On the afternoon of Thursday 14 May 2026, Wes Streeting tendered his resignation as Secretary of State for Health and Social Care, declaring in a public letter to the Prime Minister that he had "lost confidence" in Sir Keir Starmer's leadership and that to remain in Cabinet would be "dishonourable and unprincipled." The resignation was reported almost simultaneously by Bloomberg, CNN, ITV News and the New Statesman, and confirmed within hours by the GOV.UK ministerial pages, which list James Murray MP - until that morning Chief Secretary to the Treasury - as the new Secretary of State for Health and Social Care. The departure of a politician who, on his first day in office in July 2024, declared the NHS "broken" and who personally commissioned the Darzi Investigation, the Leng Review, the 10-Year Health Plan and the Medical Training (Prioritisation) Act, is not merely a Westminster drama. It is a hinge moment for English medical workforce policy, and one that demands sober examination by those who will spend the next decade of their professional lives working - and training - under the institutional arrangements his tenure has shaped.
For candidates preparing for the United Kingdom Medical Licensing Assessment (UKMLA), and for the Applied Knowledge Test (AKT) that forms its written half, the political question is not abstract. Foundation school capacity, specialty competition ratios, the regulatory status of physician associates, the architecture of the General Practice contract and the Medical Schools Council expansion plan are not bureaucratic distractions. They are the determinants of where you will work, whether you will train, and what kind of clinician you will be permitted to become. This essay sets out what Streeting's resignation means for those decisions, drawing on the Darzi report, the 2023 NHS Long Term Workforce Plan and its post-publication critique, the July 2025 10-Year Health Plan, the Leng Review, BMA position statements, NHS England recruitment data, and the Lancet's recent commentary on medical unemployment.
The Streeting inheritance: ambition and antagonism
Streeting inherited an NHS whose problems had been catalogued, with unusual candour, by Lord Darzi's Independent Investigation of the National Health Service in England, published on 12 September 2024. Darzi described a service in "critical condition," documenting a £37 billion shortfall in capital investment over a decade and a half, an elective waiting list that had grown from 2.4 million in March 2010 to over seven million by mid-2024, and a workforce demoralised by the after-effects of the pandemic, the Lansley reforms ("a calamity without international precedent") and successive failures of capital and revenue planning. Streeting adopted the diagnosis and added a slogan - "reform or die" - that would recur in almost every speech he gave thereafter.
The 10-Year Health Plan, Fit for the Future, published on 3 July 2025, codified the response. Its organising idea is the three "shifts": from hospital to community, from analogue to digital, and from sickness to prevention. A new "neighbourhood health service," intended to operate twelve hours a day, six days a week, would draw diagnostic, rehabilitative and post-operative work out of acute trusts; the NHS App was promised as the "full front door" to the system by 2028; and a phased "single patient record," initially targeted at maternity and frailty care, would integrate fragmented IT estates. The plan rejected the 2023 NHS Long Term Workforce Plan's headline staffing projections as "a fiction," promised 1,000 new specialty training posts over three years, and committed to reducing international recruitment to under ten per cent of all NHS joiners by 2035. The associated 10-Year Workforce Plan, promised for spring 2026, has not at the time of writing been published.
Streeting's working relationship with the medical profession was, by any reasonable measure, the most antagonistic of any health secretary in recent memory. He brokered a pay deal with the then–junior doctors in September 2024 that ended the immediate dispute, but the truce did not hold. In 2025 the BMA Resident Doctors Committee - operating first under co-chairs Dr Melissa Ryan and Dr Ross Nieuwoudt, and from 27 September 2025 under Dr Jack Fletcher - took three further rounds of five-day industrial action (July, October and December). In November 2025 Streeting described those strikes as "morally reprehensible" and called the BMA "cartel-like." In February 2026 resident doctors returned a 93 per cent strike mandate on a 53 per cent turnout, extending the dispute through August 2026. The GP Committee for England, chaired by Dr Katie Bramall-Stainer, entered formal dispute with the Department of Health and Social Care on 1 October 2025 over online-access contract changes; that dispute remains live, with the imposed 2026/27 contract rejected and a profession-wide referendum running from 4 to 25 March 2026.
The British Medical Association's response to Thursday's resignation was therefore pointed rather than mournful. Dr Emma Runswick, the BMA deputy chair of council, said the change comes "at a critical time," noting that "all major groups of NHS doctors in England are currently in dispute with the Government, with the very real prospect of industrial action across all primary and secondary care doctors this year." She added, pointedly, that "the new Health Secretary must also address the threat to patient safety posed by doctor replacement with non-medical staff, the shortage of training and GP jobs, and the outrageous redundancies of public health doctors."
The workforce plan: a half-built scaffold
The 2023 NHS Long Term Workforce Plan promised to double medical school places to 15,000 a year by 2031/32, to increase GP specialty training places by fifty per cent (to 6,000) and to expand adult nursing places by ninety-two per cent. It assumed an ambitious productivity growth of 1.5 to 2 per cent and made a controversial commitment to "support medical schools to move from five- or six-year degree programmes to four-year degree programmes," with a medical degree apprenticeship pilot. The National Audit Office subsequently criticised the underlying modelling, and a 2025 paper in PubMed Central by Bell and colleagues argued for "an immediate moratorium on medical school expansion in the UK" until clinical capacity, supervision and the post-graduate training bottleneck could be addressed.
The 10-Year Health Plan partially rebalanced the prospectus by accepting that NHS staff numbers in 2035 will be lower than the 2023 projections, that international recruitment must fall to under ten per cent, and that expansion should "focus on widening access to talented students from underprivileged backgrounds." But the central tension - that doubling undergraduate intake without commensurate expansion of foundation, core and specialty places will produce, not solve, a workforce crisis - was not resolved. The Royal College of Physicians, in its response to the workforce plan refresh, urged that "the expansion of postgraduate medical specialty places will be key," and the King's Fund warned that “the long-term nature of the plan means that it does not address the urgency of the issues facing health care in the here and now.”
The training bottleneck and the prioritisation act
Streeting's most contested workforce legacy is the Medical Training (Prioritisation) Act 2026, which received Royal Assent on 5 March 2026 and prioritises graduates of UK, Republic of Ireland and European Economic Area medical schools - together with international medical graduates already holding indefinite leave to remain - for foundation and specialty training. The Act responds to figures that have shocked even seasoned commentators. NHS England's planning information for the 2026 recruitment round records "c40,000 individual applicants" making "74,000 applications at CT1/ST1," chasing approximately 10,000 posts: an aggregated competition ratio of 3.8 applicants per post and 7.4 applications per post. In a Lancet correspondence published in late 2025, S. Wright reported that "there were 33,108 applicants for only 9,479 training posts in the first round of recruitment for post-foundation training," and cited the BMA's July 2025 survey, in which 547 of 1,053 FY2 respondents (52 per cent) said they had no substantive post or regular locum work for August.
The BMA welcomed the Act cautiously. Dr Jack Fletcher described it as "an important step toward fixing the jobs crisis for doctors" but warned that prioritisation alone would not solve the underlying problem of insufficient training posts. The Lancet was franker: "Although welcome, the UK Government's measures fall short of providing a sustainable solution for this crisis." The 1,000 additional specialty posts promised in the 10-Year Health Plan are roughly a tenth of what is needed to clear the current applicant–post differential, and the offer of a further 1,000 places in 2026 was, on Streeting's own admission, withdrawn when the BMA proceeded with strike action.
The Leng Review and the medical associate professions
On 16 July 2025, Professor Gillian Leng CBE published her independent review of physician associates (PAs) and anaesthesia associates (AAs), which Streeting had commissioned in November 2024. The review, informed by an evidence base that included a literature review, 8,558 frontline staff survey responses, and patient focus groups, made eighteen recommendations: renaming the roles "physician assistant" and "physician assistant in anaesthesia"; mandatory two-year secondary care experience before primary care deployment; a prohibition on seeing undifferentiated patients outside defined protocols; national uniform, badges and lanyards distinguishing PAs from doctors; a permanent faculty under the Academy of Medical Royal Colleges; and an explicit named-doctor supervision model. The government accepted all eighteen recommendations in full, and NHS England issued implementation guidance on 15 August 2025.
The recommendations remain in implementation. A consultation on "Reforming the General Medical Council legislative framework" is under way, and primary legislation to formalise the title change and supervision arrangements is anticipated within this Parliament. Streeting's departure introduces real risk of delay. The Royal College of Emergency Medicine, in October 2025, accepted the recommendations but reaffirmed that "there should be no expansion of PA roles in EM." The BMA, while broadly welcoming the review, has continued to argue that it "did not go far enough" by failing to set a nationally enforceable scope of practice. Whether James Murray, a Treasury minister with no prior health portfolio, will pursue Leng's reforms with the same political capital - or whether GMC regulation of MAPs will quietly slip down the legislative queue - is among the most consequential open questions of the moment.
General practice, ARRS and the contract dispute
In primary care, Streeting's signature intervention was the August 2024 announcement of an additional £82 million to extend the Additional Roles Reimbursement Scheme to recently qualified GPs, with primary care networks able to claim from October 2024. The expansion responded to the paradox of a GP "recruitment crisis" coexisting with newly qualified GPs unable to find substantive posts, and was credited by Mark Dayan of the Nuffield Trust as a tangible early-tenure achievement. By his last day in office, Streeting was claiming the recruitment of "2,000 more GPs" through the scheme.
NHS England's "Changes to the GP Contract in 2025/26" document recorded "an overall increase in investment of £889 million across the core practice contract and the Network Contract Directed Enhanced Service (DES) … 7.2% cash growth on the contract funding envelope … the biggest increase in investment into general practice in over a decade." That settlement broke down within months. The GPC England's October 2025 dispute, triggered by the requirement to keep online consultation tools open throughout core hours, has not been resolved, and the 2026/27 contract was imposed rather than negotiated, with a profession-wide referendum running through March 2026. Dr Katie Bramall-Stainer's public statement - "We have lost over 6,000 (around 28%) of GP partners since 2015" - frames the inheritance for any successor; NHS England's own workforce census records partner headcount falling from 24,491 in September 2015 to 18,009 in October 2025.
Structural reform: the NHS Modernisation Bill
On 13 May 2026 - the day before his resignation - the King's Speech outlined the NHS Modernisation Bill, which Streeting had publicly championed. The Bill abolishes NHS England, returns commissioning and operational powers to the Department of Health and Social Care, abolishes Healthwatch England, and creates a statutory Single Patient Record initially scoped to maternity and frailty care by 2028. Sarah Woolnough of the King's Fund warned that the Bill represented "the largest reorganisation of the NHS in more than a decade" and risked giving "the opposite impression" of devolution by pulling power back to the centre. Thea Stein of the Nuffield Trust cautioned that “the NHS is tied up reorganising itself precisely when it needs to be improving patient care.”
For workforce planning, abolition of NHS England is non-trivial. The Long Term Workforce Plan and the medical recruitment infrastructure - including specialty recruitment, foundation programme allocation and the ARRS claims portal - sit within NHS England. Their migration to DHSC was always going to be administratively turbulent; that migration must now be supervised by a Secretary of State who has, until 14 May 2026, been responsible for Treasury policy on public-sector pay.
The MLA and the implications for candidates
The Medical Licensing Assessment was delivered nationally for the first time between September 2024 and August 2025. The Medical Schools Council's first annual report records that "between September 2024 and August 2025, the AKT was delivered to more than 10,000 medical students across the UK, including those studying at UK medical schools' overseas campuses." The Content Map - 217 clinical presentations and 315 conditions across 25 areas of practice - has become the de facto syllabus of UK undergraduate medicine, and the assessment is now the gateway to GMC registration. For international medical graduates the PLAB has been brought into MLA compliance, with PLAB 1 mapped to the AKT and PLAB 2 to the Clinical and Professional Skills Assessment.
None of the policy turbulence of the past forty-eight hours directly threatens the MLA's content or delivery: the assessment is operated by medical schools under GMC regulation and is not contingent on the political identity of the Secretary of State. What is at risk is the structural environment into which MLA candidates will graduate. Whether 1,000 additional specialty training posts materialise in August 2026; whether the Medical Training (Prioritisation) Act delivers the promised halving of competition; whether the 10-Year Workforce Plan appears on schedule and contains credible expansion of foundation, core and higher training; whether the Leng reforms are translated into protective primary legislation; and whether the GP contract is renegotiated rather than re-imposed - each of these depends on ministerial energy, departmental capacity and Treasury settlement, all of which are now in flux.
Continuity, churn and the verdict
Two readings of Thursday's events are tenable. The first, articulated by Mark Dayan of the Nuffield Trust and by Siva Anandaciva of the King's Fund, is that Streeting leaves the department better than he found it. NHS England's press release of 14 May 2026 described the day's data as "the biggest cut in waiting lists in a single month in 17 years," with the overall waiting list falling to 7.11 million — the lowest in three and a half years — and CNN's independent reporting confirmed a 110,000 monthly fall, the largest non-pandemic monthly drop since 2008. NHS England's interim 65 per cent operational target for 18-week elective wait was met at 65.3 per cent in March 2026, described by NHS chief executive Sir Jim Mackey as "hitting our targets for the first time in years" (though the statutory 92 per cent standard remains distant). The Health Foundation's May 2026 analysis records acute hospital productivity growth of 2.7 per cent for 2024/25 and 2.4 per cent for April–July 2025 year-on-year. The strategic architecture - Darzi, the 10-Year Plan, Leng, the Prioritisation Act - is sound.
The second reading, advanced by the BMA, the Doctors' Association UK and (in different terms) the Lancet, is that Streeting's combative style poisoned relationships with the profession that any successor will have to inherit; that the workforce plan rests on undeliverable assumptions about clinical capacity and supervision; and that medical unemployment co-existing with patient waiting lists represents a policy failure for which no rebranded ARRS scheme is a corrective.
Both can be true. The historical record on Secretaries of State for Health, six of whom held the office between 2010 and 2024, suggests that leadership churn carries a hidden cost: priorities reset, advisors leave, working groups disband, and the implementation chapter - always the hardest - never gets written. Siva Anandaciva of the King's Fund observed, with apparent fairness, that the 10-Year Plan Streeting authored had its "chapter on delivery started, but not completed." His successor, James Murray, brings Treasury credibility and a reputation for competence but no track record on clinical workforce or medical education. The next twelve months will determine whether the Streeting architecture endures or whether, like so many of its predecessors, it becomes a document of intention rather than transformation.
Examination relevance: what AKT and MLA candidates should know
The political turbulence around the Department of Health and Social Care does not change MLA content, but it does enrich the professional-context domain of the AKT in ways that examiners may exploit. Candidates should be conversant with: the three shifts of the 10-Year Health Plan (hospital to community, analogue to digital, sickness to prevention) and their clinical implications; the Leng Review's headline recommendation that PAs be renamed "physician assistants" and prohibited from seeing undifferentiated patients outside protocols; the principle of supervisory accountability under Good Medical Practice, which applies to doctors with named PA reports; the structure of the NHS Long Term Workforce Plan and its 15,000-medical-place ambition by 2031/32; the existence and rationale of the Medical Training (Prioritisation) Act 2026; and the abolition of NHS England under the NHS Modernisation Bill 2026.
For ethics and professionalism stations, the Streeting–BMA antagonism furnishes a textbook case of the tension between the duty of care during industrial action, the GMC's Good Medical Practice (2024) requirements on patient safety during strikes, and the doctor's role as advocate for the profession. The Darzi report's findings on capital starvation and digital immaturity are recurring stems in AKT scenarios on healthcare systems. Candidates should also expect questions on the regulatory architecture of medical associate professions, on the principles of multidisciplinary team working, and on the patient-safety implications of role substitution - all of which are explicit content map domains.
