The state of medical education and practice in the UK

Executive summary

The executive summary outlines the findings in this year’s report. It shows how we’ll work with healthcare organisations to maintain high standards of patient care in the face of ongoing pressures. 

Foreword

In the foreword our acting Chair, Professor Dame Carrie MacEwan, and Chief Executive and Registrar, Charlie Massey share their thoughts on the findings in this year’s report, and explain why we must work together to address the issues raised.

Introduction

The introduction gives an overview of the challenges and opportunities facing the UK’s health systems. We look at how a new peak of pressure is affecting doctors and patients, and explore how the healthcare systems can use the report’s findings in their work. 

Chapter 1 – Working during the pandemic

Chapter 1 shows it’s been another challenging 12 months for the medical workforce. Further waves of coronavirus cases, significant care backlogs and continuous high demand are taking a toll on doctors’ health and wellbeing. 

But the pandemic is continuing to lead to positive changes that could improve future ways of working. There is optimism that we can build on what we’ve learnt, to support the healthcare systems recovery and tackle the long-term pressures the workforce is facing.

In this chapter

• Doctors reported struggling with heavier workloads during 2021, with six out of ten (59%) working beyond rostered hours at least once a week, and three out of ten (30%) feeling unable to cope with their workload weekly.
• The proportion of doctors at a high risk of burnout has increased from 10% in 2020, to 17% in 2021. There is a strong relationship between burnout, workload and levels of support, and GPs continue to report being under the greatest pressure.
• Delays to patient care and the need to deal with resultant waiting lists are key areas of concern for doctors.
• Almost half of doctors (46%) have been providing more care remotely than face to face. While remote care has allowed patients to continue to access care during periods of lockdown and social distancing restrictions, remote care is not always suitable, and in some circumstances has had a detrimental impact on patient care.
• There is evidence that adaptations to working practices during the pandemic are continuing to lead to improvements in some areas, with 60% of doctors reporting that it has had a positive impact on teamwork.

Chapter 2 – Experiences and challenges in postgraduate medical education 

Chapter 2 draws on the findings from this year’s national training survey, to present a snapshot of the experiences of doctors undertaking and delivering postgraduate training. 

We discuss the quality of their education and identify factors affecting their progression and wellbeing. 

In this chapter

• The quality of training has remained high during the pandemic. 76% of trainees rated the quality of teaching as good or very good. And 85% said they had a ‘good’ or ‘very good’ experience in their post – up by three percentage points since 2019.
• Four out of five trainees (81%) and secondary care trainers (78%) felt their working environment was fully supportive. Almost all GP trainers (96%) said the same.
• Trainees in some specialties, including public health and general practice, have experienced heavier workloads over the past year. And a higher proportion of trainees are at high risk of burnout – 15% compared with 10% in the pre-pandemic national training surveys.
• The pandemic and operational recovery continue to present challenges for many trainees and trainers around lost training opportunities, exam preparation completing workplace-based assessments, ‘backfilling’ training, and access to practical procedures.
• There have been some positive trends in the past year, including an improvement in managing the effect of rota gaps on training opportunities, as well as the successful use of virtual learning environments and remote consultations to develop trainees’ skills.

Chapter 3 – Workforce

Chapter 3 focuses on the factors affecting the shape of the medical workforce. We look at the patterns of those joining and leaving the profession, and their intentions for the future. 

We also explore how the pandemic has affected trainees and medical students, and what this means for future workforce capacity.

In this chapter

• There was a short-term reduction in the number of international medical graduates (IMGs) taking up a licence due to a range of pandemic-related issues limiting travel and access to assessments.
• The volume of IMGs joining by mid-2021 is comparable to the same point in 2019, which was a record year. This is encouraging given the disruption created by the pandemic.
• The pandemic has not changed the decision of most UK trainees to work temporarily outside the training pathway after F2. Workforce planners also need to consider the impact of doctors delaying choosing specialty training after F2 on the supply pipeline, as well as the opportunities and challenges presented by more trainees working as locally employed doctors.
• There has been an unprecedented increase in the number of students accepted into UK medical schools due to government policy changes to fund additional places with an increase of 21% of students commencing in 2021/22 from 2020/21’s starts.
• Doctors’ future career intentions are changing with the proportion of doctors taking hard steps towards leaving UK practice increasing from 4% in 2020, to 7% in 2021. This is highly concerning given the vital importance of retaining doctors for building a sustainable medical workforce.

Chapter 4 – Building towards a positive future

Chapter 4 examines the innovations and positive working practices that have emerged during the pandemic. 

We discuss how healthcare systems can sustain and build on these innovations for the benefit of doctors and patients. 

In this chapter

• Throughout the pandemic a range of innovative new approaches and adaptations has been implemented. Evaluating and learning from these will be vital in ensuring that best practice approaches are identified and retained.
• Ensuring that all healthcare settings are compassionate, inclusive, and focused on supporting workforce wellbeing will continue to play a vital role in ensuring patient safety.
• Multidisciplinary team working has been a vital element of effective working practices during the pandemic and needs to be retained as the healthcare system resets.
• We need to learn from the flexible and adaptable approaches to delivering patient care that have been accelerated during the pandemic, such as using remote consultations, triaging cases to the most appropriate healthcare professional, and sharing knowledge between professionals.
• Visible and accessible leadership will help to underline the lessons of effective multidisciplinary team working and visible leadership learned during the pandemic, and to integrate and make best use of other healthcare professionals in delivering care.

Data tables