Reflecting on the findings of the RCP’s report Training physicians for the future, Resident Doctor Committee (RDC) deputy chair Dr Max Thoburn argues that the future NHS depends on doctors developing both broad generalist capabilities and deep specialist expertise. In this next generation blog, he makes the case for protecting the opportunities to develop clinical judgement, procedural skills and decision-making that patients rely on when they are most in need within an ever more stretched NHS.
The RCP has launched Training physicians for the future: a blueprint for reforming postgraduate medical training, a major new report setting out a long-term vision for how medical training should evolve to meet the needs of patients, doctors and the NHS. Drawing on extensive engagement with resident doctors, educators and physicians across the UK, the report identifies the changes needed to create a training system that is flexible, high quality and fit for the future.
If the NHS values medical expertise, it must protect the training that creates it.
Physicians in the UK generally spend 10 to 15 years in postgraduate training. Whether or not you believe this duration is necessary, it is certainly not in itself sufficient to develop the requisite skills to become a competent consultant. Doctors are not simply learning to perform tasks. They are learning how to make decisions when information is incomplete, manage uncertainty when the correct course of action is unclear, balance competing risks and take responsibility for patients with increasingly complex needs. Developing that expertise depends on high-quality medical training.
Across the RCP’s next generation campaign, resident doctors repeatedly told us they were worried about the opportunities available to develop that proficiency. Clinics, procedures, specialty training and educational activities are increasingly competing with workforce shortages, rota pressures and service demand, and the consequences are becoming visible.
When training is sacrificed for short-term gain, any efficiency gained today is often outweighed by the false economy of a poorer quality of patient care tomorrow.
We must get away from a culture of permacrisis, where every day is cited as an emergency to justify the detrimental impact of high level decisions on training. Moving forward, quality of training must be monitored and organisations held to account and helped to improve where they are found to be inadequate. With the publication of this report, we have set out what we believe should be the expected standards by which providers are judged.
Only 26% of resident doctors responding to the RCP’s 2025 next generation survey felt ready for the next stage of their career. One in four said their current role was not preparing them to make a competitive application for the next stage in their pathway, while a further 48% said it was only partially preparing them. This is not simply about training – it is about whether the NHS will have the expert workforce it needs in the future.
One of the strongest messages in our report is that future physicians need both generalist capabilities and specialist expertise.
Ever increasing numbers of patients living with frailty and multiple long-term health conditions need doctors who can manage complexity across specialties and care settings. At the same time, they need specialists with the procedural, diagnostic and therapeutic expertise required to provide advanced care. Too often these are presented as competing priorities, but they are not.
Generalism is not the absence of specialisation. It is a specialist skill in its own right that requires doctors to synthesise information, manage risk, coordinate care and make holistic decisions in increasingly complex healthcare environments.
At the same time, specialist expertise remains essential, and as medicine becomes more sophisticated, procedural and specialty training opportunities become more important, not less. That is why Training physicians for the future calls for protected procedural training, including ringfenced training lists, immersive learning opportunities and dedicated training blocks. It argues that educational requirements should be determined by patient need and curriculum objectives, not by workforce shortages.
The new RCP report also highlights the importance of clinical judgement and risk-holding. These are among the most important capabilities physicians develop. They allow doctors to make decisions when there is uncertainty, lead multidisciplinary teams and take responsibility for complex patient pathways. We believe these skills should be recognised explicitly as core educational objectives and developed through supervised practice, graduated responsibility and real-world clinical experience.
Protecting expertise also means supporting the transition to consultant practice. Training should produce doctors who are not simply competent practitioners but confident decision-makers. That requires opportunities to develop leadership, governance and educational skills alongside clinical expertise. It also requires mentorship and protected time to consolidate specialist skills before independent practice.
Ultimately, the question is not whether patients value expertise. The question is whether the NHS is willing to protect the training opportunities needed to create it. If we want future physicians who can manage complexity, hold clinical risk, lead teams and deliver safe specialist care, we must protect and continue to develop the educational experiences that help to realise those capabilities.
Dr Max Thoburn is the RCP RDC deputy chair and representative for the West Midlands and a member of the writing group that developed Training physicians for the future. He works as a registrar in infectious diseases and general internal medicine in the West Midlands.
Dr Max Thoburn
Resident Doctor Committee deputy chair and West Midlands representative
