This section summarises the most significant events in NHS policy and medical politics. The aim is to help you catch up quickly with major changes before interviews or exams rather than having to piece together news from multiple sources. Entries are kept factual and relatively brief — follow the linked official documents for full detail.
NHS England to be Abolished
In March 2025, Health Secretary Wes Streeting announced that NHS England — the arm's-length body responsible for commissioning NHS services since its creation under the Health and Social Care Act 2012 — would be abolished and its functions merged back into the Department of Health and Social Care (DHSC). The announcement follows years of debate about the duplication, confusion, and lack of democratic accountability created by having two parallel organisations (NHS England and DHSC) both responsible for the NHS.
The move is estimated to save approximately £500 million per year in management and running costs. NHS England's chief executive Amanda Pritchard resigned shortly before the announcement. The transition is expected to take around two years, during which time commissioning, workforce planning and performance management functions will be progressively transferred to DHSC.
For junior doctors, this represents one of the most significant structural changes since the creation of NHS England in 2013. It may affect how training programmes are commissioned and managed, as Health Education England (which was itself absorbed into NHS England in 2023 after a previous restructure) will also fall under DHSC control.
Junior Doctors Pay Dispute Settled — After 11 Months of Strike Action
In March 2024, the BMA and the government reached an agreement to settle the junior doctors' pay dispute, ending the longest sustained industrial action in NHS history. Junior doctors had taken over 100 days of strike action since March 2023, the culmination of years of dispute over the erosion of pay following the 2016 contract imposition. The BMA had been calling for a 35% pay restoration, arguing that real-terms pay had fallen by over a third since 2008.
The settlement included a 22% pay rise spread across 2023–24 and 2024–25, plus a one-off consolidation payment. The BMA acknowledged this did not represent full pay restoration but described it as a significant step, particularly given the political context. The dispute had caused an estimated 1.5 million appointment cancellations across England.
The dispute arose in part from the 2016 contract imposition under then-Health Secretary Jeremy Hunt, which changed the definition of "unsocial hours" and significantly altered pay and working conditions. Understanding this background is important for ST3 interview discussions about NHS workforce and training issues.
Consultant Strike Action — First Time in 35 Years
In September 2023, NHS consultants undertook strike action for the first time in 35 years, following a BMA ballot in which 86% voted for industrial action. The dispute centred on pay, with consultants arguing their real-terms pay had fallen by 35% since 2008. The BMA sought a significant pay restoration, while the government initially offered a 4.95% pay rise, later enhanced with a one-off payment as part of a broader NHS pay review.
Several rounds of consultant strike action took place between July and September 2023, overlapping with ongoing junior doctors' strikes. At one point, both groups were striking simultaneously — an unprecedented situation that led to tens of thousands of cancellations per week. The impact on waiting list recovery was described by NHS England as "significant".
The consultant dispute was eventually resolved in September 2023 with a revised offer including a 6% consolidated pay rise plus a one-off £1,500 payment. The settlement was accepted by BMA consultants in a referendum, though some felt the restoration was insufficient.
The Health and Care Act 2022 — Integrated Care Systems Become Statutory
The Health and Care Act 2022 represented the most significant restructuring of the NHS since the Health and Social Care Act 2012. Its centrepiece was the creation of 42 statutory Integrated Care Systems (ICSs) covering England, each comprising an Integrated Care Board (ICB) and an Integrated Care Partnership (ICP). ICBs replaced Clinical Commissioning Groups (CCGs), which were abolished on 1 July 2022.
NHS England and NHS Improvement were formally merged into a single organisation. The Act also facilitated greater collaboration between NHS trusts, local authorities, and the voluntary sector, reducing the emphasis on competition that had defined the previous legislative framework. Provider collaboratives — groups of NHS trusts working together on shared services — were formalised as a key part of the new structure.
For junior doctors, ICBs are now the bodies responsible for commissioning many NHS services and, through NHS England's delegated functions, overseeing aspects of workforce planning. Understanding ICSs is important for interview questions about how the NHS is organised and how decisions about healthcare delivery are made.
COVID-19 Emergency Response — The NHS in a Pandemic
In March 2020, the WHO declared COVID-19 a pandemic. The NHS response was unprecedented in peacetime: all non-urgent elective care was suspended, critical care capacity was nearly tripled across England, and tens of thousands of doctors were redeployed into intensive care, acute medicine, and COVID wards. The Coronavirus Act 2020 provided emergency powers to temporarily expand the medical workforce, including enabling recently retired doctors to return to the register and relaxing some training requirements.
For junior doctors, the pandemic had a profound impact on training. The GMC introduced an emergency ARCP (Annual Review of Competence Progression) framework, pausing normal progression requirements and awarding certificate of satisfactory completion on a pass/incomplete basis rather than the usual detailed competency sign-off. Some specialty examinations were suspended, postponed or moved online. Many trainees found their clinical experience significantly altered, with less exposure to elective work and more acute medicine.
The pandemic also accelerated the adoption of telemedicine and remote consultations across all specialties, including ENT — a change that has persisted to varying degrees post-pandemic. The personal protective equipment (PPE) crisis in early 2020, which left many NHS workers inadequately protected, was a subject of a subsequent public inquiry.
The NHS Long Term Plan
The NHS Long Term Plan, published in January 2019, set out a 10-year strategy for the NHS backed by a funding commitment of £20.5 billion per year in additional real-terms funding by 2023–24. The plan was developed by NHS England and drew on extensive stakeholder consultation.
Key commitments included: reducing premature mortality from the five major conditions (cancer, cardiovascular, respiratory, mental health, and dementia); introducing Integrated Care Systems as the primary delivery model; expanding primary care networks; investing in mental health services to achieve parity of esteem with physical health; and improving the retention and recruitment of NHS staff.
The plan placed workforce planning as a central concern, acknowledging significant shortfalls in nursing, general practice, and many hospital specialties. For ENT specifically, the plan included targets for cancer diagnosis (60% of cancers diagnosed at stage 1 or 2 by 2028) which translated into more urgent two-week-wait referrals for suspected head and neck malignancy.
Junior Doctors Contract Dispute and the First Strikes in 40 Years
The dispute over the junior doctors contract under Health Secretary Jeremy Hunt was one of the most significant events in recent medical politics. The government sought to introduce a new contract that would change the definition of "plain time" hours — the hours during which standard pay applies — extending these to cover 7am–10pm on weekdays and Saturdays. The BMA argued this would mean working more "unsocial" hours for the same or less pay, and that the claimed cost-neutrality of the contract was illusory.
After negotiations broke down, the BMA balloted members and junior doctors voted overwhelmingly for strike action. Three rounds of industrial action took place in 2016 — the first junior doctor strikes in 40 years. After the third strike, the government announced it would impose the new contract rather than continue negotiating. The contract was imposed in August 2016, creating significant anger and demoralisation within the junior doctor workforce, with a notable increase in applications to work abroad in the months that followed.
The 2016 contract, while controversial, introduced some positive changes including a strengthened system of exception reporting (where doctors could report being asked to work beyond their contracted hours or in unsafe conditions) and enhanced safeguards around hours monitoring.
The Francis Report — Mid Staffordshire NHS Foundation Trust Public Inquiry
The Francis Report, published in February 2013, was the final report of a public inquiry chaired by Robert Francis QC into the serious failings of care at Mid Staffordshire NHS Foundation Trust between 2005 and 2009. The inquiry found that up to 1,200 patients may have died needlessly as a result of poor care, inadequate staffing, and a toxic institutional culture in which financial targets took precedence over patient safety.
The report made 290 recommendations, covering cultural reform across the NHS, the role of regulators, openness and transparency, and the need for a fundamental shift in values. Its most significant lasting impacts include: the introduction of the Statutory Duty of Candour (requiring healthcare organisations and registered professionals to be open with patients when things go wrong); the introduction of the Fit and Proper Person Tests for directors; strengthened CQC inspection frameworks; and Ofsted-style ratings for NHS trusts.
For junior doctors, the Francis Report is essential knowledge for interview questions about patient safety, whistleblowing, and healthcare regulation. The concept of "the duty of candour" — being open and honest with patients when care has fallen below the expected standard — is now a fundamental professional and legal obligation under GMC Good Medical Practice.
The Shape of Training Review (Greenaway Report)
The Shape of Training review, chaired by Professor Sir David Greenaway, was commissioned in 2012 and published its final report in October 2013. Its central recommendation was that postgraduate medical training should move to broader-based training programmes before specialisation, reversing the trend towards early subspecialty focus that had accelerated under MMC.
The review recommended the creation of "broad-based" training pathways, a more flexible Certificate of Completion of Training (CCT) with credentials for subspecialty competencies, and greater emphasis on producing generalist doctors capable of working across a wider range of settings. It also recommended a significant expansion of general internal medicine training and highlighted the need for more doctors to be trained with the skills to work in both secondary care and the community.
The impact on surgical training was substantial. Core Surgical Training (CST) was restructured, and Internal Medicine Training (IMT) replaced Core Medical Training (CMT) and the Acute Care Common Stem (ACCS) from August 2022. For ENT, the progression from Foundation to Core Surgical Training to ST3 ENT remained broadly intact, though the breadth of experience expected during CST was widened.
PMETB Merged with the GMC
On 1 April 2010, the Postgraduate Medical Education and Training Board (PMETB) was formally merged into the General Medical Council (GMC), as recommended by the Tooke Report (see below). PMETB had been established in 2003 to take over responsibility for postgraduate medical education and training from the Royal Colleges and deaneries, but had been criticised for creating a confusing dual regulatory structure with the GMC.
Following the merger, the GMC took responsibility for setting and approving standards for all stages of medical education and training — undergraduate, foundation, core, and specialty training — as well as maintaining the medical register and overseeing fitness to practise. The Royal Colleges retained their roles in setting curriculum standards and conducting specialty examinations, but the ultimate regulatory oversight now sits with the GMC.
This change has had significant practical consequences. Deaneries (now Local Education and Training Boards, or LETBs, which themselves became part of Health Education England in 2013 and subsequently NHS England in 2023) now work closely with the GMC on the annual ARCP process, which is the primary mechanism for assessing trainee progression in UK postgraduate training.
The Tooke Report
This is an independent inquiry into Modernising Medical Careers (MMC) and the Medical Training Application Service (MTAS), conducted by Professor Sir John Tooke. The final report was published on 8 January 2008 and is available to read in full via the MMC inquiry website.
Summary
The report noted that the key principles in the Unfinished Business report by Chief Medical Officer Sir Liam Donaldson (2002) — namely flexibility and "broad-based beginnings" — had been lost. Under MMC, doctors had been forced to specialise too quickly, and training should return to a more flexible and broad-based foundation model.
"Trainees increasingly supernumerary in the NHS" — Tooke recommended that a body should be established to coordinate the education needs of trainees and ensure clarity about the roles of doctors in training. Proper workforce planning was essential, and any changes to the system should take into account the number of doctors already in the training pipeline, with transitions managed over several years.
"The split between the two bodies, GMC and PMETB, creates diseconomies (both financial and in terms of expertise)." Tooke suggested that PMETB should be merged within the GMC, offering:
- Economy of scale
- A common approach to quality standards
- Linkage of accreditation with registration
- Sharing of quality enhancement expertise
- Reporting direct to Parliament rather than through a monopoly employer
With the onset of MTAS and MMC, there was considerable disarray within the medical profession — no clear unified message emerged from the professional bodies, and various colleges and departments had their own divergent opinions. "The profession should develop a mechanism for providing coherent advice on matters affecting the entire profession."
"From this damaging episode for British Medicine must come a recommitment to optimal standards of postgraduate medical education and training. This will require a new partnership between the Department of Health and the profession, and between health and education. An aspiration to excellence must prevail in the interests of patients."
The Lord Darzi Report — High Quality Care For All
High Quality Care For All: NHS Next Stage Review Final Report was published on 30 June 2008. It was the culmination of a year-long review of the NHS, led by Lord Ara Darzi — a practising surgeon and Health Minister. The report is available from the Department of Health website.
Summary
"Create an NHS that helps people to stay healthy. For the NHS to be sustainable in the 21st century it needs to focus on improving health as well as treating sickness." This public health emphasis was a central theme throughout the report.
"Every primary care trust will commission comprehensive wellbeing and prevention services, in partnership with local authorities, with services personalised to the specific needs of their local populations. Efforts must be focused on six key goals: tackling obesity, reducing alcohol harm, treating drug addiction, reducing smoking rates, improving sexual health, and improving mental health. Raised awareness of vascular risk assessment through a new 'Reduce Your Risk' campaign."
Patient choice was highlighted as a fundamental right: "Introduce a new right to choice in the first NHS Constitution. The draft NHS Constitution includes rights to choose both treatment and providers, and to information on quality, so that — wherever it is relevant to them — patients are able to make informed choices."
Clinical governance was strengthened significantly: "The Care Quality Commission will have new enforcement powers. NICE will be expanded to set and approve more independent quality standards. A new National Quality Board will offer transparent advice to Ministers on clinical standard-setting priorities. For the first time, we will systematically measure and publish information about the quality of care from the frontline up. Measures will include patients' own views on the success of their treatment, the quality of their experiences, safety, and clinical outcomes. All registered healthcare providers working for, or on behalf of, the NHS will be required by law to publish Quality Accounts — just as they publish financial accounts."