Why does the current training posts system need to change?

The COVID-19 pandemic has starkly shown the extent of health inequalities across England, as well as within regions. It has emphasised the need for us to examine the current NHS delivery system and to assess whether public funding can be better spent, based on evidence about effectiveness and value for money.

The funding of postgraduate medical training posts offers a great opportunity to better align patient need and training capacity for the future. Certain regions, such as London, have, historically, had a higher share of this finite trainee workforce resource than will likely be the case going forwards.

Many other locations across England, particularly remote, rural and coastal areas, need a fairer distribution of the training places to meet local population needs and support to meet substantial challenges in terms of recruitment and retention of staff. 

London has historically been fortunate to attract large trainee numbers, thereby filling all available training posts. The region has played a leading role in supporting other areas across England with their capacity building, as doctors trained in the capital often move to other regions as they complete training, and London is now addressing how best to retain its trainee consultant workforce in the capital.


Patient safety driving improvement

Patient safety remains a key driver behind this work programme, being led and delivered by NHS England (NHSE), and will inform all future decision-making. This overdue spotlight on current systems gives us a valuable opportunity to improve patient outcomes by creating better alignment around training, service, and patient needs in the future.


What will the programme achieve?

The MSD Programme will:

  • support patients and the wider NHS by ensuring that we have the appropriate number of doctors in the places where they are needed
  • ensure that training places continue to be of an exceptionally high quality and deliver the curriculum so that our doctors have the education and training to provide exemplary patient care
  • offer a more equitable distribution of training places across England, corresponding to areas of greatest need / health inequities.


What does this mean for London trainees?

London will be supporting this programme by offering a number of specialty training posts to other regions to ensure there is a more equitable distribution of future training places across England, levelling-up historical, regional health inequities. The specialties involved to date have been identified as they historically fill at national recruitment and will not carry the risk of under recruitment. 

However, while we anticipate fewer secondary care posts being available in the future, there are now additional training posts in the UK Foundation Programme as well as in primary care.

Through an additional 1,500 annual undergraduate medical school places now available in England, we will see an anticipated increase in the number of trainees progressing into specialty training as early as 2026, following the completion of the UK Foundation Programme. Working with hospital trusts, the first phase of the Foundation Programme expansion, scheduled for August 2023, is already underway.


How will these changes impact current trainees?

No trainees currently in post will be moved from their current location. However, NHSE will look at moving future legacy HEE-funded training posts to meet the evidenced regional need. This programme applies only to posts that are legacy HEE-funded and does not include Academic or Trust-funded posts.

Over time, the number of posts in some specialties and geographies will change as we realign our resources to better meet patient need, rebalancing to a fairer distribution for areas that previously had a poorer share of this public funding.

NHSE will annually review the numbers, as and when new investment in training posts is made available, and ensure this information feeds into ongoing decision-making processes and the pace of proposed changes.


Our ongoing commitment to trainees

We appreciate that the trainee experience will be a little different, as a result of these changes. We will protect the opportunities our trainees enjoy across each specialty so that they continue to benefit from exposure to a wide variety and pace of opportunity, unmatched across the rest of country. London provides a full curriculum of training across all specialties, some of which are only available in the capital, and will continue to do so.

We will work to ensure that training places continue to be of an exceptionally high quality so that our doctors have the education and training they need to provide the highest quality patient care.

Capacity-building and trainee experience will remain at the forefront of system design to ensure trainees experience the very best learning and training environments across London.


Pace of change 

The programme began implementing England-wide changes from August 2022. In London, the proposed movement of / reduction in the numbers of specialty training posts commenced from August 2022. Implementation timescales will remain under scrutiny as the programme progresses and will take place in stages over the next five years or more. 

We will work with trusts and clinical networks to monitor the impact of these changes on service delivery. Ongoing monitoring will inform all future decision-making with annual reviews taking place. Any course corrections will be shared with affected stakeholders as soon as possible.

At a national level, NHSE will use the learning gained from implementing earlier phases (including the specialty areas of Cardiology, Haematology and Obstetrics and Gynaecology) to apply to future programme rollout which will expand to further specialties. 

At a regional level, NHSE will be influencing the programme’s pace of change in the London region, assessing the ongoing situation through outcomes of the annual competency (ARCP) process and impacts of Covid-19 on progression, numbers of trainees returning to programme from Out of Programme (OOP) and related patient outcomes, alongside how services are delivered.


Robust modelling

Over the last 30 years, the NHS has developed sophisticated modelling techniques to guide the allocation of resources against current need. The current model takes into account over 150 separate factors to determine population weighted healthcare need.   

This is combined with HEE’s demand forecasting model that utilises Hospital Episode Statistics, alongside Office for National Statistics population projections, to understand growth in demand for key hospital services in the future, and gives weighting based on regional deprivation.  

This provides a robust method for understanding the distribution of future healthcare demand on the medical workforce. The model provides a reliable and transparent methodology on which to base the distribution of trainee posts across regions which can be revisited if changes occur. 

Regions receiving posts will only be able to accept these placements if they can meet training quality standards. Posts will be allocated based on when regions are ready to accommodate them, prioritising the areas due to inherit the most posts. It will be reviewed annually to incorporate additional factors as required.


NHSE support

NHSE appreciates this work programme may impact training and that regional frontline services may experience staff shortages as a result. Partners affected by any changes to future posts will be supported closely by the HEE Local Office with reviewing alternative service delivery models.


Developing multi-disciplinary workforce models across London

Following the examples of other regions, NHSE is looking at how to develop better multi-disciplinary workforce models for London, where appropriate, to realign training capacity to meet patient need as closely as possible, and across all specialties in due course. NHSE will be led by service leaders to develop future workforce models.

NHSE is reviewing current ways of working, to build skills and capacity differently across the workforce and to rethink how services are aligned to enhance London training programmes.

Even with a reduction in posts, London has much to offer trainees through unparalleled specialty training and learning environments, innovative research projects and exposure to industry experts.

Trainees can expect an excellent standard of training and hospital experience. Logistically, specialty rotations are sited much closer together in London, making everyday commitments for trainees easier. All of this enables London to attract the best healthcare professionals in order to train and build the best workforce possible and improve doctor retention, securing excellent patient outcomes.


Get in touch

We appreciate this programme will be implementing significant system changes and that you may have questions and concerns about what will be happening in the London region.

We are developing a range of ways for you to get in touch and involved, so that we can best support you through this ongoing process. We will update this page when we have further details.

In the meantime, you can:

  • get in touch via the mail box londonmedicaldistribution@hee.nhs.uk we will be monitoring this on a regular basis and comments / questions will be anonymised and fed into our frequently asked questions
  • read more about the national situation via the national website.



London Medical Specialty Distribution webinar (23 June 2022) – slides available below

London Medical Specialty Distribution webinar (9 March 2023) – slides available below and link to recording

London Medical Specialty Distribution – trainee engagement session (10 July 2023) – slides attached and link to recording