Future Challenges and Direction Dr Vicky Osgood Director of Education and Standards ^

Thank you

Wessex Deanery The Future

The future is here; it is just not evenly distributed William Gibson Wessex Deanery

The future is not the Isle of Wight awaiting our arrival. It is more like the Great Western Railway, something that we have to imagine, design and build. If we do not build it other people will. Sir Muir Gray director, National Knowledge Service and chief knowledge officer to the NHS The Future

Developing Areas  Patient safety  Academia  Clinical Leadership/Engagement  Professionalism  Role of Doctor  Public Health  Health Inequalities  Primary Care  Move of care into community

Curriculum  Curriculution Evolving the curriculum to meet patient and service need as well as the changes in the science of medicine.  Impact of genetics "It is much more important to know what kind of patient has a disease than to know what kind of disease a patient has.“ (Caleb H. Parry ) Wessex Deanery

Why does the GMC exist?  ‘… to protect, promote and maintain the health and safety of the public.’ (Medical Act 1983)  Our purpose is to protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine.  We are the regulator of doctors rather than a professional body for doctors.

The Role of the 21st Century Regulator Medical School Foundation programme GP/ Specialist Ongoing practice Set standards and outcomes and inspect medical schools Approve entry to the register, foundation programme curricula and the educational environment Approve specialist curricula, programmes and posts and require assurance about the quality of the educational environment Require on-going assurance of competence and fitness to practise, and support for doctors from their responsible officer

A model for Quality Improvement & Medical Schools(Specialty/GP only) PG Deaneries/LETBs & Medical Schools Royal Colleges/Faculties Medical Schools Council

QIF – four elements Enhanced monitoring

Approval Against Standards  Approve medical schools  Approve programmes  Approve curricula and assessment blueprints  Approve and recognise trainers

Standards now  Too many ‘domains’  Tomorrow’s Doctors and The Trainee Doctor too focused on process and not sufficiently on what we want to see  Don’t support our regional approach to inspection  Insufficient recognition of quality improvement  Need to determine what success looks like – but not ‘tick box’  Need to have regard to multi professional and other regulatory systems  Can’t ignore the wider healthcare environment (Francis Inquiry)

A new framework of standards  An overarching statement that patient safety and equality are fundamental  Standards grouped under four quality themes:  Learning environment and culture  Educational governance  Supporting learners and trainers  Developing and delivering curricula and assessment  Standards are a broad and enduring description of the level of quality to be met  Requirements set out what must be demonstrated to meet the standards; some may apply to a specific level of training  Exploratory questions indicate areas we want to investigate to determine if a standard is being met, and may change over time based on evidence collected

A new framework of standards: next steps  June and July 2014: Engaged with stakeholder groups, including eight workshops across the UK  Autumn 2014: Revised draft and prepared for consultation which opens 28 th January 2015  Following consultation, and after making any changes, we would aim for implementation in 2016 First visit to implement these is the South West

Standards

Requirements

Theme 3 Supporting Learners and Trainers

Requirements

Introduction The Shape of Training Review considered potential reforms to the structure of postgraduate medical education and training to ensure we continue to train effective doctors who are fit to practice in the UK, provide high quality and safe care and meet the needs of patients and the service now and in the future.  The Review focused on ensuring doctors are able to meet the changing needs of patients, society and health services.  It looked at the transitions from medical school into Foundation and on into specialty training and continuing professional development (CPD).  Chaired by Professor David Greenaway, VC Nottingham University.

Themes of the Review  Theme 1 – Workforce needs: Specialists or generalists  Theme 2 – Breadth and scope of training  Theme 3 – Training and service needs  Theme 4 – Patients needs  Theme 5 – Flexibility of training  + UG to PG transition  + Clinical academic interface

Final Report published Securing the future of excellent patient care: Final Report of the independent Shape of Training review led by Professor David Greenaway was published on 29 October  The final report offers an approach which will ensure doctors are trained to the highest standards and prepared to meet changing patient needs.  It offers an approach which will be fit for purpose for many years to come and a framework for delivering change and for doing so with minimum disruption to service.

Shape of Training model

What now? Members of the sponsorship board have met since report 6 workshops run last year Broad based themes to CST Interaction with Employers Blurring the primary-secondary care interface SAS doctors Academic Pathway Credentialing Departments of Health have now produced policy submissions to ministers Part of HEE Mandate HEE, NES, Welsh government setting up Shape of Training development groups

Don’t forget 2. More ways of involving patients in education and training 3. Medical students need to know what to expect 6. Generic capabilities framework 7. All doctors to progress at own pace within timeframe 8. Longer placements to encourage apprenticeship 9. Training should be done in places that provide high quality training and supervision. Broad based framework Transferable competencies

Generic Capabilities Three levels: Professional Clinical Cultural and systems awareness Under each level there would be sub-levels and themes – some examples on next three slides

Professional Personal behaviour: Act with integrity Communication, teamwork and shared decision making: Handover and continuity of care Quality improvement: Learning lessons from success and failure Leadership: Co-ordinating a multi-disciplinary team

Clinical Patients: - Procedural: Consent - Care: End of life Underlying causes: Recognising and knowing what to do when patients present with possible underlying causes and co-morbidities – e.g. mental health Therapeutics and prescribing: Safe prescribing

Cultural and systems awareness GMC requirements: Good Medical Practice The structure of the NHS and the independent sector, and the communities they serve: Understands the demography and diversity of the local population e.g. local patterns of morbidity. Research and data: Have an understanding of and participate in research relevant to specialty

Developing Areas  Patient safety  Academia  Clinical Leadership/Engagement  Professionalism  Role of Doctor  Public Health  Health Inequalities  Primary Care  Move of care into community

The Future Those who cannot remember the past are condemned to repeat it. George Santayana

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