Mumtaz Patel on UK NHS workforce and training issues

Jessamy is joined by Chloe to co-host as they meet with Dr Mumtaz Patel President of RCP and Consultant nephrologist.

Dr. Patel discusses ongoing challenges for Resident Doctors and reflects on the changes that are needed to improve the current training pathways in the UK.

Send us your feedback!

Read all of our content at https://www.thelancet.com/?dgcid=buzzsprout_tlv_podcast_generic_lancet

Read all of our content at https://www.thelancet.com/?dgcid=buzzsprout_tlv_podcast_generic_lancet

Check out all the podcasts from The Lancet Group:
https://www.thelancet.com/multimedia/podcasts?dgcid=buzzsprout_tlv_podcast_generic_lancet

Continue this conversation on social!
Follow us today at...
https://thelancet.bsky.social/
https://instagram.com/thelancetgroup
https://facebook.com/thelancetmedicaljournal
https://linkedIn.com/company/the-lancet
https://youtube.com/thelancettv

Transcript

This transcript was automatically generated using speech recognition technology and may differ from the original audio. In citing or otherwise referring to the contents of this podcast, please ensure that you are quoting the recorded audio rather than this transcript.

Mumtaz Patel on UK NHS workforce and training issues

Chloe: Hello, and welcome to The Lancet Voice. I'm Chloe Wilson, and today Jess Bagnal. And I am joined by Mumtaz Patel. President of the Royal College of Physicians and consultant Nephrologist to talk about workforce and training issues in the NHS.

So it's December 16th, and I just wanted to start this Lancet voice where we are joined by Mum Patel, which we're very excited about. To give you, uh, a bit of background what. About what the current situation is in the uk. Um, so the 14th strike by resident doctors in England is due to start tomorrow. Um, but setting out the context for our listeners, um, who are maybe outside of the uk, we do have a devolved government, um, in regards to health.

So this is just going on in England because there have been agreements, uh, in previous years, uh, related to Wales, Scotland, and Northern Ireland. And it's a very difficult time at the moment because public support for the strikes is actually quite low. And there's been a strong rhetoric because we have winter pressures with increase, um, in numbers of people with flu, that the doctors are actually abandoning patients.

Um, among the winter pressures. Um, so given that introduction, um, I really wanted to, to pass over to you now, um, mum to ask you. So, so what is going on, um, with the, with junior doctor strikes? Is it just about pay? Is it about something more? Thank 

Mumtaz: you Chloe, um, for the kind introduction. So I think, uh, some of, a lot of these issues are wider.

So the current situation within the NHS, um, as we treating described it, it's, um, broken. It's really hard. The demand versus the capacity issues are really, really difficult and day to day. Number of challenges we've talked about, you know, winter pressures being all year round, um, and also corridor care, which we've talked about quite a lot through the college work as well.

So all year round pressures within the NHS and workforce is integral to, um, a healthy running of the NHS. The recent lead in and the issues, uh, around the strikes, I feel are very much deeper and much more wider systemic issues as a Royal College of Physicians. And we are not the trade union, so we don't specifically get involved with the negotiations around the strike, but what we do get involved with with.

Our resident doctor committees and our next generation campaign is getting, um, the situation right for our resident doctors. So the rising competition ratios, the recruitment issues, the retention, the workforce wellbeing, wider issues, the training which doesn't work, and the reform of training that we've been asking for.

So a number of. System level issues, which we are concerned about and are wanting, um, advocating for our resident doctors and value. Everybody wants to feel valued within the roles that you do, and if you don't feel valued, you, you know, the morale gets really, really low, which sadly is an issue currently also within the, within the health sector.

Chloe: So the latest deal that I, uh, had seen that was offered by West Streeting, some of the aspects are in that. So they said that they were, they were going to try and, um, increase training numbers by 4,000 with a thousand, specifically for 2026. And for our listeners, I mean, is there a shortage of training places?

And you mentioned competition ratios. So, so what's going on? Um, from, from that side of things. 

Mumtaz: Yeah, so again, you know, there's the training post the doctors in training, which is the, um, the, the posts that are under NHS England in the, in England and NHS Scotland, um, those kind of governed and quality assured posts.

Uh, and that leads in then into sort of specialty training posts as well. And then there's lots. Of locally employed doctor posts, which are trust funded, hospital funded, and more like locum posts. And again, the quality assurance of those posts may not always be there. So with regards to the competition ratios, the issue is within those doctors in training, so the doctors in training and the training specialty posts.

Stayed stagnant for a number of years and despite the doubling in the school of medical school places, which is what we campaigned for some years ago, um, the commensurate increase in foundation core specialty training posts hasn't happened in that way. So I remember being in my other post previous to my president role as postgraduate associate dean and the expansion of medical schools were happening and there was really little consideration of, in five years time, these people will need foundation posts and core training posts.

And that kind of, you know, kind of bottlenecks was just already heading towards that. We got further increase in, um, uh, sort of, uh, medical school places during COVID and Boris Johnson Pro, um, promised some more posts. There's lots of private medical school posts as well, which, and medical schools which have come.

So the rise in competition. As well as the removal of the resident labor market test. So post xi, there was concern that we will have workforce shortages and rotor gaps. So the resident labor market test was removed. So that competition went away in the sense of, you know, kind of, um, open to all with regards recruitment, but that meant that these.

Competition ratios of people applying and then just not getting posts. So I've spoken to a number of our UK graduates, um, who have gone to Australia to get more experience, come back to the uk, applied first time round, applied second time round, and still not getting into the system for the specialty training posts.

And that's really disheartening that they've put in so much hard work and effort into, um, getting into training posts and they're stuck. Um, a loss of. Um, of a whole generation, I worry about because it's year on year, we're seeing the same things. 

Jessamy: It's interesting, isn't it, because I was speaking with colleagues the other day, no names shall be revealed, but, uh, their older generation doctors, very high profile and some of them were saying that actually what they felt was the issue was that people were less willing to travel.

To get places that there wasn't a shortage of training places, but that the genera, like generationally, there was a difference in what people were willing to do to be able to get those training places. So, you know, in my generation of, of doctors, it was very normal that you would be separated from your partner during your training and you hoped at some point that you would be able to get a training place together.

And their point was that, that's not tolerated anymore. Is there any truth in that or is this a kind of. Slightly unpleasant, generational kind of, uh, stigmatizing of men. Yeah. 

Mumtaz: No, it's hard, isn't it? And I think, um, the training systems currently are very inflexible and the rotational training, I mean, I moved 14 houses, uh, 14 places or flats, um, over the course of my training.

And, um, despite getting married, I didn't have children till very much later. And, you know, work-life balance is a real issue. And, you know, generationally yes. You know, I feel that, you know, these things shouldn't be accepted as a norm. And, you know, flexibility is absolutely key. I mean, my progression.

Wouldn't have happened if I didn't have the flexibility and support of my peers. Um, at the time. With regards to numbers, yes. In less, um, popular places. So I live in the northwest of England and we always say, you know, kind of certain places, Blackpool, barrow, coastal regions, deprived regions away from the cities are always more difficult to recruit.

That's been the case. 20 years ago, 30 years ago, and sadly still remains the case now. However, what has significantly changed is those proportions. So, you know, when we had, um, I was, uh, when I was looking at the figures in 2019, there was 12,000 applicants for 9,000 posts. Now we have 30 thou. 39,000 applicants for the same number of posts.

So, you know, that has significantly changed. So the training posts are the same. The locally and employee doctor posts, you know, those have tripled, you know, so those have gone from say, 11,000 to 29,000, um, or around that number for over the last five or six years. Um, but those are not, you know. Helping progression.

So those are like, you're stuck in a way. Um, and people are sadly having to opt to do that because they can't get into the training specialty posts. So, so I think there is still a number imbalance and those difficult to recruit areas sadly still remain difficult to recruit. So there's some places in Wales I think there are still underfilled, some places in Scotland which are underfilled, but I feel proportionately that bit hasn't changed from what it was 30 odd years ago.

Jessamy: And, and just to kind of explore that a little bit more, I mean, how have we got this so wrong? Because we, we are all familiar with the. Problems at the NHS that, you know, lots of the, as a system it's facing, but also individual clinicians and healthcare professionals, the sacrifice that they make, the, um, the, the pay that they have received is not commensurate to the role that they perform.

And then on top of that, layered on top of that, we have this sort of what feels like an injustice. Because one of the key things that you were always told as a doctor is you'll always have a job. Like, yes, you might not be earning as much as you could do in the city, but you will always have a job. And you are secure.

You are safe. And you know, you can rely on that and what it feels like, whether that's correct or not. But you know, you go onto Instagram, you go onto TikTok, you go onto any of these social media, there are, there are GPS crying there saying they're being made redundant and this feels just such a grave injustice.

How have we managed to get it so wrong? 

Mumtaz: I know it's awful, isn't it? And I think, you know, kind of that kind of lack of foresight and the workforce planning and modeling aspects side of things. I know it's really hard and um, all these things are always easy in hindsight. But some of the things that I mentioned before, you know, if you're doubling the medical school places and.

Um, you know, sort of, um, uh, promising 15,000 places by 2031. Surely you should be thinking that we need to be increasing the number of training places going into postgraduate training. And that, you know, for us in the system hasn't happened in that way. You know, we've been pinching in, um, trying to find posts for the expansions as they happened, the resident label market tests being removed, yes, appropriately, perhaps at the time, but again, I feel lack of foresight that we were gonna get.

Um, flooding of, um, a number of, um, you know, kind of international medical graduates applying, and that's absolutely fine. It should be equity and fairness for all. But having said that, there should be fairness within the system to accommodate if that's what we are trying to do as well. So, so I think perhaps, you know, the workforce.

Planning. And I think there's an opportunity now with a 10 year workforce plan, and we've been inputting a lot into that to say, just think about it, you know, and based on population need, because where the population need is greatest, that's where our medical workforce needs to be. So, you know, Manchester, London, big cities, yes.

You know, the big populations, but particularly also the wider, you know, kind of regions away from the center, more deprived regions. And that's where the health inequality. Kicks in even more so. So it's making sure it's fair across for the population Need. 

Jessamy: And nobody's saying are we that this is easy stuff because actually it's incredibly hard because this relationship between medical schools to training places, to consultants, the fact is you might be able to increase training places each year by, you know, thousands.

But ultimately the country doesn't need thousands of consultants, nor can it afford thousands of consultants being becoming consultants each year, who then essentially sit in that job for 28 years. Or for 30 years doing the same role. So. We have somehow managed to create a system where the only measure of success is becoming a consultant and everybody else who doesn't do that feels like a failure.

And also all of our incentive systems are also geared towards that. So you earn, you start earning more. You start having flexibility. When you are a consultant, you can start doing private practice in many ways. Some people feel like that is when life begins. When you become a consultant, which for some people might be training for 20 years.

You know, and then suddenly, oh, I can actually be in control of my rotor and my schedule. I can be in control of my time. How do we change this? Because it's not sustainable. We can't live in a world where the only measure of success is a consultant because one, we then get this type of of problem in in training places, but also we just physically don't need that much.

Many consultants. We're, we're here lots about innovation in AI and hopefully that will reduce some of the administrative burden and, and help workflow systems. So what does that look like? That sort of re-imagining of what a, what a medical life in the NHS looks like. 

Mumtaz: Yeah, no, completely, all fair points.

And what we can't do, certainly with even the bottlenecks and the um, the current situation is just move things down the line. Um, because that's not right either. Because you know, as you say, the need for perhaps that many consultants is not needed. But then there is certainly need for more gps, more psychiatrists, more specialists, but also generalists because we push a lot because our aging population, you know.

People are living for longer, rightfully so, and we welcome that and we want that, uh, probably even for ourselves in years to come. Um, but the complex needs of the patients is more of generalists, so we need to make sure that we are training in the right way. Um, a number of the doctors are not on training path.

Ways, like I was mentioning before, locally employed doctors are SAS colleagues. Many of those are international medical graduates, and they've made an active choice to be, and many of our UK graduates are also making an active choice to be in more SAS kind of posts and, um, specialist posts or generalist posts because of, you know, their own circumstances.

But we need to value. Those posts as well. We need to make, make sure that those posts also have, you know, not just pay progression, but progression from a career perspective. They're supported, they're valued, and they're not just seen as gap fillers. I used to hate that term when I was, um, you know, and even now when I go and it's that rota gaps, we need to fill it.

And it's like, what's the person, you know? And a person needs to be, feel valued and supported. So, so I think it's a balance between the different roles. I don't think everybody. Even wants to be a consultant and you know, having been one for 18 years, it's hard work as well. I think it certainly increases challenges as you become more independent.

So getting the balance 

Chloe: right is important. I was just gonna say, 'cause we were talking about SAS doctors, 'cause I worked as a specialty doctor in STIC fibrosis for 18 months and I think one of the challenges with, um, doctors that aren't in training per se, is that often you. As you said, you can just end up fitting the rotor, which means you don't get any of that dedicated time to, to read journals, you know, to do trials.

And for me, when I was working in cystic fibrosis, it was very easy because there was a strong emphasis on, um, on, on doing the academic side of things. But I don't think that is the case among all SAS posts, and I think that's a big part of people's job satisfaction. I mean, we see it with. With gps. Most of the people who are gps that are happier are those who are a GP with a specialist interest, or they have sessions where they're doing something else outside of the clinical workload because it's so heavy.

So what are we doing to make sure that doctors in those posts have more time that's protected to do those things outside of the, you know, the high clinical workload. 

Mumtaz: So, uh, again, within the Royal College, we have a number of our SAS doctor colleagues as well. We have a, um, SAS lead a committee. We have regional representation.

We were in Belfast recently and in Cardiff, where we have a lot of S-A-S-L-E-D doctors, and as a college we want equity and fairness across. Yes. You know, it always seems that the, you know, it's kind, there's no training, there's no career progression, and unless there's local support within a ho. Hospital or a trust or even a department level.

Um, sadly it's doesn't happen everywhere. So how do we take away that variation of quality and support, um, uh, and make it more equitable? So those are the kind of things, you know, you've got the SAS charter. We've got our SES strategy through the college. We provide that support. We've, um, uh, put forward, um, some guidance last year around support, supervision and fairness and progression and it's autonomous practice.

How can you support and value that in that way? Um, and then there's national initiatives as well in order to do that as well, um, through the, uh, NHS England and wider also, um, from the medical training review. So there was, I was really pleased to see from the Diagnos. Medical training review, Chris wit, TD Powers produced.

They specifically had an area of supporting SES, doctors, colleagues, um, locally employed doctors to make sure that that quality and fairness is there. And they're not just the gap filler. I hate that term. I really do. But sadly, it's used, isn't it? And unless the department. You feel invest in it. It doesn't happen.

Whereas I feel that if there's some quality standards that people need to adhere to and people will be accountable for providing that quality and support and supervision, um, then we can ensure that. And people who choose to do that, even our UK graduates are choosing like yourself. You know, I even also did, um, I think about nine months in a renal standalone post.

Before I got my training number. Um, but if you are choosing to do that, then that should be a supported quality assured post and that's what we are pushing for as a college as well as part of the medical training review, hopefully going forwards. 

Chloe: Gonna say how much do you think those national initiatives actually work?

Because even within an area it differs so much locally, and I think that's one of the really huge problems and that's one of the big problems that we have. Across training because we have these areas that are difficult to recruit and it, and it's often because people who live within an area, because even in, so I came back to Wales to do my foundation training and I'm from Wales and often people who have gone to medical school in Cardi Force, Swansea will stay in South Wales.

But you don't often get that many people that then move into Wales. But even within those areas, you have certain hospitals that people don't. Particularly like to work at. So I just wondered, it's great to have the national initiatives, but how can we make sure that those actually work at a local level?

Mumtaz: Yeah, no, absolutely. And I think, you know, even the variation is great. I mean, you know, kind of, I did the, um, as postgraduate associate dean role for some time and even as a. As college now as president, we do a lot of regional visits to look at quality of training, um, but also quality of the SES and the other posts and the educational environment because the environment is key and how do you make it better?

Because one hospital down the road might be doing it very differently. So making sure some of these national initiatives then you're working with, um, NHS employers, the trust, and then ensuring that this. Quality standards to measure against, because I do feel sometimes, you know, like the, um, uh, the, the top 10, you know, kind of markers that came out for quality with, from, um, NHS England recently as well.

Um, they did a League of the Trust in our region in the Northwest, and it's very evident if you're not meeting some of these standards. I mean, some of these things we're just getting your rotors out in the right. Um, time making sure that those rest facilities, all these kind of things. And I think ensuring that you are, um, a bit of a carrot and stick approach, that there's reward for those who are doing fantastically well because that gets under recognized.

Some of the trust and departments work so hard to ensure that there's, you know, maintained quality and support. And then in other ways when there isn't, I think, support to be provided to enable that to happen. I don't think anybody wants. Poor working environments or departments. So making sure that we also advocate for them, whether it's for funding, whether it's for resources to ensure that quality.

But it's hard. I, I, I, I think the top down approach has some merit, but then the bottom up approach and making sure that you are learning. We pair a lot of trust together sometimes where we've heard areas of good practice and there's some learnings. So in the Northwest, within different hospitals where we've heard challenges, we've paired them up and like a bodying system for hospitals and departments.

So there's cross-learning and hopefully support within that as well. 'cause we appreciate it's pressured environment. Nobody is wanting to make it a bad or a failing hospital. It's just sadly the situation that we are faced with. 

Chloe: Yeah. I mean, it's one of the, the other things that we, um, we talked a little bit about retention, but I do think it's an area that we, that we probably don't talk about enough, because I think we can all agree, I mean, there's more than enough work to go around for everybody, but we're always talking about increasing, increasing numbers.

But I feel like there's, there's often not very much emphasis on, on retaining the people who have already come through the system. I mean, when I. When I left, uh, general practice, I didn't even have an exit interview. There was, it wasn't even on the radar. And I know that's not the case University, but I've heard it across a lot of people.

Many of my friends, I mean, almost all of them went to New Zealand, Australia. Um, and I, in part now I think part of it is to get a job, but it's also the, the work life balance. And it feels like we, we talk a lot about resilience and I've come to hate that word almost because it feels like a. Um, almost that it's a problem with you personally rather than the system, but do we think that any of these issues on, you know, on getting your rot and actually just improving it?

Equipments, we've got, many of our hospitals are actually crumbling with the infrastructure that we have, and we are talking about things like AI revolutionizing work systems, but most of the time you still can't even get a computer on the board. Um, so I'm just wondering what it feels like Those sorts of issues are often just.

Really ignored and, and what are we doing or are we seeing any progress to make that better? 

Mumtaz: Yeah, no. So definitely we, as a college, and even in my own experience, I mean, I think the recruitment and getting the pipeline, um, bit right is one aspect, but we need to retain our staff and also the workforce wellbeing.

You know, we need to make sure that when we do have our staff in the post, they are well looked after and supported in those roles. So a lot of that I think comes down to, and as you rightly said, you know, people leave to go to Australia's. Spoke to quite a few people, um, uh, e even in the last few weeks of those who didn't get, say, an IT interview or whatnot, and they said, you know, when they went to Australia, new New Zealand work life balance was amazing.

They were doing less for more as far as work versus. Uh, what they were being paid for and the investment in the individuals is so important. I mean, I, I feel that if you value someone, if you make them feel that you are interested and you are supporting them through their career progression and uh, a wider support aspect, then that really, really helps.

But from a system side of things, you know, a lot of our current medical training systems have been outdated. The flexibility is just not there. The work-life balance. Isn't really addressed and going back to both of your points of we are just made to, um, somehow get on with it and be more resilient and somehow deal with it and have our children later or whatever, you know, rather than, uh, having a system that is adaptable and works for people.

And I think. Generation, certainly my children won't accept the kind of things that I had to go through 20, 30 years ago. So we need to make it fit for the future. The current working of, you know, kind of our resident doctors and for all the workforce, I feel, you know, because the NHS is based on Goodwill Goodwill's running out, and I think we really need to kind of invest more.

In those basic things, um, I always say even to government that I, it always takes me half an hour to put my computer on at the hospital. No chance, you know, go make a cup of tea and come back and it's still doing its thing. But you know, all this AI and digital transformation amazing. But. The basics are just not right.

Rest facilities getting food, you know, kind of the sandwich machine that just doesn't work at two o'clock in the morning when you're trying to get something to eat. I mean, surely it just feels really wrong. So those are the kind of things that we are pushing for at a system level. And yes, we're investing in it.

Um. From a royal college perspective, but then working with our key stakeholders and partners. So for us in England, NHS England, big partners with regards to delivery, the medical training review aspect side of things, getting the basic rights with the NHS employers and we give, give the resident doctors a voice.

So a lot of our resident doctors chairs meet with the key, you know, kind of Chris Witty, uh, Magna Pandit now it was. Steve Powers, you know, kind of every few months so that they can put forward their voice and we can advocate for them. Um, because I think that's important for your a your voice to be heard and then also understand where the challenges are.

So I know those kind of meetings have been helpful to us that Oh, okay. That. NHS employees, that's this person. So we need to make sure that we're addressing the concerns to the, to the right people as well. So I think a radical reform of training is what we are pushing for, getting the basics right for our, um, residents, but all staff on the ground, um, is really basic, but just needs to happen.

And then, you know, with regards. You know, burnout, all these things. We wrote a paper for the Lancet a few years back, um, around the COVID time, which looked at burnout and, uh, moral injury because that's so real and it's not, again, giving you like little huddles to go to or your coffee mornings or something that's not gonna sort out your wellbeing huddles.

It's a system level issues. Um, and I do feel wellbeing should be a key quality marker for all trusts, for all organizations, so that. These simple things can be done, could be monitored, and then it's not your fault as an individual. It should never be centered on this individual. It should be how the system and you know, the, the trainers and we can support you better on the ground to make it better and more manageable.

Otherwise, we will have no work. Force. So recruitment is one thing which we've talked about, but the retention and the wellbeing, because morale and burnout are, are so, you know, morale is really low and burnout is super high. And that's not because people are not coping this generation, it's just because it's.

Really rubbish and you know, really difficult to manage. Sorry, simplistic terms, but you know what I mean. 

Jessamy: No, it's true, isn't it? And as has been much discussed, the, the nature of healthcare has changed so much. Um, and their responsibility, the, you know, liability, the pace of things, it is different. So. I think also there's, you know, it's so wonderful to hear you speak and also to know that you are at the Royal College of Physicians trying to kind of push this agenda forward.

But I know that there are a lot of young doctors who feel kind of left behind from an older generation who, you know, were able to buy their house. We're able to have more flexibility or at least more autonomy to be valued as a profession, you know, much more. Um. And, and didn't have all of these kind of the same pressures that, that they have.

And, and so it's really is our duty as a, as a, as a healthcare group to make sure that we can look after this younger generation and, and, and show them what a wonderful career medicine can be, because it still remains a great career and there's still so many options that it gives you. But right now, when you are on that, you know, cold face, doing it day in, day out, it often doesn't feel like that.

We must, we must try and save that. It's so important. 

Mumtaz: Absolutely. And it's how we harness that because I still feel medicine is brilliant. I mean, I've been qualified for, gosh, 30, nearly 30 years, got showing my age. Um, but you know, I, I still think the diversification of what you can do in meds. And what I try and do is instill that early so you don't have to wait till you are a consultant to start doing different things in developing that portfolio kind of career.

I know people, even medical students ask me, you know, how can we do what you do now? And it's like, well get into this and do. This leadership stuff and get into these roles early, because I think then you can see the breadth of medicine more because I think people are just really, you know, kind of get fixated with the, with the doing and all the pressures because the complexity of the patients, the patient expectations has changed.

You're no longer, God. You know, my grandfather was a medical. In India and he was treated as like, you know, the person to look up to. And that's all gone. I mean, the societal expectations are very much, you know, you are having to really fight for your corner, for your patients, for doing basic things day to day.

And it feels like a battle, you know? And you shouldn't be feeling like that. And, and that's where I think the burnout comes and the reward, I still feel, I mean, I love. You know, seeing my patients and the, you know, the individual gratification that you get from that, but because of the lack of continuity, you don't see the same patients in early career grades.

You don't get that continuity of care and that feeling of value, which works. Both ways. So there's lots of things in the system that need to be addressed and fixed. I'm not saying, you know, it was wonderful 30 years ago, it wasn't far from, but certainly, you know, it feels harder now and we need to be advocates for our next generation.

And our campaign has been amazing. So our next generation campaign, which supports both doctors in traditional training pathways, as I call it, and non-traditional training pathways, um. Which includes our ISAS doctors, LED doctors, IMGs, um, and it's supporting them, um, through the challenges through their lens.

And they came up with, you know, 19 or so priorities. We're working through that, um, and being advocating to improve the quality of their lives going forward so we can keep them in the system because it's really important to both retain but also. Make them see the joy of medicine because I still love what I do.

I know it's hard. I don't always have good taste. I'm sure we all have good and bad days, but broadly speaking, there's very little else that I would do. But whether people want to get into teaching and training, leadership management research, we should be facilitating that and accommodating that. I know you wanted to talk about research as well.

Again, there's things that people get value from and feel that, oh, this is my. You know, I'm, I'm good at this and I want to do this. So we need to enable people, uh, and support them so that they can fulfill those areas of interest as well. Do 

Chloe: you think we need to recognize the opportunities to step.

Outside of the, the more traditional path they are, do you feel more limited than they used to be? I was looking at some, 'cause I'm quite interested in the clinical academics because I think that differs hugely across the uk. I think, um, you know, often. It depends on your links with the particular university, but some of the numbers, so up only one third, um, or more than one third of all clinical academics are over 55.

So that we are going to have, see that there will definitely be less clinical academics, but also in the uk our universities are struggling. We've seen it across the news even with some of the Russell Group universities, that financially they're not. Doing as well as they used to be. I, I mean, it's a global problem with funding research, but I think that we should be doing a lot more to support those sorts of, of pathways because we know that often having a diverse career and being able to do those additional things is really important to maintain somebody's wellbeing at work and find the joy in what they're in, what they're doing.

Completely, 

Mumtaz: completely agree. And I think those kind of things with the research and clinical academia have been, you know, kind of dropping off and we saw the chin report, there's lots of national reports looking at the numbers, um, around clinical academic training pathways and also the stepping in and out.

So when I did my training, I went out of program to do my research, and I had support to do my pilots. Study, which got me some funding and some papers so I can apply for funding for my PhD. But there was flexibility for me to do that. Um, the clinical academic training pathways are amazing when they work the partnerships between the universities.

So I was NIHR lead, um, in the northwest for the last whatever, eight years or so. Um, and supporting and seeing people through, within those journeys was. Fantastic. However, as you rightly say, the funding for universities is going down, the funding within hospitals for providing that 50% or whichever support, depending on the pathway, um, uh, from uh, a Cs do ACL posts, um, is dropping and service provision.

You know, kind of any kind of training pathway, which makes it really, really hard. And also the variation of the funding as you rightly say. So, you know, I know in my day it was very London centric and you know, kind of Oxford, Cambridge, and up north it was so limited. And even like, welcome, trust. Funding and big funders that you'd go for that'd look at the place.

I was always told the supervisor and the project and the place normally trumped as in, you know, kind of if you are in a big huge center, you are more likely to get funding. So what we, as a college, we've always supported clinical, AC academia, but academia per se, for supporting development of clinical academics.

Time for training, both for and time for supervision for consultants to supervise. So I still supervise my MD PhD students, which I really enjoy, but making sure that that time is carved out. And we've had discussions with government through the college roles for me, um, as well as, you know, kind of other partners.

And again, I was pleased to see that it was within the diagnostic report of the, my Medical Training Review as well with regards, you know, clinical academia should be supported because, you know, if you've learned anything from COVID, I mean, the research innovation side of things is absolutely crucial, but from an individual level, it brings joy to people.

And if that is their area of. Expertise. Again, we need to nurture that talent rather than losing it. And again, the last point would be flexibility. So somebody who's a woman with children, you know, again, these pathways are not always supportive of people wanting to have a good work life balance and we having to kind of fend for that.

And a lot of people drop off who are really, really good that I've personally seen by try and keep them in the system by that. Kind of the support, the mentorship, and making sure that their progression is enabled. And even if they choose to work less than full-time, that should be acceptable and we need to work around that.

So, so I think lots of different areas that we can promote, and as a college, we promote that flexibility, support both the clinical academic training pathways. But as part of the medical training review, the NIHR post is one. But we should be supporting even the local research as well. 'cause there's some really good local research training and the partnerships between universities and also the hospitals needs to be strengthened.

'cause I think that's got weaker over time because of different pressures of funding. And again, not pumping, just lots of funding everywhere, but the right funding in the right places and the right partnerships to be nurtured as well. It's been great 

Chloe: talking to you. 'cause it does feel reassuring to know that there are people, um, who, who do really care about, about the resident doctors and SAS doctors and are working very hard, um, to make the current.

System better. It, it's just difficult because that isn't an easy fix, I think. Um, and often when it's talked about in the news or by politicians, it's presented as if that is an easy fix, but it's something which is, you know, it's long over the, over the lifespan of, of a politician or a particular party in the lead.

But it's something that you just hope because it feels that we've just chopped and changed plans so many times that we just need some continuity to. To make, you know, the, the training pathways better and. And realistic for what life is like today. And the actual pressures in the system are very different than they used to be 

Mumtaz: because that's the thing.

I think what people forget is that we in changing times as well and things need to adapt with, um, the changing times and the expectations of people around us. And you know, we truly, I mean, education training is my passion as I'm sure you can see. It's something that I'm really invested in and I want to get right.

And I think for the. I, as I always say, that you inspire others by the journeys that you've had. But unless you learn from the things that you didn't work, that didn't work, and you try and make them better for others to follow, it's not going to be the same for others to follow. So, at a system level, um, very privileged to be in that position now to be able to drive.

Change or at least push it in the right direction. And that feeling seems to have gone away sometimes because I hear lots of key leaders speak and um, there's, you know, it becomes a bit political rather than, you know, actually, as you say, caring about. What the right thing is there to do. And it is complex.

It's not an easy fix at all, but I think the small changes can make really big differences. And even just having a good mentor, I mean, if you have a, I mean, I was really blessed with really good mentors and supporters who, who made things happen, you know? And I think even at an individual level, you can really.

Make a difference, but what I'm trying to do as president of the Royal College is do that in a systematic way and make sure that that translates onto the ground in a making a positive difference as well. 

Jessamy: Yeah, thanks Mumtaz. And I mean, just to finish, 'cause we have talked about essentially a total re-imagination of training in the UK and the necessary changes are large and complex.

One, do we have a government that has that kind of appetite? And two, what we need here really is a movement. Don't we? We need a consolidated, large movement to be able to define what that transformation needs to look like and then be able to implement it and it's gonna cost money. If there's gonna be so many barriers, how can we start that movement?

You know, we, that's what we need to do. Right. It can't just be you at the Royal College of Physicians. It has to be lots of PE key people together. Are there people trying to bring that movement together or, 

Mumtaz: yeah, no, absolutely. So I think, you know, fair point and I think. With the, I always try and see as a, you know, kind of opportunity and half, um, glassful kind of approach.

And I think it is an opportunity at the moment with the, um, the medical training review. The diagnostic bit is good and I think it has a lot of the areas that we want to see the devil's in the detail that, how you translate that into solutions. The resident doctor voice is absolutely key. We can't not listen, and I think, you know, you have the solutions, you are part of the solution.

So we need to make sure that you are heard within that, because what you will tell us, we need to try and then find ways of making that happen. So making sure that in the. The phase two of the di um, the medical training review, that that resident voice, doctor voice remains strong. That we can develop, co-create the solutions, co-create the model that we feel is going to work and be ambitious.

And then we have to be realistic as well of what can be delivered. And it could be short, medium, longer term, you know, kind of goals that we've kind of do. Some of the quick fixes that need to happen quickly. You know, some of the infrastructures. Stuff that we've talked about. Then we look at the medium, you know, sort of level, sort of training changes the burden of assessment, how training works, adopting the flexibility, and then the longer term things, which may take longer.

But if you know things are moving in the right direction, you'll keep people with you. So we'll continue to advocate as a rural college. The Academy of Medical Royal Colleges are brilliant as well, and they're a really sound voice. We go to government with themes now. So rather than saying we at RCP are most important, we go as we as the Academy of Medical Royal Colleges are really worried about workforce, we're really worried about health inequalities.

Please look at this, please try and address this. And we go with solutions rather than just telling people the problems. And the solutions come from our resident doctors when it comes to training. So I think working together, collaboration, co-creation, involving our resident doctors will be the way ahead, which is slowly happening.

And where. Strongly pushing that and advocating and facilitating that as best as we can from our end. 

Jessamy: Thank you so much. It was such a pleasure to see you Mantas. Thank 

Mumtaz: you.

Chloe: Thanks so much for listening to this episode of The Lancet Voice, and we hope you enjoyed it. If you are interested and want to find more of our podcasts, you can find them at the lancet.com/podcasts. Thanks for listening.