The Ward Round: Fall in training set to have major impact on future workforce

Covid-19 has disrupted the normal running of the NHS more than anything else since its creation. The dramatic impact on elective care, outpatient clinics and diagnostics have been well reported and the unintended consequences of the pandemic will continue to reverberate on the health service for years to come.

It has also had a huge impact on the workforce, in terms of staff sickness, stress and anxiety and in some awful cases PTSD and long-covid. But the pandemic has also had a profound impact on staff training opportunities, as they were lost along with the normal elective work and clinics back in the spring and are yet to fully return. The importance of this shouldn't be underestimated - not only can it affect the progression of trainees, but also motivation and even staff retention.

The disruption has been highlighted by the General Medical Council’s latest annual training survey, completed by over 38,000 doctors and trainers. According to the new research, the pandemic “significantly” disrupted the provision of formal training and left most trainees (81 per cent) and trainers (88 per cent) saying the opportunities available were reduced.

Doctors in medical and surgical specialties, required to hit specific competencies to move forward with their training, would have seen their training dramatically disrupted in the spring when all they were doing was treating covid. This has resulted in trainees unable to progress to their next rotation, as key milestones have not been hit.

This has not just been caused by the mass cancellations and 'redeployments' of the spring, but also by the ongoing need to minimise unnecessary patient contacts, increased remote working and socially distanced working. Doctors are examining fewer patients for their own educational development and completing fewer procedures and, I hear anecdotally, are unable to spend as much time as they might need with their trainer.

Each week HSJ reports on further trusts suspending electives to cope with rising covid cases, which not only will disrupt training further but also result in disparity of experience in parts of the country hit harder by covid. 

Considering the need to lengthen medical training in some cases, all of this could have a major impact on the future consultant workforce.

Michael FitzPatrick, co-chair of the Royal College of Physicians Trainees Committee, said: “Teaching time for consultants is often the first thing to go when service demands are high, but the long-term impact on the training of consultants for the future should not be forgotten.

“The second wave is likely to feel very different from the first as the NHS is working hard to keep non-covid services open as long as possible. This will mean that redeployment within the NHS should be significantly reduced, but this will place even greater pressure on physicians caring for acutely unwell patients.”

The GMC has acknowledged changes to training this year will have implications “in 2020-21 and subsequent training years”, which may have “added pressure or constraints to their training experience this year”.

However, the regulator also said: “Learning while working won’t always go to plan, but that doesn’t make the unplanned elements any less relevant or valued.”

It has pledged to put together a joint plan with healthcare leaders and educators to “translate” what has been learnt from the pandemic. 

“We’ll emphasise the importance of making sure medical education is flexible and responsive to changing demands," the regulator said. 

The disruption is of course not unique to the medical workforce. It also applies to nurses, allied health professionals and managers, who may have either been moved to a temporary new role or found they were unable to work as usual during the pandemic (this is particularly the case for student nurses and certain AHPs).

This will have affected students' clinical placements, continuing professional development at all different levels and other educational opportunities within all parts of the NHS.

The covid situation is fast moving and fluid and the workforce has been forced to be more flexible than ever. But protecting education and training opportunities as much as possible will be essential if future skill deficits and workforce shortages are to be avoided.