RCP college tutor (CT) and associate college tutor (ACT) network meeting

27 November 2025

The RCP college tutor (CT) and associate college tutor (ACT) network is our national community of physicians supporting postgraduate medical education by providing leadership, guidance and day-to-day support for resident doctors across the UK.

Through our CT and ACT network, tutors share good practice, connect with their peers and influence RCP policy on medical training and workforce.

This vital two-way link means that CTs and ACTs receive guidance, updates and CPD opportunities from the RCP. As the voice of physicians, the college listens and acts on what we hear from CTs and ACTs, using their experiences to guide our national policy, campaigns and advocacy work. 

Read on for the latest update from our November 2025 meeting.

Find out more about the RCP CT and ACT network

‘Medical training is operating in a period of profound change and pressure. Rising competition ratios, rota intensity, trainer burnout, less than full time (LTFT) working complexity, recruitment bottlenecks and organisational restructuring are all intersecting. Despite this, work continues across the system to strengthen curricula, improve national consistency and maintain high-quality training for physicians across the UK,’ Dr Anita Jones, interim head of school of medicine, NHS England North East, explained.

The NHS England (NHSE) 10 Point Plan for improving resident doctors’ working lives focuses on basic employment standards, reducing unnecessary mandatory training, minimising employer changes and reviewing the impact of rotations. The medical training review’s first phase identified four key priorities – flexibility, recognising excellence, tackling bottlenecks and rebuilding inclusive teams – and phase two will involve collaborative design of solutions with stakeholders.

The internal medicine training (IMT) decision aid remains unchanged this year. The Rough Guide to IMT has been refreshed to provide practical guidance for programme leads, and there is a strong national push to reduce the geographical spread of rotations, recognising that most employers can deliver core IMT within their own organisation. There continues to be widespread concern about the impact of acute take rota intensity on the quality of specialty training time.

Competition ratios for IMT have risen sharply in recent years. Increasing numbers of foundation doctors now undertake locally employed doctor (LED) posts to enhance their portfolios, yet many still struggle to secure training places. Changes for this year include a requirement for full GMC registration at the point of application, additional points for candidates applying solely to IMT, and a revised interview format. In higher specialty recruitment, some specialties remain under-filled while others continue to experience intense demand.

Foundation doctors should be encouraged to plan early, using the IMT website to understand clearly which activities score points and where to focus their efforts. While quick wins can help, longer-term preparation is equally important. For those considering LED posts, it’s vital to ensure these roles still provide opportunities for evidence-gathering, teaching, QI and leadership. The emotional strain should be acknowledged too: solutions are limited in the short term and meaningful national change is needed. Some resident doctors choose LTFT or non-rota posts to create time for portfolio-building. Expansion of posts alone will not meet the scale of current demand. The RCP continues to push the government for national reform and there is cautious optimism that we may see progress within the next two years.

Acceleration of training and flexible working 

LTFT working is on the rise. While there is strong support for flexibility, LTFT arrangements add considerable complexity to rota design, workload distribution, ARCP planning and access to training opportunities, without any parallel increase in trainer resource. Residents are encouraged to understand fully employment and training implications before applying for LTFT status.

COPMeD guidance requires decisions to be based on capability and professional maturity rather than time served or ‘exceptionality’. Acceleration should normally be considered only at the penultimate ARCP, requires educational supervisor support and carries a minimum 4-month reduction. End dates must align across all programmes for dual or triple accreditations, and early acceleration in training is discouraged. Final decisions always rest with the postgraduate dean.

LTFT doctors should be clear about how their working pattern affects their predicted end date and eligibility for higher specialty recruitment, as end dates can only be amended through the ARCP process. Importantly, residents should not assume they will finish in parallel with full-time colleagues, as progression depends on individual training time and capability sign-off.

Trainer time and burnout

GMC data shows that almost half of trainers are at moderate or high risk of burnout, with 29% unable to use their allocated training time and 11% reducing or leaving trainer roles because of workload pressures. This has knock-on effects on supervision, ARCPs, interviews, STC attendance and the availability of experienced trainers, ultimately impacting resident doctor experience and safety.

Annual review of competency progression (ARCP)

A palliative care reflection is not a requirement in the IMT decision aid or curriculum. Residents must evidence palliative care capability, but this can be demonstrated in many ways. ARCP panels should make a holistic judgement, not rely on one specific piece of evidence. Regions should avoid adding their own requirements.

Demonstrating IMT equivalence

Applicants applying via the alternative certificate must show equivalence to end IMT. Curricula are updated frequently, so individuals must map evidence directly to the current requirements.

On call overnight as an IMY3

IMY3s signed off at Clinical CiP 1, Level 3 can work with indirect supervision overnight. Some employers routinely roster IMY3s as the sole medical registrar. But resident doctors must not do this on day one. A phased introduction is essential – residents should work as a daytime medical registrar first, then move onto nights once they are confident. However, if the rota should have two registrars but only has one due to gaps, this is a workload and patient safety issue that should be escalated. A consultant must always be available.

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