Specialty Medical Training

Lord Kakkar Excerpts

Thursday 17th July 2025 Grand Committee

[Lord Kakkar (CB)]

My Lords, it is a great pleasure to follow my noble friend Lady Finlay and to thank the noble Lord, Lord Lansley, for the very thoughtful way in which he introduced this debate. In so doing, I remind noble Lords of my own registered interest as chairman of King’s Health Partners.

As the noble Lord, Lord Lansley, said, there is a continuum here—a continuum from establishing the number of places that we have at medical school through to the foundation years, where those newly qualified medical students are able to hone and consolidate their skills, and then subsequently to choose to go into core and speciality training and ultimately seek permanent consultant or GP posts.

It is fundamental to the process of planning that each part of that continuum is properly joined up. For instance, how do His Majesty’s Government deal with the question of ensuring that medical schools have an appropriate curriculum that is sufficiently flexible and will meet not only the training needs in the subsequent seven to 10 years after qualification of a medical student but the subsequent 30-odd years of clinical practice? In terms of expectations, how do we set the appropriate expectation for those bright young individuals, as the noble Lord, Lord Lansley, said, going to medical school, so they are better able to understand what clinical practice in future will mean? For a large number of them, with the Government’s determination that care is moved closer to home and into the community, the skills will include the capacity to apply digital technology and to be substantially literate in the use of data, as well as to be able to lead multidisciplinary teams, in addition to having a good understanding of pathophysiology, physiology, biochemistry and other clinical skills.

Once individuals enter their foundation years, we must be clear about what core skills we need to consolidate that will provide them with the ability to adapt over a lifetime of clinical practice—and so too into core and specialty training. It is quite shocking that, in 2022, for those entering their subsequent training in 2023, the General Medical Council assessed that some 75% of those completing their second foundation year did not go into a core or specialty training post. Where did they go? Some of them clearly became locally employed doctors, but it is clear that the majority of those who have gone through medical school and had their early post-qualification training are not going immediately into subsequent training. Why is that? What do we have to do to make that subsequent core and speciality training more effective and agreeable for those who need to commit themselves to it? If they are going into locally employed doctor positions, professional positions where they are locally employed by trusts, principally to deliver service, is there a way we can provide the opportunity for those locally employed doctors to undergo some form of training as well?

There is a substantial financial commitment to their employment and, given that commitment, which probably concerns at least half of the recently qualified workforce in the NHS, there should be an opportunity for training to be provided under those circumstances—as the noble Lord said, ultimately, potentially, to move to a portfolio system, whereby elements of that clinical practice, supervised and attended by training, could contribute to certification that could ultimately contribute to a pathway of accumulating experience, not only in core and specialty training posts with a number but through those locally employed doctor posts, increasing the amount of flexibility available.

Beyond that, we have to consider how we do workforce planning. The previous Government, quite rightly, in 2023 was congratulated for having agreed and settled a workforce plan with substantial ambition in increasing the number of medical school and nursing places as well as in training more clinicians, based on what I assume was a determination of the changing population demographic and therefore a greater need for doctors in certain specialties and disciplines.

With their 10-year plan, the Government have indicated that the workforce plan of 2023 is to be put aside. That, I think, is quite a problem. One of the things we need to be able to achieve in our country is a degree of consensus so that planning can be constructed and delivered over an extended period. What will be the new methodology? The 10-year plan indicates that the previous plan needs to be put to one side because we will have new models of care. We are going to be adopting digital technology and working in different clinical environments. That is all absolutely fine, but how is that to be modelled? What is the methodology? What is the certainty that we are applying the correct parameters to any modelling plan to allow us to determine which specialties and disciplines need to be expanded? Where are the geographical locations where this training should take place? What are the preferences of those who have gone to medical school and completed the early part of their training in terms of taking up such opportunities? In coming forward with the 10-year workforce plan, the Government are going to have to be very clear on these questions, so that whatever is proposed is plausible.

My noble friend Lady Finlay raised the question of clinical academics. These are a vital part of the medical workforce. The Government are absolutely committed to innovation and its adoption at pace and scale across entire health economies, but at the very genesis of that innovation are clinical academics, and we have seen an erosion of clinical academics in the National Health Service over the last 10 to 15 years, with great problems in being able to ensure that those who choose an academic, potentially research-driven commitment, as well as a proper clinical commitment, can achieve training for both those elements side by side and still be able to compete for consultant posts after that. How do the Government propose to address that issue?

Finally, I come back to locally employed doctors. It is critical that that large number of young clinicians are able to continue their early post-qualification clinical practice in a way where they remain strongly motivated and potentially determined to apply subsequently for core and speciality training posts. At the very least, they should continue to be developed in a supportive and meaningful way, so that they are fully flexible and have the capacity to make the important contribution that the health service over the coming years is going to require from all employees.