1. Changes, Challenges, Careers and Clinical Leadership
Professor Sheona MacLeod
Postgraduate Dean East Midlands
Chair of Health Education England’s Deans

2. Supporting Professionalism
HEE’s purpose
HEE exists for one purpose – to improve the health and wellbeing of the people of England by developing a workforce with the right knowledge, skills and values for them to always deliver outstanding healthcare.
Supporting Professionalism

3. Getting it right UK perspective:
The skilled medical workforce is one of our most important assets. The right number of doctors, in the right specialties, in the right places, with the right training, skills, aptitudes and attitudes.
Personal perspective:
For most people, after family, work is the most important aspect of their lives
and is part of their identity

4. Understanding the learner - Getting feedback on our processes
Regular feedback through current Quality processes
National / local Trainee forum discussions
GMC / College / local / school survey results
BMA JDC
Feedback to the MDRS committees
Focus on quality through HEE Quality Framework
Part of the discussion about ‘non-contractual’ training issues
National Leadership Fellows
The Media
Social Media

5. Training issues raised in 2015- 2016 by the BMA
Rota notification and fixed leave            
Deployment issues - IDT and joint applications
Opportunities for LTFT training
Variability in Study Leave
Rising costs for trainees
Induction and Mandatory Training
HEE’s position with whistleblowing
Different societal culture

6. Different societal context

7. Generations Baby boomers 25% HC workforce Generation x 40%
Generation y 35%
Generation Z 5%

8. ASiT Cost of Surgical Training survey 2016. www.asit.org

9. What do junior doctors need from training?
Future Professionals
What do junior doctors need
from training?
/ want

10. 21 22 23 24 25
I want to work near my husband
I’d like to work part time
Career change 20 19 18 17 16 11 12 13 14
If I hang around here long enough 15
The old system 10 9 8 7 6
The right interests
Academia
PRHO
SHO 3 4 5
I know professor

11. Career progression

12. New approach to careers Foundation /// Core /// Specialty
Changing and expanding number of junior doctors not in traditional training posts. 4 groups
IMGs new to the NHS
Progression problems in a chosen career
More time to choose
Time out
growing number - needs a new approach
There by choice
not ready for the train track
more exposure to different specialties for possible careers
Feedback on capabilities and personalised career advice (support with learning personalised to their situation)

13. Future careers

14. Demographics

15. The Collective Challenge
Cost containment
Workforce shortages and Rising workforce costs
Fragmented approach to the design, development and training of our workforce.
Alignment of workforce skills, roles and capacity to service models
Collaborative System Leadership
Engagement of the healthcare workforce

16. Sustainability and Transformation Plans
NHS providers, CCGs, Local Authorities, and other health and care services have come together to form 44 STP ‘footprints’. To enable the transformation required to implement the Five Year Forward View’s vision of health, quality care, and efficiency by 2021.

17. HEE transformation offer
HEE provides support around five key areas;
The supply of healthcare professionals and specialties, which includes postgraduate medical training and those who can support junior doctors in their roles.
The up-skilling of existing workforce such as advanced practitioners.
New roles such as physicians associates, the associate nurse and medical assistants
New ways of working, to enable a workforce that is flexible and adaptable
Supporting leadership development across the health and care workforce.

18. Starting to make improvements
Rota notification and fixed leave – changing the Code of Practice 
Partnership working through the 4 nation MDRS programme
more forward planning by all TPDs but some reduced flexibility in matching placements
Earlier data provision enables employers to perform checks and inform trainees eight weeks in advance of deployment, enabling leave discussions and ending fixed leave.
 The Code of Practice, agreed between the BMA, NHS Employers and HEE was updated in November 2016,
HEE is ensuring this change occurs by monitoring and reporting compliance at Board level.
NHSI is monitoring Trust compliance from October
       

19. Starting to make improvements
Deployment issues through the MDRS programme
pre-allocation of trainees to an area if they have specific caring responsibilities or ill health/disability
Inter Regional Transfers for trainees in England to create increased flexibility in addition to the current IDT process
“facilitated swaps” with others if doctors in training are allocated to a different region to their partner / spouse; Piloted manually in 2017
Oriel Technical solution for couples to link acceptances in recruitment
A Working group on improving doctors working lives
identifying and removing the barriers to access to flexible training
addressing inequity in study leave
the escalating costs of training.
enhancing support for post foundation junior doctors

20. Starting to make improvements
Whistleblowing
HEE’s Whistleblowing Policy now published. NHS Employers, BMA and HEE agreement. This provides greater assurance for doctors in training with regard to whistleblowing as HEE new accepts a shared liability in allegations, as if they were an employer
Streamlining induction processes and mandatory training
NHS Employers are working on accelerating streamlining models. Working group discussions to define what constitutes an employer responsibility in mandatory training
Pre- specialty support
HORUS e-portfolio for pre-specialty trainees

21. Starting to make improvements
Increasing the Opportunities for flexible training
Pilot launched in Emergency Medicine for much greater flexibility, allowing all higher trainees the opportunity to apply for LTFT training, regardless of their eligibility under the current Gold Guide criteria.
Aims to assess the popularity and impact of a significantly more flexible approach to training, to identify the benefits and address obstacles and risks of greater flexibility
exploring increasing flexibility in acute medical specialties through providing opportunities to split the traditional clinical week into clinical and educational/QI/research roles

22. Starting to make improvements
Variability in Study Leave
agreeing a standardised process with change in funding flow to enable all trainees to access essential training
Rising costs for trainees
HEE conducted an initial detailed cost collection which was shared with Colleges to generate debate, internally and across the Academy
Principles with regard to cost setting are still to be agreed
Transparency on cost and costing rationale to be published on the AoMRC website
Development of a junior doctor career cost calculator to help doctors plan when to make career steps and changes eg to LTFT

23. Finding Solutions to other issues
Being a valued part of a team – support in belonging / leadership
Time in one training place – HEE Deans programme review
ARCP/ feedback on progression – meaningful appraisal
Educational Supervision – time for high quality feedback
Out of Programme , Return to programme, Flexibility into and out of training – review of processes to assess competency and progression
Transitioning in training – education training & support in return to training
Time on routine tasks – alternative workforce
Rota gaps and management - The GoSW, Workforce solutions
Flexible training issues – new focus on addressing culture
Awareness of the management of issues –‘ you said we did’
Having a badge
Having a gym
Movie night
Teaching opportunities

24. ARCP Review
Reviewing the ARCP considering how processes could be improved.
An evolved process with competency assessment could facilitate exiting and re-entering training, defining the standards at exit points and validating competencies gained for re-entry.
It could enable those who are excelling to progress faster, or do more within training
Outside the CCT route, recognition of competencies, options to enter training at different stages, easier collection of parallel evidence would support the alternative training routes.
Having defined the competencies these could be signed off for other professionals, allowing the multi-professional workforce to access more development and assessment opportunities and support
Previous text: As part of

25. HEE PGME Reform Programme
HEE Quality Framework
Curriculum & Delivery
Enhancing Working Lives
ARCP Review
The HEE Quality Framework is the lens through which HEE will identify, benchmark and improve the quality and impact of the Improving Training Programme
Embedding key elements
of Shape to support
workforce transformation
and new service models
Enhancing the process and widening access to support enhanced assessment and greater flexibility
Enhancing the training environment and increasing flexibility

26. What is a doctor’s role? Healthcare delivery
Expertise in a variety of tasks
Synthesises complex information
Deals with uncertainty
Identifies and manages risk
Decision maker
Takes ultimate responsibility
Leadership and teamwork
Compassion
Jonathan Michael

27. Increasing your effectiveness as a leader
Do the basic job well
Think about what you might want and what might be possible as you train
Challenge constructively and learn from others - ask
Learn from Role models - good & bad
Be a Role Model
Understand the system and offer solutions to improve
Take opportunities as they arise

28. Personal advice Be enthusiastic Be open to challenges
Be flexible and prepared to change
Be resilient – be kind to yourself
Respect others
Be kind to each other
Have fun – Medicine is a wonderful career

29. Medical Leadership and Future Professionalism
New Role Models
Different approach to training and the role of junior staff
Increasing Professional satisfaction

30. Its all about Improving Patient Care
What makes every doctor animated?

31. Thankyou