NHS Urged to Prioritise Surgical Training

The NHS must take immediate action to protect and expand surgical training or risk struggling to maintain a sustainable workforce in future years, the Royal College of Surgeons of England (RCS England) and the Association of Surgeons in Training (ASiT) have warned.

In a letter this week, RCS England president Tim Mitchell and ASiT president Roberta Garau highlighted ongoing barriers to surgical training. The letter was addressed to NHS England National Medical Director Professor Sir Stephen Powis and Chief Medical Officer Professor Sir Chris Whitty. 

Mitchell and Garau noted that access to operating theatres had not recovered since the COVID-19 pandemic. They warned that planned government reforms, unless carefully implemented, could further limit training opportunities.

New evidence from the Joint Committee on Surgical Training (JCST) showed that resident doctors have missed out on more than three million surgical training opportunities since March 2020. The latest RCS England surgical workforce census revealed that 61% of resident doctors in surgery identified limited theatre access as a major challenge, while 52% reported insufficient time for training. Additionally, 32% of surgeons in training said they were considering leaving training.

“Resident doctors in surgery just aren’t getting enough time in operating theatres and their training has consequently taken a major hit,” said Mitchell, in a statement. “If we don’t do something now to improve their access to theatres and allow them to develop their surgical skills, we risk losing a generation of surgeons,” he alerted. 

Operating Theatre Experience Indispensable

While reducing long patient waiting times should remain a priority, Mitchell and Garau warned of a risk that training opportunities would be sacrificed at the “altar of productivity” in the drive to meet targets. Training and service delivery should “not be seen as competing priorities”, they emphasised. Instead, the current focus on clearing the backlog should be treated as an opportunity to embed high-quality training while maintaining patient access. 

To address these challenges, RCS England and ASiT called for three urgent actions:

• Balancing training needs with service delivery demands.
• Requiring the private sector to support training opportunities.
• Ensuring surgical hubs deliver on training commitments.

A failure to address these issues would lead to an undertrained and inexperienced workforce in five to 10 years’ time, they warned. 

Mitchell and Garau emphasised the importance of hands-on surgical experience. Resident doctors in surgery must be actively involved in evening, weekend, and high-intensity theatre (HIT) lists, which were introduced to help clear backlogs. “No textbook or simulation can fully substitute for real-life surgical practice,” they said.

While advances in medical practice, such as new pharmaceutical treatments, have reduced the need for some surgical interventions, evidence suggests a decline in operative experience across specialties. “If we do not act now, the NHS will struggle to maintain a sustainable surgical workforce for future patients,” Mitchell and Garau warned. 

Training Alongside Service Delivery

Surgeons have advocated for the establishment of surgical hubs to increase elective procedures and provide a protected environment for training. Mitchell and Garau described these as a crucial reform to increase elective activity, giving patients quicker access to procedures, and providing a ringfenced environment for resident doctors to develop their skills. However, data suggested these opportunities were not being fully realised, with fewer than 10% of surgical training episodes currently occurring in hub centres.

“Surgical trainees are being pushed to the sidelines, struggling to get the hands-on experience needed to become the consultants of tomorrow,” ASiT stated. “Years after the pandemic, theatre access is still limited, and system pressures continue to put training second to service delivery over training.” 

RCS England and ASiT also cautioned against the expansion of independent sector provision at the expense of of training. They called on NHS trusts to establish flexible job plans for resident doctors in surgery that included timetabled training in the independent sector and ringfenced time for trainingwithin trainers’ schedules.

NHS England has been approached for comment.

Dr Rob Hicks is a retired NHS doctor. A well-known TV and radio broadcaster, he has written three books and has regularly contributed to national newspapers, magazines, and online. He is based in the UK.