1. Tristram Lesser Brian Bingham
ENT.UK
British Association of Otorhinolarymgology Head and Neck Surgery
And
British Academic Conferences in Otolaryngology
SAC in ORL
JCST
ISCP

2. Presentation to UEMS-ORL Section
Numbers of ENT doctors
Career of ENT doctors
Selection of ENT doctors
Training of ENT doctors

3. SAC/ENT.UK Training Workforce Numbers for training are national
Numbers for workforce are local

4. ENT Workforce in England 2014
Robert Hone & Jeremy Davis
With thanks to Lyndy Pullan and the ENT UK Office

5. Previous Surveys / Other Sources of Information
The results of this survey have been compared to the 2010 workforce survey undertaken by Tristram Lesser and Jeremy Davis which just looked at Consultant and SpR numbers.
The results have been ‘sense checked’ against the Workforce Plan for England (2014/15) published by HEE which is based on employment records
HEE underestimates Locum Consultants as it does not always pick up agency employees
HEE more accurately reflects StR’s as it includes many of those on OOP

6. ENT services in England
153 Trusts surveyed
34 do not employ ENT surgeons
119 trusts provide ENT services
703 consultant posts including 6 Vacant Posts and 59 Locums

7. Total Number of Clinicians – Q1 & Q2
Permanent Posts
Male
537 (84.2%)
638
(91.5%)
697
Female
101 (15.8%) FT PT
Locums Consultants
56 (95%) 59
(8.5%)
3 (5%)
45 (76.3%)
14 (23.7%)

8. Middle Grades & Juniors
Junior Clinicians – Q4
Total of 892 of which 470 are “middle grade”
Middle Grades & Juniors FT
Vacant
Total
Fellows & HST’s
263 3
266
Staff Grades
189 15
204
Core Trainees 60 2 62
GPVTS 82 F2
116 4
120
Other SHO's
143 6
149 F1 42
Clinical Assistants

9. Number of Higher Surgical Trainees 2010 vs 2014 vs HEE data

10. LETB’s

11. Ratio of HSTs to Consultants per LETB
Averages: 0.46 in 2010 to 0.31 in 2014

12. Previously Underestimated Projections
Higher population growth
Current England Population 54 million
Projected England Population million

13. Previous Underestimated Projections
Underestimated Emigration
Anecdotal reports of between 5-7 CCT holders in ENT emigrating per year
Is this set to increase?

14. Doctors working in NHS

15. PMQ country No. of doctors %
United Kingdom , %
India , %
Pakistan , %
South Africa , %
Nigeria , %
Ireland , %
Greece , %
Italy , %
Egypt     , %
Germany , %
Romania , %
Sri Lanka  , %
Iraq , %
Poland , %
Australia , %
Sudan , %
Spain , %
Hungary , %
Czech Republic , %
Bulgaria , %
Total , %

16. Doctors added to the LRMP by World Region of PMQ for 2006 - 2015

17. Doctors by gender from 2006 - 2015  

18. Future Projections for ENT training numbers
Increase in workforce
HEE forecast a 20% increase in ENT consultants by 2020
Between 2000 and 2012 all staff groups in the NHS grew
over 50% more consultants
13% more nurses (32,000)
~140 new posts - ~28 per year to meet increased demands
Workforce requirements equate to approximately 60 posts per annum
(28 replacement, 10 associate specialist replacements plus 28 new (growth) posts = 66)

19. Future Projections

20. National Selection for Higher Surgical Training
Once a year
1 venue
Fixed number of places for England Scotland and Wales
Northern Ireland separate.
6 stations
Portfolio Assessment
Clinical Scenario
Communication Skills
Managerial Scenario
Skills Assessment
Structured Interview

21. The Training in ENT Governed by the General Medical Council (GMC)
Paid for by the Medical Programs Board (MPB)
Commissioned by Local Education Training Boards (LETB)
Delivered by Hospital Departments and Deans (including courses)
Over seen and recorded by ISCP
Syllabus, Competencies, Assessments and Recording training (log book etc) requirements (Intercollegiate Surgical Curriculum Programme. (ISCP) Part of JCST/SAC
Exams
iMRCS-ENT (European Board equivalent)
iFRCS ORL-HNS (HST completed)

22. Can include some Pre CCT Specialist Fellowships in UK or Abroad
1-2 years post CCT
Fellowship
Sub- specialist
ENT consultant
SAC CCT check
list
Specialist Register
GMC
ENT Consultant in
Independent Practice
year
6 years of Higher
Specialist
Training
Can include some Pre CCT Specialist
Fellowships in UK or Abroad 87 6 5 4 3
FRCS(ENT)
Part 1 and Part 2
Apply for HST
at National Selection
MRCS-ENT
EU-Diploma
EU-Board
Speciality ENT Doctor in
supervised practice
2 years Core Surgical Training
Take MRCS(ENT)
12 months of ENT
12 months of related
Specialities. 2 1
2 years foundation in
medicine and surgery
Take MRCS part A
Undergraduate Medical School MBBS 5-6 years.

23. Undergraduate Medical School 5-6 years MBBS
Foundation 2 years medicine and surgery Part A MRCS
Core Surgical Training 2 years Part B MRCS (MRCS(ENT))
DOHNS Part 1 and 2 or EU Diploma
Post CCT
Fellowships 1-2 years
General ENT Consultant
Or Super
Specialist
ENT
Consultant
CCT
Higher Surgical Training 6 years Part I and Part 2 FRCS ENT May include some fellowships
CESR After FRCS and Article 14 application
Working as Specialty Doctor in ENT (not independent practice)
General Practice Medicine With a Specialist interest

24. Uncoupled/Themed Programmes
Training to Consultant/CCT
Working as Speciality Doctor and possible CESR
CT1
CT2
Run through to ST3 in future
Early Years
Uncoupled/Themed Programmes
12 months ENT early in CT (6 months minimum 18 months maximum)
Additionally 2 or 3 placements over 12 months in a range of related specialties:
Plastic Surgery
Oral and Maxillofacial Surgery
General Upper GI Surgery
Neurosurgery
Paediatric Surgery
Paediatrics
Cardiothoracic Surgery
Ophthalmology need to check this one
Accident and Emergency Medicine
ITU
General Practice
The common surgical components are covered in Otolaryngology placements and complementary placements. The ENT components are covered in ENT.
A CT2 extension in ENT may be available for trainees who have chosen to change to ENT from generic CST. CT2 extension in generic surgery may also be available for themed ENT trainees who chose to change to another surgical speciality or for trainees who require additional time to pass exams or need a second attempt applying through National Selection.
The minimum ENT experience for ST3 application is 6 months and the maximum is 18 months.
MRCS(ENT) required for National Selection
ST3
ST4
ST5
ST6
ST7
ST8
Final Stage (Special Interest)
(Fellowships/Interface)
National Selection
The trainee will undergo a period of specialty training of 6 indicative years in the broad specialty as defined by the final stage (including special interest) syllabus
General ENT and Emergency Safe Training with or without subspecilaist training/fellowships. iFRCS ORL-HNS
Trust grade
LAT
Fellowship SD
Undertake LATs and Trust Grades or straight into Speciality Otolaryngologist grade
The decision to become a Speciality doctor; DO-HNS exam required
Working in General ENT and some sub specialisation as required by the service needs. FRCS or other qualifications will only be required if applying for CESR.

25. MRCS(ENT)or Equivalent e.g. European Board Exams
Part A MRCS is normally taken in Foundation Year 2. Otolaryngology trainees will be required to complete the MRCS(ENT) examination or the MRCS and the DO- HNS examinations and should do so as early as possible in the initial stage.
Those not progressing through national selection at the first attempt should either decide to become SDs and can then move into the LAT/Trust Fellowship grades. Or re-submit the next year for national selection but do non-ENT jobs in the meantime. This will enhance the chances of a career change to another specialty if unsuccessful again.

42. STANDARDS FOR HST in ENT
 Ten Standards separated into three groups
Experience standards: Experience over the last 6 years of training
Exposure standards: Training and the standards and exposure for each job.
Programme standards: Support for subspecialist, generic and academic exposure.

43. Experience Standards
Undertaking a minimum of 2000 operations during the last 6 years of training as principal surgeon or main assistant.
Undertaking, as principal surgeon, a broad spectrum of operations that are allied to emergency work, these being 10 mastoid operations, 40 tympanoplasties, 10 major head and neck operations, 10 tracheostomies, 10 paediatric endoscopies (including flexible), 5 vocal cord palsy procedures, 10 septorhinoplasties, 30 FESS, 10 removal of foreign bodies from airway including nasal and fish-bones.
Exposure to the management of emergencies as manifested by 300 nights on call and/or having managed 1000 emergencies in higher surgical training.

44. Exposure Standards Clinics: 3 or more a week, including emergencies
Conform to ENT guidelines (Numbers, Facilities)
ST3 to include weekly special interest clinics (paediatric, vertigo, audiological, otology, tinnitus, head and neck, voice, rhinological and others)
Operating Lists:
3 a week in CT/ST1 and 2,
4 a week in ST3 to ST8
Hospital Throughput: 500 ENT operations per annum per higher surgical trainee in that unit  

45. Programme Standards
Rotate through sub-specialities otology, neuro-otology, paediatrics, benign head and neck, head and neck oncology, rhinology, sinus surgery, facial plastics, voice and balance.
Generic skills training in management skills, teaching, education, leadership and team working.
Support provided for extra curricular activities; for example to the level that would support for 3 papers per year, 2 audits per year and 1 presentation per year, or a higher degree )eg MS, Mphil, MBA, Educational or other diploma) or leadership skills training or similar.
Facilities for sub special interest training within the programme.

46. “Training The Trainers” TRACE Course
Education Theory
Practical Skills
Equality and Diversity
Structure of Training
Assessments
Work Based Assessments
GMC requirement

47. Web Sites
e-log 2016
The updated Otolaryngology curriculum came into effect in August 2016.