All offers for training posts will be made through Oriel.

Appointments to training programmes or posts will be offered in rank order, based on selection scores. 

When you receive a training offer through Oriel, you will have the option to accept, decline or hold (until the hold deadline) the offer made. You will be given 48 hours (excluding weekends but including bank holidays) from release of the offer to decide whether to accept, reject or hold it. Offers which are not responded to within the 48 hour deadline will expire and will be offered to another applicant.

You should only preference and accept posts that you are willing to undertake. This includes posts in the No preference column.

Offer responses

  • You are excluded from any further offers from this and any other specialty within this recruitment round, with the exception of hierarchical upgrades (up until the hierarchical upgrade deadline).
  • Pre-employment processes commence.
Accept with upgrades
  • You will have your offer automatically upgraded if a higher ranked preference becomes available. If you have opted into upgrades, no contact will be made prior to the upgrade taking place.
  • The upgraded offer becomes the accepted offer and the previously accepted post is released and offered to another applicant.
  • Upgrades will continue to be made until the upgrade deadline for the recruitment round.
  • No offers will be received from any other specialty unless the offer is a hierarchical upgrade (up until the hierarchical upgrade deadline).

If an improved preference becomes available before the upgrade deadline, the current offer will automatically be upgraded. You will be notified of the upgrade by message within your Oriel account. You should not preference posts that you would not want to be upgraded into. After an upgrade has been made, there is no opportunity to revert to the previously accepted post.

Holding offers

The held offer can be accepted or declined at any time up until the hold deadline. Only one offer can be held at any time in the same recruitment round. Trying to hold a second offer will result in the original held post being rejected. Before the hold deadline passes, offers must be confirmed as accept, accept with upgrades or decline. If no action is taken, the held offer will expire, will be deemed to have been declined and will be offered to another applicant.

Hold without upgrades
  • You are reserving the offer.
  • No upgrades by preference will be made.
  • Offers from other specialties can still be received.
  • The held offer can be accepted or rejected at any time up until the hold deadline.
Hold with upgrades

If you receive an offer which is not your first choice preference, you can select the Hold with upgrades option.

  • You are reserving the offer.
  • The held offer preference will be automatically upgraded if preferred preferences become available. Offers from other specialties can still be received. If you opt into upgrades, you will have your offer upgraded without further contact being made.
  • The held offer can be accepted or rejected at any time until the hold deadline.

Upgrades are automatic when opting to hold with upgrades. If an improved preference becomes available before the upgrade deadline, the current offer will automatically be upgraded. You will be notified of the upgrade by message within your Oriel account. After an upgrade has been made, there is no opportunity to revert to the previously held post.


If you choose this option, you will have your offer removed and will receive no further offers from this specialty within the recruitment round. You will continue to receive offers from other specialties, if applicable.

If you do not respond to your offer within the 48 hours, this will be interpreted as declining the offer and it will be offered to another applicant.


You may withdraw completely from the process up until offers are released. You should do so via your Oriel account. Once an offer has been accepted, if you wish to withdraw you will need to contact the recruitment office directly.

If you intend to decline a training offer, you are advised to do so as soon as possible to enable the offer to be made to another applicant.

You may not initially receive an offer, but may still receive one later during the process of re-offering declined and expired offers.

If you who fail to respond to your offer within the 48 hours and allow it to expire, but would have liked to accept the post, you should contact the recruitment office at the earliest opportunity. Where possible, recruitment offices will try to reinstate applicants, however, as recycling of the initial offer may have already taken place, there is no guarantee that  you will receive an offer or that it will be the same offer as initially received.

Upgrading of offers

If you accept or hold the offer and opt-in for upgrades, you will automatically receive an upgrade, should one become available before the upgrade deadline.

You will have the option to state which of your preferences you would like to be considered for an upgrade into. This could include all, some or none of the posts that were ranked higher than the offered post, but also those that were originally ranked lower. Your upgrade options are completely configurable. Should an upgrade option become available and you are next in line to receive the offer, you will be automatically upgraded to this offer with no option to revert to the original offer.

You can opt-out of upgrades at any point. If you-opt out of upgrades in the period between an offer match being run and the offers being released, you may still receive an upgrade.

If you wish to be considered for upgrades into a particular post/programme, you should opt into this even if the post/programme is showing no vacancies. If the post becomes available at a later date, you will not be upgraded into it if you have not opted in, regardless of whether or not it was one of your higher ranked preferences in the original application form. Once an upgrade has been made there will not be an opportunity for you to request that your original offer be reinstated.

Offer upgrades are processed once all other offers for the specialty have been responded to. Upgrades will not be processed at the weekend or on bank holidays.

Important: Important

Upgrading of offers will not continue beyond the stated upgrade deadline, even if a preferred post becomes available at a later date.

After the upgrade deadline, vacant posts will be offered to the next eligible applicant who has preferenced the post and who has yet to receive an offer. They will not be offered to applicants who have already accepted a post. This includes situations whereby an applicant has accepted a Locum Appointment for Training post and an NTN post becomes available. You are advised to consider this when making your programme preferences.

If you accept a post in another specialty, you will be withdrawn from all other applications in the recruitment round and will not be eligible for any further offers from any other specialty, even if a preferred post becomes available at a later date.


Depending on the specialty and the number of posts left at the end of the offer process, a clearing process of matching remaining candidates to available posts is undertaken. Where clearing takes place, you will have the option to re-preference the remaining posts and the offers will then be made in rank order. This only applies to specialties where applicants are not in contention for all posts nationally at the initial offers stage.

Offer exchanges

Offer exchanges allow you to amend the order of your programme preferences, even when the first choice programme has been offered. 

This could be for any number of reasons, but could include the following.

  • A change in personal circumstances that could not have been foreseen at the time of application.
  • Your partner has been offered a post in another region, with no possibility of getting an upgrade to the same region.

You would use offer exchanges if you have received an offer for a specialty that you have held or accepted, where you would prefer to receive an offer elsewhere.

If you decline a post, you will not receive any further offers for the specialty and will not be eligible for offer exchanges. However, you should not accept a post that you are not prepared to undertake.

How to use offer exchanges

You must respond to your offer and opt into upgrades, where available. 

Offer exchanges allow you to re-order the programmes available as an upgrade, by clicking on Update Preferences.

This will allow you to see the post that you have been offered and the other options that you have to choose from. If a lower ranked post is preferred, preference ranks should be changed to reflect this.

Once preferences have been re-ordered, it is important to Save the changes.

After acceptance of a post

Any offers made are conditional upon the necessary pre-employment checks being carried out successfully.

If successful, you will receive an offer of employment from your employer (subject to pre-employment checks). The offer of employment is distinct from the training agreement. You may change employers several times during your training period.

The first employer will need to complete pre-employment checks before you can start working for them. Pre-employment checks are designed to ensure that every doctor working in the NHS is fit and safe to work with patients. You will be required to make declarations on the application form relating to your honesty and probity.

Checks will include verification of references, fitness to practise updates from the General Medical Council (GMC) or other regulatory bodies, occupational health clearance, Disclosure and Barring Service (DBS) and immigration status checks. They may also include validation of English language proficiency and evidence of competence.

Once pre-employment checks have been completed successfully, the employer will confirm new starter details directly with you.

An employment contract should be received within 2 months of starting in post, as per NHS Employers’ guidance.

You are expected to take up any employment you have formally accepted and to work the contracted notice period. Agreed terms, such as the notice period, will apply even if the employment contract has yet to be received.

If you are unable to take up post on the given start date, due to serving notice, you must ensure that you communicate this to the relevant NHS England Local Office/Deanery and employer as soon as possible.

You will have a responsibility for patients and services. As the GMCs Good Medical Practice points out, patient care may be compromised if there is insufficient medical cover.

Failure to arrive for work on the start date previously notified by the employer could affect patient services and their care and may have an adverse impact on the working conditions of medical colleagues. You may be in breach of contract if you do not comply with the minimum contractual notice. The better approach would be to make sure the employer has a reasonable time to make other arrangements (as a minimum, the contractual notice period).

Deferring the start date of a specialty training programme

You can only defer the start of your specialty training programme on statutory grounds such as personal ill health, maternity or parental leave. Commencement cannot be deferred for reasons such as research or undertaking a higher degree.

If you have had a period of statutory leave during the training programme from which you are applying you will be permitted to defer your entry to specialty training by the same period of time (whole time equivalent).


Following the acceptance of a training programme, reference requests will be sent through Oriel to the referees listed on your application form.

Referees will complete the reference online using Oriel. If a referee is unable to complete the reference prior to the deadline date, responsibility for requesting and collecting the reference will pass to the employer. You and/or your referees will be contacted directly by the employer if further references are required. There is no need for you to do anything until this contact is made.


You will be given feedback after each of the following stages of recruitment.

  • Longlisting (if unsuccessful)
  • Shortlisting (if applicable)
  • Interview/selection centre

Interview and/or selection centre feedback should be given no later than 7 days after the national offer deadline. Where available, the feedback will include:

  • score per interview station
  • total interview/selection score
  • maximum interview/selection score
  • your appointability and the minimum score required for appointability (as appropriate)
  • your individual ranking (if you reach the required threshold for appointability)

Page last reviewed: 22 May 2024
Next review due: 22 May 2025