Liverpool born Lib Dem Peer Lord Rennard spoke in the House of Lords this week on the Medical Training Crisis and the failures over many years to have a proper NHS workforce plan that includes training for doctors. He summarises his speech for us here.
House of Lords debate on the problems in healthcare
The House of Lords was this week grappling with a pressing issue in UK healthcare: the alarming imbalance between medical training posts and the rising number of foundation year medical students.
I used my time to draw attention to the “stark and unsustainable increase in competition for specialty training places” within the National Health Service.
There is a critical bottleneck threatening the future pipeline of essential healthcare professionals. I wanted to highlight the fact that while medical school numbers surged by 34% between 2014 and 2024, specialty training places saw a disproportionately modest 9% increase over the same decade.
This disparity has led to a situation where a rapidly increasing number of doctors are seeking to advance from foundation training, but very few available posts, leaving many “stuck outside of the speciality training pathway”.
A grim picture of escalating competition for doctors:
• Applicants on the Rise: Round one applications for specialty training in 2025 saw a 29.76% increase in unique applicants compared to the same period in 2024.
• Intensifying Competition: The overall competition ratio has soared from 1.9 applications per post in 2019 to 4.7 in 2024, with expectations of it being even higher in 2025.
I emphasised that the consequences extend far beyond individual careers. Many UK medical graduates, after years of significant investment in their education, are compelled to take insecure ‘locally employed doctor’ (LED) or locum roles.
Patient care is impacted by specialist shortages
The General Medical Council (GMC) has noted that doctors in such non-training posts have a higher rate of leaving the profession entirely, contributing to a “disillusioned medical workforce”. This situation directly impacts patient care, with 59% of respondents to the Royal College of Physician’s census reporting at least one consultant vacancy in their department.
• General Practice and Public Health Medicine ST1 (Dual CCT Programme) recorded an astounding competition ratio of 112.13 in 2024.
• Cardiothoracic Surgery ST1 stood at 45.33 in 2024.
• Even General Practice ST1 saw competition increase to 3.67 in 2024 from 2.67 in 2023, with a record 15,036 applicants for over 4,000 posts.
There has been inadequate medical workforce planning by successive governments. The expansion of undergraduate places was not matched by a commensurate increase in postgraduate training capacity, leading to ‘artificial bottlenecks’.
We need a realistic plan to tackle this critical issue
While the government’s 10-year plan for the NHS aims to create 1,000 new specialty posts over three years and prioritize UK medical graduates, I raised the concern that it is “not yet accompanied with a realistic plan for medical workforce staffing”. The promise of a detailed and adequately funded workforce plan ‘later this year’ was highlighted as critical, given the current ‘cliff edge situation facing many newly qualified doctors’.
I told the Health Minister in the House of Lords that there was an urgent need for immediate, comprehensive action to address this critical bottleneck in medical training. Failure to do risks further disillusionment and attrition among medical professionals, ultimately jeopardising patient care and the long-term sustainability of the NHS.
The commitment to increasing medical school places must be matched by an equal commitment to expanding postgraduate training capacity, ensuring that every doctor we train has a clear and secure pathway to becoming the consultant or GP of the future.
The full text of the debate can be found in the Hansard Library
