14 September 2023

The shape of medicine: the future of the workforce, education and training

Shape Of Medicine Graphic

As a result of political decisions over many years and the recent pandemic, we are undeniably at a turning point for the NHS and the medical workforce. The RCP is seizing the opportunity to take stock and make sure we are well prepared to both shape and respond to developments.

We want to hear from you

We are beginning a review of what we do by publishing this document and seeking a wide range of opinions, comments and suggestions. We will be reaching out via our regions and committees, but we are keen to hear the opinions of all medical professionals – whether or not they are RCP members. Please feel free to contact us via policy@rcp.ac.uk to register your interest in being consulted or to share your responses to what you have read.


The SoT review changed medical education and training with the ambition of better producing the doctors we need now. But it failed to recommend a significant increase in the number of doctors we train in order to realise its vision.

The government has now committed to that expansion with the publication of the NHS Long Term Workforce Plan. But because the size of the workforce has not kept pace with the demand for care, it is under severe pressure. Trainees in particular are experiencing burnout, are unable to meet the demands of training while also meeting service need, and training rotas are less flexible than those of other roles they could take up.

This is forcing an increasing number of trainees to opt out of the traditional training route. At the same time, changes to registration requirements are going to introduce different but equally valid routes to the specialist register. The traditional training pathway may become significantly less attractive unless working conditions improve and we increase flexibility.

The RCP needs to better support the growing number of doctors who are not on the traditional training pathway or the specialist register, as well as members of the wider medical team working in extended roles, in particular medical associate professions (MAP) and advanced clinical practitioners (ACP). This is true both in terms of our offer as a professional association and as an educator. Healthcare is changing, and so must we.

What the RCP intends to do

  • We will work with our partners in the Federation of the Royal Colleges of Physicians of the UK, the NHS and trainees to look at the structure and delivery of training and explore how we can improve the trainee experience. This will include operational issues such as level of fees and facilities for payment in instalments, as well as how to increase flexibility within training - for example, reducing the number of rotations and the geographical area they are spread across, making sure that assessment is relevant and proportionate, and improving general working conditions.
  • We will explore whether the current growth in SAS and LE doctors is likely to be a long term change. We will also explore how these changes – whether transient or permanent – are impacting and will impact trainees on the traditional pathway and the role of consultant.
  • We will work with our members to understand how they feel about an increase in routes to the specialist register and a system in which there could be fewer consultants, more SAS and LE doctors, and more physician associates and advanced clinical practitioners.
  • We will work with patients and carers, and the organisations that involve and represent them, to understand the impact of changes to the health and care workforce on patients and the public. This will include the skills that they want all professionals to have. We will consider the implications of what we learn for medical education and training.
  • We will work with SAS doctors to understand the support, guidance, education and training that they need to develop in their chosen career. We will develop education and training products and a membership offer that meets those needs.
  • We will work with LE doctors to understand the support, guidance, education and training that they need to progress their development, whether they ultimately intend to become a consultant or not. We will develop education and training products and a membership offer that meets those needs.
  • We will work with consultants to make sure that we are offering the credentials and other education and training products that they need.
  • We will explore the role of the RCP in making sure that competency from self-directed learning and training is assessed sufficiently to ensure that all trainees meet the same standard, whatever route they take to the specialist register. This may include widening access to the ePortfolio so that future doctors can make use of it earlier.
  • We will explore the role of the RCP in supporting other members of the medical workforce.
  • We will monitor the development and impact of medical degree apprenticeships closely.
  • We will consider the implications of these changes on how the RCP involves its members in its work and governance. This will include election arrangements, paid and voluntary opportunities, and how we gather views and opinions that inform our strategic direction.