Specialty Medical Training

Lord Rennard Excerpts

Thursday 17th July 2025 Grand Committee

[Lord Rennard (LD)]

My Lords, we are all grateful to the noble Lord, Lord Lansley, for securing this debate and, as he said, it is an important issue that has been of concern for some years. It is important for our NHS and for the long-term health and well-being of our nation. We know that, in recent years, the competition for specialty training places has kept rising. There were over 33,000 applications for specialty training in 2025, compared with less than 20,000 in 2019.

There are particular problems with some specialisms. In 2024, there were 112 applicants per post for general practice and public health medicine. This shows that there has been a serious breakdown in workforce planning to date. Parties have been ambitious in their manifestos, but not always in the planning and the execution. At the last general election, the Conservative Party expressed the desire to recruit 28,000 more doctors in the NHS than we had in 2023, and to do so by the end of this Parliament. But in government, they did not will the means to enable that to happen in that timescale. Medical school numbers increased by one-third between 2014 and 2024, but specialty training places increased by less than 10% in the same period.

This disparity has created a severe bottleneck, leaving thousands of doctors who have completed their foundational training stuck outside the speciality training pathway and facing potential unemployment or having either to go abroad or to accept insecure roles as locally employed doctors. The General Medical Council observes that, of course, doctors not in training posts have a higher rate of leaving the profession, thereby exacerbating our retention crisis.

Several factors have contributed to this untenable situation: there has been a stagnation in the funding for training places; there has been a lack of funding from Health Education England for training places, which is exacerbating the problem of competition ratios in specialty training; and the career progression of medical graduates has been impeded, leading to questions arising around the quality of patient care. The Royal College of Physicians has emphasised that increased medical school places must be accompanied by a plan to increase specialist training provision. It is illogical for us to invest in initial medical training, then deny thousands of UK doctors the opportunity to advance to specialty level.

There is also the problem that training places are generally distributed based on historical arrangements rather than current population needs. The evidence suggests that trainees often remain in the area where they complete their specialist training, meaning an inequitable distribution of posts, which contributes to disparities in doctor numbers across the country. Health Education England and NHS England have a commendable programme called Addressing Health Inequalities: Distribution of Medical Specialty Training, which seeks to distribute places more equitably, but they must ensure that this leads to an overall increase in training places rather than merely redistributing existing capacity.

The challenges in general practice training are particularly acute. The ambition to increase GP training places to 6,000 by 2031 is welcome, but the current pace of increase is not meeting the need and prospective GPs are being turned away. The current competition ratio of 3.67 applicants per post is too high. General practice is often perceived as less prestigious and GPs’ practices face immense pressures, making it difficult for senior GPs to dedicate the time and resources needed to supervision and training.

I am sure that we will shortly hear more about the Government’s 10-year plan for the NHS to

“tackle bottlenecks in medical training pathways”

and,

“over the next 3 years, create 1,000 new specialty training posts”.

We know that Professor Sir Stephen Powis and Professor Sir Chris Whitty are overseeing a medical training review, but the NHS is unlikely to achieve what is needed for medical training without a clear costed plan for the NHS overall, which must involve properly addressing the social care crisis. Unless we tackle social care, we cannot tackle the problems of the NHS.

The noble Baroness, Lady Casey, was charged with reviewing social care by the Government elected in July last year, but she did not begin this role until the end of April this year and her initial report is not due until two years after the general election, suggesting that plans for conducting such a review were not made in advance of the election. Her final report is not due until 2028, some four years after the general election, suggesting, again, that much more long grass may be involved on the issue of social care. It is 26 years since the royal commission on long-term care, 14 years since the Dilnot commission and six years since Boris Johnson’s pledge to

“fix the crisis in social care once and for all”.

Bookshelves are full of reports such as these. In the meantime, hospital beds continue to be occupied by people who should be in care but lack somewhere to go or people to look after them.

There is an immediate crisis for community equipment providers, who provide much of what is needed to support disabled people. Their business model may face imminent collapse because local authorities cannot afford to pay them, cannot pay them promptly enough or—as in at least one case—are simply refusing to pay. There is much to do. We need a comprehensive, fully funded workforce plan that genuinely addresses the current shortfalls and the projected needs. This plan must be ambitious, adequately funded and published urgently. The current situation, where thousands of doctors are finishing their foundation programme only to find themselves unable to secure a training post, represents a cliff edge.

This impacts doctors’ morale, potentially leading more towards the industrial action that we seek to avoid, more migration of medical talent and further harm to patient care. The commitment to increasing medical school places must be matched by an equal commitment to expanding postgraduate training capacity, ensuring that every doctor we train has a clear and secure pathway to becoming the consultant or GP of the future.