Intended for healthcare professionals


Transforming postgraduate medical training in the NHS

BMJ 2016; 354 doi: (Published 06 September 2016) Cite this as: BMJ 2016;354:i4778
  1. Wendy Reid, medical director
  1. Health Education England
  1. hee.communications{at}


Wendy Reid outlines Health Education England’s plans to improve the lives of trainee doctors

The issues brought into focus by the junior doctors’ dispute are far more extensive than those defined in an employment contract. Junior doctors’ anger and disillusionment show us that we need to make changes to ensure that they feel valued and can work and train in supportive environments.1

Health Education England (HEE) has been working to meet these challenges with the BMA’s Junior Doctors Committee, NHS Employers, the Academy of Medical Royal Colleges, and postgraduate deans.

Review of ARCP

Doctors’ training has shifted from a time served apprenticeship model to complex, structured programmes with assessment at all stages. All junior doctors undergo the annual review of competence progression (ARCP),2 but for many the process has become a stressful “rite of passage.” We believe that the tick box culture of the ARCP does not support the professionalism that doctors aspire to, and we are launching a review of the process in October.

Changes to junior doctors’ working patterns have been vital to ensure the safety of patients and doctors but have led to complex rotas. HEE has committed itself to improving communication between deans and trusts to ensure that junior doctors receive their rotas a month earlier than now. Moreover there will be no fixed leave within rotations.

HEE is also working to reduce the number of rotations to improve employer-employee relations. For doctors with caring responsibilities or in relationships we are reviewing the rules on applications and are determined to find a satisfactory and fair solution wherever possible.

Doctors themselves have also changed. Many want to work flexibly, and their expectations of a lifelong professional career vary. Many doctors now choose to spend time in non-training posts, and it is perhaps timely that the creation of guardian roles in hospital trusts will ensure that the educational needs of all doctors are considered.3

New care models

NHS England’s Five Year Forward View has given us the opportunity to ensure that care is delivered by the most appropriate staff and to embrace new roles such as physician associates. HEE strongly supports the involvement of junior doctors in the development of these new care models.

HEE is also keen to ensure that the delivery of training is as efficient and cost effective as possible. Working with the Academy of Medical Royal Colleges, we are considering how best to prepare junior doctors for training through simulation training and “boot camps.”

We have also agreed with the Junior Doctors Committee that the allocation of individual study leave moneys is archaic. Plans to ensure that trainees get support from this funding and from local or regional provision will empower local trainers and providers.

HEE has also extended whistleblowing protection for junior doctors, providing a new legal route directly against HEE.45 And we are concerned about the differential attainment of doctors from ethnic minority backgrounds.

HEE continues to work to improve the lives of junior doctors. To do this effectively we need support and collaboration—and to be challenged when things need improvement. We cannot afford to lose a generation of junior doctors either through disengagement or a lack of ambition among those charged with their training.


  • Competing interests: None declared.

  • A version of this article first appeared as a BMJ blog (