The future NHS depends on the doctors we train today
The NHS is facing a period of profound change. Patients are living longer and increasingly with multiple long-term conditions. Healthcare is becoming more complex. New technologies are transforming diagnosis, treatment and care delivery. At the same time, services continue to face significant workforce and financial pressures.
All of this means that the future of the NHS will not be determined solely by funding settlements, waiting lists or technology. It will also be determined by whether we develop the workforce capable of meeting the challenges ahead, and meeting those challenges will require a highly skilled medical workforce. That is why high-quality training matters.
Too often, postgraduate medical education is discussed primarily as a cost. Protected learning time, supervision and educational activity can appear difficult to justify when services are under pressure, but this framing misses a much bigger point: training is not separate from patient care, it is one of the foundations of it.
Every consultant, clinical leader, educator and researcher working in the NHS today is the product of years of support, supervision and investment. The expertise patients rely upon every day was deliberately developed through training, and so the question is not whether training requires resources, but what it will cost us if we fail to provide them.
The evidence should concern us all. Only 26% of resident doctors responding to the RCP’s next generation survey in 2025 felt ready for the next stage of their career. Only 65% expected to remain working in the NHS in 5 years’ time. Those figures are not simply measures of training quality; they are measures of risk. A health service that struggles to develop, retain and support its future workforce faces challenges that no amount of short-term operational planning can fully resolve.
The report also highlights the wider costs of burnout, attrition and workforce instability. Doctors who leave training pathways, reduce their hours or leave the NHS altogether take with them years of experience and future expertise. Replacing that capability is difficult, expensive and time-consuming. Training and development are among the most powerful tools available to improve retention, strengthen productivity and support workforce sustainability. Yet training is still too often treated as something that competes with service delivery – and loses.
Our new report, Training physicians for the future, argues that education should instead be recognised as a core NHS function. It calls for resident doctor jobs to be designed for learning, protected educational activity to be embedded in clinical work, staffing levels that support quality training, protected time for educators and greater transparency in how educational funding is used. These recommendations matter not simply because they improve training – they matter because they improve the future capacity of the NHS itself.
The cost of training is visible and immediate, but the cost of failing to train is far greater: this cost is reflected in workforce shortages, delayed progression, poor retention, reduced productivity and the slow erosion of expertise across the health service, and ultimately, those costs are borne by patients.
The medical education and training review (METR) provides an opportunity to make a different choice. For policymakers, that means recognising postgraduate medical education as a strategic workforce investment, not simply an operational cost. Workforce planning, funding decisions and service redesign must explicitly account for the educational capacity required to train the future consultant workforce. For NHS leaders, it means treating educational quality with the same seriousness as patient safety, financial stewardship and operational performance. Training and accountability for training should be part of board-level discussions and workforce planning, not delegated solely to education teams.
For employers, it means ensuring that funding medical education properly, protecting time for supervision and training and creating environments where doctors can develop the skills they will need as future consultants and clinical leaders. And for the wider healthcare system, it means moving beyond acknowledging the problem and committing to delivery.
The recommendations in our report are not aspirations for an ideal future system. They are practical investments in the workforce the NHS will rely on for the next decade and beyond. The physicians being trained today will lead services, educate future generations of doctors, conduct research and care for patients for decades to come.
The real question is not whether we can afford to invest in medical training, but whether we can afford not to. Every day we delay, we risk losing talent, expertise and future clinical leaders that the NHS cannot easily replace. The reforms set out in Training physicians for the future offer a practical route towards a training system that is fit for modern healthcare.
The future NHS will be shaped by the doctors we train today, and the decisions we make now will determine whether they are equipped to meet the challenges ahead.
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