‘Why the move away from hands-on clinical training may be damaging’

Dr Cheska Ball on the harm that the move towards ‘blended learning’ could cause general practice

General practice is facing concurrent crises: soaring demand, rising complexity in patients, and a worsening workforce landscape with unemployment on the rise. Into this pressure cooker, NHS England has introduced a bold and controversial idea: blended learning for GP registrars, which sees them spending only a third of their time in clinical practice and two-thirds in education, often online. .

On paper, blended learning is a modern and flexible training model. In initial pilot schemes, these posts targeted small groups of registrars who might genuinely benefit such as international medical graduates (IMGs) needing additional support or those with caring responsibilities. 

Now, NHS England is rapidly rolling out blended learning nationwide without any robust, long-term evaluation, with plans for all registrars to undertake such placements. This has sparked alarm from the BMA and LMCs across England about its impact on training and beyond. At this month’s LMC England conference, delegates overwhelmingly agreed that blended learning poses a serious risk to training standards and the professional standing of GPs. 

And it is not just LMCs that have concerns – registrars and educators have been vocal in their opposition. The BMA’s GP Registrars Committee (GPRC) has called for an urgent pause until there is credible evidence that supports the model. They are far from alone in that demand, yet it seems their pleas have gone unheard by NHS England.

The advantages

This is not to say there are no benefits. The pilot scheme has found improvements in training, including:

Improved AKT exam performance

Early reports suggest better AKT outcomes, with flexible, re-playable online modules supporting knowledge-heavy revision.

Greater flexibility

Asynchronous learning can help registrars with caring duties, health issues, or long commutes study at their own pace – potentially reducing burnout.

Addressing space shortages

With GP training places due to rise by 50% by 2031, practices already at capacity may struggle to accommodate more registrars. Blended learning could ease that burden.

Support for IMGs

Some IMGs have reported that the structured online content delivered by blended learning improves their understanding of UK general practice and boosts confidence.

The disadvantages

But the disadvantages seem to far outweigh these benefits and they are numerous.

Less patient contact leads to less clinical readiness

Firstly, general practice is not just academic. It’s about communication, managing uncertainty, and detecting what patients don’t say – there’s a huge difference between theory and practice. Cutting patient contact to 37% (from the current 70%)  threatens the development of these skills. 

Crucially, there’s no evidence that blended learning improves performance in the Simulated Consultation Assessment (SCA) – the exam that tests real-life consulting ability. As GPRC Chair Dr Oliver Salazar has put it: ‘We wouldn’t expect surgeons to learn to operate online. Why is general practice treated differently?’

Threat to GPs’ professional status 

GPs already battle the perception that their training is ‘easier’ due to shorter duration and a better work-life balance. A model that heavily shifts our training online risks reinforcing that stereotype, undermining the rigour of GP training and damaging public trust. It may also jeopardise international recognition of UK GP training as clinical hours decline.

A two-tier training system 

If blended learning expands, registrars could be divided into:

• Those with traditional, high-contact clinical experience;
• Those with predominantly online learning.

This could create inequity post-CCT, with employers favouring those who have had fuller, in-person exposure. 

Minimal evidence, maximum rollout 

The blended learning pilots so far have been small and short-term, involving limited groups. Despite this, NHS England has scheduled blended placements from August 2025, before any meaningful evaluation of SCA outcomes or real-world readiness. Both GPRC and GPC England have warned that even though blended learning may benefit some registrars, ‘there should be no presumption that it is suitable for all.’

Hidden inequities 

Not all registrars have quiet study spaces, strong Wi-Fi, or supportive home environments. Blended learning risks deepening digital and social inequalities.

The bigger picture

This debate is about more than online modules. It’s about what kind of doctors we want our future GPs to be. General practice depends on clinicians who can connect, communicate, and decide safely under pressure. These skills are developed through seeing hundreds of patients; not watching hundreds of slides.

GPCE and LMCs across England have warned that at a time when general practice is already under unprecedented strain, if rolled out indiscriminately, blended learning could dilute training standards, devalue the specialty and produce less prepared GPs. This is a risk the NHS cannot afford.

When the profession speaks this loudly and this collectively, it begs the question, is something clearly wrong?

I do believe that blended learning has value – when used selectively and supported by evidence. It may help certain registrars who need flexibility or structured academic time. But making it the default without data is not innovation – it is reckless experimentation. And it is patients who will ultimately pay the price.

General practice deserves modernisation, yes, but not at the cost of training quality, professional integrity, or public trust.

The profession’s message is clear: innovate, but don’t dilute. Modernise, but don’t compromise.

Dr Cheska Ball is a salaried GP