Item 9: Shape of Training report – Implications for Change

Report
The Shape of Training
Professor Jacky Hayden
Securing the future of excellent patient care
•
•
•
•
Prof David Greenaway
29th October 2013
All UK
http://www.shapeoftraining.co.uk/reviewsofar/1788
.asp
Key Messages
• General care in broad specialities generalists
• Still need Specialist
• Sustainable career – opportunity to change
• Opportunities driven by local patients need
• Academic training pathways
• Full registration to point of graduation
• Managed time out of programme
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Undergraduate
Postgraduate
Medical School
Foundation
Year Training
Professional
practice
Postgraduate
Broad-based Specialty Training
No clinical
supervision
4-6 years
2 years
Rest of career
Generic and transferable
competencies
MDT
OOP year
CPD
Credentialing
Registration
Certificate
Of
Speciality
Training
Controversies
• Moving registration
• Training
– Shorter for hospital specialties, therefore less
doctors in training
– Longer for GP
– Impact on the numbers of trained consultants
– Potential for a sub consultant grade (will CST
be less than CCT or just different)
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Provisional issue definition
What will the impact of Shape of Training be on
the supply of people with a CCT or a CST
(Certificate of Speciality Training); on the linked
requirements for post-CST credentialing; and on
the costs of training.
A potential second stage could also address: “What will
the impact of the Shape of Training be on the overall
medical workforce capacity and the generalist/specialist
split within this workforce?”
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Model boundaries
• The system being modelled would need to include
entry to F1, i.e. two years earlier than current medical
workforce models;
• However, it would not need to include current
workforce if the suggested issue definition were
accepted:
Current models:
F1/F2
?
Consultant
workforce
Training
Shape of Training model:
F1/F2
Training
?
Consultant
workforce
7
Key considerations
• “Full registration will occur at the point of graduation from medical
school” – this introduces a new point of ‘competition’ for further
medical training, as well as a potential cohort of registered doctors
who are “fit to work as fully registered doctors….. in an approved
training environment”
• “Broad based speciality training will last between four and six
years” – this, together with a range of other statements
emphasising continual progress through training, effectively fixes
the time in training and rules out all but minor extensions, meaning
that:
– GP training will be extended to a fourth year;
– All other training programmes that are currently more than 6 years will be
reduced
• Further specialty or sub-specialty training will take place through
the credentialing process.
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Statements that need to be
accommodated within the model
• Full registration at completion of medical school places UK
trainees in a competitive position for F1 places (including
competition with overseas entrants);
• That all training programmes >6 years will reduce to this
limit;
• That GP training will be extended by 1 year;
• That out of programme activities are regulated and
structured more tightly and remain within the 4-6yr training
programme;
• That ‘recycling’ will be significantly reduced and that access
back into training will be made easier, thus reducing the
overall time to achieve a CST.
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Statements that need to be
accommodated within the model
• CST outputs will be by broad specialty;
• Due to the reduction in overall training length to CST
the years of service post-CST, and hence the overall
consultant wte capacity, will increase;
• Demand for sub-specialty competences can be
managed through credentialing but are assumed to be
in over-supply at the moment (at an aggregate level);
• That there is a clear but separate nationally
commissioned academic pathway after F2;
• That the balance between non-GP generalist and
specialist medical workforce will shift over time.
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Expected impact over time
The challenge of transition….
CCT
production
Existing
trainees:
Years
Today
CST
production
SofT
trainees:
Today
Years
SofT
starts
The overlap of completion of
training due to reduced time to
CST will create a ‘bulge’ of
newly qualified doctors 4-6
years after the introduction of
SofT…………
1.What is a ‘worst case’
scenario in terms of overlap
and temporary ‘overproduction’?
2.What behaviours or
unintended consequences
might arise due to this bulge?
3.What transitional measures
can be identified and modelled
to manage this anticipated
‘bulge’?
11
Other areas of impact
Numbers
completing
either CCT
or CST:
Today
Cost of
training:
Years
Total
qualified
medical
workforce:
Today
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Today
Generalist
v’s specialist
skill mix
Years
Specialists
Specialty generalists
Years
Today
Years
12
Second stage
Proportions – not to a precise scale
• If the model is extended to explore the impact on the
shape of the workforce we might expect….
GPs
Specialists
Specialty generalists
Career grade
Trainees
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Timeframe
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of c.20 years
13
Second stage ‘story lines’
• GP expansion will work through the system over the next 35 years and will continue to grow gradually over time;
• Specialists will reduce once SofT is introduced but will then
‘recover’ with the introduction of credentialing;
• Specialty generalists will see the most dramatic increase in
the medium term, moderated by credentialing in the longer
term;
• Career Grade posts will reduce due to tighter control over
the training programme, less leakage and more potential to
train as specialty generalists;
• The number of trainees in the system will reduce because of
the shorter length of training.
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Provisional model specification
• To run in years for 20 years from 2013, with the
introduction of the SofT in 2015 (options for 2016 or
later can be included);
• The model will commence at entry to F1, but may
need to factor in numbers in medical school at some
point;
• Modelling at a national level without gender or other
detail;
• Arraying the speciality training section of the pathway
by broad speciality to reflect SofT recommendations
and to allow for differential impact on the length of
training.
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Outputs
• A description of the implications of the SofT in the
terms of the defined issue for modelling, i.e. the
impact over time on the supply, skill mix and costs of
medical trainees completing their training;
• In the light of this the identification of issues that need
to be addressed in the transitional phase to SofT.
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The impact for the North West
• Opportunity to consider the needs of the
different geographies
• Opportunity to work on realistic workforce
models based on the outputs of training.
• Opportunity to contribute to the ‘credentialed’
workforce
• Opportunity to influence the content of four year
GP training (leadership v additional clinical skills)
• Better managed out of programme.
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The impact for the North West
• Fewer doctors in training staffing middle grade
rotas.
• Potential threat to the outputs from the three
medical schools.
• Consultants who enter the grade less
experienced but (if we get it right) have
improved skills in holistic care.
• Fewer out of programme trainees working as
clinical fellows
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How do we prepare?
• Engagement in the national workshops.
• Development of the faculty of trainers
• Involvement of the existing workforce to plan
for new consultants with different skills.
• Productive fourth year of general practice
training.
• Continue with transforming the workforce.
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