Building Training Capacity

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Med Ed 2009 Sydney Australia 30 31 October 2009
Building Training Capacity The UK experience
Lessons from MMC John Tooke Dean Peninsula
College of Medicine and Dentistry
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MMC

• April 2007
• MMC Inquiry launched
• October 2007
• Inquiry Interim Report
• January 2008
• Inquiry Final Report
• March 2008
• Government Response
• June 2008
• NHS Next Stage Review

Deprofessionalisation
Engagement
MTAS
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MMC Inquiry Findings - 1

• Guiding principles lacking (Key UFB principles of
  flexibility and broad based beginnings lost)
• MMC meant different things to different people
  Policy objectives unclear, compounded by
  workforce imperatives

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Corrective action 1

• Clear, shared principles for Postgraduate
  Training that emphasise inter alia
• Flexibility
• broad based beginnings
• - aspiration to excellence
• Related health policies (e.g. community focus,
  public health, care pathway integration etc)
  should be aligned and co-developed with the
  profession

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MMC Inquiry Findings - 2

• Doctor Role Clarity
• Trainees increasingly supernumerary
• Post CCT role unresolved
• - against a background of deficient
  acknowledgement of what a doctor brings to the
  healthcare team.

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Without role clarity

• Outcome focused medical education
• Medical workforce planning
• - are impossible

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MMC Inquiry Findings - 3

• Weak DH Policy development, implementation and
  governance
• Poor intra- and interdepartmental links,
  particularly healtheducation sector partnership

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Effective policy implementation was hampered by
ambiguities and inconsistencies in supporting
organisational structure
Non-MMC
MMC
Minister
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Accountability for overall implementation split
between Director of Workforce and CMO
(England) Accountability in England split
between DCMO and Deputy Director
Workforce Accountability for IMGs and MTAS lies
outside MMC
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Director of Workforce
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CMO (England)
U.K. Advisory Group
Workforce Programme Board
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U.K. Strategy Group
COPMeD
JACSTAG
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MMC Programme Board (England)
Medical Recruitment Board
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Deputy Director Workforce Capacity
2 SROs DCMO and Deputy Director Workforce
MMC National Director
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MTAS Team
IMG Team
DH Head of Ed
MMC England Team
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AcademicHealth Service Alliance

• Collaboration is the suppression of mutual
  loathing in pursuit of Government money
• Secretary of
  State, June 2008

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HealthEducation Sector Partnership Recent
History
Abandonment of the Strategic Learning and
Research Advisory Group (StLaR)
Loss of academic representation on SHA Boards
Abandonment of Health Education Sector
Partnerships
Abandonment of Workforce Development
Confederations with academic representation
Postgraduate Deaneries links with Universities
reduced
Raiding of education and training budgets to meet
service financial pressures in 2006-07
Lack of hospital incentives for education and
research in a strongly target driven environment
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Corrective action 3

• DH Policy development, implementation and
  governance strengthened
• Medical Education lead (high level)
• One SRO
• Healtheducation sector partnership strengthened
• - Healthcare Commission inspection regime
• - SHA CEO accountability (reflecting
  training commissioning budget holder status)
• - NHS
  constitution emphasises role in
  education and research as well as service

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MMC Inquiry Findings 4

• Medical Workforce Planning Deficient
• Lack of Doctor role clarity
• Medical production line does not reflect evolving
  health policy/practice
• Run-Through stifles workforce adaptability
• Policy vacuum regarding increased numbers of
  prospective trainees including IMGs
• FTSTAs the new lost tribe?
• Planning capacity (and siting)

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Corrective action 4

• Revised medical workforce advisory
• machinery (National Workforce Intelligence Unit)
• Oversight and scrutiny of SHA role
• Resolve policy regarding IMGs
• National commissioning of subspecialty training,
  reflecting Trusts capacity to offer optimal
  experience

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MMC Inquiry Findings - 5

• Medical Professional Engagement
• Despite involvement influence weak
• - but sometimes deterred from
  questioning policy
• - inconsistent professional voice
  (although frequent calls for delay)

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Corrective action 5

• The profession should develop a mechanism for
  providing coherent advice on matters affecting
  the entire profession
• But the view proffered must embrace the
  future, not preserve the past
• Q. Which body should provide such a view? How is
  consensus reached?

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• October 2007
• Inquiry Interim Report

Despite widespread agreement attempts at
implementation have seen the re-emergence of
factional interests
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MMC Inquiry Findings 6

• Management of Postgraduate Training
• in England
• Immense efforts to implement 07 scheme
  acknowledged but
• Lack of cohesion
• Suboptimal relationships with service and
  academia (in contrast to other well developed
  health systems)

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Corrective action 6

• The interrelationships of Postgraduate Deaneries
  should be reviewed to ensure they deliver against
  guiding principles (flexibility, aspiration to
  excellence) and NHS priority of equity of access
• In England trial Graduate Schools where
  supported locally

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NHS Next Stage Review

• Transparent SIFT standard (weighted) placement
  tariff
• Contracts for PGMET (not service contribution)
• Separation of commissioning/provision of PGMET
• Trusts incentivised to engage in PGMET
• Will HIECs (Health Innovation and Education
  Clusters) be the proposed Graduate Schools?

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Training the Hospital PGMET Trainers
What are the project aims?

• To establish current provision for the training
  and accreditation of educational supervisors in
  secondary care
• To identify associated issues
• To develop a curriculum for educational
  supervisors
• To consider options for a UK approach to
  mandatory training and accreditation
• To commission an pilot, evaluate and develop a
  national implementation plan

Courtesy of Professor John Bligh, President,
Academy of Medical Educators
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MMC Inquiry Findings - 7

• Regulation
• The split between two bodies, GMC (UG and CPD)
  and PMETB (PGMET) creates diseconomies (finance
  and expertise), and risks policy differences

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NHS Next Stage Review

• PMETB to be merged with GMC by 2010
• Three Boards to cover UG, PG and CPD

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MMC Inquiry Findings 8

• Structure of Postgraduate Training
• Lacks broad based beginnings
• Lacks flexibility
• Doesnt encourage excellence
• Non resolution of NCCG contract
• FTSTA plight

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Corrective action 8

• The structure of Postgraduate Training
• should be modified to provide a broad
• based platform for subsequent higher
• specialist training, increased flexibility,
• the valuing of experience and the
• promotion of excellence

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Postgraduate trainee
Stand Alone Practitioner
Medical student
Provisionally Registered doctor
Registered Doctor
Specialist Registrar
Specialty assessments at selection centres
Competitive selection process with limits
Medical Degree
Full GMC registration
CCT
Specialist Consultant
Core Speciality Training
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Specialist Registrar
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Medical School
FY1
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• 1 year
• Standardised assessments
• Attends Graduate school
• Guaranteed place for UKMG

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Post Core Training

PMETB CESR

• 4 Core Specialty stems
• 3 years (fixed term)
• Competitive transferability option
• 4 - 6 month positions
• Integrated Masters programmes available
• - Research
• - Education
• - Management
• - Global health

• Consultant roles
• Specialist/sub
• Specialist
• Service leader/
• Manager
• Researcher
• Trainer etc
• The slope of this
• line will vary by
• Specialty, context etc
• Transition may be
• informed by enhanced
• role experience,
• sub specialty
• experience etc

Staff Grade
2
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GP Specialist Registrar
GP
Stems include for example Medicine, Surgery,
Acute Common Stem and Community. NB the term
specialty has no formal legal significance in
these examples
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Can we trust the Government (DH) to deliver on
this agenda?
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New Recommendation 47The centrality of NHSMEE

• Define the principles underpinning PGMET
• Act as the professional interface between policy
  development and implementation on matters
  relating to PGMET
• Develop a national perspective on training
  numbers for medicine working with the revised
  medical workforce advisory machinery
• Ensure that policy and professional and service
  perspectives are integrated in the construct of
  PGMET curricula and advise the Regulator on the
  resultant synthesis
• Co-ordinate coherent advice to government on
  matters relating to medical education
• Promote the national cohesion of Postgraduate
  Deanery activities
• Scrutinise SHA medical education and training
  commissioning, facilitating demand led solutions
  whilst ensuring national interests are
  safeguarded
• Commission certain small volume, highly
  specialised areas of medicine.
• Hold the ringfenced budget for medical education
  and training for England

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Summary A new beginning for MMC?

• The health service will and must evolve
• Doctors are central to shaping that future and we
  must harness the aspiration of trainees
• Our education, informed by clarity of role, must
  prepare us for that future
• The UK has a singular opportunity to grasp this
  agenda, but it will require professional groups
  to act in the common interest and the
  establishment of NHSMEE with the necessary
  authority, clear lines of accountability and
  adequate resources

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