‘At the RCP, we’ve long argued that there is a fundamental mismatch between where medical training posts are located and where patient need is greatest,’ argues Dr Sarah Logan, director of the RCP medical workforce and data insights unit in our latest blog taken from the RCP’s submission to the NHS England national medical training review.
That gap is only widening. As our population ages and more people live with complex conditions, the number of doctors we train – and where we train them – must change too.
While the government has promised to expand medical school places, that’s just the first step. Without a corresponding expansion in postgraduate training posts – especially in the medical specialties – we won’t have the consultant workforce we need. This is particularly urgent in areas with high levels of health inequality or a high proportion of older people living with frailty and chronic illness.
We need a radical rethink of how and where postgraduate medical training is delivered.
Training posts are not currently aligned with patient demand. Underserved areas – especially rural, coastal and economically deprived regions – often struggle to fill or retain resident doctors despite having high patient need. Consultant shortages in key specialties such as acute medicine, geriatrics and palliative care are not being matched by new training places in the areas that need them most. Overall, the growth in training posts has failed to keep pace, particularly in specialties where new therapies require advanced clinical expertise.
The NHS must proactively support training providers to offer high-quality placements and develop hub-and-spoke networks to share learning and best practice between settings. This means investing in facilities, infrastructure, staffing and new treatments and technologies.
The NHS also needs to collect and publish more granular workforce information – based on consultant vacancies, population health data and local workforce plans – to guide decisions on where to expand training. The 2025 iteration of the Long Term Workforce Plan must include specialty-level workforce projections and a consistent national framework for workforce modelling. Transparent, localised data on workforce demand and supply is key.
The NHS must work with medical colleges to plan our future workforce.
As the National Audit Office has recommended, NHS England must involve medical royal colleges and specialist societies early and meaningfully in its workforce modelling. My previous blog, Modelling the medical specialty workforce, outlines the key themes the NHS must consider – including the balance between specialist and generalist medicine, the physician as a multidisciplinary team leader, the evolving role of physicians in prevention, research and digital health, the importance of robust workforce data and changing working patterns.
In our next generation 2025 survey, a third (34%) of respondents said geographical location was the most important factor when applying for training and 41% said geographical rotational training had a negative impact on their experience. More than a quarter (28%) said rotational training should be scrapped altogether; 50% said it should continue only with reform.
We need to take this seriously. The NHS should pilot ‘stay local’ training schemes, particularly in areas with high health inequality or recruitment challenges. Local, college-accredited training pathways could offer a new route to the certificate of completion of training (CCT), helping residents build lasting relationships with patients, supervisors and services in the areas that need them most.
This is a system-wide responsibility – everyone must play their part.
In England, training delivery should be a shared responsibility, with commissioning bodies (eg integrated care boards, or ICBs) and providers (eg NHS trusts) co-investing in training infrastructure and supervision and required to meet minimum quality standards. Investing in the future medical workforce benefits the entire system.
Workforce planners must also adapt to a changing world. With more and more doctors choosing less than full time (LTFT) working patterns and portfolio careers, training pathways need to be flexible. The shift to community-based care and integrated services must be matched by training that prepares doctors to lead in those settings.
To retain resident doctors in underserved areas, the NHS should consider offering incentives such as additional study budgets, protected time or structured mentoring programmes, with local structured mentoring to encourage retention post-training. Training pathways should be more flexible, reducing the disruption caused by frequent rotations. Finally, medical training must be shaped by lived experience – which is why we support resident-led quality reviews.
A better distributed, more flexible and better supported training system will help tackle regional inequality, support service transformation and improve patient care. It will also help us retain the compassionate, skilled doctors we need for the future.
A version of this article was submitted to the NHS England national review of medical training call for evidence on 20 May 2025 in response to Theme 1: Is postgraduate medical training meeting the needs and expectations of patients, healthcare services and doctors? Subtheme 1.1 – Workforce distribution: what changes are needed to better align the distribution of training posts with local health needs and to meet the needs of healthcare service providers in delivering healthcare and developing their future medical workforce?
Dr Sarah Logan
Director of the RCP Medical Workforce and Data Insights Unit
