Cfwi sd boston v1
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The document discusses robust workforce planning for the English medical workforce. It outlines the challenges of workforce planning in the health sector due to complex training pathways and uncertainties. It then describes the MDSI project which used a robust workforce planning framework involving horizon scanning, scenario generation, workforce modelling and policy analysis to advise on medical school intakes to 2040. A key part of the framework was developing a system dynamics model to better understand the dynamic behavior of the workforce system over time.
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Cfwi sd boston v1
- 1. Robust workforce planning for the English medical workforce Dr Graham Willis - Head of Research and Development Dr Andrew Woodward - Lead Modeller Dr Siôn Cave - Decision Analysis Services Ltd The CfWI produces quality intelligence to inform better workforce planning that improves people’s lives
- 2. Contents 1. The challenge of workforce planning in the health sector 2. Background to the MDSI project 3. Overview of CfWI’s robust workforce planning framework 4. Application of the framework to the MDSI project 5. The MDSI System Dynamics model 6. Impact of MDSI project and benefits of the planning framework
- 3. Workforce planning in healthcare Workforce planning is ensuring “The right people, with the right skills, in the right places, at the right time” The English National Health Service employs: 1.4 million people 140,000 Doctors 370,000 Nurses
- 4. Why do workforce planning? Cost of workforce – training and employment is expensive, we want to reduce wastage. Productivity – getting the most from our investments Safety – as patients we demand a safe service Quality – we all want the best possible outcomes
- 5. Challenges of health workforce planning Supply – based on current stock and the pipeline in/out. Complicated by factors such as: +60 specialties with 15 yrs of training Delays Attrition Part time working, work/life balance
- 6. Challenges of health workforce planning Demand – assessing affordable need for the future workforce Influenced by factors such as: patient population patient lifestyle who delivers the care, doctors/nurses/others? where will care be delivered? Community vs hospital The unknown
- 7. Contents 1. The challenge of workforce planning in the health sector 2. Background to the MDSI project 3. Overview of CfWI’s robust workforce planning framework 4. Application of the framework to the MDSI project 5. The MDSI System Dynamics model 6. Impact of MDSI project and benefits of the planning framework
- 8. MDSI goals 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 Approach Long-term planning to 2040 Recognise uncertainty Generate challenging futures Quantify the key factors Robust workforce planning
- 9. Contents 1. The challenge of workforce planning in the health sector 2. Background to the MDSI project 3. Overview of CfWI’s robust workforce planning framework 4. Application of the framework to the MDSI project 5. The MDSI System Dynamics model 6. Impact of MDSI project and benefits of the planning framework
- 10. Robust workforce planning framework Robust workforce planning framework
- 11. Workforce models require... Facts we know – like current training numbers and workforce Assumptions we make – where data is missing or poor quality, like attrition during training Parameters we can control – policy levers like intake to training or retirement age Uncertainties we can quantify – which vary between different futures, like workforce attrition
- 12. Contents 1. The challenge of workforce planning in the health sector 2. Background to the MDSI project 3. Overview of CfWI’s robust workforce planning framework 4. Application of the framework to the MDSI project 5. The MDSI System Dynamics model 6. Impact of MDSI project and benefits of the planning framework
- 13. Application to the MDSI project Project started August 2011 Horizon scanning Jan 2012 – 44 experts interviewed Scenario generation Jan to Feb 2012 – two 2-day workshops with 30 participants; over 200 drivers identified April to May – 58 people involved in Delphi process Workforce modelling Jan to Oct 2012 –Vensim models developed for medicine & dentistry Policy analysis Jul to Oct 2012 –stakeholder meetings and formal HENSE review group presentation Final report published on DH website Jan 2013
- 14. SD modelling is integral to the framework Horizon scanning Scenario generation Workforce modelling Policy analysis System dynamics… • Better understanding – dynamic behaviour of a system over time • Simplify complexity – rich picture of causality, feedback and delays • High stakeholder involvement–process provides as much value as end product • Robust decisions – avoid policies and futures that lead to unexpected consequences
- 15. Contents 1. The challenge of workforce planning in the health sector 2. Background to the MDSI project 3. Overview of CfWI’s robust workforce planning framework 4. Application of the framework to the MDSI project 5. The MDSI System Dynamics model 6. Impact of MDSI project and benefits of the planning framework
- 16. WORKFORCE MODELLING Policy Analysis Analyse the scenarios, and the impact of the levers we can control (potential strategies or policies) across scenarios Specification Specify the purpose of the workforce model, the scope and boundaries Documentation and Testing Full model documentation and independent validation and verification (V&V) Development Develop the supply and demand model using the System Dynamics method We apply a rigorous approach to SD modelling
- 17. 17 Model Requirement • Calculate supply and demand for the medical and dental workforces to 2040 • Segment the workforce by age and gender • Represent the training pipeline from entering university through to delivering service as fully qualified doctors and dentists • Represent the complex career paths for doctors and dentist following qualification • Execute rapidly and produce outputs that can be readily analysed • Be fully tested and documented, with an audit trail for all assumptions Data Availability Scenario / Policy Questions Specification Specification Specify the purpose of the workforce model, the scope and boundaries
- 18. 18 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…. Medical school Foundation1 Career post Foundation2 Core training Run-throughtraining GP training GP Higher specialty training Trained hospital doctors 33,800 34,000 34,200 10152025303540 6,000 6,500 10152025303540 5,500 6,000 6,500 10152025303540 7,000 8,000 10152025303540 7,300 7,500 10152025303540 6000 6500 7000 10 15 20 25 30 35 40 12200 12300 10152025303540 0 50000 10152025303540 0 100000 10152025303540 0 50000 10152025303540 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 Development Develop the supply and demand model using the System Dynamics method
- 19. 19 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> Development Develop the supply and demand model using the System Dynamics method
- 20. 20 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> Data included… Historic range Source Accepted applicants to preclinical dentistry 2007 –11 UCAS Medical school intakes 2007–11 Higher Education Funding Council for England Foundation programme data 2011 Foundation Programme Annual Report Medical and GP workforce census for England 2008–11 Health and Social Care Information Centre National population projections 2010 Office for National Statistics Hospital episode statistics for England 2010 –11 Health and Social Care Information Centre Scenario data Policy data Development Develop the supply and demand model using the System Dynamics method
- 21. 21 Testing included: 1. Independent CfWI testing 2. Comparison with medical workforce models 3. Review of the results with relevant stakeholders 4. Sensitivity analysis Documentation and Testing Full model documentation and independent validation and verification (V&V)
- 22. 22 30000 35000 40000 45000 50000 55000 60000 65000 70000 75000 80000 2010 2020 2030 2040 FTE Year Supply: scenario1& 2 Supplyafter policy: scenario1& 2 Demand: scenario1& 2 0.0% 0.5% 1.0% 1.5% 2.0% 2.5% 3.0% 3.5% 4.0% 20 30 40 50 60 70 80 Distribution Age Now 2040 -40000 -30000 -20000 -10000 0 10000 20000 30000 40000 -40000 -20000 0 20000 40000 Changeincumulativediscrepancy Changein cumulativecost Policy1 Policy2 Policy3 Scenario 1 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 2011 2016 2021 2026 2031 2036 Year Percentageof workforcefemale Percentageof workforcemale Analysis tools • Create, store and edit future scenarios • Create, store and edit potential policies • Store the results of multiple simulations • View and analyse the results of multiple scenarios Policy Analysis Analyse the scenarios, and the impact of the levers we can control (potential strategies or policies) across scenarios
- 23. Contents 1. The challenge of workforce planning in the health sector 2. Background to the MDSI project 3. Overview of CfWI’s robust workforce planning framework 4. Application of the framework to the MDSI project 5. The MDSI System Dynamics model 6. Impact of MDSI project and benefits of the planning framework
- 24. Impact… Future supply of doctors will 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. approx 120 medical students £50 Million saving per year Many policy options tested, including rebalancing primary and secondary workforce.
- 25. Reflections on the project Strong stakeholder buy-in to a completely new approach System dynamics modelling ‘made sense’ Using scenarios to test policies proved highly effective Major decisions were taken – to reduce medical intake and not change dental intake Enabled policy makers to recognised uncertainty of the future Approach accepted by DoH and has been/is being used for: Pharmacy Psychiatry General practitioner Anaesthetics & Intensive care medicine
- 26. Robust workforce planning for the English medical workforce Dr Graham Willis - Head of Research and Development Dr Andrew Woodward - Lead Modeller Dr Siôn Cave - Decision Analysis Services Ltd The CfWI produces quality intelligence to inform better workforce planning that improves people’s lives
- 27. 27
Editor's Notes
- S. Taylor, People and Organisations, Employee Resourcing (1998)Medical means doctors in this work
- S. Taylor, People and Organisations, Employee Resourcing (1998)
- S. Taylor, People and Organisations, Employee Resourcing (1998)
- S. Taylor, People and Organisations, Employee Resourcing (1998)
- Talk about why SD is so important for the overall framework – or perhaps this fits in better with Grahams bit about the overall framework
- that we have got an approach to modelling that reduces risk of not producing the right model for the task in hand, is aligned with the overall framework and maximises client engagementA core part of the Robust Planning Framework for workforce planning is the development of suplly and demand models to enable the impact of scenarios and policies to be understood and quantified.The use of a formal method means that the right model is developed for the task in hand, with appropriate time for consultation with stakeholders, data acquisition and testing.The methodology is composed of 4 key stages:TALK through these at a high level
- The workforce models were required to:Calculate the supply and demand for the medical and dental workforces from now through to 2040Segment the workforce by age and genderRepresent the training pipeline from entering university through to delivering service as fully qualified doctors and dentistsRepresent the complex career paths for doctors and dentist following qualificationIntegrate with large datasets from a variety of NHS and other official data sources Use the data from the Delphi workshops that define the attributes of the four scenariosEnable policy analysis to be carried out to determine the impact of different policies on the different scenariosExecute rapidly and produce outputs that can be readily analysedBe fully tested and documented, with an audit trail for all assumptionsAllow the sensitivity of the input assumptions to be determined.Due to the complexity of the model scope and scale it was decided that the system dynamics approach was best suited to meeting the modelling requirements. Not only does the method allow the complex processes to be represented and to integrate with the complex datasets, but as it based on a graphical representation of the system the stakeholders can be more readily involved in the model validation.Two models were developed, one for the medical workforce and the other for the dental workforce. The models were built using Vensim DSS and Excel. A user interface was developed using Excel to enable non-SD analysts to more easily use the model and carry out policy analysis.The model specification clearly defined the purpose of the model, and defined what was required in the model and equally importantly what was out of scope. The specification was based on the initial model requirement outline in Section 3 and ensured that the developed models only represented what was needed for the purposes of the HENSE review, thus preventing scope creep and mitigating against the risk of late delivery.
- The initial stages of model development were to map out the relevant processes of the training and career pathways with appropriate stakeholders from the medical and dental systems. The maps were created in Vensim and printed out to be shared with the stakeholders. In addition, the process maps were presented at a series of national road shows hosted by the CfWI, which enabled over 80 people to comment and amend the process maps. Numerous stakeholders helped to sense-check the accuracy of the models themselves or helped to provide or sense-check the data and modelling assumptions used. Key sources of help were the DH’s Workforce Data and Analysis Team, the Health and Social Care Information Centre, the BMA, GMC and specific deaneries, UCAS, NHS Pensions, and members of the medical project reference group. Annex A provides details of the stakeholders involved.The large degree of stakeholder engagement throughout the process mapping stage ensured high levels of stakeholder buy-in to the modelling process.
- Following process mapping the process maps were converted into a quantitative model. The model was developed using a combined Vensim and MS Excel architecture. MS Excel was used to create a user interface so that multiple scenarios and policies could be specified and then simulated with Vensim. The model was developed iteratively. As each functional area was completed the model results were shared with experts to determine whether the behaviour for that functional area was sensible and explainable.The medical and dental models contain similar calculation structures. In both models the future demand is calculated based on the current demand for service, future population projections, changes in levels of need and changes in productivity (for example through technological advances) and changes in service delivery. The demand calculation is based on a framework from the Canadian research programme on health human resources.In both models the future supply is calculated based on the simplified career pathways shown above in Figures 3 and 4. The actual career pathways represented within the models are in fact much more complicated, and include attrition from the stocks, exits out of system, inflows from overseas, workforce re-joiners and re-sits. The workforce levels are also broken out into more detailed career progression pathways. Figure 5 provides a more detailed view of the complexity of the medical training and career pathway as implemented in the Vensim SD model.In addition, the supply is segmented by age (from 16 to 80 years) and gender. This enables age and gender dependent impacts to be taken into account, for example attrition and participation rates. The models have been developed so that additional segmentation can be added if required.Finally, the models contain training allocation algorithms and capacity constraints at each stage of the training pipeline. These enable the preference between types of training to be included (for example there a female gender preference for GP Training). This allows the changes in future demography to be considered within the model. Birch, S. Kephart, G. Tomblin-Murphy, G., O’Brien-Pallas, L., Alder, R., MacKenzie, A. (2011) Human resource planning and the production of heath: a needs-based analytical framework, Canadian Public Policy, 33:S1-S16. The extent to which the workforce work full or part timeThe medical model contains 15 separate influence diagrams, 997 distinct variables and is initialised with 903,525 items of data. This model takes approximately 10 seconds to simulate. The dental model is of similar complexityEach Vensim System Dynamics model is linked to an MS Excel spread sheet. The MS Excel spread sheet contains all the input data used by the Vensim model, including all data references and a complete data audit trail. The table below provides a snapshot of some of the data integrated into the MDSI models: TypeHistoric rangeSourceAccepted applicants to preclinical dentistry 2007 –11 UCASMedical school intakes2007–11 Higher Education Funding Council for EnglandFoundation programme data 2011 Foundation Programme Annual ReportMedical and general practice (GP) workforce census for England 2008–11 Health and Social Care Information CentreNational population projections2010Office for National StatisticsHospital episode statistics for England2010 –11Health and Social Care Information CentreThe MS Excel spread sheet also acted as a user friendly model interface and allowed the user to:Create, store and edit future scenariosCreate, store and edit potential policiesSelect scenarios and policies to simulateSimulate the SD modelStore the results of multiple simulationsView and analyse the results of multiple scenarios
- Following process mapping the process maps were converted into a quantitative model. The model was developed using a combined Vensim and MS Excel architecture. MS Excel was used to create a user interface so that multiple scenarios and policies could be specified and then simulated with Vensim. The model was developed iteratively. As each functional area was completed the model results were shared with experts to determine whether the behaviour for that functional area was sensible and explainable.The medical and dental models contain similar calculation structures. In both models the future demand is calculated based on the current demand for service, future population projections, changes in levels of need and changes in productivity (for example through technological advances) and changes in service delivery. The demand calculation is based on a framework from the Canadian research programme on health human resources.In both models the future supply is calculated based on the simplified career pathways shown above in Figures 3 and 4. The actual career pathways represented within the models are in fact much more complicated, and include attrition from the stocks, exits out of system, inflows from overseas, workforce re-joiners and re-sits. The workforce levels are also broken out into more detailed career progression pathways. Figure 5 provides a more detailed view of the complexity of the medical training and career pathway as implemented in the Vensim SD model.In addition, the supply is segmented by age (from 16 to 80 years) and gender. This enables age and gender dependent impacts to be taken into account, for example attrition and participation rates. The models have been developed so that additional segmentation can be added if required.Finally, the models contain training allocation algorithms and capacity constraints at each stage of the training pipeline. These enable the preference between types of training to be included (for example there a female gender preference for GP Training). This allows the changes in future demography to be considered within the model. Birch, S. Kephart, G. Tomblin-Murphy, G., O’Brien-Pallas, L., Alder, R., MacKenzie, A. (2011) Human resource planning and the production of heath: a needs-based analytical framework, Canadian Public Policy, 33:S1-S16. The extent to which the workforce work full or part timeThe medical model contains 15 separate influence diagrams, 997 distinct variables and is initialised with 903,525 items of data. This model takes approximately 10 seconds to simulate. The dental model is of similar complexityEach Vensim System Dynamics model is linked to an MS Excel spread sheet. The MS Excel spread sheet contains all the input data used by the Vensim model, including all data references and a complete data audit trail. The table below provides a snapshot of some of the data integrated into the MDSI models: TypeHistoric rangeSourceAccepted applicants to preclinical dentistry 2007 –11 UCASMedical school intakes2007–11 Higher Education Funding Council for EnglandFoundation programme data 2011 Foundation Programme Annual ReportMedical and general practice (GP) workforce census for England 2008–11 Health and Social Care Information CentreNational population projections2010Office for National StatisticsHospital episode statistics for England2010 –11Health and Social Care Information CentreThe MS Excel spread sheet also acted as a user friendly model interface and allowed the user to:Create, store and edit future scenariosCreate, store and edit potential policiesSelect scenarios and policies to simulateSimulate the SD modelStore the results of multiple simulationsView and analyse the results of multiple scenarios
- The models were fully documented and tested prior to use for formal policy analysis. This was carried out to ensure that all model assumptions were formally documented and signed off, and that the model had been implemented correctly. Each model was documented in the following ways:A Technical Description was developed that described the model architecture, model assumptions and how the model is used for analysisThe MS Excel spread sheet made extensive use of comments to describe the purpose of the cells and contained audit trail cells so that references could be included for each data itemEach variable in the Vensim model was documented using the equation editor, and the units were fully defined. A robust, formalised approach to testing was adopted. The purpose of model testing was twofold:To ensure that the model design has been transformed into a simulation model with sufficient accuracyTo ensure that the simulation model is sufficiently accurate for the required purposeA test specification was developed based on the model documentation. The test specification detailed all the tests to be carried out on the model, and included tests of the model structure, formulation and behaviour. The test specification ensured that the testing was carried out methodically, and that all areas of the model were tested. The testing was carried out by a CfWI modeller who was independent of the simulation development process. The results of the testing were captured in a spread sheet. The spread sheet identified when and by whom the test was carried out. The outcome of each test was also logged in the spread sheet. If the test resulted in a fail then the fault was corrected by the model developer. The test was then re-run by the model tester to ensure that it had been corrected, and also that the correction had had no wider implications on the model. The model tester also had the freedom to carry out additional tests on the simulation model, and these were also captured in the testing results spread sheet. In addition to the tests identified in the test specification the following analysis was carried out:The results of the model were compared with previous simulation models that represented the medical workforceThe projections produced by the model for each stage of the training and workforce pipeline, along with the associated assumptions, were reviewed with relevant stakeholders (for example the chief dental officer)The sensitivity of the model outputs to the input data was tested.The sensitivity analysis was of particular importance. There were varying levels of confidence associated with the input data, and the sensitivity analysis was used to determine whether the model outputs were particularly sensitive to any low quality data. Figure 6 shows a sample sensitivity analysis output chart.
- Once each model had been tested it was considered to be implemented correctly and fit for purpose, and therefore suitable for policy analysis. Policy analysis required the consideration of the impact of different policies against the four different scenarios defined during the scenario generation phase of the workforce planning framework. Sample policies that were tested as part of the HENSE review included changes to:ProductivitySkill MixRetirement AgeTraining preferencesTraining duration.Amore detailed review of the policy analysis is provided in the online report available at the DH websiteFurthermore, it is best practice in modelling to quantify the uncertainty that is inherent in any forecast of the future, in this case: workforce demand and supply. Decision makers need to understand this to inform their analysis of findings and to make effective decisions. We considered the level of uncertainty through the use of Monte Carlo simulation. Figure 8 provides an example of this uncertainty as a fan chart, giving a probability distribution for supply under one specific scenario.Finally, as each of the values for each of the input variables over time can be accessed from the user interface there is an infinite variety of different policies that can be tested using the model. Therefore the model has great utility outside of the HENSE review.
- Graham or Andrew to wrap it up
- Graham or Andrew to wrap it up
- Add concrete examples to aid comprehension of this system that might be new to the audience