post; it does not mean that every doctor has an identical one-in-eight chance of receiving an offer.

Doctors often apply to several specialties, some withdraw during recruitment and others decline offers. Candidates also differ in eligibility, self-assessment scores, assessment performance, interview results and geographical preferences. Since the introduction of prioritisation, the overall application count may include doctors who are considered at different stages of the offers process.

Applications versus applicants: the crucial distinction

For 2026 Round 1, NHS England reports 39,387 individual applicants and 10,682 posts, equivalent to 3.69 applicants per post. Those applicants submitted 78,735 applications, equivalent to approximately 7.37 applications per post. The specialty tables use the second measure. A doctor applying to IMT, GP and Psychiatry contributes an application to each of those specialty totals.

What the ratio does not measure

The ratio does not show an applicant's probability of passing shortlisting, achieving an appointable interview score or receiving an offer in their preferred region. Nor does it show how many people would actually accept the post. It is best used as an indicator of demand and compared with other recruitment information, not as a standalone forecast of success.

Source: NHS England – official 2026 competition ratios.

These are the 2026 Round 1 competition ratios published by NHS England, covering 22 separately advertised recruitment categories. They are ordered from lowest to highest ratio, making it easy to locate the less and more heavily subscribed programmes. Some Scotland-only and Northern Ireland-only routes appear separately; they should not automatically be added to another row for the same broad specialty.

On a phone, swipe horizontally across the table to see every column. All entries are real text, rather than an image, so the specialty names and figures can be selected, searched and read by assistive technology.

Source: NHS England – Competition ratios for 2026 (page last reviewed 21 October 2026). Ratios are based on applications divided by posts, rounded to two decimal places.

All 17 directly corresponding categories recorded lower headline ratios in 2026 than in 2025. Among the larger entry routes, Ophthalmology fell from 21.54:1 to 9.92:1 and Obstetrics and Gynaecology from 16.65:1 to 9.98:1. The changes in some small or dual-programme categories were even larger.

However, these figures should not be interpreted as meaning that a particular applicant is now twice as likely to receive an offer. A lower ratio can reflect fewer applications, more posts or both; recruitment rules, priority status and programme preferences also matter.

Change is shown in applications per post (2026 minus 2025). All 17 matching programme labels are included. The changes do not represent an individual applicant’s probability of appointment.

Which programmes had the highest 2026 ratios?

The highest published values include Emergency Medicine (Northern Ireland) ST1 (76.80:1), Community Sexual and Reproductive Health ST1 (64.78:1), Broad Based Training (Scotland) CT1 (61.73:1) and the GP/Public Health dual CCT programme (61.54:1). These are small or separately recruited programmes, so a modest change in the number of posts can produce a very large ratio.

Among larger nationwide entry programmes, Core Psychiatry Training (21.63:1) and Neurosurgery ST1 (23.63:1) remain highly subscribed. By contrast, IMT stands at 5.03:1, GP at 4.74:1 and CST at 6.91:1.

If you are applying for IMT, our separate IMT application scoring guide explains how to assess and strengthen the portfolio element of your application.

The Medical Training (Prioritisation) Act 2026 changed how eligible applicants are considered for specialty training places. This is particularly important when comparing 2025 and 2026 competition ratios, or trying to predict what the next recruitment round might look like.

What happened in the 2026 recruitment round?

For 2026 recruitment, prioritisation applied at the offer stage. Selection and ranking still followed the relevant specialty rules, but appointable applicants in the priority group were considered for offers before appointable applicants outside that group. In the official Round 1 dataset, 19,908 of 39,387 applicants had priority status in at least one application; NHS England's subsequent analysis states that priority-group applicants filled 96% of CT1/ST1 posts (as at 28 September 2026).

Applicants outside the priority group could still be appointed where no appointable priority applicants remained for posts they had selected as preferences. Priority status did not override eligibility, ranking or the need to select suitable locations.

How will prioritisation work for 2027?

For most specialty recruitment processes from 2027, prioritisation applies at both interview invitation and offer stages. There are exceptions: for 2027 Round 1 Academic Clinical Fellowship (ACF) recruitment, it applies only at the offer stage, and Public Health ST1 recruitment is excluded from the Act's specialty prioritisation arrangements.

For 2027 Round 1 and Round 2 recruitment, candidates will have a maximum of five specialty applications per round. The five-application Round 1 limit was introduced in 2026; the Round 2 limit is new for 2027.

Who qualifies for the 2027 priority group?

Importantly, the additional 2027 priority criteria have now been specified in regulations laid on 14 September 2026. Priority routes include qualifying primary medical qualifications (including UK and Irish qualifications), specified relevant UK training programmes, and certain immigration or nationality statuses, including British or Irish citizenship, indefinite leave to remain and qualifying EU Settlement Scheme status. A doctor's individual circumstances and the specific specialty entry route determine which criteria apply.

For example, at CT1/ST1 the relevant qualifying UK programme is the UK Foundation Programme. At ST3/ST4, a relevant UK core or other entry training programme can qualify; the relationship between the completed programme and the higher specialty matters.

NHS England states that priority status will be shown in Oriel the day after the application deadline. If it is incorrect, applicants must seek review within the published deadline; for 2027 Round 1 this is 24 November 2026 at 17:00 UK time, and for Round 2 it is 15 December 2026 at 17:00 UK time.

Official guidance: NHS England – Prioritisation for Specialty Recruitment, Changes to 2027 recruitment, and 2026 prioritisation data.

In some years, competition increases because applications grow more quickly than training capacity; in others, extra posts or fewer applications bring ratios down. Both sides of the calculation matter, particularly in small specialties where even a handful of additional places can have a substantial effect.

More applicants does not always mean more distinct doctors

Individual doctors can apply for more than one specialty, so a rise in total applications does not necessarily imply the same rise in the number of people seeking training. In 2026, Round 1 applications were capped at five per person, limiting but not eliminating this effect.

Training capacity cannot expand overnight

Creating new posts requires funding, supervisors and approved training environments. Workforce planning, regional capacity and demand for future specialists influence how many posts are offered. Expansion in one specialty may reduce its ratio, while a small programme may remain highly subscribed despite attracting far fewer individual applications.

Geography and preferencing matter

National ratios can hide important differences between the training regions applicants are willing to accept. Someone willing to train in a wider range of locations may have options unavailable to a candidate restricted to one region. NHS England's 2026 prioritisation data also show that some non-priority applicants were offered posts when higher-ranked priority applicants had not preferenced those locations.

Finally, remember that the introduction of prioritisation for 2026 occurred after applications had closed. The 2026 application figures therefore should not be treated as evidence of how doctors will choose to apply once prioritisation also affects shortlisting in 2027.

Moving from CT1/ST1 into ST3/ST4 can involve another competitive recruitment process. At this stage, many candidates have several years of specialty-specific clinical experience, postgraduate examinations, teaching, quality improvement and research evidence. A lower numerical ratio at higher specialty level does not necessarily mean that selection is easy.

Core training programmes also feed several different higher specialties. An IMT trainee, for example, may pursue Cardiology, Gastroenterology, Respiratory Medicine or another physician specialty. Each has its own available post numbers and selection requirements.

Where interviews are used, candidates must demonstrate insight, judgement, communication and an understanding of the specialty. Our CT/ST and Registrar Interview Course covers preparation for this stage of recruitment.

The following table contains the 2025 ST3/ST4 competition ratios from the previously published NHS England / Oriel dataset. These are not 2026 figures. They are retained as a useful higher specialty reference while the corresponding 2026 breakdown is awaited.

On a phone, swipe horizontally to see all four columns.

Source: NHS England – Competition Ratios (2025 archive). These older figures reflect recruitment before the 2026 Act.

What stands out in higher specialty recruitment?

In the 2025 data, Occupational Medicine ST3 (17.00:1), Audiovestibular Medicine ST3 (16.00:1) and Emergency Medicine ST3 (DRE-EM) (11.32:1) are among the most heavily subscribed. Very small denominators are a major reason why some specialties report exceptionally high values.

Conversely, a low reported ratio is not an assurance of appointment. Applicants still need to meet the entry criteria and achieve appointable performance in the relevant assessments.

Published competition ratios are outside your control. Your eligibility, portfolio evidence, understanding of the selection process and interview preparation are not.

1 – Plan against the actual scoring criteria

Review the current recruitment guidance for your specialty, rather than relying on a previous year's portfolio points. Identify which achievements genuinely earn marks, what evidence is needed and whether they can be completed before the applicable deadline. For IMT applicants, see our 2027 IMT application scoring guide.

2 – Build relevant experience early

Structured teaching, quality improvement and clinical governance, leadership and research can contribute to a strong application where the published criteria recognise them. Choose activities because they are useful and relevant, not simply to accumulate certificates. Our Teach the Teacher courses provide structured training in teaching for doctors.

3 – Prepare for the selection method your specialty uses

The weighting of application, assessment and interview components varies by programme. Understand whether your specialty uses the MSRA, evidence verification, presentations, interview stations or other assessments. For IMT, our 2027 IMT interview guide explains the current format, scoring and assessment domains.

4 – Practise answering, not just reading

Timed, realistic practice and specific feedback can help you communicate evidence clearly, respond to probing questions and demonstrate your thinking. To get started, explore our CT/ST interview questions and CT/ST interview preparation tips. Doctors preparing for IMT can explore our IMT Interview Course; those applying for other training grades can explore our CT/ST and Registrar Interview Course.

5 – Be strategic about the locations you preference

Understand how the matching and preferencing process works before offers begin. If you are genuinely willing to work in more than one region, rank all acceptable locations in line with the applicable programme's rules. Do not preference a post you would be unwilling to accept merely to increase your options.

This article distinguishes official 2026 CT1/ST1 figures from 2025 higher specialty data and uses NHS England’s current prioritisation guidance. For the latest recruitment decisions, always consult the original source:

NHS England – 2026 Competition Ratios (CT1/ST1)

NHS England – Competition Ratios: all available years

NHS England – 2026 Prioritisation Data

NHS England – Prioritisation for 2027 Specialty Recruitment

NHS England – Changes to Medical Specialty Training Recruitment for 2027

The Medical Training (Prioritisation for Specialty Training Programmes) Regulations 2026

Last reviewed: 23 October 2026. Round 1 ratios reflect NHS England’s page reviewed 21 October; prioritisation figures reflect NHS England’s 28 September snapshot. 2026 ST3/ST4 figures are not yet included.