Specialty Medical Training

Baroness Finlay of Llandaff Excerpts

Thursday 17th July 2025 Grand Committee

[Baroness Finlay of Llandaff (CB)]

My Lords, I am grateful to the noble Lord, Lord Lansley, for having secured this important and timely debate, given that many doctors find in August that they are without jobs. Although those graduating in medicine in this country are guaranteed a pre-registration post, there are not enough posts for all of them in the UK. It is welcome that the Government’s 10-year health plan states that these UK graduates will be given priority for F1 posts—that is, the first year after coming out of university. In those posts, they are the responsibility of the parent university, as well as whoever is responsible for their training at local level.

It has been estimated that there will be a need for at least 1,000 extra GP training posts in the very near future, to say nothing of extra medical educators, to recognise those shaping the future workforce. Although common things occur commonly, diagnosis of complex conditions is not done by simple algorithms. There has been a potentially dangerous overreliance on artificial intelligence. That is already being discussed at major medical conferences. We need the people with the training.

Part of the welcome commitment in the Government’s plan is to reverse the decline in clinical academics, which must address the need to reimburse universities for the additional cost of the contractual arrangements for NHS substantive and honorary consultants. Worryingly, last year’s negotiations took place without the involvement of the universities or the Department for Education, yet, without research, all our medical advances and their benefits to the UK economy could dwindle.

Medical schools are committed to widening participation in the profession, with a more than 50% increase now in the entrants from disadvantaged backgrounds, and a focus on under-doctored areas to strengthen the health economies of remote and rural regions, encouraging graduates who want to return to the areas from which they come. There are, however, major bottlenecks early in training due to a mismatch between training posts and numbers and available doctors between both FY2, the second year after qualifying, and internal medicine training, and then on into higher specialist training. This is contributing to a lack of workforce capacity in higher specialty training, and that feeds on into a shortage in the consultant workforce itself.

I illustrate this from my own specialty of palliative medicine and from emergency medicine, two areas where the need for high-quality medical services is rapidly increasing because of demography and the complexity of multiple comorbidities, including presentations of new conditions and, in emergency departments, of major incidents. Competition for internal medicine training has grown rapidly. Taking into account multiple applications, there are still two doctors for every available post. Applications from international graduates doubled in the last year, and the increase from UK graduates was 33%. This leaves seven in 10 recently qualified and registered doctors concerned about their future employment, of whom a quarter were apparently unsuccessful in applying for specialty training. More than one in 10 are now applying for medical jobs abroad and more than one in five are looking for an alternative career.

One area of great pressure is the number of formal training posts. If a post is taken by a doctor who then works less than full-time, the unused part of that post cannot be filled because there is no additional marginal funding. Job shares are difficult and sometimes do not work well, and internal medicine shows that almost two-thirds of certain speciality trainees are working less than full-time. This then feeds through to the shortfall in trained doctors eligible for consultant posts, leaving many vacant palliative medicine posts, for example, unfilled for prolonged periods because flow-through is stagnant due to funding constraints. It is worsened by the reliance on charitable funding for some of these posts. For example, a colleague of mine in west Wales is struggling to do the job of three consultants because two posts are vacant due to a failure to fill these jobs because of a shortage of suitable applicants.

Given the need for more posts in the community, there is now discussion as to whether general practice and palliative medicine can come together to provide joint training, an option that has proved popular for general practice and public health. I ask the Government to actively support these and other initiatives to free up the mobility of trainees, increasing their ability to move between different disciplines and places and their sense of belonging to a team. This is essential for maintaining more care in the community, which is outlined in the 10-year plan.

I turn now to emergency medicine, routes into which are through the two-year acute care common stem, which allows trainees to train towards anaesthetics, acute medicine, emergency medicine or intensive care. At the end of the two years, they have to reapply for senior training, as there are very few run-through posts. The advantages are that they have a broad experience and can switch from one line to another, having had a common stem, but the reality is that recruitment is highly competitive. Many newly registered doctors are locally employed, which means that they are not in training posts but are doing very responsible jobs. In the London area alone, one trust that I know had more than 800 applicants for a small number of emergency medicine training posts. The bottlenecks are at every point in the system.

This is another speciality where over 60% are now seeking less than full-time training, which is understandable given the stresses of the job and the difficulties of childcare commitments and so on. But if, for example, you have five training posts, and five trainees working at 0.8, which is equivalent to four whole-time posts, currently you cannot appoint a sixth person to the remaining one whole-time equivalent because of the shortfall in additional top-up funding for oncosts and so on. That means that we are chronically underreplacing, even in those disciplines where the fill rates are high.

There is another problem. Training numbers are not evenly distributed fairly within the system and around the country. They need to be determined by population need, set as a formula. It is not appropriate for the south-east to have many more training posts than other parts of the country, such as under-doctored rural areas. Geography is an important consideration for many trainees. They often want to stay near the area where they trained in medicine. That is helpful because they have all the contacts to seek informal advice and support, but the targets to get through a certain number of patients can work against the system and the allocation of training posts. For example, pathologists and radiologists are essential to diagnostic processes but they may not feature in the target minds of many planners.

The movement of finances can underpin the workforce and it is essential that we do this if we are to have our own graduates and know all aspects and the standard of their training, and if they are to be able to work and pursue careers in this country rather than be driven abroad, pulled by the attractiveness of recruitment programmes from Australia and other places. We trained them, and we need to harness all their potential.

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[Baroness Finlay of Llandaff (CB)]

My Lords, I apologise to the Committee; I should have declared my interests. I am an observer on the Medical Schools Council, I chair the Bevan Commission in Wales and I hold the chair at Cardiff University.