HCSA, The Hospital Doctor’s Union Executive Committe has welcomed elements of the government’s latest proposals and offer to resident doctors in order to address workforce challenges but warns that quick fixes will not solve deep-rooted issues in medical career progression and pay.

The measures announced include prioritisation of UK medical graduates for training posts, the creation of 4,000 additional training places over three years and converting Locally Employed Doctors (LED) roles into training or national terms and conditions posts.These steps echo key demands made by HCSA’s Resident Doctors Committee in a letter to Health Secretary Wes Streeting in October, which highlighted the urgent need to safeguard welfare and working conditions for trainee doctors and called for reforms to tackle pay erosion, training bottlenecks, and deteriorating workplace safeguards.

That letter warned:

“Resident doctors now face multiple compounding issues including pay erosion through still persistent sub-inflationary annual pay awards, difficulty in obtaining training a place and the deterioration of working conditions, training structures, and welfare safeguards. These systemic failings are not only jeopardising the mental and physical wellbeing of thousands of dedicated professionals but also eroding the foundation upon which the future of the NHS is built.” 

Key priorities outlined by HCSA resident doctors in October included:

1. Ending the cycle of pay disputes through a good-faith multi-year agreement to restore pay value and future inflation-proofing.
2. Stable employment and career planning, including reforms to reduce excessive rotations, enable leave planning beyond 6 weeks to permit family holidays and event planning e.g. weddings, improve access to training posts, and progress toward shorter, high-quality run-through programmes.
3. Working conditions and infrastructure, such as guaranteed rest facilities, safe sleeping rooms post-night shifts, IT investment, and accurate payroll systems.
4. Expenses and cost of training, including funded postgraduate exams, coverage of essential work-related costs, and measures to reduce the impact of student loan debt.
5. Quality of Training, ensuring equitable access to meaningful teaching, protected training time, and funded study leave under national oversight to reduce variation; promote innovative models such as 80/20 leadership/education schemes to build future clinical leaders.
6. Accountability, protection & psychological safety, including a named pastoral lead for each doctor throughout training (separate from educational/clinical supervision); targeted support where toxic cultures are identified; and continued access to Practitioner Health and other vital support.
7. Regulation and use of Physician Assistants/Anaesthesia Assistants, calling for a clear commitment that non‑medical roles support rather than replace doctors, do not impair medical training, and are deployed in ways that protect patient safety and preserve medical expertise.

 HCSA recognises that prioritising UK graduates/experienced NHS doctors and creating additional training places directly address parts of our October plan on access to training and stability. While the government’s proposals mark progress, HCSA reiterates its call for urgent clarity and action, as outstanding question remain:

• Distribution of Posts: It is unclear whether the new training places will be distributed according to doctors’ preferences or NHS-determined regions.  Will new posts be allocated where doctors want to work and where services need them, without forcing disruptive relocations?
• Specialty Balance: clarification is needed around whether these roles will align with projected future medical needs. Will new posts match future demand across specialties, rather than being short‑term fixes?
• Career Progression: A surge in training posts must be complemented by a guarantee of consultant positions on completion. Will increased training posts be matched by consultant roles as cohorts complete programmes?
• LED Conversion: Clear criteria are needed to ensure that converting Locally Employed Doctor roles delivers genuine training opportunities and not just quick fixes. What are the clear criteria and safeguards to ensure conversions create genuine training opportunities, not re-badged service posts?
• Pay and costs: The offer does not address pay restoration as there is no change to headline pay and it is unclear how reimbursements for additional costs such as exam fees will be implemented. How will the government move to address ongoing issues around pay erosion?

“We welcome the government’s recent commitments on training numbers and prioritisation, which reflect calls our resident doctors made in October. However, urgent clarity is needed on post distribution, specialty alignment, and genuine career progression. Above all, resident doctors need confidence that training will lead to consultant roles and fair pay, not just short-term relief.”
- Dr Claudia Paoloni, HCSA Vice-President 

“Resident doctors deserve more than quick fixes, they deserve a clear, sustainable plan for training, progression, and fair reward. Pay erosion has left resident doctors feeling undervalued and trapped in a cycle of disputes. Without a clear, inflation-proof roadmap to restore pay, the NHS risks losing the very professionals it needs most.”
- Dr Matt Church, HCSA National Executive Member for Resident Doctors

 HCSA warns that the government proposals do not resolve the underlying imbalance between effort and reward. Doctors continue to face long hours, high debt, and persistent pay erosion. Sustainable solutions must include fair remuneration alongside structural reforms.