The CfWI presented three papers at the Business Systems Laboratory International Symposia on 21 January. This presentation looks at the CfWI's robust workforce planning framework and looks at the CfWI uses system dynamics modelling and policy analysis.

1. Business Systems Laboratory 3rd International Symposium
ADVANCES IN BUSINESS MANAGEMENT. TOWARDS SYSTEMIC APPROACH
Developing robust workforce policies
for the English health and social care
system using system dynamics
Perugia, Italy - January 21-23, 2015
Dr Siôn Cave
Decision Analysis Services Ltd, England
Jack Lawrence
Modeller, CfWI, England
Dr Graham Willis
Head of R&D, CfWI, England
Daniele Gioe’
Modeller, CfWI, England

2. Business Systems Laboratory 3rd International Symposium
ADVANCES IN BUSINESS MANAGEMENT. TOWARDS SYSTEMIC APPROACH
Agenda
Background
Robust workforce planning
Past, present and future of SD modelling
Reflections on SD for policy analysis
1
2
3
4

3. The English health and social care system
is large and complex
CfWI (2014). Horizon 2035: Health and care workforce futures - Progress update

4. What size and type of workforce do
we need?
Do we trust this?
Fulltimeequivalents
Year
Now 2040
?
Supply
Demand

5. We need to understand the uncertaintyFulltimeequivalents
Year
Now 2040
Supply
Demand

6. Robust workforce planning
Understand
the system
Explore
the future
Simulate the
possibilities
Make robust
decisions
Focal
question
Transparent and participatory

7. Applying the Robust Workforce Planning
Framework
Horizon scanning
Scenario generation
Workforce modelling
Policy analysis

8. System dynamics modelling
Demand
side
Outputs
Supply
side

9. Robust and published development
approach
Workforce Modelling
Horizon Scanning Scenario Generation Policy Analysis
Model scoping
Model construction
Model documentation
Model testing

10. First application for policy analysis
Medical and dental
school intake project
To ensure an adequate and
affordable supply of good quality
trained doctors and dentists
To advise on future total intakes to
undergraduate medical and dental
training in England

11. Timeline for the medical and dental school
intake project
Horizon scanning
Scenario generation
Workforce modelling
Policy analysis
Aug 2011 Feb 2012 Oct 2012
January 2013

12. High level supply structure
Stakeholders
• DH’s Workforce Data and Analysis Team
• Health and Social Care Information Centre
• BMA
• GMC and specific deaneries
• UCAS
• NHS Pensions
• Medical project reference group
• + National road shows….
GP
Medical school Foundation 1
Career post
Foundation 2 Core training
Run-through training
GP training
Higher specialty training Trained hospital doctors
33,800
34,000
34,200
10 15 20 25 30 35 40
6,000
6,500
10 15 20 25 30 35 40
5,500
6,000
6,500
10 15 20 25 30 35 40
7,000
8,000
10 15 20 25 30 35 40
7,300
7,500
10 15 20 25 30 35 40
6000
6500
7000
10 15 20 25 30 35 40
12200
12300
10 15 20 25 30 35 40
0
50000
10 15 20 25 30 35 40
0
100000
10 15 20 25 30 35 40
0
50000
10 15 20 25 30 35 40
2011 = 34,069* 2011 = 6,081 2011 = 6,341
2011 = 7,765 2011 = 35,803
2011 = 7,346
2011 = 6,524 2011 = 12,252 2011 = 39,088
2011 = 19,687
* Based on the sum of inflows – course drop
outs accounted for at the end of the course

13. Implementation in System Dynamics
software
13
Medical School
EnglandStart Medical
School English
Start Medical
School From OOC
Medical School
Attrition
Complete
Medical School
Medical School
Complete Attrition
Leave System
Foundation
Year 1
Start F1
Resit F1
Foundation
Year 2
Start F2
Resit F2
Foundation 1
Attrition
Foundation 2
Attrition
Finish F1 Finish F2
Start F1 From
OES
Start F2 From
OES
Seeking
Training or
Career Post
Core Training
Higher
Specialty
Training
Run Through
Training
GP Training
Career Post
Without CESR
GP
Hospital
Consultant
Start GP Training
From English
System
Start Core Training
From English Medical
System
Start Run Through
Training From English
System
Complete Core
Training
Start Higher
Specialty
Training from
English Medical
System
Complete Higher
Specialty Training
Complete GP
Training
Hospital
Consultant to
GP Training
Start Hospital
Consultant to GP
Conversion Training
Complete Hospital
Consultant to GP
Conversion Training
Seeking GP
Position Start GP Position
Following Training
Seeking
Hospital
Consultant
Position
Complete Run
Through Training
Start Hospital
Consultant Position
Following Training
Start GP Training
From OES
Start Core Training
From OES
Start Run Through
Training From OES
Start Higher
Specialty Training
From OES
Start GP Position
From OES
Start Hospital
Consultant Position
From OES
Start Career
Post
Career Post
With CESRCareer Post
Gains CESR
Career Post With CESR
Become Hospital
Consultants
Start Seeking Training
or Career Post After
Career Post
Start Seeking
GP Position
Complete GP
Training Leave
System
Complete Higher
Specialty Training
Leave System
Start Seeking Hospital
Consultant Position after
Run Through Training
Complete Run
Through Training
Leave System
Complete Core
Training Leave
System
Complete Consultant
Training Core Start
Seeking Career Post
GP Training Attrition
Leave Medical System
GP Run Through Training
Attrition Rate Start Seeking
Training Or Career Post
Run Through Training
Attrition Rate Leave
System
Run Through Training
Attrition Rate Start Seeking
Training Or Career Post
Higher Specialty
Training Attrition Rate
Leave System
Higher Specialty Training
Attrition Start Seeking
Training Or Career Post
Core Training
Attrition Rate Leave
System
Core Training Attrition
Start Seeking Training
Or Career Post
Career Post Attrition
Rate Leave System
Career Post With
CESR Leave System
Start Career Post
With CESR From
OES
Start Career
Post From OES
GP Attrition
Leave System
Hospital Consultant
Attrition Leave System
Complete F2 Start
Seeking Training or
Career Post
Pass F2 Leave
System
Percentage of Medical
School Intake That Will Drop
Out
<100 Percent>
Percentage of the Students
that start F1 that will Drop
Out
<100 Percent>
Percentage Students Fail
Foundation 1 and Resit
<100 Percent>
Initial Foundation 1
<100 Percent>
Percentage Students Fail
Foundation 2 and Resit
<100 Percent>
Initial Foundation 2
Pass F2
Percentage Student Pass
F2 And Leave System
<100 Percent>
GP Attrition Rate
<100 Percent>
Initial GP
Initial Hospital Consultants
in GP training
Hospital Consultant Attrition
Rate
Initial Hospital Consultant
<100 Percent>
Percentage Career Post
Gain CESR Per Year
Initial Career Post
<100 Percent>
GP Training Attrition Rate
Leave Medical System
<100 Percent>
GP Training Attrition Rate
Seeking Training or Career
Post
<100 Percent>
Percentage Complete GP
Training And Leave System<100 Percent>
Time to find GP Position
Run Through Training
Attrition Rate Leave Medical
System
<100 Percent>
Run Through Training
Attrition Rate Seeking
Training or Career Post
<100 Percent>
Start Seeking
Hospital Consultant
Position after Higher
Specialty Training
Percentage Complete Run
Through Training And Leave
System
<100 Percent>
Percentage Complete
Higher Specialty Training
And Leave System
<100 Percent>
Time to find Hospital
Consultant position
Initial Seeking Hospital
Consultant Position
Initial Seeking GP Position
Core Training Attrition Rate
Leave Medical System
<100 Percent>
Core Training Attrition Rate
Seeking Training or Career
Post
<100 Percent>
<100 Percent>
Percentage Complete Core
Training And Leave System
<100 Percent>
Higher Specialty Training
Attrition Rate Leave Medical
System
Higher Specialty Training
Attrition Rate Seeking
Training or Career Post
<100 Percent>
Initial Seeking Training or
Career Post
Initial Career Post With
CESR
Average Time to find Career
Post
<100 Percent>
<100 Percent>
<100 Percent>
Annual Medical School
Intake From England
FLAG Start
Accademic Year
<Time>
<TIME STEP>
Accademic Year
Start Date
Time Spent In Medical
School By DelayLength
Annual Medical School
Intake From Outside Of
Country
<TIME STEP>
<100 Percent>
1 Year
<100 Percent>
Complete F2
Including Attrition
Percentage of the Students
that start F2 that will Drop
Out
<100 Percent>
<100 Percent>
<Percentage Students Fail
Foundation 1 and Resit>
<Percentage Students Fail
Foundation 2 and Resit>
<100 Percent>
GP Training Length
Including Delay Percentage
Start GP
Training
Start and Continue GP
Training By Remaining
Delay
<100 Percent>
<FLAG Start
Accademic Year>
Complete GP
Training
Accademic Year
<TIME STEP>
<TIME STEP>
<TIME STEP>
<FLAG Start
Accademic Year>
Complete GP Training
and Progress To Next
Year
Start Run
Through Training
Start and Continue Run
Through Training By
Remaining Delay Run Through Training Length
Including Delay Percentage
<TIME STEP>
<FLAG Start
Accademic Year>
<TIME STEP>
Complete Run
Through Training
Accademic Year
<TIME STEP>
Complete Run Through
Training and Progress To
Next Year
<100 Percent>
Start Core
Training
Start and Continue
Core Training By
Remaining Delay
<TIME STEP>
<FLAG Start
Accademic Year>
<TIME STEP>
Complete Core Training
Accademic Year
<TIME STEP>
Complete Core
Training and Progress
To Next Year
<100 Percent>
Start Higher
Specialty Training
Start and Continue Higher
Specialty Training By
Remaining Delay
Higher Specialty Training
Length Including Delay
Percentage
<100 Percent>
<FLAG Start
Accademic Year>
<TIME STEP>
<FLAG Start
Accademic Year>
<TIME STEP>
Complete Higher
Specialty Training
Accademic Year
<1 Year>
Complete Higher
Specialty Training and
Progress To Next Year
<100 Percent>
Foundation Year 2
TOTAL
Seeking Training or
Career Post TOTAL
GP Training TOTAL
Run Through Training
TOTAL
Core Training TOTAL
Higher Specialty
Training TOTAL
Career Post Without
CESR TOTAL
Career Post With
CESR TOTAL
Seeking Hospital
Consultant Position
TOTAL
Hospital Consultant
TOTAL
Hospital Consultant to
GP Training TOTAL
Seeking GP
Position TOTAL
GP TOTAL
<TIME STEP>
<FLAG Start
Accademic Year>
<100 Percent>
GP Training New
Entrants
<FLAG Start
Accademic Year>
<TIME STEP>
Foundation TOTAL
Training Run
Through New
Entrants
<TIME STEP>
<FLAG Start
Accademic Year>
Higher Specialty Training
New Entrants
<TIME STEP>
<FLAG Start
Accademic Year>
<TIME STEP>
<FLAG Start
Accademic Year>
Number of CCT
Consultant Per Year
<TIME STEP>
<FLAG Start
Accademic Year>
Number Completing
Core Training
<TIME STEP>
<FLAG Start
Accademic Year>
Start Consultant
Training Core TOTAL
<TIME
STEP> <FLAG Start
Accademic Year>
Pass F2 TOTAL
<TIME STEP>
<FLAG Start
Accademic Year>
Number of Completing
Consultant Training
HS
<TIME STEP>
<FLAG Start
Accademic Year>
<100 Percent>
<Time>
<INITIAL TIME>
<Time>
<INITIAL TIME>
<INITIAL TIME>
<Time>
<INITIAL TIME>
<Time>
<INITIAL TIME>
<Time>
<INITIAL TIME>
<Time><INITIAL TIME>
<Time>
<100 Percent>
<100 Percent>
<INITIAL TIME> <Time>
<INITIAL TIME>
<Time> <INITIAL TIME>
<Time>
<100 Percent>
<INITIAL TIME>
<Time>
<INITIAL TIME>
<Time>
<INITIAL TIME>
<Time>
<INITIAL TIME>
<Time>
<TIME STEP>
<INITIAL TIME>
<Time>
<TIME STEP>
<Time>
<INITIAL TIME>
<Time>
Annual F1 Intake From
Outside Of English System
<TIME STEP><FLAG Start
Accademic Year>
Annual F2 Intake From
Outside Of English System
<FLAG Start
Accademic Year> <TIME STEP>
Annual GP Training Intake
From Outside Of English
System
<TIME STEP>
<INITIAL TIME>
<Time>
Annual Run Through Intake
From Outside Of English
System
<INITIAL TIME>
<TIME STEP>
<FLAG Start
Accademic Year>
Annual Core Training Intake
From Outside Of English
System <INITIAL TIME>
<Time> <TIME STEP>
Annual Higher Specialty
Training Intake From
Outside Of English System
<INITIAL TIME>
<Time>
<TIME STEP>
Annual Career Post Without
CESR Intake From Outside
Of English System
Annual Career Post With
CESR Intake From Outside
Of English System
Annual Hospital Consultant
Intake From Outside Of
English System
Annual GP Intake From
Outside Of English System
<FLAG Start
Accademic Year>
<TIME STEP>
<TIME STEP>
<TIME STEP>
GP TOTAL By Gender
Start Consultant or GP
Training From Career
Post
Start Higher Specialty
Training From Career
Post
<TIME STEP>
Time to Complete
Consultant to GP
Conversion Training
Annual Hospital Consultant
Start GP Conversion
Training
<TIME STEP>
<INITIAL TIME>
Complete
Consultant Core
Training Available
For Higher
Specialty Training
<TIME STEP>
Start Consultant or GP
Training Core Career Post
TOTAL
<FLAG Start
Accademic Year>
GP Training TOTAL
By Gender
Career Post Without
CESR TOTAL By Gender
Run Through Training
TOTAL By Gender
Core Training TOTAL
By Gender
<Initial Medical School
By Completion Year>
<Start Core Training
From F2>
<Start Core Training
From Career Post>
<Start GP Training From
F2>
<Start GP Training
From Career Post>
<Start Run Through
Training From F2>
<Start Run Through
Training From Career
Post>
<Initial GP Training By
Delay Length>
<FLAG Start
Accademic Year>
<Initial Run Through
Training By Delay
Length>
<FLAG Start
Accademic Year>
<Initial Run Through
Training By Delay
Length>
<Initial Higher
Specialty Training
By Delay Length>
<Initial Higher Specialty
Training By Delay
Length>
<Initial Core Training
By Delay Length>
Core Training Length
Including Delay Percentage
<Initial Core Training By
Delay Length>
Start GP Position
Rejoiners
Annual GP Rejoiners
Start Hospital
Consultant Position
Rejoiner
Annual Hospital Consultant
Rejoiners
Start Career Post
With CESR Rejoiner
Annual Career Post With
CESR Rejoin
Start Career
Post Rejoiners
Annual Career Post Without
CESR Rejoin
<FLAG Start
Accademic Year>
InputString
TimeLine
<TIME STEP>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine> <InputString
TimeLine>
<InputString
TimeLine><InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine> <InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine> <InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
Start Consultant C RT or
GP Training RT From
Career Post TOTAL
<TIME STEP>
Start Career Post
TOTAL
<100 Percent>
Annual Career Post With
CESR Become Hospital
Consultants
<InputString
TimeLine>
<TIME STEP>
Seeking
Training or
Career Post
Core Trained
Seeking Training or
Career Post Completed
Core Training TOTAL
Career Post
Completed
Core Training
Career Post
Completed Core
Training Gains CESR
Career Post Completed
Core Training Attrition
Rate Leave System
Start Career Post
Completed Core
Training From OES
<100 Percent>
Initial Career Post
Completed Core Training
<100 Percent>
Annual Career Post
Completed Core Training
Intake From Outside Of
English System
<FLAG Start
Accademic Year>
Career Post Completed
Core Training TOTAL
By Gender
Start Career Post
Completed Core
Training Rejoiners
Annual Career Post
Completed Core Training
Rejoin
<InputString
TimeLine>
<InputString
TimeLine>
Start Career Post
Completed Core
Training
<Average Time to find
Career Post>
<Percentage Career Post
Gain CESR Per Year>
<100 Percent>
Initial Seeking Training or
Career Post Completed
Core Training <InputString
TimeLine>
<Number Start Higher
Specialty Training From
Career Post Completed
Core Training>
Start Seeking Higher
Specialty Training From
Career Post
<TIME STEP>
<Number Start Higher Specialty
Training From Career Post
Completed Core Training>
Foundation Year 2
TOTAL By Gender
<Start GP Training
From Career Post>
<Start Run Through
Training From Career
Post>
<Start Core Training
From Career Post>
Foundation Year 2
TOTAL Gender Ratio
Start F2 TOTAL
<TIME STEP>
<FLAG Start
Accademic Year>
Start F1 TOTAL
<TIME STEP>
GP Training Gender
Ratio
Career Post Completed
Core Training TOTAL
<Time>
Initial Seeking Training Or
Career Post Age Profile
<100 Percent>
Annual GP Training Intake
From Outside Of English
System Age Profile
<100 Percent>
Initial Seeking GP Position
Age Profile
<100 Percent>
Initial GP Age Profile
<100 Percent>
Annual GP Intake From
Outside Of English System
Age Profile
<100 Percent>
Start GP Position Rejoiners
Age Profile
<100 Percent>
Initial Hospital Consultant to
GP Training Age Profile
<100 Percent>
Initial Hospital Consultant
Age Profile
<100 Percent>
Annual Hospital Consultant
Intake From Outside Of
English System Age Profile
<100 Percent>
Annual Hospital Consultant
Rejoiners Age Profile
<100 Percent>
Seeking Hospital Consultant
Position Age Profile
<100 Percent>
Annual Career Post With
CESR Rejoin Age Profile
<100 Percent>
Annual Career Post With
CESR Intake From Outside
Of English System Age
Profile
<100 Percent>
Initial Career Post With
CESR Age Profile
<100 Percent>
Annual Career Post
Completed Core Training
Intake From Outside Of
English System Age Profile
<100 Percent>
Annual Career Post
Completed Core Training
Rejoin Age Profile
<100 Percent>
Initial Career Post
Completed Core Training
Age Profile<100 Percent>
Initial Seeking Training or
Career Post Completed
Core Training Age Profile
<100 Percent>
Annual Career Post Without
CESR Intake From Outside
Of English System Age
Profile
<100 Percent>
Annual Career Post Without
CESR Rejoin Age Profile
<100 Percent>
Initial Career Post Without
CESR Age Profile
<100 Percent>
Annual Core Training Intake
From Outside Of English
System Profile
<100 Percent>
<100 Percent>
Annual Higher Specialty
Training Intake From
Outside Of English System
Age Profile
<100 Percent>
<100 Percent>
Annual Run Through Intake
From Outside Of English
System Age Profile
<100 Percent>
<100 Percent>
Career Post With
CESR Age Ratio
Career Post Without
CESR Age Profile
<100 Percent>
Career Post
Completed Core
Training Age Profile
<100 Percent>
Number Complete Core
Start Seeking Career
Post
<TIME STEP>
<FLAG Start
Accademic Year>
<Career Post
Completed Core
Training Age Profile>
<TIME STEP>
<TIME STEP>
<100 Percent>
Aging
S T
CP
Aging
GP T
Aging
GP T
AR LS
Aging
GP T
AR
SToCP
GP Training TOTAL
By Age
Aging
S GP Aging
GP
<TIME STEP>
GP TOTAL By COO
Aging
RT T
Aging
RT T
AR ST
orCP
Aging
RT T
AR
SToCP
Aging
HCto
GP T
Start Hospital Consultant
to GP Conversion Training
TOTAL
Complete Hospital
Consultant to GP
Conversion Training
TOTAL
<100 Percent>
Aging
HCAging
S HC
Aging
CP
Aging
CPw
CESR
Aging
CPw
CT
Aging
SCPo
T wCT
Aging
CT T
Aging
CT AR
STor
CP
Aging
CT AR
LS
Aging
HS T
Aging
HS T
AR LS
Aging
HS T
AR SC
PoT
<InputString
TimeLine>
Career Post Without
CESR Age Profile By
Age Band
Career Post Attrition Rate
<Career Post Attrition Rate>
<Career Post Attrition Rate>
<InputString
TimeLine>
Core Training TOTAL
By Age
Core Training
RATIO Age
GP TOTAL By Age
GP RATIO By Age
<100 Percent>
<Start Seeking Higher
Specialty Training
From Career Post>
<Seeking Training or Career Post>
Career Post Without
CESR TOTAL By COO
GP Training New
Entrants From English
System
<TIME STEP>
<FLAG Start
Accademic Year>
Training Run Through
New Entrants From
English System
<TIME STEP>
Start Core From English
System TOTAL
<TIME STEP>
<FLAG Start
Accademic Year>
<FLAG Start
Accademic Year>
<Percentage Start
Higher Specialty
Training>
<FLAG Start
Accademic Year>
Hospital Consultant
TOTAL By COO
Hospital Consultant
TOTAL By Gender
<Percentage Complete Run
Through Training And Leave
System>
<Percentage of the
Students that start F1 that
will Drop Out>
<Start and Continue GP
Training By Remaining
Delay>
<Career Post With
CESR>
<Career Post With
CESR Age Ratio>
<Percentage Start
Higher Specialty
Training>
F1 Complete
Attrition Leave
System
<100 Percent>
Pass F1
<100 Percent>
<Percentage Complete
F1 And Leave System
Including F2 Limits>
<Percentage Complete
Medical School And Leave
System Including F1 Limits>
<INITIAL TIME>
<Time>
<INITIAL TIME>
<Time>
Start Consultant CT From
Career Post TOTAL
Start Consultant RT From
Career Post TOTAL
Start Consultant GP Training
RT From Career Post TOTAL
<FLAG Start
Accademic Year>
<Time>
Annual Medical School Intake
From England Age Profile
Annual Medical School
Intake From Outside Of
Country Age Profile
<InputString
TimeLine>
Initial Foundation 1 Age
Profile
<InputString
TimeLine>
Annual F2 Intake From
Outside Of English
System Age Profile
<InputString
TimeLine>
Annual F1 Intake From
Outside Of English
System Age Profile
<InputString
TimeLine>
Initial Foundation 2 Age
Profile
<InputString
TimeLine>
<100 Percent>
<100 Percent> <100 Percent>
<100 Percent>
Aging
F2
Aging
F1
Aging
MS
Start Medical
School
<FLAG Start
Accademic Year>
Complete Study Year
and Progress To Next
Year
Start And
Continue Medical
School
<TIME STEP>
Foundation Year 2
TOTAL By Age
Finish F2 TOTAL
<TIME STEP>
Sum Finish F2 Age
MS F
Sum Finish F2 Age
Workforce
<Flag Aging Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<100 Percent>
<TIME STEP>
<Time>
<INITIAL TIME>
<GP Attrition Rate Inc
Scn and Pol and Max
Age Adj>
GP Attrition Rate
TOTAL
<100 Percent>
<TIME STEP>
<1 Year>
<Hospital Consultant
Attrition Rate Inc Scn and
Pol and Max Age Adj>
<1 Year>
<Career Post Attrition
Rate Inc Scn and Pol and
Max Age Adj>
<Start Seeking Training or
Career Post After Career
Post>
<TIME STEP>
<1 Year>
<Career Post Attrition
Rate Inc Scn and Pol and
Max Age Adj>
<Career Post With CESR
Become Hospital
Consultants>
<TIME STEP>
<1 Year>
<Career Post Attrition Rate
Inc Scn and Pol and Max
Age Adj>
<1 Year>
Pass F2 And Stay
In System TOTAL
<TIME STEP>
Career Post With CESR
Become Hospital
Consultant TOTAL
<TIME STEP>
<FLAG Start
Accademic Year>
Foundation Year 2
TOTAL By Gender
and COO
GP Training TOTAL
By Gender and COO
GP TOTAL By Gender
and COO
Run Through Training
TOTAL By Gender and
COO
Core Training TOTAL
By Gender and COO
Higher Specialty
Training TOTAL By
Gender and COO
Hospital Consultant
TOTAL By Gender and
COO
Career Post Without
CESR TOTAL By Gender
and COO Career Post With
CESR TOTAL By
Gender and COO
Career Post Completed
Core Training TOTAL By
Gender and COO
Hospital Consultant to GP
Training TOTAL By
Gender and COO
<Start GP Training To
Meet Desired Places>
<Time>
<TIME STEP>
<Start Run Through
Training To Meet Desired
Places>
<Start Core Training To
Meet Desired Places>
<Start Higher Specialty
Training To Meet Desired
Places>
Hospital
Consultant
Attrition Rate
TOTAL
<100 Percent>
Hospital Consultant
TOTAL Percentage
Increase
<100 Percent>
<TIME STEP>
Number Completing
Run Through
Training
<TIME STEP>
<FLAG Start
Accademic Year>
Number Completing
GP Training Core By
Gender
<TIME STEP>
<FLAG Start
Accademic Year>
<FLAG Start
Accademic Year>
<Percentage of the
Students that start F2 that
will Drop Out>
<Initial Hospital Consultant>
<Time>
GP Total By 10 Yr
Age Bands
Hospital Consultant
TOTAL By Age
Hospital Consultant
Total By 10 Yr Age
Bands
Number Completing
GP Training Core By
Age
<TIME STEP>
Number Completing GP
Training Core By Age
By 10 Yr Age Bands
<Start Seeking Hospital
Consultant Position after
Higher Specialty Training>
<Start Seeking Hospital
Consultant Position after Run
Through Training>
<Start Hospital
Consultant to GP
Conversion Training>
If this structure is
implemented may want to
consider using a different
delay type
<Initial GP Training By
Delay Length>
<Initial Run Through
Training By Delay
Length>
<Initial Core
Training By Delay
Length>
<Initial Higher Specialty
Training By Delay
Length>
Hospital Consultant
Attrition Rate Fixed
for 12 Months
<100 Percent>
Flag
Attrition
Trigger
Fixed Attrition
Rate Start Date<Time>
<TIME STEP>
<INITIAL TIME>
GP Attrition Rate Fixed
for 12 Months
<Flag
Attrition
Trigger>
<100 Percent> <TIME STEP>
<1 Year>
Career Post With
CESR Attrition Rate
Fixed for 12 Months
<Flag
Attrition
Trigger>
<100 Percent>Career Post Without
CESR Attrition Rate
Fixed for 12 Months
<Flag
Attrition
Trigger><100 Percent>
Career Post Completed
Core Training Attrition
Rate Fixed for 12 Months
<Flag
Attrition
Trigger>
<100 Percent>
GP Training
Attrition Delayed by
1TS
<TIME STEP>
Run Through Training
Attrition Delayed by
1TS
<TIME STEP>
Core Training
Attrition Delayed by
1TS
<TIME STEP>
Higher Specialty
Training Attrition
Delayed by 1TS
<TIME STEP>
Start Hospital
Consultant Position
Following Training
TOTAL by Age
<TIME STEP>
<FLAG Start
Accademic Year>
<1 Year>
<1 Year>
<1 Year>
<1 Year>
<Percentage Training
Entrants From English
System Start GP
Training>
Complete F1
TOTAL
<TIME STEP>
<FLAG Start
Accademic Year>
Number Completing GP
Training Core
<TIME STEP>
Start GP Training
From F2 TOTAL
<FLAG Start
Accademic Year>
Start GP Training
From Career Post
TOTAL
Start Run Through
Training From F2
TOTAL
<FLAG Start
Accademic Year>
Start Run Through
Training From Career
Post TOTAL
Start Core
Training From F2
TOTAL
<FLAG Start
Accademic Year>
Start Core Training
From Career Post
TOTAL
Number Start HST from
Career Post
<FLAG Start
Accademic Year>
Start HST from
English System
TOTAL
<FLAG Start
Accademic Year>
<TIME STEP>
<TIME STEP>
<Higher Specialty Training
Attrition Start Seeking
Training Or Career Post>
<Complete Consultant
Training Core Start Seeking
Career Post>
<TIME STEP>
<GP Run Through Training
Attrition Rate Start Seeking
Training Or Career Post>
<Run Through Training
Attrition Rate Start Seeking
Training Or Career Post>
<Core Training
Attrition Start Seeking
Training Or Career
Post>
<Start Seeking Higher
Specialty Training From
Career Post>
<TIME STEP>
• 15 separate influence
diagrams
• 997 distinct variables
• Initialised with 903,525
data items
• Segmented by age and
gender
Model takes approximately
10 seconds to simulate.

14. Impact
The SD approach enabled rapid quantitative policy analysis.
Future supply of doctors projected to exceed future demand in all scenarios
examined.
Influenced HENSE group to recommend a 2% reduction in medical school
intake from 2013, to be reviewed in 2014 and regularly at 3yr intervals. This is
approximately 120 medical students.
Many policy options tested, including rebalancing primary and secondary
workforce.

15. Where system dynamics has been used so
far…
Jan 2012 Jan 2013 Jan 2014
Medical and dental school intake
Pharmacy workforce
Speech and language therapy workforce
obstetricians and gynaecologists
Trauma and orthopaedic surgeons
Social care workforces
Anaesthetist workforce
Dental care professionals workforce
Dental workforce
Psychiatrist workforce
General practitioners
Jan 2015
Horizon 2035

16. Considering the workforce system as a
whole

17. A new challenge:
Horizon 2035 – A system level analysis
What skills and
competences do
we have?
What might we need
in future?

18. Framework + system = insights
Numbers
Skills
Costs
Supply
Demand
People and skills?
Workforce groups?
Training?
Education?
Money?
Future
challenges?
Skills
gap and
overlaps?
Idea skill
mix?

19. Reflections…
Systemic
Future-oriented
Flexible
Transparent
Inclusive
Comprehensive
Understandable
System dynamics and Systems Thinking methods are being
used to inform UK health and social care policy

20. More information on CfWI’s work is
available online…
www.cfwi.org.uk/publications/a-strategic-
review-of-the-future-pharmacist-workforce
www.cfwi.org.uk/publications/a-strategic-
review-of-the-future-dentistry-workforce-
informing-dental-student-intakes
www.cfwi.org.uk/publications/gp-in-depth-
review-preliminary-findings
www.cfwi.org.uk/publications/a-strategic-
review-of-the-future-healthcare-workforce-
informing-medical-and-dental-student-
intakes-1
Workforce
studies
Method
based

21. Contact details
Dr Graham Willis
Head of Research and Development
CfWI, England
@
+44(0)7812 340 405
Graham.Willis@cfwi.org.uk
www.cfwi.org.uk | www.horizonscanning.org.uk
Dr Siôn Cave
Decision Analysis Service Ltd, England
+44(0)7825 758 139
SionCave@DAS-Ltd.co.uk
Questions welcomed…

22. Business Systems Laboratory 3rd International Symposium
ADVANCES IN BUSINESS MANAGEMENT. TOWARDS SYSTEMIC APPROACH
Developing robust workforce policies
for the English health and social care
system using system dynamics
Perugia, Italy - January 21-23, 2015
Dr Siôn Cave
Decision Analysis Services Ltd, England
Jack Lawrence
Modeller, CfWI, England
Dr Graham Willis
Head of R&D, CfWI, England
Daniele Gioe’
Modeller, CfWI, England