Modernising Medical Careers

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Modernising Medical Careers
www.mmc.nhs.uk
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MMC Present and Future

• Steve Buggle
• Operations ManagerMMC England

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From recent trainee feedback

• Training
• should be seen as a journey,
• not a forced route,
• not a race.

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Whats in this presentation

• A preview of specialty recruitment 2009
• Future context
• Developing the structure of PGME
• New organisational changes

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Recruitment and selection into Specialty
Training
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A preview of specialty recruitment 2009

• Local recruitment by deaneries for most
  specialties
• Up to 3 recruitment episodes
• First and main process starts 5 Jan, runs until
  22 May 2009
• Most posts start first week in Aug
• Further recruitment by deaneries up to 31
  December 2009

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A preview of specialty recruitment 2009
Specialties offering run-through training in 2009

• Obstetrics Gynaecology
• Ophthalmology
• Paediatrics and Child Health
• General Practice
• Public Health Medicine
• Neurosurgery
• Histopathology

• Chemical Pathology
• Medical Microbiology
• Clinical Radiology
• Clinical Oncology
• Urology
• Trauma Orthopaedics

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A preview of specialty recruitment 2009
Specialties offering uncoupled training in 2009

• Cardiothoracic Surgery
• General Surgery
• Oral Maxillo-Facial Surgery
• Otolaryngology (ENT)
• Paediatric Surgery
• Plastic Surgery
• Trauma and Orthopaedic Surgery

• General Medicine
• Anaesthesia
• Psychiatry
• Occupational medicine
• Emergency Medicine
• Urology

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Context and competition
Competition Ratios 2007

• 27,800 applicants, 103,000 applications, 15,560
  posts
• Competition ratio overall around 21
• Cardiothoracic Surgery around 541
• Trauma Orthopaedics around 221
• Core Medical Training around 61

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Short term view latest competition data?

• Application ratios for ST1 in 2008

Are competition ratios as 1 application made
per applicant
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Short term view competition data?

• Patterns show links between following
  specialties
• CMT GP Psych PCH
• Anaesthesia ACCS
• General surgery surgery in general
• Psychiatry GP
• Surgical specialities surgery in general

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Context and competition

• Choice of location appears to have shifted from
  2007
• Deaneries in 2008 with low no. applicants per
  post
• London
• Northern
• Wessex
• Deaneries in 2008 with high no. applicants per
  post
• East Midlands
• Oxford

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A view of the longer term

• General Surgery and Trauma and Orthopaedics
  producing excess CCT holders
• Reducing General Surgery ST3 by 100 over next 5
  yrs
• Reducing TO ST3 by 100 over next 6 yrs
• Currently an excess of core posts over higher
  specialty training in medicine and surgery
• Historic geographic disparity between core
  posts HST posts (e.g. better chances in
  Oxford, lower in Midlands)
• Looking at reducing core posts to redress balance

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Reduce 100 ST3 posts for next 5 yrs
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Reduce 100 posts for next 6 years
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A view of the longer term

• A fair and robust recruitment process, which
  reflects needs of the Service, employers and
  consultants, enables the best doctors to be
  appointed, taking account of speciality choice
  and geography and achieves a high fill rate.
• More Colleges led national recruitment
• Move away from white space shortlisting
• Single interview
• More flexibility over when recruitment is done
• Sequencing of recruitment and offer periods

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A view of the longer term

• Adapting to the needs of patients and the service
• Rising demand in primary care 400 extra GP
  posts in 2009 and more to follow
• Increase in public health and dual accreditation
  e.g. in cardiology, diabetology
• Need more in paediatrics
• Looking for management and leadership skills
• Expansion in generalist - adaptable
• Development of super-specialist

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Developing the structure of Postgraduate Medical
Education
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Modernising Medical Careers

• Is involved in developing the shape of
  postgraduate medical education training

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Tooke Inquiry Model
Higher Specialty Training
Selection
4 Core Specialty Stems3 Years
Selection
1 Year
Selection
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Mixed economy model
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Possible future structures of education
Higher Specialty Training
Run Through Training
Selection
Core Training 2-3 Years
Selection
Selection
Broad Based Training
Selection
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A view of the long termChanging needs of
patients and the serviceSome pointers from the
NHS Next Stage Review

• Clearer pathways for career progression with more
  flexibility
• Modularised training
• Modular credentialing
• More recognition for doctors in non-training
  posts
• Funding tariff based money follows the trainee

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Modular Credentialing

• Training pathway divided up into modules
• Modular credentialing formal accreditation at
  defined points knowledge, skills, attitudes,
  experience capabilities
• Post-CCT credentialing life-long learning

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Cardiff Declaration Model
CCT
CESR/CEGPR
Higher Specialty Training
Specialty doctor posts
Selection
Credentialed waypoint
Core Specialty Stems Variable length
Selection
2-3 Years
Selection
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A view of the longer term

• The role of the doctor
• GMC/PMETB merger
• Developing new organisational structures
• NHS Medical Education England (NHS MEE)
• Centre of Excellence
• Health Innovation Educational Clusters (HIECs)

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NHS Medical Education England

• Advises DH on medical education and training
• Also covers healthcare science, dentistry
  pharmacy
• Reform/ review postgraduate training pathways
• Formal evaluation of Foundation Programme
• Review extension of GP training, with RCGP
• Review curricula, assessment methods trainer
  accreditation
• Finalise structures of PGME
• Assure quality of workforce planning
• Work with SHAs on commissioning education and
  training
• Regional MEEs for each SHA

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New organisational changes

• (Workforce) Centre of Excellence
• To advise on building workforce capacity
• Health Innovation and Education Clusters
• Partnerships e.g. of universities, trusts,
  industry
• Focus on improving patient care (innovation)
• May provide postgraduate education, subject to
  local agreement

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Commissioner-Provider Split Current Principles
for Implementation 1

• The commissioner and provider roles/ functions in
  PGME must be clearly separated within each SHA.
• SHAs must draw a clear distinction between the
  two roles/ functions, and objectively describe
  how the separation will be effected at a local
  level.
• This may be achieved through being part of a
  separate provider organisation an example of
  such an organisation could be a Health Innovation
  and Education Cluster (HIEC).

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Commissioner-Provider Split Current Principles
for Implementation

• SHAs will determine the best model to suit local
  circumstances, but the postgraduate deans should
  remain in the commissioning (SHA) part of any
  split.
• Commissioning plans must include explicit key
  performance indicators (KPIs) (qualitative and
  quantitative) against which the commissioned
  provider(s) can be quality assured
• The preferred commissioner-provider model must
  ensure high quality education and training, and
  academic excellence.

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Commissioner-Provider Split
Possible Model A
Commissioner
Provider Unit
Provider
For example, a Partnership model involving
Deanery staff, Postgraduate Schools Trusts
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Commissioner-Provider Split
Possible Model B
SHA
Commissioner
Provider
Postgraduate Schools
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• Your views and questions?

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Modernising Medical Careers
www.mmc.nhs.uk