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

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

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

National Health Service, UK.

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

Application success by protected characteristics.

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.

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.