The Medical Training (Prioritisation) Bill is designed to give UK (and Irish) medical school graduates priority for NHS foundation and specialty training places. DK went over the nuts and bolts of the legislation when it was published a fortnight ago.

It’s been rushed through the House of Commons this evening, continuing unamended with broad cross-party support – which is not to say that there wasn’t plenty of debate. We also learned that many universities have been raising concerns about the legislation’s effects.

One issue is around UK universities’ overseas campuses which offer medical degrees. Health committee chair Layla Moran pointed out that

Graduates of institutions such as Newcastle University Medicine Malaysia, Queen Mary University of London in Malta and St George’s in Cyprus are excluded from the Bill.

She said that one vice chancellor had written to her to point out that graduates of these programmes “complete the same medical degree, receive the same accreditation, and the majority then go on to train and work in the UK.”

Many other MPs reported that similar concerns had been sent their way. Lib Dem Helen Morgan warned of “serious” implications for one particular UK university if its overseas medical graduates – “who have always been considered UK graduates, undertaking NHS training, and a UK medical qualification registered by the General Medical Council” – were suddenly informed they would be, relatively speaking, at the back of the queue for NHS training.

Health secretary Wes Streeting got the government line in early on, in response to a question on Queen Mary’s Malta campus:

Students studying in Malta will not be prioritised in the Bill, but they will still be able to make applications. Queen Mary University’s Malta website is clear that Queen Mary does not administer the UK foundation programme and cannot control whether or on what basis applicants are accepted into the programme, and no one is guaranteed a post on qualification.

There was further detail from health Karin Smyth at a later point in the debate, pushing back against an amendment that would extend prioritisation to all UK nationals, whether or not they had graduated from a UK medical school (various MPs had flagged how many medical students studying on UK programmes abroad were British):

We therefore cannot accept the amendment. To do so would risk a significant increase in the pool of prioritised doctors who would compete with UK-trained doctors. The amendment would incentivise the expansion of the market for overseas medical schools, including medical schools working with foreign Governments to grow the overseas campus sector. That could offset any increase in postgraduate training places and undermine workforce planning.

It’s not an enormous vote of confidence in this particular aspect of TNE. And as well as threatening (you might imagine) the prospects of overseas programmes, it also creates enormous unfairness for the students there, who had started their programmes under the assumption that they would be able to apply for NHS posts on a level playing field. Labour’s Danny Beales made this point in relation to the daughter of a constituent who had enrolled on a UK programme taught abroad:

When she enrolled last year, she was given a guarantee by the university that she would face no disadvantage compared with students on the London campus.

We have heard that there can never be any guarantees; that there is not a legal contract that this Government make with individuals; and that this House is sovereign, and can make different decisions. But I think there are issues of fairness around the retrospective applications of decisions that we make that can affect people’s lives, particularly at crucial points, such as when studying or getting a job – decisions that have major impacts on someone’s future life chances.

Alisha studies a British curriculum and she will be awarded the same degree qualification as her peers on the London campus. However, if the Bill’s current wording is interpreted strictly geographically instead of institutionally, it would mean that she is categorised as an international medical graduate, despite being a British citizen, studying a British medical degree at a British university.

If the changes were being introduced in a gradual, transitionary way, some – though not all – of the unintended consequences could be smoothed over. Plenty of the parliamentary debate related to unintended consequences of the legislation being introduced in an emergency fashion – Royal Assent is targeted for the start of March in order for the measures to largely be in effect for the coming academic year.

These consequences include things like the effect on current international NHS staff worried about missing out on scarce specialty training places as their careers progress, or any potential effects on international recruitment to medical schools. An opposition amendment called for an annual report on this latter point, in the interests of gauging impact on medical school finances. But it wasn’t taken up.