For years rigid training structures have frustrated doctors and prompted some to leave the profession. Earlier this year the GMC concluded an initial programme of work designed to tackle the problem. Here, Professor Sue Carr, the GMC’s Deputy Medical Director, looks back at what has been done, and why working towards greater flexibility will now be an ongoing process.

It can be a challenge to recall the issues that dominated healthcare before the pandemic. The contract dispute in England, and the resulting industrial action by doctors in training during 2015 and 2016, might seem a distant memory. But it triggered changes that have been an important part of the GMC’s work in the years since.

Contracts may have been the spark that ignited that dispute, but it highlighted other deep-rooted concerns doctors had and that needed to be addressed. One was a lack of flexibility in their training.

The so-called ‘snakes and ladders’ effect meant doctors who decided, during their training, to switch from one specialty to another had in effect to go back to the beginning and start again.

Not surprisingly, having to go back to a more junior level, with little or no recognition of years already spent in training, wasn’t appealing. As a result, some felt it wasn’t worth the effort and so left the profession entirely.

Following the dispute, the then Secretary of State for Health, Jeremy Hunt, asked us to review training. We did. We listened to the views of trainees, trainers, patients and medical colleges and faculties, and in 2017 we published Adapting for the future: a plan for improving the flexibility of postgraduate medical education.

Avoiding the ‘snakes and ladders’ was a key change that we have now implemented. If you embark on internal medicine training, then decide instead to train as a GP, there is no need to start again at the bottom.

This makes sense. Many of the generic skills doctors have are appropriate to multiple specialties. For example, the principles that underpin communicating with a patient as a physician are the same as communicating with a patient as a GP.

Making it easier for doctors to transfer specialty means they are more likely to stay in the workforce. And if the last 18 months has taught us anything then it’s the importance of retaining and supporting the workforce we have.

It’s not just about snakes and ladders. Many of the other changes we have introduced are technical in their nature, for example the types of certificates that are awarded after completing training programmes, flexibility in curricula development, and options for doctors working, and training, less than full-time.

But the general principle is the same. We recognise that people can gain expertise and experience, and develop their competencies, in different ways and at different times. We’re making sure the right doctors can progress, without insisting on box ticking exercises and by focusing on outcomes rather than on time served.

Of course, what some might think of as mere box ticking others might consider crucial for maintaining high standards and ensuring patient safety.

That’s why we listened to patients and their representatives, as well as doctors, while developing and implementing our flexibility review. Key to the changes we have made has been ensuring patient safety is in no way compromised.

Our work on flexibility doesn’t end at this point though. The work will be ongoing, as it needs to be. The flexible and adaptable response of the GMC, and others in healthcare, during the pandemic shows the importance of reacting and responding quickly.

Maintaining a more flexible approach to postgraduate training is now one of the fundamental principles that guides our education work. And patient safety remains at the heart of it, as ultimately patients will benefit from more good doctors remaining in the profession.

For more information about the GMC’s work to improve the flexibility of medical training go to our website.