Orthopaedics Online
09 Jul 2026

Expanding horizons: How private sector involvement can enhance opportunities for orthopaedic trainees

By Fauzi Alhakmi
 

Introduction

Orthopaedic training in the UK is under sustained pressure, with intense competition for posts and an increasing proportion of elective activity delivered in the independent sector. BOTA’s Top 5 priorities for trainees are clear: protecting and increasing access to training opportunities; reducing the cost of training; improving working conditions; improving the workplace environment; and professionalising training for trainers. In this context, the independent sector is particularly well placed to support priorities 1 and 2, and with thoughtful planning, can be repositioned from a perceived threat into a structured contributor that broadens and strengthens trainee opportunity1.

Why this matters now

With more than three applicants per T&O ST3 post, training capacity needs to grow through multiple levers. Over a tenth of NHS-funded elective activity is delivered by independent providers, and national policy commits to extending clinical placements, including in the independent sector. Viewed together, workforce pressures, the shift in service delivery and policy support, mean leveraging the private sector is a realistic and necessary, system-aligned step rather than an optional extra. Used thoughtfully, the independent sector can be a meaningful part of the training pipeline, increasing operative exposure, accelerating skills acquisition, standardising access to advanced technology, and supporting a culture of continuous improvement2-5.

The independent sector as an integral training experience

The principle is established: surgical training should occur wherever the operation is performed. The Joint Committee on Surgical Training (JCST) guidance, endorsed by the BOA and Health Education England, explicitly supports training in the private sector to avoid losing educational value as more NHS cases are outsourced6-8.

Evidence from orthopaedics shows feasibility at scale. During COVID-era outsourcing in the East of England, nearly half of trainees accessed independent-sector operating, completing supervised procedures and rating the experience positively. The main barriers were access and induction paperwork, not educational suitability. The authors concluded that independent-sector operating “should be embedded to supplement training in the future”9.

Similarly, cross-specialty experience strengthens the case. In ophthalmology, a structured programme in an independent surgical centre allowed trainees to perform roughly double the number of cataract cases per list, with safety and outcomes comparable to NHS training. This demonstrates how high-volume, well-supervised lists in the independent sector can safely increase trainee throughput10.

Implementation is now a delivery problem and not a policy vacuum. The NHS Long Term Workforce Plan commits to extending clinical placements into the independent sector, and the Elective Recovery Taskforce frames the independent sector as part of the system solution. Local partnerships should therefore accredit selected independent hospitals as training sites, specify supervision and indemnity, whilst also ensuring that patient consent mirrors NHS standards11.

Using industry partnerships to expand simulation, skills and innovation

Orthopaedics is technology-rich. Device companies already deliver high-fidelity education that trainees value, including cadaveric wet labs, virtual reality (VR), augmented reality (AR), and haptic simulators. Smith+Nephew’s Academy, for example, provides structured VR curricula in arthroplasty, sports medicine, and robotics, with reported high user demand for more VR training. Growing literature across orthopaedics indicates VR training can accelerate early skill acquisition and improve procedural performance versus traditional methods. Embedding such programmes regionally (for example, annual cadaveric bootcamps and VR modules mapped to curriculum) would standardise access and reduce inequity12-14.

In theatre, industry application specialists and representatives already support safe adoption of new implants and technology. Professional guidance recognises their role in technical education, while setting clear guardrails for patient privacy, consent and scope. Trainees benefit from device-specific tips, troubleshooting, and exposure to innovation, provided oversight remains with the consultant and the educational aim is explicit. Local policies should align with established statements so that educational value is captured without blurring professional responsibilities15,16.

Industry also widens participation by underwriting and sponsoring conferences, courses and fellowships, offsetting the high cost of orthopaedic training. Trainee bodies have explicitly advocated that training opportunities should not be lost when NHS care is delivered in the independent sector, and that costs of training should be reduced. As such, private partners can help address both through grants, subsidised places and equipment loans.

Proposed practical model considerations for orthopaedics

Accredited and timetabled placements: Deaneries and TPDs could designate a small number of independent-sector 'training hubs' with consultant trainers, MDT access, and agreed case-mix. Trainees would rotate for focused blocks of elective lists, while maintaining trauma exposure in NHS bases.

Clear supervision and indemnity: Usage of standardised Memoranda of Understanding that set trainer responsibilities, supervision levels, data access, and confirm indemnity arrangements and patient consent language.

Measurable training quality: Treat private-sector lists like any training list, with WBAs, logbook monitoring and trainee feedback. Deanery/NHSE education quality visits can also be used, as per GMC standards and NHSE quality processes.

Integrated simulation training: Regional, industry-supported cadaveric and VR programmes, mapped to the ISCP curriculum and FRCS needs could be commissioned, ensuring equitable access across trainees.

Fair access and parity across subspecialties: Allocate placements transparently, budget for travel where needed, and ensure sub-specialties with less private activity get alternative simulation or rotations to balance opportunity.

Managing conflicts of interest: Follow GMC and NHS England conflicts of interest guidance and RCS England policies on working with industry. Any conflicts should be clearly declared, whilst also ensuring that educational content is evidence based, vendor-neutral where possible, and separated from promotion.

Streamlined onboarding: Addressing the known hurdles, namely induction and IT access, via a single regional onboarding pack and named administrative contacts at each hub.

Conclusion

Integrating the private sector in orthopaedic training is no longer just speculative. The principles are endorsed nationally, the feasibility has been demonstrated, and high-volume independent settings could deliver safe, efficient training with appropriate supervision. Pairing accredited placements with industry-enabled simulation gives trainees more repetitions, earlier familiarity with new technologies, and protected routes to competency. The task now is execution: formalising partnerships, fixing administrative friction, and measuring quality. If stakeholders act together, the independent sector will not dilute training, but rather expand it, producing consultants who are skilful, innovation-ready, and prepared to meet the population’s needs.

References
  1. British Orthopaedic Trainee Association. BOTA Top 5 Priorities for Trainees. 2024. Available at: www.bota.org.uk/botastop5priorities.
  2. NHS England. Medical Specialty Recruitment Competition Ratios 2024. Available at: https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/competition-ratios. [Accessed 23rd August 2025].
  3. Independent Healthcare Providers Network. In Train A review of training in the independent healthcare sector. 2024. Available at: www.ihpn.org.uk/wp-content/uploads/2024/01/IHPN-Report-In-Train.pdf. [Accessed 21st August 2025].
  4. Independent Healthcare Providers Network. Doctors in Training in the Independent Sector. 2022. Available at: www.ihpn.org.uk/wp-content/uploads/2022/03/IHPN-DiT-report-March-22.pdf. [Accessed 21st August 2025].
  5. NHS England. NHS Long Term Workforce Plan. 2023. Available at: www.england.nhs.uk/long-read/nhs-long-term-workforce-plan-2. [Accessed 21st August 2025].
  6. Health Education England. Guidance for Placement of Doctors in Training in the Independent sector (also known as Postgraduate medical trainees). 2021. Available at: www.hee.nhs.uk/sites/default/files/documents/Guidance%20for%20placement%20of%20doctors%20in%20training%20in%20the%20independent%20sector.pdf. [Accessed 23rd August 2025].
  7. British Orthopaedic Association. BOA welcomes JCST document on ‘Training in the Private Sector’. 2018. Available at: www.boa.ac.uk/resource/boa-welcomes-jcst-document-on-training-in-the-private-sector.html. [Accessed 21st August 2025].
  8. Joint Committee on Surgical Training. Training in the Private Sector JCST Guidance on Training Implications and Principles to Consider. 2018. Available at: www.jcst.org/-/media/Files/JCST/Key-Documents/JCST-Principles-for-Training-in-the-Private-Sector_Nov2018.pdf. [Accessed 21st August 2025].
  9. Lenihan J, Ngu AWT, ORCA Collaborative. Access and feasibility of orthopaedic training in the independent sector - A Deanery’s experience. Surgeon. 2022;20(5):291-6.
  10. Chen Y, Crothers O, Ting DSJ, Severn P, Mansoor Q. Outcomes of cataract surgery training among ophthalmology trainees in the independent sector and within the NHS. BMJ Open Ophthalmology. 2025;10(1):e001716.
  11. Department of Health & Social Care. Elective recovery taskforce: implementation plan. 2023. Available at: www.gov.uk/government/publications/elective-recovery-taskforce-implementation-plan/elective-recovery-taskforce-implementation-plan. [Accessed 22nd August 2025].
  12. Smith+Nephew. Smith+Nephew Academy expands global access to professional medical education through virtual reality and other advanced simulation technologies. 2022. Available at: www.smith-nephew.com/en/news/2022/09/21/20220921-sn-academy-expands-global-access-to-professional-medical-education-through-virtual-reality#:~:text=Healthcare%20professionals%20can%20now%20conveniently,of%20excellence%20around%20the%20world. [Accessed 21st August 2025].
  13. Kuhn AW, Yu JK, Gerull KM, Silverman RM, Aleem AW. Virtual Reality and Surgical Simulation Training for Orthopaedic Surgery Residents: A Qualitative Assessment of Trainee Perspectives. JB JS Open Access. 2024;9(1):e23.00142.
  14. Bartlett JD, Lawrence JE, Stewart ME, Nakano N, Khanduja V. Does virtual reality simulation have a role in training trauma and orthopaedic surgeons? Bone Joint J. 2018;100-B(5):559-65.
  15. American College of Surgeons. Revised Statement on Healthcare Industry Representatives in the Operating Room. 2016. Available at: www.facs.org/about-acs/statements/health-care-industry-representatives-in-the-operating-room. [Accessed 22nd August 2025].
  16. Bedard J. What Should Patients Be Told About Device Representatives' Roles at the Point of Surgical Care? AMA J Ethics. 2021;23(9):E692-6.
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