Intended for healthcare professionals

Analysis And Comment Medical education

Challenges of training doctors in the new English NHS

BMJ 2006; 332 doi: (Published 22 June 2006) Cite this as: BMJ 2006;332:1502
  1. Linda Hutchinson, associate director (
  1. 1Office of the Strategic Health Authorities, London SE1 6LN
  • Accepted 3 May 2006

Current health service reforms in England aim to create services that are more patient responsive. Will changes in the design and delivery of services be at the expense of medical education and training?

The health service in England is undergoing fundamental changes. Three principles emerge from recent policy documents: patient led culture, mixing of skills, and plurality of providers.1 2 Each of these separately presents a challenge to medical education, and together they present an even greater one. Medical and lay press carry stories of reported threats to doctors' education and training from some of the initiatives.36 This article examines the challenges.

Challenges to current system

The centralist arrangements of the NHS have allowed universal adoption of changes and improvements to medical training. Although health policy is now devolved to the four UK countries, medical education is mostly considered a UK-wide activity. However, the health service in England is creating a new context, increasingly different from the other three administrations, making common approaches more challenging. Within England, the established framework for education and training of doctors will need to be adapted for the new environment. The box summarises the main initiatives that will affect education.

Patient led services

A truly patient led health service requires a major cultural change. Moving from a paternalistic care service to one that is centred around information, advice, and guidance with a choice of procedural services is going to be challenging. Many staff will easily embrace the shift in emphasis, but for others it will be harder. Medical education could take a lead in producing doctors who are prepared for a health service characterised by choice and personalised care. The question is whether we have a critical mass of clinical leaders in both education and service who can be the role models for future generations. The early signs …

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