RCR responds to postgraduate medical training review from NHS England

There are major issues with the delivery of specialty training. Despite the dedication and expertise of our trainers and the enthusiasm and resilience of resident doctors, systemic challenges too often get in the way. That is why the RCR have taken the opportunity to respond to NHS England’s consultation for their review of postgraduate medical training. 

We need to ensure that any changes in the way training is delivered are targeted to address the real issues and improve the experience of residents and trainers alike – not to ignore the major problems, nor to make matters worse.  

This review is an opportunity to fix some of the problems that exist. Resident doctors are the future leaders of multidisciplinary healthcare teams – so it is vital that their training is prioritised. 

Our response to the consultation was developed with input from the committees of the Radiology Resident Doctors’ Forum and Oncology Registrars’ Forum, along with discussions with Heads of Training, Clinical Directors, Heads of Service and RCR Officers.  

We want to share it with you in full... 

In our response, we made the following arguments: 

• Rotations and programme structures: residents need to know ahead of time where they will be posted and how long each of their rotations will last. There should also be a reasonable limit to the geographical dispersion of a resident’s rotations. Currently, the quality of information residents receive about this is not good enough.  
• Bottlenecks within and after training: residents should not encounter bottlenecks or blockages during their training. They must be confident there will be sufficient training places for them to have a good chance of joining the training programme they wish for. This is why we need more specialty training posts in radiology, which has a huge competition ratio. Residents must also have the assurance that there will be consultant posts for them to take up after they complete their training. 
• Creation and distribution of training posts: we need to know far in advance how many specialty training posts and how many consultant posts there will be available each year. We also need advanced knowledge of where these posts will be located. Currently, there is a lot of misalignment and uncertainty in the provision of both these types of post. 
• Recognising the value of specialty training: specialty training is not a “nice to have”, but rather a crucial element of the health system. The NHS at all levels needs to recognise and reflect this reality. A healthy training pipeline is a non-negotiable for a sustainable healthcare service. Resident doctors are the future leaders of healthcare teams. They are critical to the healthcare system and to patients. They should therefore be valued and served well by the healthcare system to which they give so much of their dedication and expertise. 
• Flexibility and choice: a careful balance must be struck between giving residents a greater say in where and how they are trained on the one hand, and stability in training programmes and workforce plans to meet the needs of patients on the other hand. Enabling greater flexibility in residents’ training would help to boost wellbeing and morale. But training programmes need confidence that they will have sufficient residents to meet their local service requirements. We encourage NHSE to tackle this difficult balancing act head-on. 
• Facilitating specialty training: the NHS needs to increase the amount of specialty training it can deliver. This entails addressing systemic challenges. These include the time trainers have to deliver training. It also means providing sufficient office space, clinic space and radiology workstations, amongst other requirements.  

The consultation touched on many other topics besides these, including the use of and training in digital tools like artificial intelligence, and the delivery of specialty training within community settings. 

Resident doctors are the future leaders of clinical teams. It is therefore vital that with this review NHSE ensures that their training is prioritised and championed. We understand that the team at NHSE are now analysing the feedback they have received, and that publication of the review’s findings can be expected in the autumn.  

We will be monitoring NHSE’s ongoing work on this review and advocate on your behalf wherever we can. There are opportunities for the College to feed into the review via discussions with NHSE staff and via formal listening events; we will be making use of these. We are also in dialogue with the training team at NHS England and will be raising these points with them at every opportunity. If you have any questions, please contact us at: [email protected].