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Shape of Training Review: all the key reaction

A new report by the Shape of Training Review say a new way of training doctors is needed for a changing healthcare landscape. It says patients will need doctors who are able to provide general care in broad speciality areas across a range of different settings.

Here’s all the reaction to the report:

The Royal College of Physicians

Sir Richard Thompson, president of the Royal College of Physicians

“The RCP welcomes the emphasis of the new proposals on broader-based ‘generalist’ training for all doctors, as suggested in the recent report of the RCP’s Future Hospital Commission.  We are also delighted that the report recognises the need for an increased focus on patient centred care and the patient experience throughout medical training.

“We know our trainees are struggling to cope with the increasing demands placed on them by the service, so the recommendations for an improved training process with increased mentoring and coaching, the apprenticeship approach, and longer placements with more consistent educational supervision will provide welcome and extra support for our hard-pressed trainees.

“However, we are concerned that no immediate action is being suggested to fix the current crisis in acute medicine.  The proposed changes are five years away and there is a risk of generating planning blight that would delay making the urgent changes that are necessary now while we wait for the implementation of the new plans.

“We’re also concerned that specialist training programmes beyond Completion of Specialist Training (CST) need to be planned, funded and managed on a national basis to ensure that we maintain the existing range of specialists so that patients continue to have access to high quality care wherever they are.”

Dr Ruth Dobson, chair of the RCP’s trainees committee

“We are pleased that the report recognises that early medical training must focus on more general skills. We need more doctors who can provide general care for the increasing number of older patients suffering from multiple conditions.

“We welcome the proposed move away from time-based training to a model where trainees doctors progress at their own rate according to their own progress.  However, it is essential that doctors at the end of their training scheme are fully trained to practice independently and without supervision.”

The BMA

We agree with many of the suggestions, including more flexible training and improving careers advice for medical students, but there are a number that cause concern including moving full GMC registration to the end of medical school; the complete overhaul of the training programme structure, without a commitment to first comprehensively consult or assess these changes; the proposed timescale for implementation of the report’s recommendations.

The BMA supports the concept of broader-based training which incorporates generic capabilities and greater flexibility for trainees, and agrees that medical training should be responsive to changing demographics and patient need. However we believe there are less disruptive options available to achieve this goal.

The report also suggests moving the point of full GMC registration to the end of medical school, and places the onus on medical schools to demonstrate that graduates are ‘capable of working safely in a clinical role.’ Although the BMA agrees it is crucial for doctors to be properly prepared and safe to practise at full registration, this is at odds with the idea of removing a whole year of education and experiential training by bringing forward the point of full registration.

We are also concerned about the effect this change could have on workforce planning, with additional scope for applicants from many more EU member states to an already oversubscribed Foundation Programme.

The BMA supports the suggestion that training should be limited to places that provide high-quality, GMC-approved training and supervision and to increase the length of placements to at least six months.

However, we are concerned by the recommendation to move the achievement of highly-specialised skills outside the scope of postgraduate training, and fear it will lead to a sub-consultant grade. The ‘certificate of specialty training’, which would replace the current ‘certificate of completion of training’, must remain at the end of postgraduate training and demonstrate that doctors are competent to work in their chosen field.

Dr Kitty Mohan, co-chair of the BMA’s Junior Doctor’s Committee, said:

“This report is an important contribution to the debate on the future of postgraduate medical training and while we support some of the suggestions we are concerned about the implications of some of the more far-reaching recommendations, which we do not believe are fully evidence-based or sufficiently developed. Because of this we don’t believe the proposals in this report are ready to be implemented at the rapid pace proposed. Further work is needed to explore the report’s findings and the implications of its recommendations before moving to implementation.”

Royal College of Physicians of Edinburgh

Dr Neil Dewhurst, president of the Royal College of Physicians of Edinburgh

“In broad terms, we welcome the report with the recognition that we need to train more hospital generalists to respond to the complex care needs of our ageing population. This should theoretically create a future generation of hospital doctors who will have the knowledge to treat a wider range of patients. But this will only work if the training and employment opportunities and the working environments are sufficiently attractive to recruit enough doctors into these positions.

“The evidence is clear – hospital-based specialties with the lowest ratios of trainee doctors to trainers (such as anaesthetics and radiology) are popular and attract higher numbers of applicants. This is because trainee doctors value one-to-one supervision and experience a better quality of training and learning. In contrast, other specialties including general and acute medicine are much less attractive due to an imbalance of service pressures and training time. As a result we have many vacancies around the UK. This is bad for patients, for doctors’ morale and recruitment

“We recognise that local service needs will influence the numbers and location of training opportunities in many sub-specialties through what is being called post-Certificate of Specialty Training credentialing.  However the NHS must remain alert to the risk of further damaging the popularity of hospital medicine as a career if such opportunities are delayed or unavailable to ambitious and capable trainees

“The Shape of Training Report has recognised the tensions which exist between the competing demands of service provision and training. It is essential that the medical workforce is expanded at all levels to alleviate service and training pressures and to improve the training environment. Only by doing this will we be able to improve the quality of training for trainee doctors, make recruitment more sustainable and ultimately result in a higher quality of care for patients.”

Royal College of Surgeons

Professor Norman Williams, President of the Royal College of Surgeons

“We welcome many aspects of this report, particularly its focus on ensuring that postgraduate medical education and training is responsive to changing demographic and patient needs. However, from a surgical perspective we do have some concerns. As acknowledged by the review, surgery takes time to master. It is unclear how, without significantly lengthening their training, surgeons in highly specialist areas such as cardiothoracic surgery or neurosurgery would acquire the necessary skills and experience in the proposed broad based training programmes. We await further detail on how this will work in practice.

“While the College supports the re-introduction of apprenticeship based training, at the heart of this is the relationship between trainers and trainees which is often undermined by shift patterns and rotas. The report does not say how more time for training will be made available under the current working patterns of trainees.

“The recommendation that registration is awarded a year earlier, following graduation from medical school, is of concern to the College. For some time we have expressed our disquiet about the lack of a national curriculum across medical schools. While the review acknowledges issues with undergraduate training, we await to see how medical schools will provide assurance that graduates are capable of working safely in a clinical environment having had limited experience on hospital wards.”

General Medical Council

GMC chair Professor Sir Peter Rubin

“We warmly welcome the final report from Professor David Greenaway’s Shape of Training review.

“We are pleased Professor Greenaway’s focus is on the changing demographics in the UK, and especially on the ageing population and growing number of people with complex medical conditions.

“We particularly welcome the idea of a more flexible training structure for doctors and for doctors to be able to change roles and specialties throughout their career so we can continue to attract and retain the best doctors in the profession.

“Some of the recommendations will require further discussion, including the suggestion that full registration should be awarded at the point of graduation from medical school. But overall we are confident that these recommendations will help to improve the way doctors are trained and provide clear benefits for patients and the public within the health service now and in the future. The key is to ensure that we are able to make steady progress towards these reforms while maintaining some stability in a system that has already been subject to a great deal of change and pressure in recent years.”

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