FAQs on national recruitment and training places - December 2025
We have received a number of questions concerning the College’s role in national recruitment, including assessment methods and prioritisation of applicants, as well as questions about our role in allocating training posts, and our College exam.
We hope these FAQs are helpful in setting out the College’s role and explaining the steps we are taking to address the challenges that are being faced.
Any additional questions not included below can be submitted to the College Officers via our Question Time with the Officers page (members-only access).
Resource: Medical Specialty Recruitment | NHS England Medical Hub
All medical doctors in the UK are recruited through a national process managed by NHS England. Doctors who want to train and work in psychiatry specifically are first recruited into Core Psychiatry Training (three years) and then into Higher Psychiatry Specialty Training (a further three to five years depending on the psychiatric specialty chosen). There are two ‘run-through’ psychiatry training programmes, both in Child and Adolescent and Intellectual Disability Psychiatry, where successful candidates who are progressing well, do not have to reapply for higher specialty training.
Resource: Psychiatry | NHS England Medical Hub
NHS England Northwest manage the operational delivery of Psychiatry Recruitment at both Core and Higher Specialty Training for the whole of the UK.
As you will be aware, for Core Psychiatry Training, doctors must have demonstrable skills in written and spoken English; must have completed a medical degree and are required to provide evidence of achievement of Foundation competence within the three and a half years prior to the intended start date of the post they apply to. This is usually demonstrated through the completion of a two-year UK Foundation Programme or equivalent (CREST form).
Doctors submit a standardised application via a central, national system called Oriel, and their eligibility is checked against a nationally agreed person specification. They then sit a Multi-Specialty Recruitment Assessment (MSRA) before being ranked and allocated to a training programme based on their score.
The College does not run national recruitment at Core or Higher psychiatry training levels.
At present, the MSRA does not include the ability to capture commitment to specialty. This has previously been discussed by the National Psychiatry Recruitment Board and is again being considered by our Task and Finish Group. We are pleased that having spoken with the leads at NHS WTE, they have confirmed that they will consider mechanisms suggested by the Task and Finish Group, regarding changes to the MSRA that show commitment to psychiatry.
The College does not run national recruitment at Core or Higher psychiatry training levels.
For Higher Psychiatry Training, doctors must have completed core training including the MRCPsych Examinations or be able to demonstrate equivalent experience when they submit a standardised application via a central, national system called Oriel. Their eligibility is checked against a nationally agreed person specification for the specialty they are applying to.
With regard to psychiatry, the National Recruitment Board (NRB) agrees the role requirements. The RCPsych has some input into this via the Chair of the National Psychiatry Recruitment Board, Professor Nandini Chakraborty. Applicants must also complete a mandatory self-assessment on their experience and achievements, which is verified by experienced, trained psychiatric assessors, (the RCPsych is not responsible for appointing these specialty specific assessors). The self-assessment score along with an online 15-minute interview, which focuses on suitability and commitment to specialty, and the MRCPsych Clinical Assessment of Skills and Competencies (CASC) score are used to give a final score to rank candidates. Offers are then made in rank order.
The UK Government and NHS England are responsible for national recruitment and whether UK graduates are prioritised or not. The College does not have control over this.
As we know, every person training in a UK Medical School is guaranteed a two-year UK Foundation Programme placement. The RCPsych have been advocating for UK Foundation Doctors to be prioritised at national recruitment for Core Training in psychiatry for a number of years. We welcome the growing interest in psychiatry as a career, however, the recruitment system is struggling to keep pace and without action, we risk losing talented Foundation Doctors eager to join the profession. We understand that prioritisation is being considered by the national recruitment board and we will share any update once it is available.
Training places are funded by the Government, through the NHS Statutory Education bodies (NHS England, Health Education and Improvement Wales, Northern Ireland Medical and Dental Agency and NHS Education Scotland) as well as through NHS Trusts and Health Boards that also provide clinical service provision.
We are pleased that there is such strong interest in psychiatry but recognise that the recruitment system is not keeping pace with the number of doctors who want to pursue a career in the profession.
The College has lobbied for an increase in Core Training (CT) posts for some time and has been successful in securing 32% more posts in England, 21% more in Scotland and 83% more in Wales when comparing data from 2024 with 2017. We continue to raise the issue of historical underfunding in mental health services and the psychiatric workforce, with fill rates for higher specialty training (ST4) trending upwards in recent years and reaching 87% in the most recent recruitment round for August 2025.
A Task and Finish Group has been established to review both the selection methodology and the operational viability of any proposed changes to Core Psychiatry recruitment. It includes members of the PRDC, experienced College educationalists and members of the National Recruitment Board.
The Group will consider a range of different evidence-based selection tools and methodology as well as whether they are deliverable by the NHS England team.
A statement with more information is available on our website.
It is unusual for there to be more candidates for the CASC exam than there are places. There was a small oversubscription for the 2025-2 CASC and so there were 12 candidates we could not initially offer a place to. We operated a waiting list and were ultimately able to offer all candidates on the list a place. Affected candidates who didn’t sit the exam were prioritised for 2026-1.
Subsequently, there was a historically unprecedented 937 applications for the 2026-1 CASC, which surpassed all previous records, and reflects the increasing popularity of psychiatry. As a result, we were unable to offer places to everyone who applied to sit the CASC in Sheffield for the January 2026-1 diet. We arranged an additional CASC exam sitting for the 104 candidates affected by the January 2026 oversubscription and this will take place in February 2026. We have been working closely with the National Recruitment Team to ensure that this aligns with the National ST4 Psychiatry Recruitment timetable. Affected candidates have been contacted directly about this and more information will be available on our website shortly.
We do not wish to disadvantage anyone wishing to sit the CASC, particularly if they plan to apply for Higher Psychiatric Specialty Training. We are therefore focused on creating longer-term capacity for the CASC.
We don’t currently prioritise doctors in UK core psychiatry training. This is because we have previously sought legal advice on prioritising UK workers for the CASC and have been advised against it. We are aware that some other Colleges have prioritisation approaches in place, and there are other Colleges are in a similar position to us. The issue of prioritisation for exams has been discussed at length at the Academy of Medical Royal Colleges’ Academy Assessment Committee (AoMRC AAC), and the RCPsych are seeking fresh legal advice on this issue.
UK graduates are permitted to apply for the CASC diet in Doha, however, one of the reasons for holding a CASC exam in Doha was to reduce the pressure on CASC places in the UK by making the CASC more accessible to International Medical Graduates closer to their homes. Having said this, UK graduates did travel to Doha to take the CASC in November 2025.
In 2024 and 2025 candidates from the UK could not apply for the CASC in Singapore as there was sufficient capacity for the 2024 and 2025 UK diets. We accepted applications from UK candidates for the 2025 Doha diet. We have already planned to increase capacity in 2026. No more than two attempts at the CASC are permitted in each calendar year, regardless of venue or training status.
The College sets the educational standards for psychiatry training and drives progression by designing curricula and robust formative and summative assessment points (Work-Place Based Assessments and the MRCPsych Examinations). This enables us to ensure we are training the psychiatrists our patients need.
We also monitor and support senior psychiatrists who are educators and trainers, and resident doctors (doctors in training) to progress through training to an agreed standard.
In order to do this, the College liaises with patients, carers and considers how the curriculum can be delivered equitably and safely across the UK. This helps ensure enough psychiatrists are trained to meet rising demand for psychiatric care.
Professional exams are a key component of the assessment of postgraduate medical education in all specialties. They are a way of ensuring, maintaining and improving quality through learning. The General Medical Council (GMC) — the regulator for doctors in the UK — sets out the standards for postgraduate medical education in their Excellence by design: standards of postgraduate curricula guidance document.
These standards, which place patient safety at the heart of all aspects of education, requires the inclusion of summative assessments. Exams are summative assessments which allow doctors to demonstrate that they have met the learning outcomes set out in the curriculum and provide assurance that the required standard of knowledge and competence has been demonstrated by candidates who pass the exams. By aligning assessment with curriculum objectives, it drives learning, guiding candidates to focus on core knowledge and skills that underpin safe and effective practice.
Exam fees are set to cover all the direct costs of delivering the exam, the continuous development of exams as well as a contribution to the overheads of the wider College. Direct costs of exam delivery include everything from venues, invigilators, role players, catering, exam software, examiner’s travel expenses to the recruitment and training of examiners, external psychometric services and the piloting of CASC stations. Over 1,000 College members are involved in delivering the MRCPsych.
The College is committed to keeping the costs of exams as low as possible and if exams generate a loss, as they have done in the past, these costs are covered by the College’s central funds. The College works to ensure that any surplus from examinations remains at less than 10% each year and if additional surplus is made, this is assigned to the RCPsych Resident Doctors Fund. The College publishes a report on the cost of training which details exam-related income and expenditure.