Modernising Medical Careers

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Modernising Medical Careers
www.mmc.nhs.uk
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The workforce of the future Realistic career
planning

• Dr Alison Carr
• Dean AdviserMMC 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 view of the long-term
• Possible future structures for postgraduate
  medical education training
• Short term view - latest competition data?
• Brief recap on organisational changes MEE
• Your views

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A view of the long termChanging needs of
patients and the serviceSome pointers from the
NHS Next Stage Review

• ? demand in primary care community
• ? GP up to 60 of training posts
• More emphasis on health
• ?public health workforce, dual accreditation e.g.
  in cardiology, diabetology
• ? Paediatrics
• ? Generalists - adaptable
• Centralisation- Development of super-specialist
• Management and leadership skills

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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 formal accreditation at
  defined points knowledge, skills, attitudes,
  experience capabilities
• Funding tariff based money follows the trainee
• More recognition for doctors in non-training
  posts
• Career planning even more individual!

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Possible future structures of Education

• Tooke Report recommended
• Splitting Foundation Programme,
• developing broad-based beginnings concept with
  four core specialty stems,
• followed by competitive entry (in all
  specialties) to post-core 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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Possible future structures of Education

• Health Committee and NSR recommended
• No change to Foundation Programme pending full
  evaluation
• Continuing with the mixed economy training
  structure (until 2010)

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Mixed economy model
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Possible future structures of education Current
Thinking
Higher Specialty Training
Run Through Training
Selection
Core Training 2-3 Years
Selection
Selection
Broad Based Training
Selection
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Possible future structures of education Current
Thinking
Core Training 2-3 Years
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Short term view latest competition data?

• Current excess of core posts over higher
  specialist training posts in medicine surgery
• Surgery up to 31, Medicine up to 21
• Historic geographic disparity between core
  posts HST posts
• (e.g. better chances in Oxford, lower in
  Midlands)
• General surgery and TO producing excess CCT
  holders likely to reduce posts
• 400 additional GP posts in 2009 and more to
  follow

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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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Workforce Planning is inexact science

• Medical School Expansion and long lead in time.
• Feminisation of workforce
• Participation rates
• EWTD, reduced working hours
• CCT holders bulge over next few years (Hutton
  NTNs)
• Ratio of GP to hospital specialty training
  numbers
• Ageing population
• Choice, access, expectations
• IMGS
• NCCG, specialist, subconsultant
• Skill mix (doctor substitution)

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• Risk of long term undersupply of GPs despite
  planned ? intake
• Confirms current plans to change ST1 balance
  towards GP training
• Even in the high supply scenario, demand is
  larger than supply

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• Risk of long term oversupply of CCT holders
• But will be differences between specialties
• Supports current plans to change ST1 balance
  towards GP training
• For the medium demand scenario, even with low
  supply there is an oversupply of CCT holders

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ImplicationsCurrent training number plans

FP Intake ST1 Intake ST1 Intake
FP Intake GP CCT
2008 5,900 2,300 3,650
2009 6,100 2,700 2,900
2010 6,150 2,900 3,000
2011 6,300 3,200 3,000

additional non-ST1 posts e.g. uncoupled
specialty posts at ST3
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Competition Ratios 2007

• 37,000 applicants made 129,000 applications for
  17,887 posts
• Competition ratio overall 21 (applicants posts)
• Applications per post
• Cardiothoracic surgery 53.81
• Trauma Orthopaedics 22.51
• Core Medical Training 6.31

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Competition Ratios ST3/4 03 07
www.mtas.nhs.uk
Specialty No posts No 1st choice applications Comp Ratio
T O 147 862 5.9
General Surgery 205 1089 5.3
Plastic Surgery 55 262 4.8
Cardiology 100 433 4.3
Ophthalmology 86 239 2.8
Neurosurgery 21 58 2.8
Dermatology 30 85 2.8
Obs Gynae 384 949 2.5
Haematology 54 112 2.1
Anaesthesia 503 933 1.9
Psychiatry (ST4) 365 651 1.8
Emergency Medicine 187 291 1.6
Paediatrics (ST4) 300 482 1.6
Acute Medicine 121 128 1.1
2558
6702
9661 1st choice applications for 4022 ST3 posts
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Competition Ratios ST1 03 07
Specialty No posts No 1st choice applications Competition Ratio
Public Health 69 368 5.33
Clinical Radiology 184 846 4.60
Medical Micro Virology 26 101 3.89
Ophthalmology 110 257 2.34
OFMS 25 58 2.32
Neurosurgery 35 77 2.20
Obs Gynae 289 513 1.78
Chem Path 11 19 1.73
ACCS 458 782 1.71
Surgery in General 850 1434 1.69
CMT 1338 1927 1.44
Anaesthesia 525 641 1.22
Psychiatry 594 711 1.20
Paediatrics 458 512 1.12
www.mtas.nhs.uk
4972
8246
12807 1st choice applications for 7577 ST1 posts
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Competition Ratios ST1 SIG- Gen Surg Generic
UoA No Posts CR UoA No Posts CR
Mersey 7 4.43 Northern Ireland (Generic) 22 1.55
West Midlands (Generic/ Gen Surg) 3/22 3.0/1.86 S Yorks Humber (Generic/ Gen Surg) 6/8 0.33/1.38
Scotland 20 2.8 LNR 7 1.29
London/KSS 24 2.5 Oxford (Generic/ Gen Surg) 12/8 0.67/1.25
Yorkshire (Generic/ Gen Surg) 24/48 2.13/ 0.69 SW Peninsula 17 1.12
Northern 18 2.11 Eastern 30 0.97
North Western 30 2.07 Wales (Generic) 26 0.42
Wessex (Generic/ Gen Surg) 8/4 2.0/1.5 Trent 14 0.29
Severn 8 1.88 Trent 14 0.29
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Competition Ratios 2007

• 37,000 applicants made 129,000 applications for
  17,887 posts
• Competition ratio overall 21 (applicants posts)
• Applications per post
• Cardiothoracic surgery 53.81
• Trauma Orthopaedics 22.51
• Core Medical Training 6.31

Competition Ratios 2008

• 85,201 applications made for 9,666 posts
• Average of 4.8 applications per applicant
• Applications per post
• At ST1 8.9 1
• At ST2 7.8 1
• At ST3/4 10.31

• CT Surgery 12.4 1
• TO 54.4 1
• CMT 9.1 1

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Short term view latest competition data?

• Application ratios for ST1 in 2008

Programme Posts Apps Ratio
Paediatric surgery 1 39 39
Clinical radiology 156 5,055 32.4
ACCS All 390 8902 22.8
Obstetrics and gynaecology 242 1,503 6.2
Histopathology 60 317 5.3
Paediatrics 388 1,728 4.5
General practice 2,301 7,020 3.1
Are competition ratios as 1 application made
per applicant
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Short term view latest competition data?

• Applications appear to have shifted in choice of
  location from 2007 competition data
• 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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Short term view latest competition data?

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

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Brief recap on organisational changes

• NHS Medical Education England (NHS MEE)
• Also covers healthcare science, dentistry
  pharmacy
• Reform/ review postgraduate training pathways
• Advise DH on medical education and training
• Assure quality of workforce planning
• Formal evaluation of Foundation Programme
• Work with SHAs on commissioning education and
  training
• Regional MEEs for each SHA

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Brief recap on organisational changes

• Finalise structures of PGME
• Review extension of GP training, with RCGP
• Review curricula, assessment processes trainer
  accreditation
• (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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• Your Views?
• Your Questions?

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Modernising Medical Careers
www.mmc.nhs.uk