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Mark Drakeford, Minister for Health and Social Services

First published:
9 December 2013
Last updated:

This was published under the 2011 to 2016 administration of the Welsh Government

Good health education and training is essential to maintain and improve the standards of service provided to patients across the UK. 

In recent years, a number of reports about medical education have led to changes being introduced to the education and training programs, these include the independent inquiry into Modernising Medical Careers, led by Sir John Tooke in 2007. It called for a more flexible and broad based approach to medical training; integrating both training and service objectives into workforce planning. Other inquiries highlighted the need to further develop the current structure of postgraduate medical education and training to ensure it supports and responds to society’s changing needs.

In 2011 it was agreed further work was necessary and that this work should led by an independent chair, Professor David Greenaway Vice Chair of Nottingham University, who was appointed in February 2012.

Building on earlier work the key tasks were to consider and make recommendations in relation to the following areas


  • Workforce needs: Specialists or generalists - The current model of medical training is based on a high degree of specialisation and sub-specialisation of medical practice. There are currently more than 60 specialties and over 35 sub-specialties.
  • Breadth and scope of training – Consideration of how trainees can be better supported in gaining the right mix of knowledge, skills and behaviours to prepare them for the different environments and contexts in which care is provided. 
  • Training and service needs – Consideration of the  role trainees should have within the service and how the competing needs of the service and training can be addressed. 
  • Patient needs – Developing training structures that provide clarity about the competencies attained by individuals and the roles and responsibilities of trainees and trained doctors.
  • Flexibility of training – Exploring ways that trainees and trained doctors  can  move into another specialty to which they may be better suited or when the nature of medical practice, or patient or service needs, have changed.


On 29th October the culmination of this work was published:   Shape of Training: Securing the future of Excellent Patient Care was published. 

This review is set against the backdrop of the changing needs of patients across the UK and the consequent need to address more chronic illness and with patients presenting with multiple and complex conditions. This is a result of unhealthy lifestyles and an ageing population. The Report makes a number of recommendations aimed at ensuring doctors have the appropriate skills, competences and aptitudes to meet these changing needs. It also focusses on the need to redress the balance between doctors trained to provide generalist care and those trained for more specialist care. The background and aims of the report are consistent with the requirements of NHS Wales that the workforce be flexible enough to adapt to change with patient safety, continual improvement and dignity and respect at the heart of the service provided.

The full report can be found at:

I welcome the broad thrust of the report and the collaborative approach with which it has been developed. All four countries across the UK have been involved in the discussions, workshops and wider evidence gathering exercises which informed this final Report.
It is now for Governments across the UK to consider these proposals in detail and agree which will be confirmed and taken forward. The Welsh Government is currently in discussion with the UK Government and the other devolved administrations to agree how this work will be taken forward. I made it clear when I met with Professor Greenaway earlier this year that I welcome opportunities for Wales to be involved in any pilot programmes to inform these developments.

I am keen that this Report is acted upon quickly, but we must ensure the new arrangements we agree to put in place are appropriate and longlasting. In the coming months there will be opportunities for Members to become involved in awareness sessions about what the Report might mean in practice and further details of these opportunities will be made available shortly.I am also conscious that while this Report focusses on postgraduate training for doctors it must be set in the wider health education agenda.  For example, there has been a call from the Royal College of General Practitioners for an increase in the duration of their training. This must now be considered against the proposal in the Greenaway Report for a wider focus on generalist training, 

Increasingly there are new roles being created which enable doctors to be freed up to focus on those things for which they have received extensive training, while others are able to undertake some of the duties they have traditionally undertaken.  Any shift in responsibilities must of course be driven by the need to ensure patient safety but there are many examples of good innovative practice being undertaken across Wales. We need to harness these efforts and share ideas across the NHS.

It is important that discussions around workforce planning, role design and education commissioning are undertaken in a multi professional way and not in isolation because there are inevitable dependencies which exist across the workforce.

In order to promote this approach I have decided to explore how these functions can be brought together across all aspects of the health education agenda without the need to negotiate separate organisational boundaries and agendas. In the coming months work will begin to agree a way forward on this and I will keep Members informed of progress.