NHS England Medical Training Review – Phase 1 Diagnostic Report
Posted on 06/11/2025
Posted by Gemma
Post Type Insights
The NHS England Medical Training Review – Phase 1 Diagnostic Report (October 2025) is a landmark analysis of postgraduate medical education in England — the first comprehensive review in over 15 years.
Led by Professors Chris Whitty and Steve Powis, the review sought to diagnose current challenges and strengths in medical training and assess whether incremental change is sufficient or if a fundamental reform is needed.
Key Messages from the Foreword
- Training must ultimately improve health outcomes for patients.
- The boundary between service and training time is often artificial — both serve patient care.
- All doctors are both trainees and trainers across their careers.
- Medical training must evolve to meet the changing workforce structure, with a growing number of SAS and LED doctors who fall outside traditional training routes.
- Incremental changes have reached their limits; systemic reform is likely required.
CORE FINDINGS
1
Training Model Mismatch
The postgraduate system has remained largely unchanged for 20 years, while population health, workforce demographics, and medical practice have evolved dramatically. The number of doctors and medical school graduates has risen sharply, but training capacity hasn’t kept pace, creating bottlenecks.
2
Changing Workforce
Over two-thirds of new joiners to the medical register now qualified overseas. The LED and SAS workforce has grown substantially and now plays a crucial role in service delivery, but often with limited training or career progression opportunities.
3
Competition and Bottlenecks
Competition ratios for core and higher training posts have reached record levels. Up to 77% of FY2 doctors do not progress directly into training, many entering LED roles instead. This misalignment fuels dissatisfaction and hinders workforce planning.
4
Training Quality and Delivery
While 84% of trainees report positive experiences, pressures from service delivery, rota gaps, and inconsistent supervision threaten training quality. Doctors value flexibility and autonomy, but also seek predictability and stability, creating competing demands.
5
Equity and Representation
There is significant variation in experience and outcomes between specialties and regions. International medical graduates (IMGs) report additional challenges in accessing training and development.
6
Population and System Needs
The health system must adapt to an ageing, multimorbid population and growing inequality between urban and rural/coastal areas. Training must build stronger generalist capabilities, digital literacy, and community-based experience to align with the NHS Long Term and 10-Year Health Plans.
7
International Comparisons
The UK’s centralised, time-based training contrasts with competency-based models in Canada, Australia, and the Netherlands. Other systems offer greater flexibility, modular pathways, and better alignment to workforce needs.
Four Priority Recommendations
- Increase flexibility for trainees to tailor training to individual career needs.
- Reconsider the divide between formal training and non-training posts — recognising and accrediting the learning that occurs outside traditional pathways.
- Address training bottlenecks that block progression and prevent effective workforce planning.
- Rebuild team structures that foster belonging, mentorship, and continuity, avoiding the pitfalls of rigid hierarchies.
Next Steps
This diagnostic report is not a reform blueprint but a foundation for detailed consultation and design of future training models.
Phase 2 will involve specific proposals for change, informed by ongoing engagement with doctors, educators, patients, and NHS partners.
“A foundation for detailed consultation and design of future training models.”
NHS England Medical Training Review – Phase 1 Diagnostic Report
Access the full report here.
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