The Medical Training Review: Phase 1 report – Initial response statement from BOTA / BOA / SAC

The British Orthopaedic Trainees Association (BOTA), British Orthopaedic Association (BOA) and Trauma & Orthopaedic Specialty Advisory Committee (SAC) welcome the publication of the Medical Training Review (MTR) Phase 1 Diagnostic Report, published by NHS England on 24th of October 2025. This is the culmination of a listening exercise and call for evidence that BOTA was involved in from the start, and to which BOTA, BOA and the SAC have all separately and collaboratively contributed to in the interests of T&O trainees and patients.

Much work to address many of the issues highlighted is already underway within the BOA, BOTA and the SAC, and we are particularly keen to develop solutions in collaboration with the other key stakeholders to address the following specific recommendations from the Report:

2: Bottlenecks should be considered urgently – Despite the presence of a healthy pool of early-years’ residents keen to pursue a career in T&O, many feel they are currently unable to progress. It is vital that the recruitment system enables timely flow from Foundation-level to Core and Core into higher specialty posts in a way that prevents inequality and loss overseas of the most able. Bottlenecks should be removed urgently.

3: Training should be more flexible – T&O aims to be an inclusive and welcoming specialty to all, and career flexibility is essential to ensuring that anyone with such needs can be supported to do so. Whilst a flexible pathway is important, T&O is unique from other surgical specialities and this flexibility should not mean ‘early years’ lost in service.

5: Review of rotational training – Learning from a variety of trainers and institutions is highly valued for developing well-rounded and experienced surgeons. This has to be balanced against the cost of trainee commutes, wellbeing and welfare. Implementation of the 10-point plan will begin to address some of the challenges faced by trainees.

7: Support for trainers and transparency over funding – There are many excellent trainers in our specialty, and their commitment to this aspect of their work should be celebrated and supported with the time and resources to ensure training remains of the highest quality. Funding for hospital training is hard to trace and is not currently accompanied by any accountability from the Trust for providing appropriate training opportunities or releasing trainers for important educational activities in return.

8: Craft trainees to have time for, and access to, training opportunities, including in the independent sector – A better balance between service and training must be found for trainees to allow them to develop essential skills at the time in their careers where this is most beneficial – no trainees should be ‘struggling for numbers’. Access to planned essential care (elective) orthopaedic surgery is an essential requirement of the curriculum and producing an employable consultant in the NHS. Access to these training opportunities must be prioritised wherever that activity is undertaken. Much of this activity has moved to the independent sector. Unlocking the access to this work been a priority over the last 12 months for BOTA and BOA, and will continue to be so in light of these recommendations.

We acknowledge that this Phase 1 Diagnostic Report is just the start of the process, and as a high-level, pan-specialty document there remains much detail to be developed. In preparation for this next phase, BOTA will be gathering views from its members in the upcoming 2025 BOTA Census, and progress will continue on current workstreams already dedicated to these areas highlighted above.

BOTA, the BOA and SAC will continue to  work with the Royal Colleges and NHS England (including successor bodies that will address education, training and workforce) to ensure that our medical education and training system improves the experience for resident doctors, outcomes for current and future patients, and the health of the wider population.

Further details on the Medical Training Review: Phase 1 report here.