DOI: 10.1177/01410768261475034 ISSN: 0141-0768

Competition and equity in NHS specialty training, 2021–2024: longitudinal cohort analysis of protected-characteristic outcomes

Dinesh Aggarwal, Meera Roy-Chowdhury, Nicola Xiang, Sharon J Peacock
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Objectives:

To evaluate recruitment equity for NHS specialty training posts between 2021–2024, characterising demographics, quantifying appointment disparities by protected characteristics and assessing temporal trends.

Design:

Longitudinal cohort study using national recruitment data via annual Freedom of Information requests.

Setting:

National Health Service, UK.

Participants:

All medical and surgical specialty training applications to NHS England (2021–2024).

Main outcome measures:

Application success by protected characteristics.

Results:

Of 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, p  < 0.001). Pregnant/maternity-leave candidates had lower success (21.3% vs 25.8%, Δ4.5%, 95% CI 3.15–5.82, p  < 0.001), most markedly in paediatrics (Δ14.8%, 95% CI 8.95–20.58, p  < 0.001) and surgery (Δ13.7%, 95% CI 7.60–19.82, p  = 0.008). UK graduates outperformed non-UK graduates (40.7% vs 15.5%; Δ25.2%, 95% CI 24.8–25.6, p  < 0.001). Adjusted for country of graduation, 15/15 minority ethnic groups had lower odds of success versus White-British, with steepest declines among Black Caribbean and Bangladeshi graduates.

Conclusions:

Inequities 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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