1. FUNDING FOR POSTGRADUATE MEDICAL EDUCATION Jo Stevens Business Manager – Wessex Deanery and Chair of National Forum of Deanery Business Manager 24 January 2012

2. Overview of Business Management Current funding structure Current MPET Levy Business Planning How posts are funded Workforce challenges for Business Planning Medical Training Numbers Transition posts Better Training Better Care New specialties Potential future funding structure MPET review – primary and secondary care Liberating the NHS: Developing the Healthcare Workforce From Design to Delivery – financial challenges OUTLINE

3. OVERVIEW OF BUSINESS MANAGEMENT Workforce Planning Quality Management Operational and Financial management including LDA monitoring Support and management of the employer/training interface Educator and faculty development Leadership Development Programme Management –Recruitment –Assessment –Revalidation –Remediation and Trainee support –Information management –Provision of courses In conjunction and liaison with provider organisations

4. CURRENT FUNDING STRUCTURE

5. MPET – Multiprofessional Education and Training Levy NMET – Non-Medical Education and Training SIFT – Service Increment for Training MADEL – Medical and Dental Education Levy

6. CURRENT FUNDING FLOWS – ENGLAND Department of Health Strategic Health Authorities x 10 Deaneries NHS Trusts PCTs HEIs MPET ££

7. MPET Allocations 2010/11& 2011/12 AllocationEngland 2010/11 £ million England 2011/12 £ million NMET2,063 2,182.8 MADEL1,8801,908.8 SIFT999961.4 Topslice(160)(174) Total4,7824,879

8. Business Planning Process September - develop outline plan –Identification of continuing activity – i.e. Training posts, recruitment etc –Scope new potential developments – new programmes, quality or information requirements October - Undertake Zero based budgeting plan November – submit draft financial plan and strategy paper January – refine plan with potential savings March (ish) – budget confirmed

9. SAVING CHALLENGES 95% of the Deanery budget goes directly to Trusts/GP practices 2.2% management costs 2.8% on educational activity including recruitment, assessment, faculty development/courses, doctors in difficulty, public health and GP developments If we have to make a 5% saving, this equates to £5.65 million – the challenge is from where

10. Workforce Challenges for Business Planning

11. Medical Training Numbers From Dr Simon Plint

12. South Central Facts and Figures 3400 Trainees 2800 MADEL Salary Support 600 Trust Funded

13.  Currently trainee numbers based on historical service patterns, and there is projected over-supply  If NHS employed all new CCT holders over next 10 years, consultant numbers would increase from 35,000 to 61,000

14.  If we base training numbers on replacing the present consultant workforce on 2:1 basis  Overall numbers would reduce in South Central from 3400 to 2900 = 15% fewer doctors

15. Training numbers based on 2:1 replacement

16. Proportions of Medical Workforce – NHS Census 2009 51,000 trainees Trainee Pipeline GP and Consultant Workforce Hospital service is dependent on the trainee pipeline 35000 Consultants 36000 GPs

17. We can’t reduce numbers of trainees without disrupting hospital service Unless we increase the numbers of trained doctors delivering service Or........ we reconfigure the way we deliver services

18. Rebalancing the Medical Workforce Trainee Pipeline GP and Consultant Workforce If we reduce trainee numbers by 15%

19. Rebalancing the Medical Workforce Trainee Pipeline We could remap the funding to expand the consultant workforce with the excess CCT holders

20. Rebalancing the Medical Workforce The 15% proportion of trust funded trainee posts The 15% reduction in trainee numbers to align with future workforce demand Available trust funding for trained doctor expansion

21. TRANSITION POSTS 215 “Hewitt” posts 2007 165 “Johnson” posts 2008  The funding for the “Hewitt” posts will cease October 2012  The funding for the “Johnson” posts will cease August 2013

22. Better Training Better Care Consolidation of the recommendations from the Collins and Temple reports Implications include reduction in hospital based FY1 Surgical posts to be remapped to F1 psychiatry and core psychiatry to FY2 psychiatry 100% Foundation community experience – currently around 45% http://www.mee.nhs.uk/our_work/work_priorities/better_training_better_care.aspx

23. New Specialties and Service Changes Several new specialties are coming on line: –Intensive Care Medicine from August 2012 –Vascular surgery from August 2012 –Pre Hospital Care from August 2013 –Broad Based Curriculum – pilot August 2013 –Interventional Radiology – August 2012 Service Developments –Review of Major Trauma Networks –Modernisation of Pathology services

24. MPET REVIEW

25. CHANGES TO FUNDING SYSTEM  Current system based on historical funding flows and varies across England  Committed to the principle of tariffs for education and training and a transparent funding system  Reduction in SIFT to fund NMET placements  MADEL should be steady state  Healthcare providers responsible for funding development of existing workforce  Levy system with some providers funded to train

26. MPET REVIEW Cont... Options for MADEL  Do nothing – the “base case”  50% salary support and a placement rate of approx £12,000 per funded MPET post Ongoing evaluation of the second – preferred – option to assess impact across Trusts/providers Clarification on what is “in” and “out” of tariff

27. MPET REVIEW cont.. What is the Tariff? – Linked to placement rate for “in” tariff activity based on number of MPET funded posts – excludes Trust funded training posts “ In” Tariff Salary support for trainees inc. Study leave, relocation, excess travel – except GPRs and Public Health trainees Education Centres and Libraries – which includes staff GP Infrastructure costs inc GP F2 Trainer grant

28. WHAT COULD THIS MEAN IN TERMS OF FUNDING? Current F1 – 100% basic salary funding @ £27,800 Future – 50% basic salary funding plus £12,000 (ish) placement rate: £13,900 + £12,000 = £25,900 BUT – the placement rate is to cover Education Centres, Libraries, etc

29. MPET REVIEW cont.. “Out” of Tariff Directors of Medical Education/Clinical Tutors Foundation and Specialty Schools – inc. Recruitment & Assessment Training for Junior Doctors funded by Deanery – e.g. induction, leadership, etc. LTFT trainees SAS Remediation GP CPD, Tutors, Course Organisers/Directors etc Dental VTS etc MADEL funded Deanery administration/management costs

30. Liberating the NHS: Developing the Healthcare Workforce From Design to Delivery

31. Local Education& Training Boards (LETBs) Purpose:  To lead workforce planning and education commissioning Core functions: Security of supply Workforce planning and identifying local priorities for education and training Holding and allocating funding for the provision of education and training Commissioning education and training on behalf of member organisations, Securing effective partnerships

32. Duties on Providers  To consult on workforce plans  To provide data about the current workforce and future workforce needs, and  To co-operate in planning the healthcare workforce and in the planning and provision of professional education and training

34. Funding Flows – Scope of the central education and training budget In the original paper - proposal to abolish central funding and replace with a top slice levy from service from any organisation providing NHS care – could include private organisations and would include General Practice MPET funding will be predominantly provided to support the next generation of clinical and professional staff with flexibility for LETBs to invest in innovative approaches to education and training for the existing workforce. Proposals will be developed on the level of flexibility LETBs will have to fund such innovation without compromising the responsibility of employers to develop their own staff. HEE will be responsible for developing a more transparent allocations policy

35.  Future allocation methodology should: –Recognise existing patterns of training –Not be unnecessarily disruptive –Be transparent and clearly based on rules –Be equitable –Ensure economies of scale in commissioning e.g. small specialist groups –Support high quality education and training –Support the education and research interface  Investment in Health Sciences –AHSNs are anticipated –Not yet clear on relationships between AHSNs and LETBs

36.  Move to a Tariff-based system for education and training –Ongoing work through 2012 –Introduce tariffs for non-medical & undergraduate clinical placement for medical students from April 2013 –Continue to develop proposals for postgraduate medical and primary care education and training –In future education and training tariffs will be set alongside service tariffs  Raising the education and training budget through a levy on providers –Ongoing work to develop proposals for consultation

37. And Finally! The Operating Framework for the NHS in England 2012/13 set an expectation that running costs in 2014/15 will be, on average one third lower than running costs in 2010/11.

38. ANY QUESTIONS?