NHS England Workforce Education and Training carry out education quality reviews to assess how effectively organisations deliver safe, high-quality, and sustainable education and training, and to identify where additional support or oversight may be required. It uses intervention activity to triangulate evidence from multiple sources – including performance data, quality indicators including survey data, regulatory intelligence, and local insight – ensuring decisions are fair, proportionate, and based on a comprehensive understanding of risk.
This education quality intervention report sets out NHS England’s assessment of the issues affecting the organisation at the time of review, and should be considered alongside ongoing performance information, the provider response, and progress made since the assessment. It explains why NHS England has taken formal action, what risks have been identified, and highlights the changes that are required to ensure high quality education and training, protect patient safety and service quality. NHS England will continue to work closely with the provider to monitor progress, offer targeted support, and ensure that the required improvements are delivered and sustained over time.
Provider statement
University Hospitals Sussex NHS Foundation Trust – progress update (July 2026)
Further to the Senior Leader Conversation visit to Radiology at Royal Sussex County Hospital (RSCH) on 3rd December 2025, we are pleased to provide an update on progress regarding the report requirements and recommendations
With regards to Mandatory Requirement MR-CR1, two pulse surveys were conducted in February 2026 to understand current trainee and trainer experience. This allowed us to identify areas of progress as well as any areas where further attention is needed. While the surveys capture a specific point in time, we are encouraged that responses clearly show that changes implemented following the red flags in the 2025 general medical council national training survey (GMC NTS) have resulted in a marked improvement in the trainees’ experience.
We look forward to this being further reflected in the 2026 GMC NTS.
Feedback from the pulse survey sent to the registrars demonstrated a significant improvement in overall satisfaction, with all respondents rating the overall quality of experience in their current post as either “Very good” (47%) or “Good” (53%). This is a positive shift compared to the 2025 GMC NTS results.
Teaching provision (both formal and informal) was also rated highly, and with regard to clinical supervision all respondents confirmed they knew who was providing clinical supervision at all times and no concern with accessing supervision were raised. Registrars very rarely felt forced to cope with problems beyond their competence or experience. Again, this demonstrates a notable improvement.
Feedback via the registrar pulse survey also demonstrated that changes such as consultant-led teaching sessions, practical opportunities, and real-time feedback have made a tangible difference to the registrar experience.
There is still room to improve, and a few themes stood out. Specifically, workload pressures, protection for subspecialty time, timelines over DOPs/IPX and ultrasound teaching lists have been highlighted and we are continuing work on these areas.
In terms of the pulse survey sent to the trainers, there was a slightly more mixed response. It is worth highlighting that overall, trainers are enjoying the role. There are of course challenges which are common to all specialties as trainers juggle the balance between service provision requirements and education.
We have shared these surveys with the consultant body and registrars. The management team remain committed to further improving and resourcing the department and the Local Faculty Group (LFG) will continue to work with them in this regard, with a goal to providing an excellent trainee and trainer experience, which ultimately translates to better patient care.
We are encouraged that feedback at our most recent LFG meeting (May 2026) was largely favourable, with the registrars reporting positive changes and recognising a real desire to improve both educational experience and working lives of resident doctors. Where concerns are raised at the LFG, a proactive approach is taken, supported by an action tracker methodology to allow for ongoing monitoring of improvements.
With regards to the visit recommendation to establish a cross-site faculty forum, we are pleased to confirm that the above-mentioned Radiology LFG already provides this, incorporating all UHSussex sites as well as Eastbourne and QVH. This format has been running for the last couple of years and provides a forum for the review feedback from resident doctors, alongside other metrics such as the GMC survey and exception reporting data, to support the provision of a consistent, high-quality learning environment across all sites.
Executive summary
The panel would like to thank the senior leadership team at University Hospitals Sussex NHS Foundation Trust (UHSx) for accommodating this senior leadership conversation and for their positive engagement in discussions around the quality of education and training in the clinical radiology department within their organisation. The visit and discussions focused on the Trust’s response and actions regarding the recent general GMC NTS 2025 red outliers.
The panel were impressed with the commendable work done by the college tutor in just two months of appointment as well as the support given to him by trust leadership. During the discussions by senior leaders, including the college tutor and trust representatives, the panel noted that the department has demonstrated insight into the concerns raised through the GMC NTS survey. While paediatric radiology workforce shortages remain a significant challenge, it was noted that mitigations are in place and further recruitment is actively pursued. The trust highlighted that continued monitoring through internal surveys, strengthened leadership structures, and sustained engagement with trainees will be critical to embedding improvements and ensuring ongoing educational quality. The details of actions presented by the trust to address areas of concerns identified through the GMC NTS have been included within the relevant domains of this report.
The panel was impressed by the trust’s proactive approach to addressing the 2025 GMC NTS red outliers. By demonstrating significant insight through independent actions such as commissioning internal surveys and implementing site-specific inductions, the trust has shown it is improving education quality without external prompting. Consequently, the panel has issued one consolidated mandatory requirement (MR) to review internal trainee feedback in early 2026. The MR will be monitored via an action plan, ensuring the improvements are effectively embedded to ensure compliance with the standards of the NHSE education quality framework.
In conclusion, the review panel would like to receive feedback from trainees through a trainee focus group in the Radiology post and programme early in 2026.
Review overview
Background to the review
This senior leadership conversation was arranged by the Kent, Surrey and Sussex (KSS) education quality team following the General Medical Council’s annual National Training Survey 2025 results which showed negative outliers in the Clinical Radiology post and programme at University Hospitals Sussex NHS Foundation Trust (UHSx).
The Clinical Radiology College Tutor presented an overview of the trust’s work to address concerns which led to the visit and has implemented a broad range of actions across governance, supervision, induction, feedback, and trainee experience, details of which have been included under the relevant domains of this report.
The KSS education quality team sought assurance regarding the adequacy of the clinical learning environment for trainees in the department and to identify any quality improvement actions aligned with the quality standards prior to issuing any mandatory requirements or recommendations.
Who we met with
The panel met with the following representatives from the trust:
- chief medical officer
- trust director of medical education
- clinical director radiology/imaging (Royal Surrey County Hospital)
- clinical director radiology/imaging (all sites)
- radiology college tutor/local faculty group lead (RSCH)
- associate director – imaging/radiology
- training programme director sussex radiology
- director of medical education for Worthing (overseeing Radiology pan-trust)
- chief of Service – clinical support services
- head of medical education and quality
- medical education manager for RSCH
- director of medical education for RSCH
Review panel
Education quality review lead
- Associate Dean KSS
Specialty expert
- Training Programme Director, Clinical Radiology
NHS England education quality representative and scribe
- Education Quality Project Officer and Lay Representative, KSS
Review findings
Quality Domain 1: Learning environment and culture
Psychological safety and overall satisfaction
The trust reported that prior to the GMC NTS survey, trainee anxiety and reduced confidence were linked to gaps in paediatric clinical radiology supervision, leadership instability, and communication issues. However, they are now focusing on creating a psychologically safe, supportive, and empowering learning environment by implementing an open-door policy, as described by educational supervisors (ESs) and clinical supervisors (CSs), to encourage open communication. This is stated in their curriculum, though it was noted that most times the trainees appear not to take time to read it.
The panel noted that efforts have been made to improve engagement between consultants and registrars. This includes joint acute sessions aimed at strengthening team identity, as well as monthly college tutor meetings with Brighton-based registrars to enhance visibility, engagement, and trust. The trust have ongoing initiatives in place to normalise in-person working and reduce excessive remote working among the ESs/CSs, which will enhance the teaching and learning culture. The panel learned that the trust are also considering accessibility and inclusion, particularly regarding neurodiversity awareness, in collaboration with equality, diversity, and inclusion (EDI) teams.
Furthermore, the panel heard that timetables and rotas are to be published in advance of rotations. Additionally, new consultant-led teaching sessions will be held in the morning and at lunchtime to complement dedicated academy teaching, with an emphasis on increased engagement. The trust is ensuring that consultants and registrars participate in acute clinical sessions to foster team identity, recognising the importance of building confidence and a supportive training culture in addressing raised concerns. The panel heard that currently, there has not been significant patient feedback, aside from a few complaints about long waiting lists, which are now beginning to improve.
Quality Domain 2: Educational governance and commitment to quality
The panel heard that though the trust had experienced significant fluctuations in the local leadership of registrar training, as well as changes in the leadership structure within the Radiology department across UHSx, the trust has made considerable efforts to establish leadership structures. For instance, a new clinical director was appointed, leading to the hiring of a new college tutor for the department as of September 2025. This has resulted in more visible leadership and a more collaborative team dynamic.
Additionally, the panel learned that there is now a revamped management structure for the department, including protected administrative time for the college tutor to enhance trainee engagement. Communication has improved through representatives from the general scheme and information dissemination via notice boards, emails, and the Trello system. The trust also reported that regular monthly meetings with all the Brighton-based registrars have proven useful.
When asked how these solutions could be further embedded and sustained, the panel learned that these guidelines were developed with input from the registrars and this approach is expected to be effective, as they plan to proactively conduct consistent surveys to gather feedback and track progress. Please see Mandatory Requirement MR-CR1. From a management perspective, the panel heard that plans are in place to bring new consultants on board, ensuring they are available and accessible on-site as this is essential to maintain consistency in leadership moving forward.
The trust where asked how the data on training quality is fed into the trust boards. In response, it was reported that they utilise multiple quality data sources, including GMC NTS surveys, local surveys, deanery and NHS England visits, exception reporting, and guardians of safe working (GOSW) concerns to monitor progress in improving education quality for the trainees. The panel heard that the director of medical education (DME) is responsible for triangulating quality data and presenting it to the trust board and the people committee. The trust stated that the planned regular internal surveys will be effective in monitoring progress rather than depending solely on GMC NTS survey results. Additionally, the trust also maintains oversight of clinical quality metrics to support proactive improvements.
Quality Domain 3: Developing and supporting learners
Clinical supervision
The panel was informed that five years ago, the paediatric radiology team consisted of five paediatric radiologists. However, due to retirements and relocations, the team has been reduced to three consultant paediatric radiologists, with a full-time equivalent of 1.7. This represents a significant shortage, as radiology consultants are rare nationally. The department is actively working to recruit more staff, and this shortage has been noted on the department risk register for some time.
The trust reported that the department conducted a local survey of trainees which highlighted issues with supervision and support of trainees, lack of troubleshooting sessions for paediatric radiology which should usually hold Mondays through Fridays from 9am to 5pm. The troubleshooting sessions were not conducted particularly during a period of leave and sickness last year, which became a significant challenge highlighted in the GMC NTS survey. This was noted by trust to be a one-off event and supervision in other areas was deemed appropriate. The panel heard that in the last two months, the department commissioned its own survey to gain insight into the trainees’ experiences. To address these concerns raised, the department re-established troubleshooting sessions where registrars serve as the primary contact for clinical questions. In most adult neuro cases, a consultant is typically present.
The panel heard that despite these challenges, feedback from local focus groups and the survey indicated that the core training for paediatric radiology is adequate, due to the support of paediatric sonographers and other practitioners who help fill the gaps left by the shortage of paediatric radiology consultants. In the long term, the department is focused on recruiting more paediatric radiology consultants. For short-term mitigation, they are working to reduce the number of days when a paediatric radiologist is unavailable.
Additionally, the trust mentioned that an escalation policy has been put in place with senior management support, and new policies aimed at assisting registrars with troubleshooting, which will go live within a week. The panel was informed that the department is utilising pooled resources within the now larger UHSx Trust and has arranged dedicated teaching sessions led by paediatric radiology consultants to support registrars. Also, the department is offering teleradiology support and has expanded their skill mix through the recruitment of paediatric sonographers, advanced practitioners, and a new paediatric operations manager starting in February 2026.
When asked how they verify that supervisors are fulfilling their job plans, the trust indicated that documentation serves as proof. They monitor which higher specialty trainees (HSTs) are assigned to which supervisors through discussions aimed at balancing those needing more intensive support or lighter supervision, and adjustments are made as necessary. The panel was informed that a database within the medical education team tracks individuals requiring extra support for ongoing discussions as the department is actively addressing these issues.
In response to questions about current mitigations, the answer from trust indicated that out-of-hours supervision is not problematic and if a paediatric emergency arises during working hours, senior registrars will be contacted, and there are multiple layers of assistance available, which is documented in their induction materials.
During the discussions, the trust confirmed that local trainees are expected to be appointed in the coming months, which reflects a shift towards greater collaboration and a positive outlook for future recruitment. Key takeaways for the trust regarding clinical supervision include the need to clarify expectations for CSs and normalise frequent interactions between registrars and consultants to enhance teaching opportunities while reducing remote working.
Feedback
The trust was asked to address a few negative reports from some registrars who were unsure about when to receive feedback from clinical supervisors and educational supervisors, as well as the lack of contact with consultants and the need for more subspecialty teaching. In response, the panel heard that the college tutor has improved communication regarding when registrars can meet with supervisors. Also, the rotas were changed to include named registrar and consultant hot reporting sessions.
The trust confirmed that in the last two months, funds from the School of Radiology that were previously unused have been utilised to develop dedicated ST1 ultrasound teaching lists. This initiative allows registrars to learn ultrasound while working with consultants. Registrars are now actively participating in radiology events and learning meetings (REALM) where they present and provide written feedback which contributes to reflection and the development of standard operating procedures (SOPs). Additionally, this written feedback complements their e-portfolios and registrars are also encouraged to use technology, such as Teams, for communication.
The panel heard that in general, feedback is collected through surveys, senior representatives, and direct meetings. Please see Mandatory Requirement MR-CR1. Trainers provide structured feedback through meetings, portfolios, and the annual review of competence progression (ARCP) processes, which includes ongoing training for supervisors on delivering effective feedback. Discussions have highlighted the administrative burden associated with supervision and feedback documentation and suggestions have been made to streamline processes and reduce duplication while continuing to assure and support trainees.
Regarding obtaining anonymous feedback, the trust reported that all surveys are conducted anonymously and feedback from trainee representatives, including meetings with trainees, is also available. In response to how feedback from trainers to trainees is monitored, it was noted that the e-portfolio is structured to discuss highlighted issues collectively and efforts are made to ensure that comments shared within the training environment are of high quality and adhere to professional accountability and documentation standards. However, there are concerns that trainees in the clinical radiology department may be reluctant to provide written feedback. This issue is addressed through regular updates on how to effectively give and receive feedback to supervisors and trainees.
Induction
The panel heard that trust inductions have already been transitioned to a site-specific model at Worthing, Chichester, and Brighton. As the trust has successfully implemented a single-source communication policy and established specific departmental induction packs, the panel is satisfied that the previously identified confusion regarding induction has been resolved through internal leadership actions. Inductions for doctors occur primarily in August, September, and October, while outside of these months, there is a trust welcome day. The panel heard that new doctors joining Brighton must sign in for both trust and departmental induction. Furthermore, new ST1 trainees will now be paired with a senior registrar for support.
In response to questions about making inductions accessible, particularly for those who are neurodiverse, the panel noted that the trust provides training for trainers on neurodiversity. This is an ongoing effort, with plans to signpost trainees to additional support resources as needed. In addition to trust-level inductions, departmental and school-level inductions include checklists to ensure comprehensive coverage are provided. To enhance accessibility, the team is implementing cream-colored slides and is collaborating with EDI and HR teams to address diverse needs. The panel heard that a trello-based online handbook, developed by registrars as a practical guide, is set to be updated and launched at all sites soon. This resource will be dynamic and easily accessible for trainees, serving as a supplement to traditional induction documents and ensuring that up-to-date information is readily available.
Quality Domain 4: Developing and supporting supervisors
Educational supervision
The trust confirmed that they are conducting a comprehensive reset of job plans for all Supervisors where supervisory time will be allocated and documented in the job plans, and the engagement of ES and CS will be monitored through attendance at local faculty groups. The trust also mentioned that a continuing professional development (CPD) program for supervisors is running throughout the year, with plans to introduce specialty-based meetings for ESs. The panel heard that there is ongoing work to clarify the expectations for both CSs and ESs, aiming to improve consistency. The trust acknowledged the administrative burden associated with supervision and feedback and are having discussions on ways to streamline these processes.
Quality Domain 5: Delivering programmes and curricula
This requirement was not specifically discussed as part of the review, however themes in other sections may link to this domain.
Quality Domain 6: Developing a sustainable workforce
Retention
The trust reported that the clinical radiology training program operates Sussex-wide across various locations: UHSx (East – RSCH/PRH and West – Worthing and Chichester), Eastbourne, and Queen Victoria Hospital, with a total of 44 registrars. The panel noted that the department is facing challenges in recruiting enough doctors. When asked about strategies for supporting future careers and if they considered the conversion rates from registrars to consultants, the panel was informed that they assess the conversion rates from higher specialty trainees (HST) to consultants by using various sources of intelligence to evaluate departmental ratings and facilitate career discussions.
The panel heard that regarding workforce planning and future mapping, the focus is on diversifying the workforce and identifying necessary skills. The DME leads these efforts, emphasising the importance of growing their own leaders and locally developing doctors.
During the discussions, the panel heard that the trust is currently facing challenges in recruiting paediatric radiologists for the clinical radiology department due to a significant national shortage of consultants in this specialty, which is impacting supervision. To address this, they are making efforts to grow consultants from within their trainee pool. Recent improvements in leadership and departmental culture have led to increased interest and successful appointments from the local training scheme. The panel learned that in terms of career development opportunities, the department is focusing on providing academic and digital innovation prospects, as well as flexible job offers and fellowships to promote career growth and retention. However, it is noted that some students need to adopt a more flexible mindset regarding their choice of specialties and training.
Areas for improvement
Mandatory requirements
| Review findings | Required action | Reference number and or domain(s) and standard(s) |
|---|---|---|
| The panel heard that in the last two months, the department commissioned its own survey to gain insight into the trainees’ experiences. | The trust is required to submit the findings of their internal trainee pulse surveys to the Deanery. This will allow the panel to verify that the local interventions are having the intended impact on trainee satisfaction and supervision. Evidence required: Submission of internal survey results and any changes made as a result by the College Tutor. Please provide evidence by 3 April 2026. | MR-CR1 |
Recommendations
| Recommendation | Reference number and or domain(s) and standard(s) |
|---|---|
| The trust is recommended to establish a cross-site faculty forum to align supervision standards and triangulate education quality feedback by cross-referencing diverse data, including GMC NTS surveys, local trainee feedback, clinical safety metrics, and exam performance. This integrated approach allows leadership to synthesise multiple perspectives to identify systemic risks and ensure a consistent, high-quality learning environment across all sites. | Domain 2 Domain 5 |
Report approval
Report completed by: Chidi Onyeze, Education Quality Project Officer, KSS
Review lead: Dr. Michael Hobkirk, Associate Dean, KSS
Date approved by review lead: 8 January 2026
NHS England authorised signature: Prof. Jo Szram, Regional Postgraduate Dean, NHS England South East
Date authorised: 17 February 2026
Final report submitted to organisation: 17 February 2026