RCoA response to GMC State of Medical Education and Practice in the UK report

Published: 16/12/2024

The GMC recently published its report, The state of medical education and practice in the UK, which highlights the changing nature of the medical workforce. 

We have considered this report carefully. One of the key findings is the substantial growth in locally employed doctors across all specialties. This mirrors the large and growing bottleneck between foundation and core training highlighted in our recent State of the Nation report and suggests increasing numbers of doctors are in locally employed roles because they are unable to enter formal training programmes.  

The GMC report is further evidence of the increasing crisis in postgraduate specialty training that we have been highlighting for several years: 

  • Across the entire medical training system, there is a huge and growing bottleneck between foundation and core training. In 2024, there were 54,012 applications (from 26,138 unique applicants) for just 9,341 specialty training places.  

  • We see this acutely within our own specialty of anaesthesia. In 2024, there were 3,520 applications for an available 540 core anaesthetic training places. At the same time, we have a shortage of 1,900 anaesthetists across the UK, which prevents around 1.4 million operations and procedures from taking place each year. Urgent intervention is required by the Government to fund more anaesthetic training places, for which there is currently capacity in the system, both in the immediate and long term.  

  • This lack of opportunities for specialist training is unacceptable and explains why so many doctors are employed on contracts set by individual trusts/health boards with insufficient opportunities for continued education and career progression. We see this not as a choice, but rather a consequence of the failure of successive governments to fund an adequate number of specialty training numbers to meet the needs of patients.   

  • All doctors should be enabled and supported to progress in their careers, whatever role they are in. There is an urgent need to support locally employed doctors to progress in their careers and achieve their potential. For example, all locally employed and early career specialty doctors should be offered a nominated educational supervisor, as set out in our best practice guidance on how doctors outside formal training programmes should be supported within their departments.  

  • The GMC reports a 6% decrease in the number of doctors training in anaesthetics between 2019 and 2023. This reported reduction is of concern, and we will work the GMC and NHS England Workforce, Training and Education to seek clarification on the data presented. From our recent work in lobbying for additional specialty training posts, we think it likely that the reported decrease has been precipitated by a combination of factors including trusts/health boards refusing to fund additional posts, statutory education bodies allocating posts to regions that do not have the training capacity to take them and increased take up of Less Than Full Time Training, which means doctors remain on formal training programmes for longer. This number remains of concern, and we will utilise the findings of this GMC report to continue to support the needs of our members for better access to anaesthetic training.  

Dr Claire Shannon, President of the Royal College of Anaesthetists said:  

“The lack of opportunities for doctors to access postgraduate medical training is unacceptable. We cannot go on with vast numbers of doctors unable to progress to specialty training at the same time as more and more patients need specialist treatment.  

“The RCoA has long argued for successive governments to address this. The forthcoming ten-year plan for the NHS offers an ideal opportunity for action and we urge the Government to consider this growing problem. 

“We need a fully developed and funded plan for specialty training both in the short and long term so that all doctors can achieve their potential – only then will we be able to fully meet the needs of patients.”