Nursing Workforce Summit What the Medics are thinking and doing Simon Plint Dean of Medical Education Commissioning

1.Images of the NHS 2. Economic Context 5.Principles for South Central 4.MPET Reduction 3.National Training Context 6.Illustration of Mismatch 6.Our Shared Challenge

Reorganisation, Reorganisation

The NHS

New Model – Same Function

Expenditure Receipts £178bn borrowing this year Highest spending since 1982–83 Lowest tax burden since 1960–61 Highest borrowing since WWII

Do we have a 'General McChrystal moment' on the way? Nicholson said the government plans raised big issues that were being 'hotly discussed and disputed'

NHS chief executive Sir David Nicholson has launched a scathing attack on health secretary Andrew Lansley's proposals for handing over commissioning responsibility to GPs Sir David also turned his fire on the ability of GP commissioners, saying that if PBC groups were rated on the quality of their commissioning on a scale of one to 10, even the best were ‘only about a three’

Workforce Planning - Steering the Super Tanker

Gender Profile of Medical Undergraduates

South Central Facts and Figures 3400 Trainees 2800 MADEL Salary Support 600 Trust Funded £122m MADEL Budget Nearly 90% Salary Support Only 2.7% Management Costs

National Context Overall reduction nationally in junior doctor training numbers From 7500 in 2007 down to 6500 in 2011 Balance between Hospital and GP

National Context Future numbers of commissions should be based on projected future service need Services should be planned around delivery by trained practitioners and move away from dependence on junior doctors

Temple Report Time for Training High quality training can be delivered within the reduced number of hours available but fails if trainees: have the major role in providing out of hours service; are poorly supervised; or have limited access to learning.

Temple Report Time for Training Hospitals remain too reliant on junior doctors to provide out-of-hours services Service needs to be redesigned so consultants work more flexibly and more "directly responsible" for patient care around the clock

MPET Reduction 14%

Impact of MPET reduction £000

MADEL Reduction 14% Management cost reduction of 30% across deaneries would only save 1% 14% reduction in MADEL investment equivalent to £17m 14% reduction in MADEL training activity equivalent to 390 doctors

Principles for South Central MPET Review MPET should be invested on the principle of supplying the local workforce Investment should be proportionate to future service need, with a duty of care to the tax payer and students to commission neither an oversupply nor undersupply of health professionals The long term outcome of the MPET reduction should be a sustainable steady state investment plan which will supply the future service need of South Central

Principles for South Central MPET Review Can we be smarter than simply reproducing the existing workforce, and anticipating and shaping the future workforce? At time of disinvestment, consideration should be given to prioritising retraining of the existing workforce rather than training new workforce Role substitution

Wessex Deanery CCT Supply and Demand Scenarios

Wessex Deanery GP Demand & Supply Scenarios

General Surgery - National Supply Forecast Source – 2009 WRT Supply Model

CT1 CT2 ST7 ST3 ST4 ST5 ST6 RETIREMENTS

CT1 CT2 ST7 ST3 ST4 ST5 ST6

CT1 CT2 ST7 ST3 ST4 ST5 ST6

O&G - National Supply Forecast Source – 2009 WRT Supply Model

Our Shared Challenge Ensuring MPET envelope invested for future workforce supply Avoiding / deliberately destabilising service provision? What opportunities for service redesign and role substitution?