We need Parliament to give us legislation fit for 2030, not fit for 1983.

Prof. Terence Stephenson, Chair of the General Medical Council, reflects on his appearance last week at the House of Lords select committee to discuss the Long-Term Sustainability of the NHS. 

I was recently invited to give evidence to the House of Lords committee looking at the sustainability of the NHS, where I was asked about the challenges for the NHS in 2030 and how we can prepare for them now.

It’s clear that an older population with more co-morbidities means we’ll need more generalists and more people in primary care. Already 90 per cent of people who attend an NHS appointment are seen by a GP. So I think it would be rash to train people today for a fixed role in 2030; we need to train doctors in a more flexible way, and for doctors to take a more flexible approach. The GMC is looking at that with our review of flexible training and our framework of generic professional capabilities which will launch next Spring. We also need the capacity to retrain those already working in the NHS, to enable them to adapt to the changing health landscape.

Our approach to training in the UK is not helped by the reliance of the NHS on trainee doctors

Our approach to training in the UK is not helped by the reliance of the NHS on trainee doctors. Over the last four or five years I have been to 23 different countries and seen how they train doctors. There is no country in the world that takes as long to train as us because there is no country in the world that is so dependent on its trainees for delivering the service. In most countries, training is much more formalised and structured. We have to recognise that we have 55,000 trainees out of a workforce of 150,000 and that, for much of their time, their training is long because they are not being formally trained, they are providing a service.

Do we have the capacity to change our approach to training? Yes, we will be working closely with the medical royal colleges to adapt their curricula for post-graduate training and with postgraduate deans to ensure there is flexibility in the journeys that doctors will take through training. We also need to free up time for trainee doctors, many of whom are spending a lot of time doing things that don’t require a medical degree. There needs to be a focused conversation about other entrants to the healthcare workforce who would allow us to free up doctors to do what we all want them to do – make diagnoses and get patients on the right treatment pathway.


The medical workforce isn’t the only body confined by rigid structures. The GMC’s legislation is the 1983 Medical Act, which is now over 30 years old. We would like new enabling legislation which allows us to reform our practices, protect the public, improve professional standards, change training and change the way that we deal with fitness to practise issues. We cannot change the current over-prescriptive processes we have without primary legislation.

That’s stopping us getting upstream to where problems originate. We get 10,000 complaints a year about doctors, of which about 7,000 we close very quickly. With the other 3,000, we put people through the mill and eventually 80 to 90 people are struck off. We are dealing with legislation that was not designed for 10,000 complaints a year. Many of those complaints could be dealt with locally and those doctors do not always need to be taken out of practice; it is a hammer to crack a nut.

Modern regulation should be targeted, proportionate, data-driven and intelligent. It should not be a blunderbuss. Whether it is the way we inspect medical schools or the way we deal with complaints, we should be focusing our attention on where we need to and not labouring under very old legislation where one amendment can take two years. We need Parliament to give us legislation fit for 2030, not fit for 1983.

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2 responses to “We need Parliament to give us legislation fit for 2030, not fit for 1983.

  1. Pingback: Stepping up support for doctors: message from Terence Stephenson | General Medical Council·

  2. “…there is no country in the world that is so dependent on its trainees for delivering the service” is a correct statement. The logical question to follow should be: Does the UK unprecedented amount of trainee delivered service have implications for quality of the clinical service? In another words, is the proportion of trainee delivered (vs. trained delivered) service related to clinical outcomes?
    I work in a specialty that has even higher part of service delivered by trainees (~90%) and I am persuaded that trainee delivered service is the strongest factor for UK’s poor outcomes according to international benchmarking in my field.
    I am glad that GMC is now focusing on quality of training as well as quality of clinical services but GMC should specifically examine the tension between the two. Trained delivered service should be set as standard. Considering relatively short length of training compared to length of career between completion of training and retirement, there should be no excuse for trainee delivered service anywhere. Yet, there are areas of medicine, where most of the service is utilized for training and most of training is utilized for provision of service resulting in almost exclusively trainee delivered service.

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