WIREDGOV

Two of England’s leading doctors have set out their recommendations following the first phase of a review into postgraduate medical training.

The government’s Chief Medical Officer, Professor Chris Whitty, and the former National Medical Director at NHS England, Professor Stephen Powis, have led the Medical Training Review to understand current challenges and identify key areas for potential improvements.

A comprehensive engagement exercise for the review generated over 8,000 responses from doctors at all stages of their career, patients, and professional and regulatory bodies across the country following its launch earlier this year, including more than 6,000 resident doctors.

The report makes clear there are risks to major changes to training, but that the gap between what is needed and the current system is large enough that they are justified.

The phase 1 diagnostic report, published today, mainly aims to lay out the current situation but it also identifies 11 recommendations, including four key priorities needed to modernise medical training.

The 4 key priorities recommended by the report’s authors are:

1. Training must become more flexible.
2. We must build on excellence beyond formal training routes including around the increasing role played by SAS and locally employed doctors.
3. Current training bottlenecks are damaging and must be addressed.
4. We need to rebuild inclusive team structures where doctors at every stage of training feel valued.

The report makes it clear that there are some trade-offs between different aims, and that these need to be addressed honestly by all.

The next phase of the review will involve the medical royal colleges, postgraduate deans, the General Medical Council, NHS England and the Department of Health and Social Care, as well as patient groups working together with doctors from all stages of training to design a package of reform.

NHS England is already taking actions this year to improve the experience of resident doctors on workplace issues like payroll errors and leave entitlement, announced as part of a 10-point plan to improve resident doctors’ working lives which was published earlier this year.

The 10-year health plan also commits to 1,000 new postgraduate places and working across Government to prioritise UK medical graduates, and other doctors who have worked in the NHS for a significant period, for specialty training.

Professor Stephen Powis, former National Medical Director at NHS England and co-author of the phase 1 diagnostic report, said: “Healthcare professionals do a fantastic job of treating patients every day and it’s vital that the NHS continues to evolve to meet the changing needs of the population.

“We deliberately set out to make this a review by the medical profession with patient input, and we firmly believe that the solutions to the training challenges we face lie within the profession.

“We are extremely grateful to the many thousands who have participated in the first phase of the review, providing a substantial and wide-ranging response. We will now work to make those recommendations become a reality to improve the working lives of doctors and provide better care for patients.”

Professor Chris Whitty, Chief Medical Officer, said: “Training is essential for good medical practice and patient care and all doctors are involved both in being trained and in training others from the start to the end of their career.

“This report sets out key areas where medical training is working well and where it isn’t working well and needs reform. It is now for us as the medical profession to weigh up the trade-offs and put forward solutions to improve medical training and ensure the profession is fit for the future.”

Dr Jeanette Dickson, Chair of the Academy of Medical Royal Colleges said: “We completely agree with the analysis provided by professors Whitty and Powis. It is a great first step, and now we need to maintain the momentum and work together to provide solutions that tackle the underlying issues; supporting our resident colleagues to have a positive experience of training.

“I know that the medical royal colleges are up for the challenge, as well as those who deliver training.”

Dr Alan Abraham, Chair of the Academy Resident Doctors Committee at the Academy of Medical Royal College and Co-Chair of the Ophthalmologists in Training Group at the Royal College of Ophthalmologists, said: “It is essential that postgraduate training continues to evolve and offer opportunities to all resident doctors to develop their skills and expertise, to better meet the needs of our patient population both today and in the future.

“This diagnostic report distils key recommendations to guide reform of medical training, representing the culmination of extensive engagement across the health service. Importantly, this has been clinically led with meaningful input from resident doctors across the country, and at all stages of a medical career.

“Although this is the first step towards a consensus, we must work together as a profession to develop solutions that both build on the best aspects of postgraduate training today, whilst also learning from its challenges too.”

Dr Deepthi Lavu, Royal College of General Practitioners GP Registrar Co-Chair and resident doctor representative, said: “Resident doctors are deeply committed to providing the highest quality care to their patients. However, the current medical training system presents significant challenges when developing the skills needed to deliver the care our patients truly deserve.

“The thousands who engaged with the review so far reflect the profession’s strong desire for meaningful change and, more importantly, their willingness to actively contribute to shaping it.

“These recommendations mark a pivotal step towards long-awaited and much-needed reform driven by the profession itself.”

Professor Mumtaz Patel, RCP president, said: “The Royal College of Physicians welcomes the findings and recommendations of the NHS England medical training review, which confirm what our members have long been telling us: the current system is no longer fit for purpose and is failing both doctors and patients.

“Many of its recommendations echo the priorities for reform of medical training that we set out in our ‘NextGen Top 10’ briefing earlier this month, and we welcome the focus on clinical academic medicine. We wholeheartedly agree that there must be reform of postgraduate medical education and training, more flexibility in training and that addressing bottlenecks in training must be an urgent priority. Now this review has recommended what is needed, we need swift action to deliver change.

“This review offers us a once-in-a-generation opportunity to fundamentally improve how we train and retain the next generation of physicians. We urge the government to take forward these actions as soon as possible and look forward to engaging on a comprehensive and urgent reform of postgraduate medical education and training.”

Professor Subodh Dave, Dean of the Royal College of Psychiatrists, said: “The Medical Training Review provides a promising pathway through which we can ensure that enough doctors are trained to meet people’s needs. It has the potential to reduce bottlenecks which prevent clinicians from developing vital skills and particularly hinder specialities like psychiatry.

“We are pleased to see flexible training and inclusive team structures are key priorities and hope this will include educator development being formally recognised and incentivised. It is crucial that staff feel supported and valued throughout their training and beyond if we are to build a more effective and resilient NHS.”

Professor Pushpinder Mangat, Medical Director and Director of Education and Standards at the General Medical Council, said: “This is a welcome and timely report which aligns with our own ambitions for medical education and training. Working with others, our goal is to ensure healthcare professionals have the skills and support they need to meet the evolving needs of patients, by creating a system that provides flexible, fair and innovative learning.

“This report, based in part on GMC data, provides further evidence for issues we have identified in our own work, and we look forward to continuing to play an active role as the focus turns to solutions to these issues, which will also benefit patient outcomes.”

Anthony Martinelli, Clinical Lecturer in Respiratory Medicine at the University of Cambridge and Vice-Chair of the Academy of Medical Royal Colleges Resident Doctors’ Committee, said: “Thousands of resident doctors have fed into this process and a clear picture has emerged of a medical training system that all too often simply does not work for us or for our patients.

“We therefore fully support the key recommendation: that urgent reform of postgraduate medical education is undertaken. It is only through radical change that we can hope to address the deep-seated issues identified in the report, ranging from bottlenecks in progression to challenges in procedural training, and from inconsistent educational supervision to a need to ensure all our population can receive the medical care they need.

“We know this endeavour is not without risk, but firmly believe the time is now right to take on this mission. With effective leadership from across the profession, including – critically – an ongoing voice for residents, we believe we can build a training pathway that is fit for the future of the NHS.”

Dr Zeeshan Arif, Vice-Chair of the Academy Resident Doctors Committee, said: “As a resident doctor, I strongly welcome the findings of this physician-led review. It’s encouraging to see the challenges facing our profession clearly acknowledged – from bottlenecks in training to the loss of supportive work environments, all of which diminish our future workforce.

“That being said, what matters now is maintaining this momentum and ensuring the next phase of this review delivers tangible improvement for future consultants and their patients.”

Dr Adam Harvey-Sullivan, GP ST4 and Senior Clinical Fellow to Dr Claire Fuller, National Medical Director said: “As a resident doctor, this review feels like a very honest diagnosis of the current state of training. It celebrates that we continue to train many excellent doctors who deliver high-quality care for our patients. At the same time, it recognises the persistent and familiar ways in which the current system fails us.

“Bottlenecks, excessive admin and a lack of belonging are symptomatic of a system that, for both trainees and trainers, often feels it gets in the way rather than supports training. This is particularly notable for IMGs and locally-employed doctors.

“Resident doctors must now seize this opportunity to collaboratively shape the  future of medical training. We must develop a system that supports current and future generations of doctors – and the wider workforce – to flourish and develop the skills and capabilities to provide the best care for our patients and communities.”

The phase 1 medical training review report is available on our website: NHS England » The Medical Training Review: Phase 1 diagnostic report