NHS England has announced it will conduct a ‘significant’ review of all postgraduate medical training, including GP programmes.
England’s chief medical officer Professor Sir Chris Whitty and NHSE’s national medical director Sir Stephen Powis will oversee the review, which was prompted by ‘concerns from resident doctors’, according to the commissioner.
It confirmed to Pulse that this will cover all postgraduate programmes, including GP training.
The national review will cover:
- placement options
- the ‘flexibility’ of training
- ‘difficulties’ with rotas, control and autonomy in training
- and the ‘balance’ between developing specialist knowledge and gaining a broad range of skills.
It will begin with ‘national listening events’ with doctors, trainers and patients over the next two months, which will be followed by a ‘call for evidence’ in the spring.
This engagement process will run until June and a report on the review’s findings will be published in the summer.
NHS England said today that resident doctors, previously known as junior doctors, have ‘made it clear that they have concerns and frustrations with their training experience’.
It continued: ‘We are also aware of the needs of the increasing numbers of doctors in locally employed posts in NHS trusts and the specialty and specialist workforce.
‘As the people responsible for training doctors, there is much more the NHS and our partners can do collectively to improve their learning and working experience in the NHS.’
The BMA welcomed the announcement and said that the review ‘finally’ recognises the need to take action on the ‘broken’ training system for resident doctors.
BMA resident doctors committee co-chairs Dr Melissa Ryan and Dr Ross Nieuwoudt said: ‘Patients are struggling to access expert medical care because the UK is under-doctored compared to other OECD countries.
‘There is little benefit in rearranging the deck chairs while a ship is sinking; we need more training places for doctors and an increase in post-training jobs to meet the expectations of patients languishing on waiting lists.’
The union added that around 20,000 doctors are expected to miss out on a training place this year due to the ‘mismatch’ in the number of formal training places and the number of applicants.
Dr Ryan and Dr Nieuwoudt added: ‘Can the country afford the loss of so many future consultants and GPs when waiting lists are so high?
‘A resident doctor is a fully-qualified doctor undertaking specialist training to become a consultant or GP and is often the most senior doctor in hospital overnight or on weekends.
‘Yet resident doctors’ training is in dire need of improvement. Residents are regularly thrown from one side of the country to the other, often plugging gaps in a broken NHS.’
Professor Whitty and Sir Stephen expect their review, which is aligned to the Government’s upcoming 10-year health plan, will ‘improve’ the working lives of resident doctors and ‘enhance’ career progression.
England’s chief medical officer said ‘many things’ have changed in medicine and so it is ‘sensible’ to examine the ‘key issues, problems and successes of lifelong training’ that need to be addressed.
Professor Whitty added: ‘Getting the balance right between competing, reasonable aims of training and service provision will help ensure doctors are best equipped to treat patients in the coming decades.’
Sir Stephen pointed out that it has been ‘several years’ since postgraduate medical training was last reviewed, and in that the way medicine is practised has ‘evolved’ along with the ‘needs and expectations of medical graduates’.
‘So, the time is right to look at again, especially with a new 10-Year Health Plan in development,’ he added.
The GMC welcomed the review and recognised that ‘repurposing medical education and training for the modern age’ is an ‘ambitious undertaking’.
Professor Colin Melville, the regulator’s medical director and director of education and standards, said: ‘The needs of patients have changed considerably in recent years and will continue to do so in the future.
‘It is important we ensure that doctors have the right skills and experience to meet these changing demands, and a training model that will meet these future needs.’
NHS England’s long-term workforce plan from 2023 pledged to increase GP training places in England by 50% to 6,000 by 2031.
But many have warned that this plan will fail without sufficient expansion of trainer capacity and support.
To treat doctors decently at Trust level, for employees to have decent terms and conditions, to remove the CCT bottlenecks, to not have to vie for PA rotas, rotation, and training, is the job that Powis and Whitty should have been doing on doctors’ behalf. A review is unnecessary. A review suggests an agenda to dilute training. Sam Everington suggests CCT should be delivered mostly in general practices. I strongly disagree, both for specialty medical training and for levels of supervision requirements.
The team carrying out the NHS England review of postgraduate medical training must have appropriate representation from medical students and junior doctors. Without them, the review risks missing important issues such as poor working conditions, burnout or gaps in training. A team filled with senior figures from medical profession and the NHS the might look impressive on paper, but if they are too disconnected from the perspectives of students and resident doctors, they are more likely to produce recommendations that sound good but don’t work in practice.