This week, the RCP welcomed over 400 doctors to Regent’s Park for our autumn annual conference, Med+ 2025. With over 1000 people also joining us online, the 2-day event was a celebration of clinical excellence. On Wednesday, a wide-ranging breakfast Q&A session between Resident Doctor Committee (RDC) deputy chair Dr Max Thoburn and RCP president Professor Mumtaz Patel brought sharp focus to the urgent issues facing resident doctors.
Launched last year, the RCP next generation campaign aims to support and empower residents to deliver the best possible patient care, while advocating for radical reform of the postgraduate medical training system.
During our Med+ breakfast session, Dr Max Thoburn interviewed Professor Mumtaz Patel, who set out the scale of the challenge during an open conversation in front of more than 100 people.
Professor Patel welcomed the diagnostic report of the medical training review, which she said reflected many of the challenges raised by resident doctors for years. But she warned that the key question now is ‘what happens next?’.
With a plethora of organisations including medical royal colleges, NHS England and trusts all holding responsibility for different parts of the system, she stressed the need for clear accountability and realistic implementation timelines. ‘Everyone wants change,’ she said, ‘but it needs to be sustainable.’
A central theme was the rise in training bottlenecks. Competition ratios for internal medicine training (IMT) have climbed from 1.4 in 2019 to around 5.27 this year. Professor Patel was unequivocal: this is the result of long-term workforce planning failures.
‘The expansion of medical school places was well intentioned,’ she noted, ‘but foundation posts, supervision capacity and training time didn’t follow. The bottlenecks simply worsened.’
Asked about physician assistants, Professor Patel was clear. ‘Doctors cannot – and must not – be replaced. Multidisciplinary teams add huge amounts of value, but this should never be at the expense of medical training.’
‘Yes, trusts face competing pressures – ambulance waits, corridor care, emergency departments – but looking after our workforce must be front and centre,’ she argued.
On the question of prioritising UK graduates, she emphasised the importance of fairness. ‘We must not disadvantage our international medical graduate colleagues who have served the NHS for decades,’ she said. ‘But NHS experience matters, and doctors leaving medical school in the UK should be able to continue their training in the NHS. We cannot continue losing good people.’
The discussion turned to the NHS 10 Point Plan to improve residents’ working lives, where Professor Patel welcomed local progress but warned that accountability and sustained implementation were essential. ‘Good training and supervision lead directly to good patient care,’ she said. ‘Senior buy-in is improving, but we need monitoring. You need carrot and stick.’
There was a clear appetite for greater transparency. ‘The government must not use training numbers as a bargaining tool,’ stressed Professor Patel. ‘Workforce planning should be based on need, not negotiation.’
On postgraduate exams, Professor Patel described the MRCP(UK) Part 2 written examination error (September 2023) as ‘deeply distressing’. She welcomed the McLachlan review’s recommendations, emphasising that governance and processes must be strengthened to prevent future incidents.
Other key areas included the need for a radical rethink of generalist medicine training and better integration of community placements, digital health and AI technologies into curricula.
‘A tweak here and there isn’t working,’ Professor Patel explained. ‘Many residents see general internal medicine as a tick-box exercise, so we need a radical rethink – high quality education, supported trainers and incentives that make generalist medicine a valued career choice. This is the only way we’ll be able to deliver the 10 Year Plan hospital to community shift.’
Ending with a conversation about flexibility, rotational training and inclusive workplace culture, Professor Patel agreed that the NHS should make inter-deanery transfers easier and tackle unacceptable behaviours and bullying. ‘Creating fair, inclusive and supportive cultures isn’t optional,’ she said. ‘It’s the foundation of safe and sustainable care.’
Closing the session, Professor Patel thanked participants, reaffirming her commitment to championing the concerns of resident doctors throughout the next phase of the training review. ‘We cannot let this become another report that sits on a shelf,’ she said. ‘Residents need change, and they need it to last.’
As the voice of physicians at every stage of their career, the RCP will continue to speak up on behalf of our fellows and members to shape the next phase of the 10 Year Health Plan, the 10 Year Workforce Plan and the national medical training review.
This Med+ 2025 breakfast session was exclusive to in-person delegates and is not available to watch on-demand. But don’t despair! You can catch up with Med+ content until 10 February 2026. In the meantime, why not explore our medical streaming service, RCP Player, packed full of webinars, videos and podcasts?