• The NHS long term plan needs a “cogent” workforce strategy to succeed, says RCP president
  • Public health and prevention must be tackled in the long term plan
  • There is an appetite in the leadership “high up” to improve NHS culture

The number of medical students need to double in the next decade to avoid “an absolute disaster”, the new head of the Royal College of Physicians has told HSJ.

Andrew Goddard, who took over the presidency from Jane Dacre on 26 September, warned there were “great concerns” the long term NHS plan would “fail without a cogent workforce strategy to go alongside it”.

He said the £20bn announced earlier this year for the NHS did not include training and workforce, which is a “challenge” and he pointed to the fact Health Education England’s budget had been held flat.

“Everybody feels they are working really hard,” Professor Goddard said. “The number of medical registrars is the same as it was ten years ago and that is why trainees feel overloaded and why consultants feel they are having to take the weight of all of that.”

“If you have more [doctors] on the ground, people have time for high quality training and people can work more flexibly,” he stressed.

“I’m being conservative asking for a doubling of medical students. Not to sort out the problems now but so we don’t have an absolute disaster in 12 years,” Professor Goddard said. “That is an opportunity for the long term plan.”

In a letter to the British Medical Aauthority last week, health and social care secretary Matt Hancock said he had asked HEE to accelerate efforts to improve training and to roll out a pilot on flexible working in emergency medicine to other specialisms.

He also said trusts will be required in future to publish an annual report on rota gaps and a plan to improve those signed off by the chief executive.

Professor Goddard stressed the need for the long term plan to tackle prevention and public health.

“Most of the problems we see people with are preventable and public health intervention is the way to do that,” he said. “And the reason why we can’t get people home is because social care is falling to pieces.”

In terms of solutions to the workforce crisis in the short term, Professor Goddard highlighted the importance of immigration and stressed “we have to keep those doors open” as “we’re clearly reliant on doctors from the EU”.

He also discussed the role of the multidisciplinary teams and said the RCP was “really excited” that health secretary Matt Hancock announced physician associates would be regulated, which would allow them to prescribe in due course and request X-rays.

“They need to do that to be valued parts of the team,” he said.

Professor Goddard said that advanced clinical practitioners are also a “really effective” part of the team and work side-by-side with medical trainees.

“The idea that [only] one group of professionals can do one set of roles is not what we need in the long term,” he said.

Although Professor Goddard said the NHS has “a way to go” in terms of improving culture within medicine, he said in “leadership high up there is a real appetite to improve the culture”, which is “what we need”.

“We can sense the culture on the wards, but the culture of blame within an organisation has to come from the top,” he said. “You’ve got to learn from mistakes and errors and I think things have reached a nadir with a blame culture.”

In terms of the future of the RCP, Professor Goddard stressed the need for the college not to be seen as a “London centric body” and said it needs to support other countries in training medics.