Rational of programme and ensuring training opportunities

10 questions were raised relating to this theme, the collated answer is below:

The work of the distribution programme will support patients and the wider NHS by ensuring we have the appropriate number of doctors in the places where they are needed. It will also support trainees by offering more training places in areas where disease prevalence (linked to given specialty) is high, therefore offering more exposure and more training opportunities.  

The Government through the Department of Health and Social Care (DHSC), in discussion and agreement with the Treasury, determines the funding available for postgraduate specialty training programmes and balances this investment over 65 different medical specialties across the different geographical areas of the country. Where caps are applied to posts this is determined through mapping workforce planning based on population need. NHS England identifies priorities for investment, in line with the service priorities of the NHS across all medical specialties and the wider workforce.

Through an additional 1,500 annual undergraduate medical school places now available in England, we will see an anticipated increase in the number of trainees progressing into specialty training as early as 2026, following the completion of the UK Foundation Programme. Working with hospital trusts, the first phase of the Foundation Programme expansion, scheduled for August 2023, is already underway.

The NHS Long-Term Plan set out the five-year ambition for service delivery from 2019, but Covid-19 placed unprecedented, unpredicted demands on the NHS workforce. The most recent Spending Review supported an initial boost to medical specialty training by 1000 additional programmes over the course of the 3-year spending review, to support three priority areas:  Elective recovery, Acute and Urgent Care and the response to the Ockenden report.   This is in addition to the previous commitments to increase the medical workforce in Cancer and Diagnostics, Mental Health and General Practice, all highlighted as Long-Term Plan priorities. 

Doctors in training provide significant service whilst training and are therefore a key component of the current workforce, as well as the NHS’ future consultant and GP workforce. As doctors in training progress into higher specialty training, they become more senior decision-makers, assume greater autonomy and can deliver more complex care. The increases in medical training need to be modelled and distributed in alignment with population health need, as this is critical to helping address health inequalities. Recruitment for the first year of the 1000 expansion saw the first 333 additional doctors in training enter the workforce from August 2022. The remaining expansion was modelled during May and June 2022 and informed regional planning for expansion and distribution, with plans finalised in October 2022 in line with HEE and NHSE investment planning timescales.

We are continuing discussions to further expand places in postgraduate specialty training and we recognise that enable further workforce investment it is essential that we see the investment to support the growth in infrastructure and educational capacity required. The requirement is for more than just workforce, training and education but a whole system approach which will support these changes.

Work is being undertaken to ensure that appropriate access to trainers remains of a high quality.  The recently published Educator Workforce Strategy also shows our commitment to maintaining quality training for medical speciality trainees.

As highlighted above, work is being undertaken as part of the Distribution programme to ensure that educational capacity expands alongside increases to trainee placements. Aligning speciality training places with geographical need also offers trainees more exposure to cases and procedures relevant to their chosen speciality.

A report published by Health Education England (HEE) outlines the many improvements that are being made to enhance the training experience of doctors and improve their well-being. This is the 4^th annual report describing the work that HEE, with doctors in training and partners including the British Medical Association Junior Doctor Committee (BMA JDC), NHS Employers, the Medical Royal Colleges, the General Medical Council (GMC) and have undertaken to improve the issues trainees said were important to them.

The quality of training programmes is monitored and surveyed regularly and the same processes are applied where there are concerns regarding quality of the learning environment, regardless of the location.