The case for training reform has been made – it’s time for action

Few doctors would disagree that medical training is under strain. Across the NHS, resident doctors report losing valuable training opportunities to service pressures, while consultants increasingly struggle to find time for supervision, teaching and feedback. Today’s new report, Training physicians for the future, sets out a compelling vision for change. But there is a question we must answer honestly: how do we ensure this time is different?

For more than 20 years, the medical profession has repeatedly identified shortcomings in postgraduate training and proposed solutions. Yet service delivery has continued to take priority whenever pressures rise. Training clinics are cancelled, educational activity is squeezed and learning opportunities disappear. The result is a cycle of reports, recommendations and goodwill, with too little sustained change.

At the heart of the problem is a broken educational contract. Doctors in training contribute enormously to patient care and the functioning of the NHS. In return, the NHS has a responsibility to provide the training, supervision and experience that will develop them into the consultant physicians of the future. Too often, that responsibility has not been fulfilled.

This is not simply an issue for individual trusts, health boards or departments. It is a system-wide challenge created by years of decisions about workforce planning, service delivery, funding and performance management. The erosion of training opportunities did not happen by accident. It is the predictable consequence of a system that has repeatedly prioritised immediate operational pressures while failing to protect education. National leaders must therefore accept responsibility not only for recognising the problem, but for creating the conditions that will solve it. 

Most importantly, we need to change how we think about training itself. Medical training is not a cost imposed on healthcare delivery. It is an investment in the future capacity, quality and safety of the NHS. It is also critical to retaining a motivated and engaged medical workforce. Every missed training opportunity represents a missed investment in future patient care.

That means resident doctors should not be viewed primarily as service providers who receive training when circumstances permit. They should be regarded as doctors whom the NHS has an explicit obligation to train while they contribute to delivering care. This is the fundamental shift that sits beneath many of the RCP's recommendations.

One of the strongest proposals is the creation of regular protected training experiences, including supervised clinics and teaching ward rounds. These are vital because clinical work alone does not automatically become training. Learning depends on supervision, reflection, discussion and feedback, precisely the elements most vulnerable to being lost during periods of high service pressure.

However, protecting training requires more than aspiration. We have already spent years asking organisations to prioritise education, and we know that approach has not been enough. If protected training time is genuinely important, workforce planning and funding arrangements must reflect that reality. Training cannot continue to be treated as optional whenever services become stretched.

The NHS recognises the importance of investing in physical infrastructure. We maintain buildings, scanners and digital systems because we know they are essential to future healthcare delivery. Training should be viewed in the same way. It develops the NHS's human capital, equipping doctors with the skills and experience they need to provide high-quality care throughout their careers.

When educational opportunities are repeatedly sacrificed to meet immediate demand, we are effectively borrowing capacity from the future. The consequences may not be visible today, but they will emerge through workforce shortages, poorer retention, reduced productivity and pressures on patient care. That is why I believe reform must be built around four simple principles: protect, fund, measure and enforce. 

Protected training time should become a genuine entitlement. Educational funding should be transparent and accountable. We should measure training that is delivered, not simply what appears on a timetable. And where funded training repeatedly fails to materialise, there should be clear accountability and consequences. At the same time, organisations that consistently deliver excellent training should be recognised and celebrated. Most importantly, responsibility for delivery must be visible. When training standards are not met, it should be clear who is accountable for putting things right and how improvement will be achieved.

Meeting these ambitions will require more than good intentions. It will require stronger oversight and sharper accountability than currently exists. Despite decades of reports highlighting the same concerns, there remains no single organisation with a complete picture of whether training is being delivered as intended across the NHS.

I believe there is a strong case for an independent national body charged with monitoring, scrutinising and safeguarding the quality of postgraduate medical training. Such a body would bring together data on resident doctor experience, educational outcomes, protected training opportunities and local performance, providing a transparent and authoritative view of what is happening on the ground.

Crucially, this would not be another advisory body. Where serious concerns are identified, it should be able to require improvement plans, escalate persistent failures and ensure action is taken. For too long, problems in medical education have been identified, discussed and revisited without sufficient change. A stronger framework for accountability would help ensure that concerns lead to action rather than simply another round of recommendations.

Of course, change will require capacity. It is unrealistic to expect significant protected training time while demanding the same level of clinical activity from an unchanged workforce. Creating that capacity will sometimes require investment. It will also require making doctors more productive by reducing unnecessary administrative work, improving digital systems and ensuring teams have the support they need to focus on delivering care and training.

The encouraging reality is that we already know much of what needs to happen. We understand the causes of the problem. We know that responsibility has often been fragmented, funding insufficiently transparent and educational outcomes inadequately measured. We also know many of the solutions. We know that educational funding is not always transparent, that training outcomes are not consistently measured and that accountability has too often been unclear. We also know many of the solutions. The question is no longer whether reform is needed. It is whether leaders across the system are willing to take ownership of delivering it.

The challenge now is implementation. If high-quality postgraduate training is essential to the future of the NHS, national leaders must explain how they will ensure it is protected when service pressures inevitably arise. The RCP has provided a roadmap. What is needed now is clear leadership, visible accountability and a commitment to act. The organisations responsible for shaping the training environment must not only endorse reform; they must own its delivery and be accountable for its success.
 
Doctors have waited a long time for meaningful reform. We cannot afford another decade of describing the same failures and proposing the same remedies. Every year that action is delayed, resident doctors lose training opportunities that cannot easily be recovered, and patients lose the benefits that a well-trained future workforce will bring. The NHS has become very good at recognising the challenges facing medical training. It must now become equally good at taking responsibility for solving them. This time, we need action.

This article reflects the personal views of Dr Patrick Davey and is intended to contribute to discussion about the future of medical training. The views expressed are his own and do not necessarily reflect the position or policy of the RCP. If you would like to write for the RCP, please read our guidance for RCP authors writing for Commentary and the RCP website.