RCPE Press Release

18 May 2011

Following its recent warning that Scotland is in danger of producing a generation of inadequately trained doctors and compromising patient safety [1], the Royal College of Physicians of Edinburgh (RCPE) will today (18 May 2011) publish a new Charter for Medical Training which it has developed and believes will provide a practical foundation for ensuring that both doctors’ training and patient safety can be improved. However, the RCPE will warn that this will only happen if all involved parties (including the Scottish Government, NHS Boards and training-related organisations) recognise the fundamental problems which exist and commit to the Charter’s implementation in practice.

The Charter for Medical Training is relevant to all doctors working within the medical specialties in the hospital sector and was developed in response to an erosion in the balance between the time that Medical Trainees (doctors training to become consultants) have for training and providing direct patient care, and their Trainers (consultants) have for overseeing this training. Most significantly, successive Independent Inquiry reports and multiple surveys conducted by the Medical Royal Colleges had indicated that this has become a major problem within the NHS throughout Scotland and the whole of the UK with Trainee doctors often simply and inappropriately used to plug gaps in hospital rotas at the expense of their training.

The Charter is based on five guiding principles –

  • patient safety and care is paramount;
  • all parties recognise that training and service elements must be balanced;
  • Trainees are valued for their service (patient care) contribution;
  • Trainees are actively involved in the training process; and
  • Training is fair, based on principles of equality and fosters the development of professionalism

The Charter then lays out 26 detailed commitments (covering the areas of Patient Care and Safety, Recruitment and Induction, Balancing Training with Service Provision, Ensuring Quality Training, Assessment and Curricula, and Support and Development). Key commitments include –

  • the duties, workload and work patterns of Trainees should ensure patient safety;
  • Trainees and their Trainers should receive protected time for clinical training;
  • Trainee numbers will be based on accurate workforce planning;
  • Trainees should receive supervision and support with their clinical case-load and work at a level appropriate to their level of competence;
  • Trainees have access to a sufficient breadth and depth of clinical work to enable them to achieve clinical competencies;
  • processes for recruitment, selection and appointment are open, fair and effective with specific details regarding training posts available at the time of application;
  • Trainees receive equitable access to personal, ring-fenced study leave budgets to support their training needs; and
  • Trainees are supported in monitoring and accurately documenting working patterns.

The Charter for Medical Training was developed by the RCPE’s Trainees & Members’ Committee, which represents approximately 4000 medical Trainees, and is backed by the RCPE.   

Dr Neil Dewhurst, President of the Royal College of Physicians of Edinburgh (RCPE), said,

“In recent years increasing pressures upon the NHS have reduced the amount of time that can be devoted to medical training. As a result, many Trainee doctors are currently receiving an inadequate level and quality of training, and their consultants have insufficient time to oversee this training effectively. This has the potential to seriously undermine the future provision of high quality and safe patient care in Scotland and throughout the UK.

“Having recognised these problems, and as a major contributor to the training of doctors, the RCPE has developed a Charter for Medical Training which we believe can lay a solid foundation for beginning to tackle the problems which exist and securing the future level of care needed by patients. However, we simply will not be able to make progress in decreasing the potential risk to patient safety and improving the quality of training if all involved do not commit to the implementation of this Charter. This issue has to be considered urgently at a national level by the Scottish Government and all stakeholders. Consensus then needs to be reached on how we can tackle these problems together, and a timescale agreed and resources identified for implementing the recommended measures.”

Dr Kerri Baker, Chair, RCPE Trainees & Members’ Committee, said,

“Patients and the public, in general, may be largely unaware of the extent to which Trainee doctors prop up the NHS. Trainees, often experienced doctors in their own right, are frequently the first point of contact for patients and are fully committed to providing them with the highest quality of care. But, in addition to providing direct patient care, Trainees also need to be able to access training which will enable them to become fully trained and to function safely and efficiently as the consultants of the future. 

“It has now reached the point where the need to plug gaps in hospital rotas, increasing work intensity - in part due to working time regulations - and the reduced availability of Trainers, by the same mechanisms, are preventing Trainees’ ability to receive adequate training. Almost 60% of Trainees who responded to a recent survey believed they would not be adequately trained by the time of completing their training. It is, therefore, essential that Trainee doctors are better supported and are provided with protected training time if we wish to secure the future safety and quality of patient care.

“The Charter does not provide all of the answers, but by clarifying the roles and expectations of Trainees and their Trainers, and encouraging a consistent approach to Trainees’ experiences nationally, we believe the Charter could afford Trainees greater support, strengthen their training and reassure patients.

“We urge government and NHS Boards to support the Charter and to contribute to the development of a more engaged Trainee workforce at a time when current pressures risks alienating them and also risks their potential longer term loss to the NHS. Inadequate workforce planning can result in a mismatch between the number of doctors completing their training and the limited number of consultant positions available for them to progress into. Unfortunately, the NHS’s loss (and that of the taxpayer who has supported the cost of training young doctors) can all too often be other countries’ gain as talented, but frustrated, doctors feel they have little option but to progress their careers abroad. This can represent a significant loss to the NHS and more accurate workforce planning is required.”

Dr John Colvin, Chair of the Academy of Medical Royal Colleges in Scotland, said,

“The publication of this Charter is very timely. The principles on which it is based are of fundamental importance and offer potential for application across a wide range of specialties. While all are already agreed that patient care and safety should be paramount, the experiences of Trainees can vary and their contribution to NHS service delivery is not always valued. Perhaps of even greater importance is the need to ensure that training and service needs are balanced and that time is protected for both training and integrated clinical experience in order to ensure patient care and safety.

“The RCPE is to be applauded for highlighting these issues and presenting a possible framework for further development. The Royal Colleges play a significant, and often under-recognised, role in the training of doctors and in ensuring the quality of patient care. I would support the need for a national discussion in order to build consensus with all involved parties around how we can collectively improve medical training.”  

The Charter for Medical Training will be submitted to the Scottish and UK Governments and circulated widely to all of those involved in training [2]. The Charter represents the views and practical experiences of RCPE Trainees and Trainers, and builds on earlier General Medical Council (GMC) standards and other source documents.

Addressing the need for protected training time for Trainees and Trainers was identified as one of the main Health Priorities for Scotland in the RCPE Scottish Parliamentary manifesto published in March 2011 [3], and will form an ongoing policy objective for the RCPE.

Access the Charter for Medical Training

Contact: Graeme McAlister on 0131-247-3693 or 07733-263453


Notes to Editors


[2] The system of medical training in Scotland and the UK is quite complex and involves multiple organisations. In broad terms, the system can be summarised as follows –

  • Trainee Doctors’ contracts are with their employing NHS Board, and their training (undertaken during their employment) is overseen by local postgraduate Deaneries (based around University Medical Schools)
  • The Royal Colleges of Physicians of the UK (in Edinburgh, Glasgow are London) are responsible for developing and overseeing the medical curricula within the training programmes for Medical Trainees throughout Scotland and the UK, covering 30 medical specialties (i.e. cardiology, gastroenterology etc)
  • The General Medical Council regulates training
  • Whilst training remains a reserved issue, under the control of the UK Government, the four Departments of Health (Scotland, England, Northern Ireland and Wales) are responsible for overseeing the administration and implementation of the overarching training programmes and policies in their respective countries

[3] RCPE Health Priorities for Scotland