Wilkinson and colleagues present the extent of chronic abuse of locally employed doctors (LEDs) in the NHS. International medical graduates and ethnic minority doctors often worked as permanent senior house officers (SHOs) and permanent registrars regardless of their qualifications, skills or experience. They were rarely promoted to associate specialists after years of service. The reform created "visiting registrars" who were only trained for permanent registrar posts with no career progression. A further renaming led to an employment class role which is the same as the previous permanent role of registrar and is now called specialist doctors. The SHO position was renamed and divided into Chief Trainees and LEDs with different contracts.