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More medical school places will not automatically mean more junior doctors

A lack of postgraduate training is creating a specialist workforce shortage.

By James Hadlow and Chris Farmer

“We’re training more doctors than ever before” is a phrase we often hear from politicians.

It makes sense for a health service currently on its knees to try to meet demand. The NHS is desperate for more doctors, nurses and allied healthcare professionals to serve patients. The Nuffield Trust think tank estimated in its evidence to the Health and Social Care Committee that there may have been up to 12,000 doctor vacancies in the UK in May 2021. But what does “training more doctors than ever before” or “not enough doctors” really mean – and do even the politicians using these phrases understand?

The question not as clear cut as it’s made out to be. In 2018, when he was health secretary, Jeremy Hunt initiated work to open new medical schools, which will soon have their first graduates. This has led to a much-welcomed increased supply of doctors into the NHS. Indeed, Labour has pledged to take this further by doubling medical school places should the party form the next government. It is clear that phrases such as these will garner public support. But how useful is it really to discuss doctor places in pure numbers?

We already know that in terms of the number of doctors per head, the UK lags behind other G7 countries such as France and Germany. In addition, for patient safety reasons, the working hours of doctors in training have been reduced in recent years through measures such as the European Working Time Directive. So to simply look at the number of UK doctors being trained today compared to previous years is not helpful.

[See also: Without a GP workforce plan, the NHS will fail]

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Additional medical school places are of course welcome, but this is a blunt instrument and it may not solve the problem, particularly in specialties where it is difficult to recruit, such as psychiatry, general practice, emergency medicine, obstetrics and gynaecology, and anaesthetics. The issue does not lie solely in the supply of new doctors – these will be needed to meet future demand but there has not been enough ambition in postgraduate training opportunities once doctors finish medical school, or in improving working conditions to ensure staff retention.

Only a few weeks ago, 350 anaesthetists in training were left without training posts. All of these individuals are highly qualified postgraduate doctors with at least five years of postgraduate training, including three years’ specialist training for anaesthetics. This group provided a significant contribution on intensive care units during the darkest days of Covid-19 and yet they have been left without the ability to progress. Senior doctors such as Dr Fiona Donald, president of the Royal College of Anaesthetists, have pleaded for more training places in the UK for anaesthetists. Elective surgery demand is high as part of the Covid-19 recovery process and anaesthetists are a vital part of this work. There are literally hundreds of trainee anaesthetists who want to serve patients but have been left without the means to do so. Are we in danger of anaesthetics becoming unattractive – and workforce shortages worsening as a result – purely due to the valid perception that progression in the field is too difficult?

This is a moral failure. These individuals have dedicated their lives to serving their patients but have been let down at the final hurdle. These doctors are forced to seek alternatives, such as find temporary solutions for a year or two while they wait for another opportunity to apply for a training post, switch specialties, continue working in anaesthetics through a non-training, non-consultant route, move into a different career outside of medicine, or leave the country to be a doctor in Australia or New Zealand.

Expanding medical school places without joined-up thinking and enough postgraduate training as part of a comprehensive workforce plan is naïve and is creating wholly avoidable bottlenecks. The number of postgraduate training posts must be matched to medical school places, and training posts must be available for postgraduate doctors who want them. This would be a better, joined-up approach that allows for clear progression and demonstrate how much the UK values doctors and their sustained training. A much-needed NHS workforce plan with specific numbers is sadly still lacking.

The NHS needs more doctors, as well as nurses and allied healthcare professionals. But increasing undergraduate places without matching this at postgraduate level has a profound long-term impact. This approach is letting down the NHS, the public and hundreds of dedicated doctors. “Training more doctors than ever before” sounds good but in the grand scheme of things, it is meaningless.

[Read more: The NHS workforce crisis could be solved by reforming medical training]

This article was originally published on 5 May 2023.

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