Healthcare hiring in the UK is more competitive than it has been for years. If you're a candidate, you're up against more people than usual. If you're a hiring manager, you're trying to pick the right person from a much bigger pile than you used to.

This blog looks at what's driving the change, what it means for both sides, and what to do about it.

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Quick answers

The headline points are short.

• Application numbers in healthcare have gone up sharply, in clinical training and across the wider sector
• In 2024 there were 4.7 applications for every specialty training post, up from 3.4 in 2023 and just 1.9 in 2019
• Some areas are far worse. Cardiothoracic surgery hit 45 applications per ST1 post in2024
• Hiring managers are sifting bigger shortlists, and good candidates can get missed in the noise
• Standing out now comes down to evidence, specialism, and a tighter application

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Why is the market so crowded?

A few different pressures have come together at the same time.

The number of applications for specialty training in England jumped 39.5% in one year, from 42,794 in 2023 to 59,698 in 2024. The number of training places only went up by a small amount, leaving 12,743 to handle that demand.

The picture is sharper in popular specialties. The BMA reported competition of 45:1 for cardiothoracic surgery, 26:1 for community sexual and reproductive health, and 17:1 for public health medicine at ST1 level. Only one specialty (genitourinary medicine) had a ratio under one.

It isn't only doctors. NHS Trusts and integrated care systems are reporting bigger application pools across non-clinical roles too, including finance, governance, HR, procurement and business support. Sifting takes longer, and busy recruitment teams are leaning on agencies more often.

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What it means for candidates

The volume of competition you're up against is real, not just a feeling.

The Doctor magazine reported that 70% of the 2020/21 F2 cohort didn't go straight into specialty training, compared with 38% of the 2012/13 cohort. A lot of doctors are taking locally employed roles or building their portfolios for longer before they apply.

Three things help in this market:

1. Be specific. General experience statements get lost. Real numbers, real settings and real outcomes are what shortlisters look for.
2. Build evidence early. Clinical leadership, audits, governance, quality improvement work, all of it counts towards a stronger application.
3. Be open to interim and locum roles. They are no longer just gap-fillers. They keep y our skills fresh and they keep you visible while permanent posts are tight.

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What it means for employers

Volume is a quality issue, not just a logistics one.

When 200 CVs come in for a single post, the risk isn't filling the role. The risk is missing the right person in all the noise. Big shortlists also slow your time to decide, and slow processes lose strong candidates to faster competitors.

Three things make a real difference:

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1. Tighten your must-haves. Sifting 200 CVs against five clear must-haves is a different job to sifting against twelve loose ones.
2. Score consistently. Whether you do it in-house or with a recruiter, agreed criteria reduce gut feel and reduce risk.
3. Move quickly when you find the right person. In this market, candidates rarely have only one option. Speed matters as much as sourcing.

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What candidates should do next

If you're job-hunting in healthcare in 2026:

• Apply more widely than you would have a year ago
• Tailor every application properly, even if it adds time
• Use a sector-specialist recruiter who knows where you fit and which roles area ctually open

You can browse current vacancies on the Castlefield job board.

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What employers should do next

If you're hiring in healthcare in 2026:

• Audit your shortlist criteria before you go to market
• Set a clear timeline and stick to it
• Use a recruiter that meets and vets candidates, so you're reviewing genuine experience rather than working through a high pile

To submit a vacancy, contact the Castlefield team.

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How Castlefield can help

Castlefield works with NHS Trusts and wider healthcare organisations across the UK. We support permanent and interim recruitment across Healthcare & Clinical, Finance & Accounting, Governance & Risk, Procurement & Supply Chain, HR & OD and Business Support & Admin roles.

You can see examples of how we've supported NHS hiring in our success stories, or read more market insight on The Castlefield Briefing.

Sources used in this blog

• BMA,The Doctor magazine, "Specialty training squeeze" (Ben Ireland, 17April 2025):https://thedoctor.bma.org.uk/articles/life-at-work/specialty-training-squeeze/
• NHSEngland, 2025 Competition ratios:https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/competition-ratios/2025-competition-ratios
• GMC,The state of medical education and practice in the UK Workforce report 2025:https://www.gmc-uk.org/cdn/documents/wfr25-report-251117_pdf-112967442.pdf

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