You can't create consultants by cutting the doctors who become them

Today, the Health Service Journal (HSJ), widely read by NHS managers, published an opinion piece by HSJ editor Alistair McLellan that suggests the NHS is ‘too reliant’ on resident doctors. Mr Raiyyan Aftab, President of the Association of Surgeons in Training, and Mr Tim Mitchell, President of RCS England, respond.

You can't create consultants by cutting the doctors who become them 

Recent commentary in the Health Service Journal (HSJ) reopens the debate on how the NHS workforce is made up. We welcome discussion about how to strengthen operational efficiency across the NHS and share the ambition to reform services so patients receive timely care. We agree that improvements are needed to how resident doctors’ roles are structured, to make jobs more satisfying, better supported and more sustainable. We also support looking carefully at patient flow to ensure good operational management, including where earlier senior clinical decision-making in some pathways may improve efficiency and patient experience.

Resident doctors are not only the consultants of the future – they are highly-skilled clinicians delivering essential frontline NHS care today. Alongside their consultant colleagues, SAS doctors and locally employed doctors, they carry a significant share of service delivery and are central to elective recovery. Re-engaging, valuing and motivating this workforce is critical to NHS performance, and this will not be achieved by framing them as a problem rather than as part of the solution.

The suggestion that the NHS is too reliant on resident doctors - and the reportedly widely-held view that the resident doctors workforce should be reduced in number - is flawed. At a time when NHS England and the Department of Health and Social Care are undertaking the 10-Year Workforce Plan and the second phase of the Medical Training Review, reducing resident doctors, as reportedly suggested, would seriously undermine the Government’s ambition to create a sustainable, home-grown NHS workforce.

The central question is quite straightforward: if there are fewer resident doctors, where will the consultants our NHS requires in the future come from? As the needs of our ageing population become more complex, the NHS is becoming more consultant-dependent, not less. As productivity expectations rise and senior clinical decision-making becomes increasingly central to care delivery, the consultant workforce will need to grow. This requires a well-supported and properly funded training pipeline.

The stability of the NHS’s future consultant workforce is already on a fragile footing. RCS England’s 2025 UK surgical workforce census shows that 59% of surgical consultants aged 55–59 plan to retire within four years, rising to 72% among female consultants, with significant variation between specialties. This is why RCS England and ASiT have called on the government to expand core and higher surgical training posts, protect access to training, and invest in supervision and teaching time, so that we will have the highly-trained consultant workforce that patients will need in the decades ahead.

This approach directly aligns with the Government’s ambition, as set out in the Medical Training (Prioritisation) Bill, to build a sustainable, domestically trained workforce and reduce reliance on international recruitment, while putting safeguards in place to ensure that International Medical Graduates, who have contributed so much to the NHS, are not unfairly penalised.

It also reflects the Darzi Review, which emphasised the importance of staff engagement and capital investment as essential to NHS recovery. The fundamental problem facing the NHS is not an excess of doctors, but a system that drives down productivity.

Our census also confirmed that restricted elective capacity remains a major barrier to productivity, with 53% of surgical consultants citing limited theatre access as a key challenge – primarily due to lack of theatre space (73%), theatre staff shortages (59%), and insufficient bed availability (47%). Training is similarly constrained: reduced access to elective lists, driven by emergency workload and theatre pressures, continues to limit hands-on operating experience for resident doctors, contributing to burnout and doctors leaving the NHS. These findings make clear that system‑level constraints - not an oversupply of doctors - are suppressing surgical productivity.

The NHS cannot cut its way to productivity. It must address the structural inefficiencies that prevent skilled clinicians from working at their full potential. When staff work in a system constrained by bottlenecks, outdated processes, and poor resource flow, those inefficiencies are absorbed into their workloads, limiting productivity and morale. Elective recovery depends on expanding, not eroding, the surgical workforce, and matching it with the capacity that allows teams to actually deliver: more operating theatres, ringfenced beds, modern diagnostic equipment, and the staff to run them. 

A more efficient NHS will enable resident doctors to deliver greater value. Without this foundation, resident doctors and consultants alike are stretched thin, productivity flatlines, and waiting lists grow. A sustainable pipeline of well-trained resident doctors and consultants, backed by serious investment in surgical and diagnostic capacity, is the only credible route to a resilient, high performing NHS.