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Doctors in England are being held back from becoming specialist consultants because of a bottleneck in the training available in the NHS.
The Royal College of Physicians, which represents doctors, said a failure to match the growing number of medical school places with specialist training posts is leaving doctors at the start of their careers in limbo.
In an interview with the Financial Times, Dr Anthony Martinelli and Dr Catherine Rowan, co-chairs of the RCP resident doctor committee, warned that much-needed future NHS consultants either become stuck at a lower level, are forced to travel abroad for training, or leave the health service entirely.
After an initial five to six years at medical school, resident doctors, formerly known as junior doctors, complete two years of foundation training. They are then required to undergo two to three years of more specialised training, which for the majority of doctors is the first stage of pursuing a career as an NHS consultant.
However, last year there were 3.7 times as many applications for this specialised internal medicine training as there were posts, according to NHS England data. In 2024, there were 1,698 IMT posts and 6,273 applications in England.
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Under the NHS England’s long-term workforce plan, published in June 2023, medical school training places will be doubled to 15,000 by 2031 — part of an attempt to tackle both a staffing crisis and long waiting lists for treatment.
The growth rate for senior doctors in England is far lower than for junior roles. While the overall number of full-time equivalent doctors employed by NHS England hospitals and community health services increased 5.6 per cent to 147,120 in the year ending October 2024, the number of consultants increased just 3.6 per cent to just over 58,000.
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“There is just this huge mismatch between demand and supply of these posts to carry on training,” Martinelli told the FT. “When we start medical school, we understand you are on a training pathway . . . But waiting to get to the next stage of training is quite distressing and not what many expect will happen,” he said. “These doctors are powerless to progress their careers.”
Rowan added that a growing number of resident doctors are moving abroad, or leaving the NHS entirely and writing off seven or eight years of training.
As the NHS grapples with one of its most challenging winters on record, the RCP is calling on both government and the NHS across all parts of the UK to review postgraduate medical training and address the lack of training posts.
“It’s a bottleneck in a specific area,” said Rowan. “But in order to progress your medical training you need to enter this pathway and we are seeing more and more doctors unable to progress.
“We need to match new medical school places with later training posts for these doctors.”
The Department of Health and Social Care said: “This government is committed to building our own homegrown talent, improving opportunities for resident doctors, and training thousands more doctors, including consultants.
“We are working with NHS England on a review of training numbers to address the training bottlenecks and ensure patients have both access to the resident doctors they need today, and the consultants and GPs they will need in the future.”
