The Quango-Killer: Starmer’s Bye-Bye to NHS England

The PM’s bold move to cut bureaucracy in healthcare

Keir Starmer made headlines this week by announcing plans to abolish NHS England, claiming it's all in the name of cutting “bureaucracy.” Everyone momentarily panicked at the headline before realising that this change wouldn’t affect anyone’s access to the NHS. As of March 2025, at least, it remains free at the point of use, offering the same services as before. So, what’s really happening here?

NHS England is the administrative giant responsible for managing a budget soon approaching £200 billion. It determines how health services are delivered nationwide, with approximately 15,000 administrative roles—mostly managers and officials, not the doctors and nurses actually treating patients. It was created in 2013 under the Cameron government by then-Health Secretary Andrew Lansley. It was often accused of shifting operational accountability away from politicians and onto an autonomous body. This structure allows politicians to dictate broad policy goals (e.g., reducing waiting times) without being directly blamed when things go wrong.

Starmer argues that NHS England is riddled with inefficiencies—layers of management, excessive paperwork, and a structure too bloated to effectively respond to healthcare needs. Branding it a “Quango” (Quasi-Autonomous Non-Governmental Organisation), he claims that this semi-independent status creates accountability gaps. Quangos are publicly funded yet not directly answerable to the electorate, raising valid concerns about transparency and oversight.

Is Starmer’s Solution Bureaucracy Busting?

Scrapping NHS England doesn’t eliminate bureaucracy; it transfers its functions to the central government. And do we have a solid case to suggest the government will be any better at handling the workload? —already overwhelmed by competing priorities and stretched resources. If inefficiency is the problem, handing more power to an even bigger bureaucracy may be problematic.

NHS England was designed to decentralise decision-making, empowering local bodies to tailor services based on specific population needs. Local health challenges are not uniform. A strategy effective in inner-city London won’t necessarily work in rural Yorkshire. By re-centralising control, Starmer’s plan risks imposing one-size-fits-all solutions on complex, diverse healthcare needs.

Some may argue that Starmer’s criticism of NHS England as a quango is ironic. Its very purpose was to allow healthcare management to operate with a level of autonomy, protecting it from political micromanagement. By eliminating it, are we returning to a system where healthcare becomes more vulnerable to short-term political agendas?

However, abolishing NHS England might sound appealing to many doctors fed up with management overreach. Too often, they feel buried under paperwork and micromanagement by administrators far removed from clinical realities.

As always, we will have to let time show us if this move works out for Starmer and his government…

The Growing Gap: UKMGs vs. IMGs

Numbers matter. They anchor our opinions in reality. But interpreting those numbers—that’s where things get tricky. But you can’t draw conclusions without the data.

Here’s the diagnosis:
In 2023, 19,675 doctors applied for speciality training—9,273 UK medical graduates (UKMGs) and 10,402 International medical graduates (IMGs). Fast forward two years and the 2025 data shows 33,108 applicants: 12,305 UKMGs and 20,803 IMGs.

That’s a 32.7% increase in UKMGs and a staggering 99.9% surge in IMGs. IMGs now make up nearly two-thirds of all applicants, all while training places remain stuck at 12,800.

The critical question at the centre of the debate is this: Does a government have a fundamental duty to protect the interests of its own citizens?

An essential debate, and one we’ll dissect further in next week's On-Call newsletter. Stay tuned.

The NHS Won’t Make You Rich—But This Will

How doctors can build wealth without leaving medicine…

In 2016, I stood on the picket line as an F2 doctor, feeling stuck. Overworked and underpaid. Exhausted and frustrated. Looking at my colleagues holding up their DIY placards, it was clear that we all felt the same.

Yet outside of medicine, my friends were climbing the financial ladder, while I remained trapped in a rigid system.

That’s when it hit me: The NHS doesn’t reward ambition. A traditional medical career meant waiting years for small pay rises, on terms I couldn’t control. If I wanted financial freedom, I had to take control myself.

But I wasn’t ready to leave medicine. I loved being a doctor, I just wanted more income, more flexibility, and more options.

So I made a choice. I built my career differently.

I created a six-figure portfolio career while still practicing medicine. Secured high-paying clinical and non-clinical roles that fit my lifestyle. I built additional income streams, without leaving medicine, and designed a career that gave me financial security and freedom.

More income. More flexibility. More options.

That journey led me to develop The Portfolio Pathway™—a step-by-step system to help doctors build the careers they want, rather than a career dictated by rigid training programmes and rota coordinators.

Now I use that same system to help other medics secure high-paying medical roles, build additional low-maintenance income streams, and create financial and career security—without leaving medicine or depending on extra shifts.

If you’re ready to take control of your career and your finances, I’m offering free strategy sessions this month—but spaces are limited: 10 for doctors, 5 for medical students.

As medics, we don’t have to just accept what we’re given, we have the power to shape careers that are as financially rewarding as they are fulfilling.

Want in? Book a free session to learn more.

Capital Gains or Capital Pains? The London Training Debate

Priorities decide whether training in the capital is for you…

At nearly every hurdle in the journey of becoming a consultant, one has to ask themselves where they want to apply in the country. For many, being accepted into a training programme in the capital is the dream, despite the additional difficulty it brings from a competition point of view, as well as from a financial and cost-of-living aspect. As we all know, the ability to save, invest, and progress financially is severely hampered in the Capital. Whilst we acknowledge there can never be an objective answer to such a question, it’s worth exploring why London remains so competitive for speciality and foundation training.

For some, London isn't just a city; it's home. Born and bred in the capital, with their family and friends around, these individuals have grown accustomed to the daily dilemmas of city life—whether it's choosing between a two-hour traffic jam, a death-dying spandex-covered cycle, or getting up close and personal with a finance bro’s armpit on the Northern Line. Maybe the £2,800 rent for a two-bedroom "cosy" flat is a normal price after all?

And the data backs this up. Medical students often choose universities close to home, and when it comes to foundation training, over 40% apply to foundation schools within 50 miles of their family home according to the 2024 General Medical Council National Training Survey. Add to that the tendency for students and junior doctors to stay in the region where they've already been training, and it’s no surprise why the capital is so oversubscribed.

A Harsh Reality

Yes, London boasts world-famous teaching hospitals and consultants who are at the top of their game, but very few people actually move to London because they think it's the best place to train. Studies indicate that while prestigious hospitals offer exceptional specialist knowledge, levels of autonomy, teaching quality, and clinical independence are often rated higher outside of the capital.

Take the 2019 GMC Survey, which reported that trainees in less urban areas consistently rated their educational supervision and overall satisfaction higher than those in London. This discrepancy has only grown with the increasing strain on London's healthcare system post-pandemic.

For most careers—Accounting, Finance, Law—being close to the capital means greater opportunities for career progression. But medicine? Not so much. Salaries are almost identical nationwide (whilst living costs certainly aren’t!), and training opportunities can be tougher to secure within London due to high competition.

So why London, Then?

Because it's London. The city itself is the draw. Whether it's the bustling social scene, access to countless cultural experiences, or simply the thrill of being in one of the most dynamic cities in the world, the lifestyle appeal is undeniable. The general trend of younger professionals gravitating towards big cities partly explains this desire to be in the capital - particularly in the earlier parts of one’s career.

You can find elements of the above factors in other UK cities, sure. But it's like comparing a small, edgy festival to Glastonbury. The scale is never going to be the same.

It seems, therefore, that training opportunities shouldn't be the reason to aspire to London—rather, it’s the city itself that casts the spell.

Former BMA UKDC Chair Dr Rob Laurenson on Abolition of NHS England: “Today is a very good day. I've always said that the NHS was reformed into this mess, and so it'll always require reform to get out of it.”

“In the grim darkness of the far future, the Alphabet-Soup Gods reign supreme. The land is overrun by PAs, ACPs, SCPs, ANPs, ENPs, ACCPs, and AAs. Doctors? They’re mere legends now—mythical creatures with stethoscopes, spoken of only in bedtime stories told by exhausted nurses. From bed 34, you hear a patient’s cry as a staff member introduces himself as a KFC. ‘I thought that was fried chicken’ - echos through the corridor”

“Ask the speciality least likely to accept the patient first. Then, tell the other that the alternative has already been rejected for x, y, z. If no one accepts, don’t argue just escalate within your team. … and they’ll be admitted under medics.”

What’s on your mind? Email us!

Some things to review when you’re off the ward…

Nearly a fifth of the reduction in national waiting lists last year was achieved by a single trust, whose director noted that a key factor in this success was providing higher overtime rates to their consultant staff. Perhaps money IS the answer. Read in the HSJ

Further concerns over the safety of Physician associates citing Oxford Uni’s Prof. Trish Greenhalgh's work in The Standard 

Weekly Poll

Last week’s poll:

Should Medical Schools Lower Academic Entry Requirements for Disadvantaged Students?

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April 6th Countdown: ISA Tips for UK Docs

The end of the financial year is fast approaching – April 6th is almost here! That means time is running out to make the most of tax-efficient accounts before the reset.

You’ve got a £20,000 annual ISA allowance to save or invest. You can spread this across different ISA types as long as you don’t exceed the limit. If you’ve got spare cash sitting in non-ISA accounts and haven’t hit your ISA limit yet (and if you have, well done – only 7% of ISA users manage this!), consider moving it into a tax-free ISA. Interest rates are finally generous, and many doctors might be nearing their personal allowance limits on earned interest. But with an ISA, you can kiss those tax worries goodbye.

So whether it’s a Lifetime ISA, Cash ISA or Stocks and Shares ISA (sorry to the 3 innovative finance ISA users, move on), you are using for your financial goals, consider moving the spare cash you have into these accounts.

We don’t want to sound out of touch here at On-Call – £20,000 is a lot to stash away in a year, especially with costs rising all around us. While it’s definitely achievable for our more senior readers, there are still smart moves everyone can make. If investing isn’t your thing, no worries – there are some fantastic Cash ISA and Lifetime ISA providers out there, offering generous interest rates, perfect for doctors with emergency funds or house deposit savings sitting in non-ISA accounts.