After decades without any coherent NHS workforce plan, some recent developments are encouraging for doctors in training. These new developments bring promise of a better future. First, the Medical Training (Prioritisation) Act improves the chances for young doctors from UK and Republic of Ireland in securing the training posts they desire. Then there’s the appointment of Prof. Dame Jane Dacre to lead the Medical Education and Training Review which promises to radically change the system. So, the future sounds bright? Does it?
There will be many doctors out there who are not getting excited. Unfortunately, they have faced numerous false dawns in recent years. These have included the new flexible approaches communicated by Dido Harding, who made a lot of sense in her early days as Chair of NHS Improvement before she moved onto other things. Then there was The Future Doctors Programme with the idea of Broad-Based Training. And who could forget the series of headline-grabbing “step-change” NHS funding announcements.
The sun was due to rise with new these initiatives but, each time, the new dawn was eclipsed by other events. The COVID pandemic, cost of living crises and energy shocks have taken their turns at getting in the way. Sometimes the new future didn’t appear due to changes in political direction. Other times, there’s been a simple lack of follow through. Words are easy – actions often less so.
Let’s hope those now in control learn from the past and that the future is indeed going to be bright.
But what about now?
Unfortunately, that bright future can seem a long way off from the dark clouds of career progression bottlenecks that are currently leaving countless doctors in limbo.
Much of the attention is focused on the early career training post bottleneck caused by the slow increase in spaces failing to keep pace with rapidly growing numbers of medical graduates. As a result, Foundation Years doctors have been dealing with ever increasing competition rates for securing a training post.
At the same time, the mid-career progression bottleneck facing doctors achieving their CCT or CESR via the Portfolio Pathway is getting less attention. But lack of attention doesn’t make it any less real. The numbers entering the GMC specialist register is increasing by around 3-5% each year and will continue to do so. But lack of workforce planning means there’s over-supply for some specialties and under-supply for others. While NHS patients are typically facing long waiting lists due to the high number of Consultant grade vacancies, NHS Trusts are trying to manage their funding-shortfall/financial-overspend through recruitment freezes. This results in 3 conflicting truths:
- We have a Consultant shortage.
- We have unfilled consultant vacancies.
- New specialists are struggling to get jobs
And what’s the current reality if you are an IMG? In addition to now being penalised for access to training posts, a government declaration to reduce reliance on IMG’s along with the general political discourse around immigration all adds up the UK sounding like an unwelcoming place than it was 2 years ago. Back then, IMG’s were filling important gaps in the medical workforce. But studying the GMC register and taking feedback from other sources, the flow of experienced doctors has suddenly dried up. It’s important to note that the Governments target is to reduce reliance on IMGs by 2035 – not immediately. There are still plenty of opportunities for good experienced doctors.
Combining the CCT/CESR progression bottleneck with the IMG slowdown limits the number of doctors who are able to supervise trainees. This in turn exacerbates the lack of spaces for higher training. It’s all linked. Urgent, radical change is definitely long overdue – but likely to take years to have any impact.
So, what about me?
You may well be able to act as a part of a large collective to influence the system via the current dispute channels. In sharp contrast, you can’t shape the system as an individual – but you can shape yourself. In addition, you can’t wait for the world to change before you respond. To give yourself the best chance of success, it’s important to take the initiative and prepare yourself for the opportunities that will arise.
How can you become the best version of yourself? The answer to that lies in investing time and effort in own personal development. This includes fully participating, making good use of on-the-job opportunities and support available to you as part of your employment or current training programme. Lot’s of other doctors will be doing that too. So, if you also want to stay ahead of the competition, then it also includes seeking out additional opportunities for yourself.
As we say at Oxford Medical: Develop your abilities. Maximise your potential.
Stephen McGuire – Managing Director
