Andrew Long

In a new Royal College of Physicians survey of more than 1,000 resident doctors, only 26% felt ready for the next step in their career. Only 65% expected to still be working in the NHS in five years. These figures are in the RCP’s report Training physicians for the future, published last week. They’re hard to read. But I don’t think they’re a story about doctors lacking resilience, or trainers lacking commitment. 72% of resident doctors said staffing gaps and rota gaps had the biggest negative impact on their training and wellbeing. And only around half of trainers are always able to use their allocated training time for education. I spent years as a Director of Medical Education, so I know how that happens. It isn’t that trainers don’t care. It’s that the time is short, the patient list is long, and teaching is the first thing to give. Trainers are squeezed too. What I find encouraging is a point the RCP’s resident doctors make clearly: we already know what good training looks like. What’s been missing is the accountability and sustained, system-wide action to deliver it. The RCP calls for protected educational time, staffing that shields training from service pressure, and protected, properly paid time for educators to teach well. It also proposes greater use of SAS doctors in supervisory roles, and more education for locally employed doctors. From working with thousands of doctors and trainers, I’d add three things: ✅ Protect training time in how rotas are built, so it doesn’t depend on goodwill ✅ Support trainers properly, with clear roles, lighter admin and development of their own ✅ Recognise the supervisors we already have, including SAS doctors, who bring huge experience and are ready to do more Nearly a quarter of the resident doctors surveyed weren’t sure whether they’d still be in the NHS in five years. They haven’t made up their minds yet, and the conditions around them can still change that. What one change would make the biggest difference to training where you work?

What a superb day in Oxford with SAS Leads and Advocates at the MedEd Leaders SAS Leads Annual Conference. My session was on building the business case. The idea at the centre of it was simple. Clinicians already use SBAR for every handover. We just need to use it on a post instead of a patient. In this version, each letter stands for something slightly different: S - Situation and Strategic Fit. What is happening now, and how does fixing it serve what the organisation has already said it cares about? B - Benefits and Risks. What improves, by how much and for whom? What is the risk of doing nothing? A - Ask and Alternatives. Make one clear ask, and show the alternatives you considered and why they don't work. The alternatives are what make an ask look reasoned rather than opportunistic. R - Resources and Route to Delivery. Who does it, how it is governed, and how you will know it worked. If a case fills all four boxes, it is hard to refuse without giving a reason. Two tests I'd add. If you can't say the ask in one or two sentences, you don't have a case yet. You have a feeling. And count how often the benefit lands on the doctor and how often it lands on the organisation. If it's all doctor, rewrite it. The tables then built real cases using SBAR and pitched them to a Dragons' Den panel in ninety seconds. You soon find out whether your case holds up. A good business case is not a request for money. It is an answer to somebody else's problem. Thank you to everyone who came ready to connect, challenge and collaborate.