It is crucial that careful consideration be given to where the existing postgraduate medical education, support, and training functions will sit following the dissolution of NHS England. This is critical to ensuring the system is fit for purpose and that it strives for excellence in quality. Rushed reforms without involvement of the profession have previously been deeply damaging for postgraduate medical training in the UK.
It is the BMA’s view that the following principles should apply in this decision-making process.
1. National consistency
There must be one clearly accountable national body for postgraduate education and training that holds and enforces national standards, ensures consistency across regions, and is answerable for training quality. Workforce planning must be carried out at a national level.
Standards should be set nationally and implemented locally by lead employers. Any changes to programme delivery must be underpinned by national governance and strategic oversight led by the medical profession, to ensure there is a shared understanding of the aims, consistency in programme development, and to avoid detrimental divergence in quality.
2. Regional relevance
The day-to-day oversight and operation of education, training and support must remain at a local level, with local teams mapping onto existing local team and deanery functions. This is essential to ensuring postgraduate education and training remains relevant to local population health needs, placement capacity, and overall workforce planning.
3. Clear separation from government departments
The content and delivery of medical education must be led by the profession and free from political interference. To ensure the confidence of the profession and public, there needs to be clear arms-length separation. For these reasons, we do not believe the postgraduate training functions of NHSE should be contained within the Department of Health and Social Care.
4. Clear separation from contractual matters
Employment contracts are held between the employer and the employee. National and regional education bodies should not have any role in determining or re-interpreting contractual matters, such as when annual leave can be taken. This does not preclude education bodies from acting upon their important duty of care towards doctors in training programmes by engaging with their employers or ensuring that those employers provide a suitable training environment.
5. Led by medical professionals and guided by expertise
Educational functions at a local and national level and must continue to be professionally led by qualified medical practitioners, with expertise in medical education relevant to the context. Decision-making should be based on the specialised expertise of medical professionals as to what works for medical education and training. The medical profession must remain the key interface between policy and implementation in postgraduate medical education. It is essential that Training Programme Directors have the experience and confidence of the community they represent in undertaking this role.
Future appointments to Training Programme Director roles should only be those who have completed specialty training in the relevant medical specialty.
6. Open, transparent, and accountable
Organisations hosting national and local education and training functions must be open, transparent, and accountable to the professionals they train and all relevant stakeholders, including representative bodies. The organisations must engage regularly with the profession, with clear routes for the profession to raise issues and escalate quality concerns with a single national arbiter of standards. There must be an external, independent aspect to oversight and accountability for training environments. Appointments to management roles within the bodies must be open and transparent, with clearly defined roles and limits on authority.
7. Strengthen professional support
Professional Support Units play an essential role in supporting doctors through postgraduate training, reducing dropout rates and supporting safe progression. Access must be protected and consistently available across regions, not limited to doctors in training, and should include exam support, neurodiversity support, support with inquests, and professional and wellbeing help.
8. Educator support and development
The senior medical workforce must be supported to develop as educators. These roles must be properly remunerated and job planned (where job planning is relevant), with costs sufficiently reimbursed to their employers (where educators are not employed by education bodies directly) and GP practices to avoid financial disincentives from fulfilling educational roles. This is integral to supporting the educational leadership pathway.
Development opportunities must be available to all doctors, with the training framework facilitating the inclusion in national and regional decision-making bodies of SAS doctors and those on locally employed contracts, thereby promoting equity, recognition, and structured progression for all doctors delivering care and education.
9. Properly resourced and ringfenced
The oversight of existing education and training functions has been decimated through a series of resource cuts to NHS England and Health Education England before that. This places the future of the medical profession in serious jeopardy and acts against patient interests by risking the ongoing supply of well-trained doctors. Mechanisms, including ringfencing, must be put in place to ensure both local and national education and training functions are properly funded and that governments do not view it as the first stop for cost savings.