Transcript The Tooke report - Royal College of Surgeons of England

Aspiring to excellence
“To deal with many of the deficiencies identified and to
ensure the necessary concerted action, the creation of a new
body, NHS:Medical Education England (NHS:MEE) is
proposed. NHS: MEE will relate to the revised medical
workforce advisory machinery and act as the professional
interface between policy development and implementation
on matters relating to PGMET. It will promote national
cohesion in England as well as working with equivalent
bodies in the Devolved Administrations to facilitate UK
wide collaboration. The Inquiry has charted a way forward
and received a strong professional mandate. The
Recommendations and the aspiration to excellence they
represent must not be lost in translation. NHS:MEE will
help assure their implementation”
The NHS Next Stage Review describes a vision
for the NHS that delivers high quality for all and
gives staff the freedom to focus on quality.
Achieving this vision requires us to provide the
best possible education and training for future
generations and to ensure that our existing
staff get the support they need to continuously
improve their skills.
Chapter 3 ‘A high quality
workforce’
“We will improve key aspects of
workforce planning at national
level
by
establishing
an
independent
advisory
nondepartmental body, Medical
Education England (MEE)”
Sir John Tooke’s response to ‘A high
quality workforce’
 “I am particularly pleased to see the creation of
Medical Education England which will give the
profession the strong voice and the scrutiny function
that it needs”
Structure of MEE
Board
29 members
6 meetings per annum
Structure of MEE
Board
Med
D
P
HS
NHS NSR:A high quality workforce
MEE agenda 1
 Suggest more valid and reliable selection methods
 Commission a formal evaluation of the 2 year Foundation
programme and consider an alternative model linked to wider
reform of postgraduate medical education
 Look at the balance between generalist/core training and
specialty training
 Reach a consensus on PGME and training structure by August
2010
 Continue discussions with Royal Colleges, deaneries, junior
doctors, patients, employers, trade unions, SHAs and other
stakeholders on how to take PGME and Training forward.
NHS NSR: A high quality workforce
MEE Agenda 2
 Work with the Royal College of General Practitioners to
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develop cost- effective proposals for training at least half of
doctors going into specialty training as GPs.
Strengthen the public health workforce and produce a system
of dual accreditation
Be responsible for the development of modular credentialing
Advise on how the training of dentists should reflect the
changing pattern of dental needs
Develop modular training for healthcare scientists leading to
the post of accredited specialist
Promote the incorporation of leadership and management
training into undergraduate curricula
NHS NSR: A high quality workforce
MEE Agenda 3
 Ensure that educational supervisors in secondary care undergo
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mandatory training and review of their performance
Promote the incorporation of academic pathways as per the
Walport report.
Develop the modernising scientific careers programme (Life
Sciences, Physiological Sciences, Physical Sciences and Engineering
each with a rotating training programme)
Take responsibility for the development of the training programme
for pharmacists with the new emphasis on promoting health and
well-being and giving life-style advice
Take on the responsibility for low volume specialties that require
national planning
Take on the job of working with the newly established HIECs to
develop a model interface between universities and the NHS for
innovation in education, training, certification, local workforce
development and translational research.
Additional items suggested by Board
members
 Quality of training agenda; developing trainers;
metrics and incentives; effect of EWTD
 Disseminating information on workforce planning;
working with CoE
 Development of a national simulation strategy
including collaboration with MoD
 Ensuring that all final year medical students have an
opportunity to shadow in the hospital in which they
will be working
The 2007 / 08 PMETB survey showed the
following implementation rates for F1 shadowing.
Lowest
 Warwick
 Cambridge
 Oxford
 Keele
 Birmingham
Highest
48%
45%
42%
42%
37%
 Belfast
 Glasgow
 Aberdeen
 Barts
 Dundee
96%
86%
81%
78%
78%
Kieran Seyan et al BMJ 2004
Definition of the standardised
admission ratio for applicants to
medical school
No of admissions from a particular
population subgroup as a proportion of
all admissions
___________________________________
Proportion of the general population that
belongs to that subgroup
Kieran Seyan et al BMJ 2004
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Asians Social Class 1
6.07
Whites
0.73
Blacks Social Class IV
0.07
No black people from Social Class V were admitted to
Medical School
 Females
1.15
 Data from 1996-2000
Gender balance in Medical Schools
“I could not find any information on male to
female ratio of current medical students at
Newcastle medical school . Grateful for any
information”
“In our year the ratio is about 2:1,
females:males. In my seminar group of 20,
for example, 14 are female and 6 are male.
This is the same with the majority of
seminar groups.”
__________________
Third year Medical Student at Newcastle
University, Tyne Clinical Base Unit
Graduate entry into Medicine
 Normal mode of entry in USA for many years
 1997 Four Australian Medical Schools changed
exclusively to graduate entry
 Ireland has now changed to graduate entry
GP Analysis:
There is a clear risk of an undersupply of GPs
Analysis with impact of supply side variation
Comparison of forecast GP demand and supply
(medium demand & various supply scenarios)
The magnitude of the
likely GP
undersupply depends
on supply
assumptions, e.g.:
65,000
60,000
55,000
Future participation;
Future attrition;
Future retirements.
FTEs
50,000
45,000
The GP age profile
suggests an imminent
retirement bulge.
40,000
35,000
30,000
20
05
/0
20 6
06
/0
20 7
07
/0
20 8
08
/0
20 9
09
/1
20 0
10
/1
20 1
11
/1
20 2
12
/1
20 3
13
/1
20 4
14
/1
20 5
15
/1
20 6
16
/1
20 7
17
/1
20 8
18
/1
20 9
19
/2
20 0
20
/2
20 1
21
/2
20 2
22
/2
20 3
23
/2
20 4
24
/2
20 5
25
/2
20 6
26
/2
20 7
27
/2
20 8
28
/2
20 9
29
/3
20 0
30
/3
1
25,000
Demand (medium)
July 15
Supply (low)
Supply (medium)
Not intended for publication
Early indications
from modelling
development suggest
the higher end
scenarios may be
more likely as supply
assumptions are
updated
Supply (high)
16
Specialist Analysis:
There is a clear risk of an oversupply of CCT holders
Analysis with impact of supply side variation
Comparison of forecast CCT holder demand and supply
(medium demand & various supply scenarios)
65,000
The magnitude of
the likely CCT
oversupply depends
on supply
assumptions, e.g.:
60,000
55,000
Future
participation;
Future attrition;
Future retirements.
FTEs
50,000
45,000
40,000
35,000
30,000
20
05
/0
20 6
06
/0
20 7
07
/0
20 8
08
/0
20 9
09
/1
20 0
10
/1
20 1
11
/1
20 2
12
/1
20 3
13
/1
20 4
14
/1
20 5
15
/1
20 6
16
/1
20 7
17
/1
20 8
18
/1
20 9
19
/2
20 0
20
/2
20 1
21
/2
20 2
22
/2
20 3
23
/2
20 4
24
/2
20 5
25
/2
20 6
26
/2
20 7
27
/2
20 8
28
/2
20 9
29
/3
20 0
30
/3
1
25,000
Demand (medium)
July 15
Supply (low)
Supply (medium)
Not intended for publication
The demand profile
is dependent on skill
mix: moving towards
a trained doctor
delivered service
may result in
increased CCT
holder demand in
the short term.
Supply (high)
17
HIECs
 Health Innovation and Education Clusters (HIECs) are
aimed at more rapidly translating research and
innovation into clinical practice, and linking workforce
planning to a quality framework of education.
 HIECs could be one of the key ways in which MEE is
‘plugged in’ at a local level
HIECs
 A partnership between
 NHS organisations (primary, secondary and tertiary)
 HE sector (universities and colleges)
 Industry (healthcare and non-healthcare)
Principles of HIECs
 Span settings (Trusts, FTs, private sector; primary,
secondary and tertiary care)
 Span sectors (NHS, HE, Industry)
 Span professions (i.e. Multi-professional)
 Deliver measurable impact in innovation
 Focus on quality
 Support the purchaser-provider split in education and
training
HIEC 2009 timetable
 May distribution of national prospectus to outline
HIEC’s concept, application process
 May- July regional stakeholder events run by SHA
 Early September completion of pre-qualification
questionnaire
 October submission of formal applications
 November presentations to National selection panel
 December first wave of HIECs announced
EWTD:
John Black’s February Newsletter ‘Carpe Diem’
“I explained that a general reduction to a 48hour week would in our view have profound
consequences for the provision of local
services and training. Many medium-sized
and small hospitals would not have
sufficient staffing levels to maintain rotas.
Surgical services would become
unsustainable and of course without surgical
cover accident and emergency departments
would have to close. The increasing
demands on consultants to keep emergency
services going would inevitably have a
serious impact on elective surgery, with little
hope of meeting government targets on
waiting times.”
EWTD: ASiT survey Jan 2009
 ASiT suggest that to ensure optimal training, with
adequate time for exposure and high quality patient
care with increased continuity, it is necessary to return
to a working week of approximately 65 hours. For
higher specialty trainees (ST3 and above), on-call rotas
rather than shift working would best protect training
opportunities, and would be the optimal arrangement
where workload permits.
Professor Michael Eraut
University of Sussex
JCST discussion document of the Eraut
report
 “..disturbing insight into the current condition of
surgical training in the UK. Many factors are identified
as being responsible for this unwelcome state, not all
of them obviously remediable.”
 “Allowing for the environmental factors identified in
the Eraut report is the ISCP ‘fit for purpose’ as a
curriculum for surgical training?” (these factors
included the EWTD and the MTAS disaster)
Annual Specialty Report Overview JCST
 ISCP:
 “despite its many strong points, the ISCP continues to generate a degree of
discontent amongst some trainees and trainers, and engagement with both
groups, in some areas, is less than the JCST would wish to see”
 Opportunities for training in operative surgery:
 29% ST1 trainees have access to less than two operating sessions per week;
“JCST would like to see a commitment to innovative training methods such
as simulation to help offset this reduction in clinical experience”
 Support for trainers:
 “..widespread evidence that surgical trainers are poorly supported by their
employing Trusts. Urgent action is needed to correct this before consultant
surgeons become completely disengaged from the training process”.
Summary
 The creation of MEE is an opportunity to produce a
more coherent approach to manpower planning and
the promotion of excellence in the education and
training of doctors, dentists, pharmacists and
healthcare scientists
 If we are to tackle the very challenging agenda then the
MEE Board and Subcommittees will need to work
closely together to produce a consensus which best
represents the interests of the professions, trainees
and, above all, patients