The Thames Valley Quality Team has a responsibility for ensuring that clinical learning environments meet quality standards for education and training set by NHS England and the GMC. This process is managed under the Quality Strategy and Framework and is informed by the risk register. The risk register is multi-professional, but most of the risks are medical due to arrangements between Local Education Providers and the universities for managing quality concerns in non-medical education. Risks are graded using the Intensive Support Framework.
Over the past training year (August 2024 to July 2025) 31 risks were managed on the risk register. Three of these were of a significant concern and were therefore reported to national and regional teams within NHSE-WTE and to the GMC. These were:
- Ophthalmology at Oxford University Hospitals NHS Foundation Trust – closed April 2025 from the significant concerns register. It was fully removed from the Thames Valley risk register in December 2025. See further detail below.
- Cardiology at Buckinghamshire Healthcare NHS Trust – was removed from the significant concerns register in July 2025 – see further detail below.
- Histopathology at Royal Berkshire Hospital was removed from the significant concerns register in March 2025 but remains open on the Thames Valley risk register – see further detail below.
As a result of actions taken to resolve concerns, 21 risks were closed. At the time of writing, 27 risks remained open on the Thames Valley risk register which include 15 new risks arising from the NTS 2025 and two new risks arising from the annual quality review meetings with the School of Histopathology and Oxford Foundation School.
The list below comprises a selection of the main training issues that arose from previous GMC surveys or via other governance routes and a summary of how these were addressed.
Buckinghamshire Healthcare NHS Trust
| Learning Environment | Source of concern | Summary of concern | Action taken/outcome |
| Paediatrics | NTS 2022-2024 | Multiple red outliers and pink flags in three consecutive surveys including workload, teamwork, handover, induction, educational supervision, local teaching and rota design. The Trust provided a comprehensive action plan following each survey detailing its plans to improve the training environment. This was monitored on the TV risk register. | Following an update from the Trust and positive feedback the risk was closed in April 2025. At the quality review with the School of Paediatrics we heard from resident doctors on how they had supported a collaborative approach to improve the training experience. An academic half-day was attended by residents and consultants to generate ideas and included a wellbeing session facilitated by a psychologist. The event resulted in a seven-point plan which included the introduction of a bespoke rota – enabling better access to leave, an increase in workforce numbers – improving access to training opportunities and teaching sessions and several cultural initiatives to foster teamwork and cohesiveness. The NTS 2025 results showed a marked improvement with no red or pink flags. All indicators were within the Inter Quartile Range (IQR). |
| Cardiology | NTS 2023 & 2024, School of Medicine | Multiple red outliers in GMC survey 2023 and 2024 across most indicators. An Urgent Risk Review took place at the Trust in July 2024. A new education lead had been appointed and improvements to education and training had begun. Workforce numbers increased and new Consultant appointments were made. Immediate Mandatory Requirements for supervision and support were met by the Trust satisfactorily and there was positive feedback from resident doctors supporting this. Further mandatory requirements were set for increasing education and training time by improving the rota/staffing, raising concerns, incivility and handover. The Trust successfully addressed the majority of these training concerns. | This was reported on in last year’s report. It remains on the TV risk register but was removed from the significant concerns register in July 2025 following significant improvement to many aspects of education and training. The NTS 2025 also reflected improvement with most red outliers changing to pink flags. The remaining concern – ensuring that the rota design allows resident doctors to access sufficient procedural skills training and to meet specific curriculum requirements – is being monitored by the School of Medicine. A fresh round of resident doctor feedback is expected in early 2026. |
Frimley Health NHS Foundation Trust
| Learning environment | Source of concern | Summary of concern | Action taken/outcome |
| Obstetrics and Gynaecology | NTS 2024 | Five red outliers for supportive environment, rota design, teamwork, reporting systems and handover. Pink flags for educational governance and adequate experience. After analysing the outliers, the main concern appeared to be rota impact on education and training and some concerns regarding incivility and adequate experience. Since O&G had been a previous significant risk for rota issues and supportive environment, the Trust were asked to respond to the outliers. | The Trust rapidly responded to the concerns. The rota was re-written for the August 2024 intake which reduced the number of on call shifts increasing educational opportunities. It also removed the ‘twilight’ shift easing the burden on trainees. Staffing also increased reducing rota gaps. Trainee oversight of the rota was reinstated, and feedback has been positive since this change was made. The concerns relating to incivility were dealt with promptly and professionally and the Trust’s Local Faculty Group did not identify any further concerns. The NTS 2025 showed much improvement with one single pink flag for clinical supervision out of hours. The risk was closed April 2025. |
| Medicine – AIM, IMT, GIM, Gastroenterology | NTS 2024 & 2025 | Red outliers across multiple medical specialties. Main concerns were workload, rota and supervision | This remains on the TV risk register for monitoring. The Trust has instigated a significant piece of work to address the rota issues which were known to the Trust through its Local Faculty Groups. This included a rota redesign with increased staffing, improved rota communication and out of hours cover and improved access to teaching sessions. Induction is also being reviewed to improve guidance around obtaining consent. |
Oxford Health NHS Foundation Trust
| Learning environment | Source of concern | Summary of concern | Action taken/outcome |
| Child and Adolescent Psychiatry – Warneford Hospital | NTS 2023 | Multiple red outliers but following analysis main concerns were educational governance – not aware how to raise or escalate a concern and lack of confidence they would be dealt with difficulties arranging study leave supportive environment – some negative responses for treated fairly and incivility. | Meetings occurred between the TPD and resident doctors in which clarification was given around raising concerns. Further meetings were held between the Head of School, TPD and DME and further concerns were raised relating to a lack of networking opportunities and teaching, and a lack of trust and confidence in systems for raising concerns. There were also allegations of discrimination against protected characteristics. A joint action plan between consultants and resident doctors was produced and improvements were noted in the annual quality review meeting with the Trust in March 2025, along with assurances that formal Trust procedures were followed in relation to discrimination allegations. The risk was closed in November 2025. |
Oxford University Hospitals NHS Foundation Trust
| Learning environment | Source of concern | Summary of concern | Action taken/outcome |
| GP training in Obstetrics and Gynaecology | GP School – March 2024 | GP School managing concerns about workload, lack of training opportunities and incivility. 7 red outliers and 6 pink flags appeared in the 2024 NTS. | The School’s concerns were added to the risk register for monitoring. The School worked with clinical leads and the Deputy DME to address issues. The Trust developed an action plan which included: additional support and a video induction on the postnatal ward improved communication of rota changes. additional teaching sessions on common obstetric and urgent presentations and signposting of training opportunities prioritisation of training days for GPVTS education & training forum was introduced and escalation pathway highlighted for raising cultural concerns. Following improved feedback, the risk was closed in March 2025. |
| Ophthalmology | School of Ophthalmology – July 2021 | The School raised concerns that resident doctors may not be able to fulfil curriculum requirements for cataract surgery due to a change in the way the Trust managed new referrals, limited theatre time for Ophthalmology and competition between trainees and departmental fellows for training lists. To increase numbers, resident doctors were on occasions attending weekend lists. | Levels of cataract surgery numbers have been closely monitored by the School and Trust. In 2023 a private provider was introduced and offered some limited access to cataract training lists. This improved in time with more reliable and consistent access. A second private provider was able to offer an additional dedicated training list from August 2025 and it is hoped this will increase to two lists by August 2026. An audit of cataract numbers was undertaken by the Trust and this showed improvement in the achievement of case numbers within work schedules. The risk has been closed but the School and Trust will continue to monitor the situation. |
Milton Keynes University Hospital NHS Foundation Trust
| Learning environment | Source of concern | Summary of concern | Action taken/outcome |
| Foundation training in Surgery | NTS 2023 & 2024 | Multiple red outliers for Foundation Year 1 and Year 2 across Surgery. Main concerns were incivility, workload, rota, supervision, teaching and induction. | Reports of incivility had been made outside of the NTS process and the Trust responded promptly and appropriately to these concerns, providing regular feedback to resident doctors. Among the actions taken by the Trust to address the remaining concerns were: an increase in the number of Foundation TPDs a training session for named Educational and Clinical Supervisors the appointment of a new surgical tutor. an improved induction at each foundation rotation a new rota reducing the number of day and night time on calls increased teaching, journal club and simulation workshops. NTS 2025 results improved for both foundation years but Foundation Year 2 – Surgery had moved from 10 red outliers in 2024 to no outliers in 2025. The risk was closed in April 2025. |
| General Surgery | NTS 2024 / School of Surgery | A small number of red outliers and pink flags arose in the NTS 2024 with local teaching the main area of concern. Subsequently, further concerns were raised during the annual quality review meeting with the School of Surgery relating to rota gaps, a lack of theatre time and endoscopy training and rudeness and incivility. It was heard that, since the publication of the NTS results, the Trust had made progress in addressing the teaching provision and there were plans to improve induction with the support of a newly appointed surgical tutor. | The Trust continued to make progress towards improving the training experience for resident doctors. At the Education Quality Committee meeting in May 2025, it was heard that many aspects of education and training had improved such as handover, an improved teaching programme, and better access to theatres. There was a plan to provide endoscopy training to those with an interest. Persisting incivility remained a concern and the Trust were asked to respond to this. Subsequent assurances were received and resident doctors were made aware of routes for raising and escalating concerns. This outstanding issue remains an open risk register item and a follow-up event is planned for February/March 2026. |
Royal Berkshire NHS Foundation Trust
| Learning environment | Source of concern | Summary of concern | Action taken/outcome |
| Gastroenterology | NTS 2024 | Six red outliers for overall satisfaction, clinical supervision, feedback, facilities, supportive environment and educational governance. Four pink flags for induction, adequate experience, educational supervision and study leave. | Multiple factors were impacting the education and training experience for resident doctors. At the time of the survey the department had several workforce gaps and increased workload and there were changes to the administrative team which had disrupted operational management and access to training opportunities. Following the NTS results, the department set up formal educational governance meetings to hear the trainee voice and address issues. Through these meetings improvements were made to training and there was positive feedback regarding approachability of senior staff and good clinical supervision. Registrars were accessing directly supervised clinics and there was protected teaching time and good access to endoscopy lists. The NTS 2025 results were much improved with three green positive outliers for higher training: local teaching, regional teaching and rota design. The risk was closed in April 2025. |
| Histopathology | NTS 2024 / School of Histopathology | Concerns were raised during the annual quality review with the School of Histopathology. These were: 1. A lack of technical assistance during lab work 2. Access to post mortem training to meet curriculum requirements 3. Clinical and educational supervision time 4. Incivility 5. Lack of educational resources | The Trust had made significant and rapid progress to address the training concerns: A lab assistant was temporarily provided to ensure safety in the lab. The Trust later confirmed that it had employed a permanent Medical Laboratory Assistant with plans to employ a further MLA to provide cover. Educational resources were promptly supplied. A newly appointed education lead was in post. Consultants were allocated time in their job plans for the educational supervisor role. Actions to address incivility were initiated and are ongoing. Post mortem training remains vulnerable due to a lack of consultants skilled in PM training. While the Trust has been able to mitigate this to date, it is being closely monitored until a sustainable solution can be found. This is a live risk register item and is due for formal review at the January 2026 Education Quality Committee. |