1. Medical Education & Training in the context of the White Paper
9th National
Multi-Specialty Conference
David Sowden
Chair of COPMeD (UK)
PG Dean & Managing Director
EMHWD

2. 2 critical papers: Equity and excellence: Liberating the NHS
(paras 4.32 to 4.34; pages 40 to 41)
Liberating the NHS: Developing the Healthcare Workforce
(published December 2010)

3. Main themes of consultation
New body: Health Education England (HEE)
Greater accountability for healthcare providers:
Duty to consult on workforce plans
Duty to provide workforce data
Duty to cooperate on professional education and training
Healthcare providers in “skills networks” (all publically funded)
Tariff introduction from 2012/13
Education and training levy to replace MPET

4. Developing the Healthcare Workforce.
5 Objectives:
Security of supply
Responsiveness to patient(s) needs and changing service models
High quality education and training that supports safe, high quality care and greater flexibility
Value for money
Widening participation

5. 12 underlying principles
System alignment
Fairness and transparency
Capability to plan for current & future workforce
Integrated, multi-professional approach
Only do nationally what has to be national [otherwise “local”]
Effective professional engagement

6. Integration with planning of PH & social care workforce
Strong partnerships with universities & education providers
Sustainable investment
Streamlining
Clarity of roles, responsibilities & accountabilities
Reinforcing values and behaviours

7. Key demands include:
Local healthcare provider led “skills networks”; greater autonomy & accountability for providers with a duty to consult on workforce plans & a duty to co-operate on professional education & training
New national body, Healthcare Education England, from 2012 as a Special Health Authority
Change from MPET to a tariff for all placements including medical, and a levy from all (publically funded) providers (including any willing provider) to fund all education and training but not CPD [note : restricted model of CPD]

8. Local skills networks requirements:
Healthcare leadership, with local employers and GPs as providers
Be legally required to work together (“legal entities” by April 2012)
Increased autonomy & accountability
To work in partnership with universities, colleges and other education & training providers ( provider deaneries ?) and they will need to include educational expertise
To be more “multi professional”

9. Local skills networks (cont)
Commissioners of education and training
Will take on responsibility for current “PG Deanery” functions including provision
Thus a major conflict of interest with regard to PGMDE
Work with LAs across health, public health and social care
PS – funding routes unclear.

10. Health Education England.
Provide national leadership with respect to workforce planning and development
Will replace and absorb MEE and its constituent programme boards (from April 2012)
Support development of (provider) skills networks
Manage workforce plans and planning data informed by CfWI (final arbiter on workforce planning)
Will ensure the long term supply of the regulated workforce

11. HEE (continued)
Promote high quality and responsive education & training
Allocate & account for NHS education and training sources

12. Governance model Service Allocations Education & Training Levy
Secretary of State
E&T Regulator
Including GMC
National Provider Development Board
HEE
National Commissioning Board
Service Allocations
Education & Training Levy
GP Consortia
Service Commissions
Healthcare Providers
Healthcare Provider
Scrutiny
Education & Training Tariff
PGMET Commissions
Provider Skills Network
Non-Medical Education Commissions
HEI’s
HEI’s etc.

13. Timeline ? ? ? ? Indicative only 2011 2012 2013 Beyond
SHA resp. for WFP, E&T
HEE Responsible for WFP, E&T
HEE (shadow form)
Healthcare provider ‘skills networks’ undertake WFP & commission E&T ?
Providers create ‘skills networks’
Tariff fully implemented ?
Development of tariff structure
Transition to tariff funding
MPET budget ?
Levy implemented ?
Development of E&T levy

14. Focus on Provider Skills Networks
Some potential options
Regional commissioning model
Hub and spokes
Localised networks (i.e. sub-regional)
Super-regional approach (e.g. EM and EofE)
Common-interest model (market segments)

15. Regional commissioning model
A potential option
HEI’s
Nursing degrees
AHP training
Generic training
CPD
Healthcare providers
PG medical training
PG dentistry and pharmacy
Commercial providers
Specialist courses & CPD
Generic skills development
Strategy
WF planning
E&T commissioning
“Deanery” functions
Provider relations
Provider Skills Network

16. Network “head office” functions
Hub and Spokes
A potential option
Network “head office” functions
Locality
Each locality “spoke” responsible for WF intelligence, E&T commissions, provider relationships
Head office/hub responsible for WF planning, strategy , co-ordination, finance, and shared functions

17. ? Localised networks A potential option
Locality
Each local network independently responsible for everything “from soup to nuts” ?

18. Supra-regional approach
A potential option – perhaps longer-term
Provider Skills Network HQ
Hub?
Locale
Hub?
Locale

19. Common-interest model
Potential option based on market segments
Common interest group “hub”
(e.g. Mental Health):
- Strategy & HQ functions
- WF Planning
- Billing / finance
- Could be national in scope
Per locality:
E&T commissions
Provider relations
Quality management

20. Issues Conflict of interest service vs. training
Funding route for E&T potentially problematic -provider skills networks could be starved of resource
Resolution of governance and regulation is critical
Limited time to effect change before demise of SHA
Universal agreement and implementation within 15 months
Consensus required – directive approach will not work

21. Issues Radical change creates risk
Networks must deliver, or service providers will walk away
Potential for existing E and T providers to exit “market”
Removal of CPD from central funding is risky as there are no specified guarantees of investment levels

22. Opportunities Should encourage confirmation of workforce priorities
New organisational forms - ? Efficiency and effectiveness
New alliances (improved multi-professionalism)
Collaboration between service providers
Competition to improve quality
Current assumptions will be challenged (may reverse rush to specialisation)

23. C O G P E D
9th National Multi-specialty Conference for Heads of Schools, Programme Directors, Directors of Medical Education
25 & 26th January 2011