The Future of Specialist Training Wendy Reid Vice President RCOG Postgraduate Dean, London

What does the service want? ‘Generalists’ Flexible and adaptable workforce Decision-makers Leadership Productivity Efficiency

Trainee & Consultant Expansion

The context for future specialist training The service More ambulatory care Less in-patient care Commissioning will drive service configuration 7/7 day, 24/7 service Education and Training commissioning may mean not all trusts train Will trusts want to train doctors?

The context for future specialist training Education HEE - ? National commissioning, all health professions LETBs – Local Education and Training Boards, providers and commissioners? Who is responsible for quality? How will funding flow from HEE to LETBs to LEPs?

The context for future specialist training Trainees Work-life balance expectations More women 50/50 split GP and Specialty Not all trusts will train

Do women doctors work less? Results – Migration Retention varied by specialty group – Surgery trainees the most mobile and – GPs the highest local retention levels Retention varied by gender – 89.8% of females – 84.6% of males A. Knapton, WRT, 2010

Level of SHA retention by specialty and gender

The context for future specialist training Regulation Will the same specialties be on the register? Will the GMC influence ‘the shape of training’ Will other providers be recognised? What will post-CCT education look like? What will be the impact of re-validation?

Consultant delivered service – Trainee programme 7yrs – Consultant 25-30yrs Consultant:trainee alignment – Consultant : Trainee 3:1

Time for Training A review of the impact of the European Working Time Directive on the quality of training Professor Sir John Temple

The effect of service on training

"It's not the hours you put in; it's what you put in the hours." Elmer G Letterman

Use of simulation accelerates the acquisition of skills

Multidisciplinary Team & Team Leader Consultant SpR SHO MedicineSurgeryT&O Anaesth A&E Nursing MedicineSurgeryT&O Anaesth A&E Nursing Admin Resize the team Gain: new competences Competency based team

Teams save lives Mean mortality index %staff working in teams Source: Health Care Team Effectiveness Project, Aston University, Birmingham, England

Whole System Approach Workload at night Reduce out of hours operating Treat & Transfer Maximise primary care contribution Draw work into Extended Day

What should the clinical team look like?

Financial pressures - The NHS is facing a significant financial challenge, with an estimated funding gap of between £15-20 billion that needs to be resolved by The impact of this will be felt across all specialties; new ways of working and service redesign will be essential if the efficiency aims of the Quality, Innovation, Productivity and Prevention (QIPP) agenda are to be realised, while improving the quality of care delivered.

What will happen to training programmes? Curricula will need to reflect service change More use of technology More use of simulation Programmes will be quality assured What might happen to training programmes? Possibly modular credentials, different exit points Core training more general i.e. Broad focus More multi professional programmes Specialty training may shorten if more consultants in front line service Sub-specialty training may be post CCT

What is happening? Political reforms, Future Forum, Health Bill CfWI – long term, horizon scanning to inform workforce planning LETBs forming GMC – ‘Shape of Training’ AoMRC – ‘Consultant Care’ RCOG, RCPCH, RCGP, RCP – all producing work on service design and implications for training

The Future of Specialist Training? Summary More emphasis on quality Public and patient input Greater alignment with service needs Possibly ‘modular’ May have step off/step on points More post CCT formalised, credentialised training