All-Specialty Competition Ratios
Round 1 applications-per-post, 2024 vs 2025, NHS England official data. Click a specialty to see its ratio, how it's scored, and where to score your own portfolio.
| Specialty | 2024 ratio | 2025 ratio | Change | 2025 posts | Next cycle (projected) |
|---|---|---|---|---|---|
| GP & Public Health Dual CCT ST1 | 112.1 : 1 | 167.2 : 1 | +49% | 13 | ~249.2 : 1 |
| Community Sexual & Reproductive Health ST1 | 25.6 : 1 | 98.5 : 1 | +285% | 14 | ~378.8 : 1 |
| Cardiothoracic Surgery ST1 | 45.3 : 1 | 73.7 : 1 | +63% | 10 | ~119.8 : 1 |
| Public Health Medicine ST1 | 17.5 : 1 | 28.5 : 1 | +63% | 95 | ~46.6 : 1 |
| Neurosurgery ST1 | 19.7 : 1 | 26.7 : 1 | +36% | 21 | ~36.3 : 1 |
| Core Psychiatry Training CT1 | 9.4 : 1 | 21.8 : 1 | +131% | 489 | ~50.4 : 1 |
| Ophthalmology ST1 | 14.4 : 1 | 21.5 : 1 | +49% | 102 | ~32.2 : 1 |
| Obstetrics & Gynaecology ST1 | 7.0 : 1 | 16.6 : 1 | +138% | 297 | ~39.6 : 1 |
| ACCS Emergency Medicine CT1/ST1 | 7.6 : 1 | 14.2 : 1 | +88% | 357 | ~26.7 : 1 |
| Anaesthetics CT1 | 6.5 : 1 | 12.6 : 1 | +93% | 539 | ~24.3 : 1 |
| Clinical Radiology ST1 | 11.9 : 1 | 11.3 : 1 | -5% | 356 | ~10.7 : 1 |
| Histopathology ST1 | 5.0 : 1 | 9.5 : 1 | +88% | 104 | ~17.8 : 1 |
| Core Surgical Training CT1 | 5.3 : 1 | 8.6 : 1 | +63% | 630 | ~14.0 : 1 |
| Paediatrics ST1 | 3.3 : 1 | 5.6 : 1 | +71% | 476 | ~9.6 : 1 |
| Internal Medicine Training CT1 | 3.7 : 1 | 5.3 : 1 | +43% | 1678 | ~7.5 : 1 |
| General Practice ST1 | 3.7 : 1 | 4.9 : 1 | +34% | 4276 | ~6.6 : 1 |
| Oral & Maxillo Facial Surgery ST1 | 1.9 : 1 | 3.5 : 1 | +85% | 22 | ~6.5 : 1 |
“Next cycle (projected)” is a simple extrapolation of the 2024→2025 trend for each specialty — we only have two years of official data, so treat this as a rough direction and size of change, not a forecast.
GP: roughly what MSRA score should you aim for next cycle?
Extrapolating the applications/posts trend, next cycle's ratio is projected at roughly 6.6 : 1— meaning you'd likely need to rank in the top ~15%of applicants. Mapped against NHS England's published GP MSRA score bands, that's roughly a score of 299 on each paper (Professional Dilemmas and Clinical Problem Solving are banded separately, mean 250 / SD 40 each sitting).
Take this as a rough compass, not a target to bank on: it chains together a two-point trend line and a score-band table whose own review date predates this cycle. It also assumes posts stay flat and the 2024→2025 growth rate repeats — a real forecast would need more years of data than NHS England currently publishes.
Selection mechanisms
IMT / joint IMT-ACCS-IM
Self-assessment only, max 30 (+5 IMT-only bonus in 2026 = max 35). No MSRA. Final rank by interview.
GP ST1
Confirmed 100% MSRA — no Selection Centre, no interview, no portfolio. Applies through at least the August 2026 round; NHS England hasn't yet published the mechanism for February 2027.
Core Psychiatry CT1
Confirmed 100% MSRA — no interview, no portfolio, through at least the August 2026 round. RCPsych has a Task and Finish Group reviewing the MSRA-only model after 2025's 21.83:1 ratio spike, but NHS England (who has final say) hasn't announced any change.
ACCS-Emergency Medicine ST1
Confirmed MSRA 40% / online interview 60%. Interview includes a portfolio-verification station, but no official points/domain breakdown for it is published — only narrative person-specification criteria.
Anaesthetics CT1 (incl. ACCS-Anaesthetics)
Confirmed MSRA 15% (PD 7.5% + CPS 7.5%) / interview 85%. Portfolio/self-assessment scoring was explicitly removed from the CT1 application form — the 85% is a pure structured interview (two 15-min stations), 60/100 minimum to be appointable.
Obstetrics & Gynaecology ST1
Confirmed MSRA (33.3%) / two-station online interview (66.6%). No portfolio stage. Top 75 MSRA scorers bypass interview straight to offer; everyone else needs 50/100+ at interview to be appointable.
Core Surgical Training CT1
MSRA 10% / portfolio station 45% / management & clinical interview station 45% (portfolio scored at interview, not pre-scored)
Clinical Radiology ST1
MSRA shortlists into interview only (doesn't carry to final rank). Verified scoring matrix: portfolio 40% + interview 60% of final rank — see the Clinical Radiology portfolio scorer.
Ophthalmology ST1
MSRA gates the first shortlisting cut only (doesn't carry to final score). Verified scoring matrix for the self-assessment Evidence Folder — see the Ophthalmology portfolio scorer.
Cardiothoracic Surgery ST1
No MSRA. Self-assessment (16 domains across 5 sections, max 59) verified against evidence, then combined with a structured interview — NHS England Wessex doesn't publish the weighting. See the Cardiothoracic Surgery portfolio scorer.
Histopathology ST1
No MSRA. Self-assessment (10 domains, max 71) shortlists to evidence verification; final rank is interview-only. See the Histopathology portfolio scorer.
Neurosurgery ST1
Confirmed two-stage ranking: MSRA 40% + self-assessment 60% ranks for interview; final rank is MSRA 12% + self-assessment 18% + four-station interview 70%. 65% of available marks needed to be appointable. Exact self-assessment domain point values not yet obtainable (source PDF unreachable) — no scorer built yet.
Oral & Maxillofacial Surgery (OMFS) ST1
No MSRA. Self-assessed portfolio (confirmed domains: MFDS/MRCS, OMFS and non-OMFS courses, OMFS and non-OMFS surgical logbook experience, OMFS educational activity, postgraduate degrees, prizes, QI/audit, teaching, training in teaching, presentations, publications, leadership, other achievements) plus a four-station interview (7 min/station, 60% overall + 40%/station to be appointable). Exact point values per domain not yet obtainable (source page removed/relocated) — no scorer built yet.
Community Sexual & Reproductive Health (CSRH) ST1
MSRA-ranked shortlisting into interview; NHS England doesn't publish the MSRA/interview weighting. No scored portfolio.
Public Health Medicine ST1
Does not use the MSRA. Assessment Centre (3 computer-based papers) is pass/fail only; final rank is 100% Selection Centre (virtual interview) score. Accepts non-medical applicants.
MSRA minimum standard: 201 on each component (PD and CPS). 201 on each of the 2 components (PD and CPS) — falling below on either is an automatic fail regardless of specialty.
Inter-deanery transfer patterns
This measures existing trainees transferring between deaneries mid-training, not initial ST1 recruitment competition — a later-career question, not "where's easiest to get an offer." Don't read it as a regional difficulty score for applying in the first place.
Obstetrics & Gynaecology
North London and South London consistently draw the highest transfer demand — 18-20 applications per round in recent years, vs. 0-7 for most other regions.
Clinical Radiology
Even more pronounced than O&G: North London alone drew 32 applications-to-join in August 2024 (26 in February 2024) — typically 3-6x the volume of the next-busiest region. North and South London combined regularly account for 40-50% of all national transfer demand. Total national volume has grown from ~10-20 applications per round pre-2020 to 50-69 per round in 2023-2025.
Ophthalmology
no signalNo usable signal — Ophthalmology's trainee cohort is too small to generate reliable transfer data. It only qualified as a tracked "top 6" specialty for a single round (August 2021: 15 applications, 7 offers) since NHS England began publishing this data.
Sources
Every number on this page is drawn from an official source, not estimated. Competition ratios for every specialty come from NHS England's own archive; the per-specialty breakdowns below link to each scoring/selection document individually.