NHS chief wants big overhaul of medical training

Authors: Gareth Iacobucci 

Publication date:  24 Jan 2017

The head of the NHS in England has told The BMJ that he will push for a major overhaul of medical training to focus more on the needs of the modern NHS and rejuvenate morale among the junior workforce.

NHS England’s chief executive, Simon Stevens, said that he wanted to use the government’s recent announcement of 1500 extra medical school places by 2018 as a springboard for change to how doctors are trained.[1] This refocus should include a stronger emphasis on primary care and psychiatry and an increased recognition of the importance of multimorbidity and frailty, he said.

Alongside this, Stevens said that the NHS would work urgently to provide a more supportive environment to junior doctors training in clinical practice, in response to the frustrations that came to a head during their long running contract dispute with the government.

In particular, he cited as issues to look at over the next two to three years: the loss of the “firm” system in hospitals, the move towards shift systems that often left doctors feeling detached and unsupported, changes to specialty training, and the lack of time available for learning and research.

Stevens acknowledged that the additional 1500 medical training places announced by the government would not be an instant solution but said that it should be used as an opportunity to rethink the way training was conducted. “It will take 10 years plus for those new doctors to be working in frontline clinical practice, but we’ve got to use the opportunity to ensure that the curriculum, the training experiences, and the support that undergraduates get are aimed at the health service we will have in 10 or 20 years—as against the health service of today, let alone the health service of 10 or 20 years ago,” he said.

“We would like to see a strong emphasis on primary care and psychiatry as well as other traditional hospital disciplines, a recognition of the importance of comorbidity and frailty, and a whole range of other things.”

Stevens said that there should be an equally strong focus on tackling the accumulation of issues that have caused low morale among the junior workforce. “It’s a combination of changes that came in as a result of the move towards shift systems . . . the way in which changes to specialty training have developed. It is ridiculous that people don’t know ahead of time where they are likely to be working, particularly if they have partners or they have children, and we need to ensure that people have time during their seven day working week to both learn and research and potentially to contribute to the improvement of services.

“So, it’s a huge agenda here. We’ve got to be very careful that we don’t cause unintended consequences to the viability of smaller and medium sized hospitals, but it is a debate that we can no longer dodge.”

Stevens spoke to The BMJ at the Health Foundation’s annual conference in London on Tuesday 24 January, where earlier, in his keynote speech, he had raised the importance of tackling low morale among junior doctors.

“We’ve got bright and brilliant people coming into medicine who have a lot of that squeezed out of them by the way in which the training processes work,” he warned.

BMJ Careers Making junior doctors’ lives easier: Health Education England’s Wendy Reid discusses HEE’s plans [Link]


  1. Torjesen I. Hunt aims for fully home grown doctor workforce. BMJ  2016;355:i5399. [Link]   [Link] .

Gareth Iacobucci The BMJ


Cite this as BMJ Careers ; doi: