MMC presentation (including new competition ratios)

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  • At the recent stakeholder events, we were surprised by how much you can see a change of thinking in all the various groups whether trainees, Trusts, deaneries or colleges Difficult to find the balance on some issues, but on the whole a lot of common views are coming out in the feedback, and when you read it, you can almost see a change happening. People are getting better at dealing with the complexity of developing a medical workforce for the NHS of the future.
  • Predicting the future in the health service is very difficult These are some of the trends that are clear from the NHS Next Stage Review GP already increasing in 2008 – likely to get up to 50% of posts by 2010 In general there is a big drive to improve leadership in the NHS and to involve clinicians more in policy and planning and a drive for innovation and change. The doctors that will do well will be good in this environment will able to develop management as well as clinical skills The shift will continue towards more care closer to home, making the most of technological and medical advances and the boundaries between primary and secondary care will be less defined At the same time continued centralisation of specialised care requiring the development of the super-specialist
  • Modular training and modular credentialing are opening up the possibilities for flexibility. This is what a lot of trainees want, although there are some particularly focused individuals with more of a fixed vocational approach. Modular credentialing will make it possible for people to move in and out of training, move between programmes and gain a wide range of experience – fits with the changing demography of trainees coming through Also matches better the needs of the service, where the NHS needs to change the number of posts in certain programmes as it adapts to service changes. Makes sense for money to follow the trainee in this scenario, protected funding and flexible approach to training with protection For advisers such as you, the job of supporting career planning will need to become even more sophisticated and tailored to each individual CURRENT OUTCOMES-TRAINED & UNTRAINED; Pathway from untrained to trained, and from competent, to proficient and to expert Requires modular and staged credentialing Formal recognition of specific capabilities and specific points in career Credentialed (certified) level of practice Regulation of credentialed achievements Transferability Enhances patient safety and clinical governance Recognises capability and expertise in career grade posts Post CCT credentialing and Lifelong learning
  • Extending the foundation programme to 3 years will provide broad based training while allowing the third year to be themed towards the specialty to which the trainee will apply for a core training programme.
  • Credentialing points will occur at intervals during training, for example the 2 shown here: after FP and after Core. A doctor credentialed to the second level will be able to practice with indirect supervision within a prescribed area of capability. FLEXIBILITY: A new structure for PGME should allow flexibility to enter and exit training throughout a trainee’s career consequently movement between training and service posts should be possible each way and at many levels. Modular credentialing will clarify what capability is needed at each credentialing point and so will indicate what is needed to progress to a higher point of credentialing. TRAINING POSTS: Training posts provide different amounts of experiential learning but this has not been quantified. The new model will allow trainees to chose their rate of progress through credentialingpoints: for example, fast track through the training programme in posts providing comprehensive training or take longer through less intense training posts interspersed with service posts.

Transcript

  • 1. Modernising Medical Careers www.mmc.nhs.uk
  • 2. The workforce of the future: Realistic career planning Dr Alison Carr Dean Adviser MMC England www.mmc.nhs.uk
  • 3. From recent trainee feedback
    • Training should
    • be seen as a journey,
    • not a forced route,
    • not a race.
    www.mmc.nhs.uk
  • 4. What’s 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
    www.mmc.nhs.uk
  • 5. A view of the long term Changing needs of patients and the service Some 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
    www.mmc.nhs.uk
  • 6. A view of the long term Changing needs of patients and the service Some 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!
    www.mmc.nhs.uk
  • 7. 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
    www.mmc.nhs.uk
  • 8. Tooke Inquiry Model www.mmc.nhs.uk 4 Core Specialty Stems 3 Years Higher Specialty Training 1 Year Selection Selection Selection FOUNDATION PROGRAMME
  • 9. 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)
    www.mmc.nhs.uk
  • 10. “ Mixed economy” model www.mmc.nhs.uk FOUNDATION PROGRAMME Core Training2-3 Years Higher Specialty Training Run Through Training 2 Years Selection Selection Selection Selection
  • 11. Possible future structures of education: Current Thinking www.mmc.nhs.uk Core Training 2-3 Years Higher Specialty Training Run Through Training Selection Selection Selection Selection Broad Based Training FOUNDATION PROGRAMME 3 Years Themed
  • 12. Possible future structures of education: Current Thinking www.mmc.nhs.uk Core Training 2-3 Years FOUNDATION PROGRAMME Run Through Training 3 Years Broad Based Training Themed Higher Specialty Training Credentialing Credentialing Service Posts Flexibility Recognition that training posts provide different amounts of experiential learning
  • 13. Short term view – latest competition data?
    • Current excess of ‘core posts’ over higher specialist training posts in medicine & surgery
      • Surgery up to 3:1, Medicine up to 2:1
    • Historic geographic disparity between ‘core posts’ & HST posts
      • (e.g. better chances in Oxford, lower in Midlands)
    • General surgery and T&O producing excess CCT holders – likely to reduce posts
    • 400 additional GP posts in 2009 and more to follow
    www.mmc.nhs.uk
  • 14. Reduce 100 ST3 posts for next 5 yrs www.mmc.nhs.uk
  • 15. Reduce 100 posts for next 6 years www.mmc.nhs.uk
  • 16. 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)
    www.mmc.nhs.uk
  • 17.
    • 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
  • 18.
    • 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
  • 19. Implications: Current training number plans
    • *
    www.mmc.nhs.uk + additional non-ST1 posts e.g. uncoupled specialty posts at ST3 FP Intake ST1 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
  • 20. Competition Ratios 2007
    • 37,000 applicants made 129,000 applications for 17,887 posts
    • Competition ratio overall 2:1 (applicants: posts)
    • Applications per post
      • Cardiothoracic surgery 53.8:1
      • Trauma & Orthopaedics 22.5:1
      • Core Medical Training 6.3:1
    www.mmc.nhs.uk
  • 21. Competition Ratios ST3/4 03 07 www.mtas.nhs.uk 2558 6702 9661 1st choice applications for 4022 ST3 posts 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
  • 22. Competition Ratios ST1 03 07 www.mtas.nhs.uk 4972 8246 12807 1st choice applications for 7577 ST1 posts 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
  • 23. 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
  • 24. Competition Ratios 2007
    • 37,000 applicants made 129,000 applications for 17,887 posts
    • Competition ratio overall 2:1 (applicants: posts)
    • Applications per post
      • Cardiothoracic surgery 53.8:1
      • Trauma & Orthopaedics 22.5:1
      • Core Medical Training 6.3:1
    • 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 10.3:1
    Competition Ratios 2008
      • CT Surgery 12.4: 1
      • T&O 54.4: 1
      • CMT 9.1: 1
  • 25. Short term view – latest competition data?
    • Application ratios for ST1 in 2008
    www.mmc.nhs.uk * Are competition ratios as 1 application made per applicant 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
  • 26. 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
    www.mmc.nhs.uk
  • 27. 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
    www.mmc.nhs.uk
  • 28. 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
    www.mmc.nhs.uk
  • 29. 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
    www.mmc.nhs.uk
  • 30.
    • Your Views?
    • Your Questions?
    www.mmc.nhs.uk www.mmc.nhs.uk
  • 31. Modernising Medical Careers www.mmc.nhs.uk