Medical training
The system for approving and accrediting training placement providers and programmes should be configured to apply the principles set out above.
- The GMC's quality assurance framework includes a structured process for approving and monitoring training programme providers and local education providers. Approval is based on evidence of compliance with standards, including evidence from the National Training Survey, quality assurance visits, and data on patient safety outcomes. Where providers fail to meet standards, the GMC can impose conditions on approval or withdraw approval (GMC quality assurance of medical education and training).
- The Health and Care Act 2022 transferred HEE's functions to NHS England from 1 April 2023. The postgraduate deans, who manage the approval and monitoring of training placements at regional level, now operate within NHS England's Workforce, Training and Education directorate, enabling closer integration of training quality assurance with NHS England's broader quality oversight functions (Health and Care Act 2022, s.96).
- The government's response in "Hard Truths" confirmed that the system for approving training placements should prioritise patient safety and that the GMC's quality assurance framework would be strengthened accordingly (Hard Truths, DHSC, November 2013).
How was this evidence gathered?
Response
Accepted
Response
AcceptedThe government published "Hard Truths: the Journey to Putting Patients First" (Cm 8777) on 19 November 2013, responding to all 290 recommendations of the Francis Report. This followed an initial response "Patients First and Foremost" in March 2013. Key reforms included a new Chief Inspector of Hospitals, strengthened Care Quality Commission inspection regime, a statutory duty of candour, and the fit and proper person test for NHS directors. Volume 2 (Cm 8754) contains the government's detailed responses to each of the 290 recommendations. See: https://assets.publishing.service.gov.uk/media/5a7cd486ed915d63cc65d167/34658_Cm_8777_Vol_1_accessible.pdf
Published Evidence
Published assessments of progress from inspectorates, select committees, official progress reports, and other sources. Source type badge indicates whether each assessment is independent or government self-reported.
Research published 2023 marking ten years since the Francis Report found mixed results. Structural and legislative changes largely delivered (duty of candour, FPPR, CQC overhaul, revalidation, Freedom to Speak Up Guardians). However, cultural change not fully embedded; understaffing, fear of speaking up, and poor complaint handling persist in parts of the NHS.
Government published "Culture Change in the NHS" (Cm 9009) reporting progress on all 290 recommendations. Key achievements: 19 hospitals placed in special measures; those trusts recruited 109 additional doctors and 1,805 additional nurses; 129 board-level changes made; excess avoidable deaths fell by 450 in less than a year.
Government published "Hard Truths: The Journey to Putting Patients First" (Cm 8777) in two volumes. Vol 1 set out new actions; Vol 2 provided detailed response to each of the 290 recommendations. Approximately 204 of 290 recommendations were fully accepted.
GMC medical revalidation launched December 2012. All licensed doctors must demonstrate fitness to practise every five years through appraisal and evidence. Francis Report endorsed and recommended strengthening revalidation.