Issues and Opportunities for the Medical Workforce Prof Liz Hughes Director and Dean of Education and Quality HEE (London and SE) Regional PG Dean West Midlands

New Structure of Medical Education Challenges and Opportunities for the medical workforce The future Overview

15 Arms Length Bodies (ALBs) in the English health system. They are accountable to the Secretary of State for Health. > 400 provider organisations – acute, mental health, community, ambulance Department of Health Health and Social Care Information Centre Health Education England Care Quality Commission National Institute for Health and Care Excellence Public Health England NHS England (NHS Commissioning Board) Monitor NHS Trust Development Authority NHS Litigation Authority Human Fertilisation and Embryology Authority Human Tissue Authority NHS Blood and Transplant Medicines and Healthcare products Regulatory Agency NHS Business Services Authority Health Research Authority Accountability of HEE

‘ Health is all about people. Beyond the glittering surface of modern technology, the core space of every health care system is occupied by the unique encounter between one set of people who need services and another who have been entrusted to deliver them’ Health professionals for a new century [first published in the Lancet], 2010 HEE exists for one reason: to improve the quality of care delivered to patients. Through our Local Education and Training Boards (LETBs), we ensure that our workforce has the right skills, values and behaviours, in the right numbers, at the right time and in the right place. HEE Purpose

LETBs Total of 13 LETBs Committees of HEE Not Statutory Bodies Provider led Stakeholder representation Manage all placements and QA of all doctors in training Commission all healthcare staff education and training Provide workforce data for central planning

HEE Priorities for 15/16 General Practice and Primary Care Shape of Training Shape of Caring Genomics Emergency Medicine Children and Young People Mental Health including Learning Disability Cancer Taskforce Public Health

The NHS Five Year Forward View was published on 23 October 2014 and sets out a vision for the future of the NHS. It has been developed by the partner organisations that deliver and oversee health and care services including NHS England, Public Health England, Monitor, Health Education England, the Care Quality Commission and the NHS Trust Development Authority. It sets out how health services need to change and promotes more engagement with patients, carers and citizens. NHS Five Year Forward View

Multispecialty Community Provider- Groups of GPs to combine with nurses, other community health services, hospital specialists and possibly mental health and social care to create integrated out-of-hospital care Primary and Acute Care Systems- integrated hospital primary care provider- general practice and hospital services working together Redesigning of Urgent and emergency care- These services will be redesigned to enable A&E departments, GP out-of-hours services, urgent care centres, NHS 111 and ambulance services New Care Delivery Options

Dawn of a New Era

It is a multi-disciplinary approach

Demographics DEMAND (Patients) More of us: UK population set to grow by 7% by 2022 More elderly: number of people >85 to increase from 1.4m to 2.4m by 2037 Live longer: In 1948, 48% died before 65. At least one third of people born today will live to 100 Greater care needs: People >65 with care needs projected to increase by 60% SUPPLY (staff) More women in the workforce: In 2012, 55% of medical students were women. Older workforce: Average age of workforce in 2023 = 47. Patterns of working are changing: Currently fewer than 30% of NHS employees are part time.

42% of the adult population have one or more long term condition Cancer rates are increasing, but better survival 46% of men and 40% of women are predicted to be obese by 2035 Dementia rates to double in the next 40 years 52% increase in people with multiple conditions by 2018 How can we educate and train our staff so that they can prevent ill-health where possible and provide care for individuals with a range of physical and mental health and social care needs? Patients will have more long term conditions

Health app downloads predicted to triple to 142m in 2016 One of the main topics of google searches is health Patients are likely to become members of communities of health 91% of cancer patients want to be involved in care decisions But the capacity to be engaged is not distributed equally across society Expectations of quality are increasing all the time How can we educate and train our staff so that they can respond to the full spectrum of needs in society, able to treat the whole person and not just one disease or specialty? Patients will be more informed, active and engaged, and with higher expectations

‘Computers in the future will weigh no more than 1.5 tons’ (popular mechanics 1949) ‘We don’t like their sound and guitar music is on the way out’ (Decca recording company re: The Beatles 1962) Heavier than air flying machines are impossible (Lord Kelvin 1895) Louis Pasteur’s theory of germs is ridiculous fiction (Prof Pierre Pachet, Prof of Physiology 1872) Looking to the future © Ian Cumming

Genomics

Click to edit Master text styles Second leve Third level Fourth level Fifth level In a context where training will need to focus on new skills, including supporting citizens to self care The model for managing care of mostly healthy adults will be based on enabling patients to play a role in their own care… …whereas providers will need to work very differently for managing care of elderly patients with LTCs Individual Skills needed ▪ Supporting citizens to self care ▪ Generalist skills ▪ Ability to work in multidisciplinary teams ▪ Skills bridging the boundary between health and social care

Shape of Training model

How training will change Need for greater number of generalists capable of flexible working and able to undertake training and credentialing to support developing healthcare pathways and technology Blending of roles and multi – professional working - other professional will undertake roles historically undertaken by medical staff Greater delivery of primary care but with GPs with additional credentialing for areas of special interest

Opportunities Opportunity to deliver innovative new roles eg in expanded endoscopy roles Opportunity to enter speciality training through schemes such as DREEM Need for experienced educational and clinical supervisors trained to GMC accreditation standards Need for medical leadership at all levels Expect to lead a portfolio career

Medical Leadership Competency Framework To deliver appropriate, safe and effective services, it is essential that any doctor is competent in each domain.

The Future Increasing demand on healthcare services Need for a cost effective but high quality service Great diversity of healthcare delivery models and locations Greater emphasis on integrated care and multi-professional working Remodelling of speciality training and medical workforce Shape of Training with more generalism and credentialing Continued need for cost effectiveness in training budgets Opportunity to deliver innovative new roles

“We always overestimate the change that will occur in the next two years and underestimate the change that will occur in the next ten. Don’t let yourself be pulled into inaction.” Bill Gates We must be bold and brave…