Supporting international medical graduates in the National Health Service: what is the way forward?

Differential attainment (DA) among International Medical Graduates (IMGs) remains a persistent challenge within the National Health Service, with implications for workforce sustainability, leadership diversity and patient safety. Evidence consistently shows that DA is driven predominantly by systemic, structural and organisational factors including leadership behaviours, governance processes and inequities in representation—rather than differences in individual capability. Drawing on reflective leadership experience, critical engagement with current literature and analysis of organisational approaches to IMG recruitment, training and progression, this paper explores how inclusive, compassionate and systems‑focused leadership can influence the cultural and structural conditions that shape IMG outcomes. Key insights highlight the central role of leadership in mitigating DA: inclusive governance, bias‑aware recruitment, structured mentorship and balanced representation on panels strengthen fairness and trust; compassionate leadership enhances psychological safety, supports equitable incident‑management processes and prioritises learning over blame; and systems leadership addresses the persistent underrepresentation of IMGs in senior clinical, managerial and regulatory roles, improving organisational performance and leadership pipelines. Sustained investment in mentorship, induction quality and support structures promotes professional integration, career progression and retention. Reducing DA requires leaders to recognise and act on the organisational conditions shaping IMG experiences. Embedding inclusive, compassionate and systems‑oriented leadership across governance, workforce planning and culture is essential for achieving equitable outcomes and strengthening the NHS workforce.