Consultants are often very good at quietly fixing things.

Chasing the result, squeezing in the patient, correcting the letter, answering the email, staying late, covering the gap, making the unsafe process just about safe enough.

Is that part of the problem?

At what point does professionalism become enabling?

Posted previously in r/consultantdoctorsuk

Consultants are often very good at quietly fixing things. Chasing the result, squeezing in the patient, correcting the letter, answering the email, staying late, covering the gap, making the unsafe process just about safe enough. Is that part of the problem? At what point does professionalism become enabling?

Thousands of doctors have urged the BMA to abandon its stance that non-UK medical graduates and others not automatically prioritised should have five years' NHS experience to access specialty training, fearing it disadvantages international medical graduates (IMGs).

Under the Medical Training Prioritisation Act, UK medical graduates and other specific groups have been prioritised for access to specialty training - but IMG doctors can be prioritised if they have 'significant experience' of working in the NHS.

At the 2026 BMA annual representative meeting, doctors voted for 'significant experience' to be defined as five years. The vote sets the BMA position on the issue and does not mean the government will adopt this stance - but more than 2,000 doctors including GPs have signed a petition calling on the BMA to drop the five-year policy and 'adopt a fair approach that protects UK graduates without scapegoating international colleagues'.

Dr Ibrahim Toeima, a locally employed doctor who set up the petition told GPonline that a five-year experience rule could leave IMG doctors facing unemployment or a loss of visa sponsorship because many NHS non-training jobs are only available on fixed term contracts.

Specialty training

Legislation to prioritise UK graduates and the BMA vote come after a surge in competition for NHS specialty training places. The BMA said its policy aimed to support prioritisation of UK-trained medical graduates - and that the root cause of high competition was that underfunding had left a shortage of training posts. In response to the petition, the BMA told GPonline that it will still be lobbying for five years’ experience as a requirement for training places.

The petition reads: ‘The training crisis was not created by IMGs. It reflects years of inadequate workforce planning, insufficient training numbers, insecure locally employed doctor posts, and limited consultant and GP expansion. Restricting IMG progression will not solve these problems. 

‘A health service that depends upon international recruitment while treating overseas-trained doctors as expendable when competition intensifies is pursuing an unsustainable contradiction.’

Dr Toeima, who is an IMG doctor, told GPonline that the BMA policy is ‘gutting’. He added: ‘You come to work and you carry the hate, the weight of all this exclusion. You try to prevent it, you speak to psychologists, you speak to the consultant, you speak to your colleagues about it. Some people support and some people don’t. It is something that has touched a lot of people and this petition has reached so many people.’

Exclusion

Dr Saif Ahmad Malik, also an IMG doctor, who was recently working in trauma orthopaedics and is one of the petition’s signatories, said: ‘The BMA policy makes me feel excluded. It feels like what happens in your life and your problems don't matter to the organisation that you are part of. It’s your problem and you have to deal with it. You have to figure things out for yourself, if you don’t get a contract you have to leave. I do not feel represented in the organisation.’

The petition says 'doctors who complete two years of NHS medical service should be treated equally in specialty training access'. The BMA has pointed to 'analysis from NHS England...that a two-year NHS experience threshold would have a limited impact on reducing training bottlenecks' - but says the fundamental problem is a shortage of training places overall.

BMA deputy chair Dr Emma Runswick said: ‘Prioritisation for UK medical graduates has long been a contentious topic, which has been caused by years of successive poor workforce planning. We simply should never have been in a position where we have un- and underemployed doctors because there aren't enough training places.

‘Doctors have been forced to try and find solutions to a problem that was not their fault, and the BMA policy reflects the balance between needing to end the absurdity of UK-trained doctors unable to get jobs, while also recognising the invaluable contribution of international medical graduates. The BMA will be lobbying for five years' experience as the requirement for prioritisation for training places.’

You can read or sign the petition here and read BMA FAQs on its stance here.

Some jobs look fine on paper and are clearly awful once you understand the department. What are the warning signs? High DCC? Vague SPA? No office? No secretary? Constant vacancies? Too many sites? “Exciting service development”? Friendly but desperate clinical lead? What would make you walk away now?

Lots of people talk about dropping PAs as the obvious way to regain control. For those who actually did it, any regrets? Did the workload genuinely reduce, or did the same amount of responsibility just leak into fewer paid sessions? Interested in both positive and negative experiences.

Any one have any experience with inserts? Do they degrade quality or are cumbersome Vs prescription TTL loupes

Every specialty has problems, but some consultant jobs seem much more sustainable than others. Which specialties currently have a decent balance of pay, workload, OOH, autonomy, PP options, admin, and long-term sanity? And which look good from the outside but are actually grim?

What activities are routinely treated as “just part of being a consultant” but should obviously have dedicated SPA or admin time? Educational supervision? Governance? Service development? Audit/QI? Appraisal/revalidation prep? Complaints? Mortality reviews? Guidelines? Rota work? Curious what people have successfully negotiated.

What should a new educational supervisor know which experienced educational supervisors here got to know the hard way.

If a patient is not booked, a result is not actioned, an MDT outcome is not followed, or a letter is delayed because the admin system is broken, how much of that risk realistically lands on the consultant? Do people document/escalate this formally, or just absorb it because doing so feels safer?

How do people define the end of a clinic? Is it when the last patient leaves, when the letter is done, when results are checked, when follow-up is booked, when the GP letter is corrected, or when the inevitable patient query two weeks later has been dealt with? Some job plans seem to treat clinic admin as a small add-on. In reality it feels like a second clinic attached to the first one. How is it counted where you work?

https://preview.redd.it/tl4km6digdhh1.png?width=1136&format=png&auto=webp&s=b9c05921c525558d77aa37ea167a8e495210d8a4

https://preview.redd.it/dv01qm5mgdhh1.png?width=785&format=png&auto=webp&s=05501e86f15f1571bb6be88d046e6448dbba1812

https://preview.redd.it/drk2clgqgdhh1.png?width=770&format=png&auto=webp&s=84f6f34bb2095d0d1ea906945e7c11bedb7d8e44

How boring. As a medical profession, this is on us to have let this nonsense proliferate.

Give an inch take a mile.

Not “wellbeing webinars”. What practical changes would make people stay longer? Fewer PAs, better admin, less OOH, pension/tax fixes, more SPA, better offices, flexible working, proper secretaries, less governance burden, more autonomy, better pay? What would move the dial?

For those who have built some PP, is it still worth the effort? I’m not asking for exact earnings. More whether the admin, indemnity, letters, billing, patient expectations, tax, and loss of free time are worth it. Does it feel like a sensible escape valve, or only worth it in certain specialties/regions?

Consultant-delivered care sounds good in policy language. But in practice, does it sometimes just mean consultants personally doing or supervising work because the wider system cannot staff, train, administrate, or risk-manage properly? Where is the line between good senior care and using consultants as expensive glue?