RSM President calls for medical training overhaul as MPs raise alarm about NHS “workforce crisis”

Investing in better postgraduate training is key to retaining doctors in the NHS, according to the President of the Royal Society of Medicine.

Professor Roger Kirby’s comments came as the House of Commons’ Health and Social Care Committee published its Workforce: recruitment, training and retention report, which warned that the NHS faces the “greatest workforce crisis” in its history.

The cross-party Committee, chaired by former Secretary of State for Health and Social Care, The Rt Hon Jeremy Hunt MP, had a broad scope and its wide-ranging report, published on Monday 25 July 2022, addresses workforce planning, recruitment, training, working culture and retention. It makes a number of recommendations for the Government to consider, including an independent review of all postgraduate medical training.

Professor Kirby gave evidence to the Committee as an expert witness in May 2022. As a senior doctor and President of one of the leading medical education charities in the country, his testimony focused on the important role of lifelong education in retaining doctors and other healthcare professionals.

Summarising his position in the journal Trends in Urology & Men’s Health, Professor Kirby warned against placing too much emphasis on recruitment and to also focus on retention. He said: “Focusing exclusively on recruitment of additional students to medical schools fails to appreciate many of the issues.

“It is critical that a holistic approach is taken, otherwise these recruitment efforts will become a sunk cost.

“If we assume that it costs in excess of £250 000 to train a doctor, and then add on the costs of supporting training, it is obvious that more effort needs to go into retaining them in the workforce, rather than letting them go.”

He argued for better educational support to smooth the transition from medical school into the workplace. He said: “There is much that could be done to enhance the quality of life of UK medical graduates as well as to enhance their skills, not only as clinicians, but also as researchers.

“A greater emphasis on leadership, negotiation and communication skills would also be helpful.

“The role that organisations such as the Royal Society of Medicine play in the ‘lifelong learning’ of healthcare professionals, also needs to be recognised.

“Closer connections need to be made between medical schools and postgraduate organisations so that they complement the training that takes place in the workplace.

“Future investment in professional development will be the key to retaining excellent doctors.”

He also highlighted the disconnect between senior and junior colleagues brought about by the 2005 Modernising Medical Careers (MMC) report. He said: “The heavily criticised implementation of MMC resulted in the dismantling of the so-called ‘firm’ structure of training, replacing it with a rotation of trainees from unit to unit in separate institutions on an annual basis, or sometimes even more frequently.

“As a consequence, trainees have often become dislocated and disengaged, as a 12-month period in a hospital is frequently an insufficient time for a clinician to build trust and feel secure within the unit to which they are allocated.

“The changes have also meant that senior clinicians are less likely to go out of their way to provide career oversight and mentorship.”

On postgraduate training, the Committee’s report states:

“We believe that the GMC’s emphasis on acquiring competency in postgraduate training, rather than focusing on “time-served”, is correct. The Government should commission an independent review of all postgraduate medical training to consider whether it is possible to reduce the time it takes to obtain a postgraduate qualification, whilst maintaining rigorous patient safety and professional standards.”