The BMA’s annual representative meeting can often feel a bit like Groundhog Day. The chairman kicks off events with some combative rhetoric about the government, the usual suspects speak in turn about concerns over NHS privatisation, and things get a little bit heated during the ethics section as rival groups exchange blows over topics such as assisted suicide and abortion. Give or take, it was ever thus.

But each year there are also one or two subjects that hint at a subtle change of direction. This year one such subject was workforce planning.

Tucked away at the end of the first day, after many delegates had left, there was an open microphone debate on how the medical workforce would need to adapt in the future. It’s always dangerous to draw too many conclusions from such a meeting, but Peter Bennie, who was chairing the debate, picked out three strands that showed a marked departure from the past.

1. Several medical students remarked that it was time to reduce their own number. Dr Bennie pronounced that it was “momentous to have a debate where we say we should reduce medical students”.
2. There is a danger of having a large number of trainees working under the false promise that there is a consultant post for them – we need to reduce the number of doctors training to CCT. Ram Moorthy told the conference he had gone into ENT training under the impression there was a need for consultants but now, half way through, he is being told there will be few jobs at the end.
3. We need a specialist service rather than a consultant service. Both Keith Brent and Mark Porter of the BMA’s consultant committee commented that the status quo was unsustainable and that consultants would have to work differently in future.

What was also striking was that despite being an open debate, very little debating was done – it seemed that the majority of delegates were in total agreement. And while nobody was willing to mention the “S” word (sub-consultant), it seemed that in many ways it was merely a matter of semantics.

Fewer doctors training to CCT (certificate of completion of training) or consultants working differently – whichever way you spin it we are looking at a new type of specialist.

Workforce planning is a minefield. Even slight percentage shifts in part-time workers or foreign graduates can have a significant impact on service provision. Right now the headlines are about doctor shortages in hospitals, but the best guesses are predicting the complete opposite for a few years’ time.

Nobody can predict exactly where we will be in 10 or even five years time, but what seemed significant at the ARM was the shift in focus from idealistic workforce planning to realistic workforce planning.

Ed Davies is editor, BMJ Careers.