Aspiring to excellence“To deal with many of the deficiencies identified and to ensure the necessary concerted action, the creation of a new body, NHS:Medical Education England (NHS:MEE) is proposed. NHS: MEE will relate to the revised medical workforce advisory machinery and act as the professional interface between policy development and implementation on matters relating to PGMET. It will promote national cohesion in England as well as working with equivalent bodies in the Devolved Administrations to facilitate UK wide collaboration. The Inquiry has charted a way forward and received a strong professional mandate. The Recommendations and the aspiration to excellence they represent must not be lost in translation. NHS:MEE will help assure their implementation”

The NHS Next Stage Review describes a visionfor the NHS that delivers high quality for all

andgives staff the freedom to focus on quality.Achieving this vision requires us to provide thebest possible education and training for futuregenerations and to ensure that our existingstaff get the support they need to continuouslyimprove their skills.

Chapter 3 ‘A high quality workforce’

“We will improve key aspects of workforce planning at national level by establishing an independent advisory non-departmental body, Medical Education England (MEE)”

Sir John Tooke’s response to ‘A high quality workforce’

“I am particularly pleased to see the creation of Medical Education England which will give the profession the strong voice and the scrutiny function that it needs”

Structure of MEE

29 members 6 meetings per annum

Board

Structure of MEE

Board

Med D P HS

NHS NSR:A high quality workforceMEE agenda 1

Suggest more valid and reliable selection methodsCommission a formal evaluation of the 2 year

Foundation programme and consider an alternative model linked to wider reform of postgraduate medical education

Look at the balance between generalist/core training and specialty training

Reach a consensus on PGME and training structure by August 2010

Continue discussions with Royal Colleges, deaneries, junior doctors, patients, employers, trade unions, SHAs and other stakeholders on how to take PGME and Training forward.

NHS NSR: A high quality workforceMEE Agenda 2

Work with the Royal College of General Practitioners to develop cost- effective proposals for training at least half of doctors going into specialty training as GPs.

Strengthen the public health workforce and produce a system of dual accreditation

Be responsible for the development of modular credentialing

Advise on how the training of dentists should reflect the changing pattern of dental needs

Develop modular training for healthcare scientists leading to the post of accredited specialist

Promote the incorporation of leadership and management training into undergraduate curricula

NHS NSR: A high quality workforceMEE Agenda 3

Ensure that educational supervisors in secondary care undergo mandatory training and review of their performance

Promote the incorporation of academic pathways as per the Walport report.

Develop the modernising scientific careers programme (Life Sciences, Physiological Sciences, Physical Sciences and Engineering each with a rotating training programme)

Take responsibility for the development of the training programme for pharmacists with the new emphasis on promoting health and well-being and giving life-style advice

Take on the responsibility for low volume specialties that require national planning

Take on the job of working with the newly established HIECs to develop a model interface between universities and the NHS for innovation in education, training, certification, local workforce development and translational research.

Additional items suggested by Board membersQuality of training agenda; developing

trainers; metrics and incentives; effect of EWTD

Disseminating information on workforce planning; working with CoE

Development of a national simulation strategy including collaboration with MoD

Ensuring that all final year medical students have an opportunity to shadow in the hospital in which they will be working

The 2007 / 08 PMETB survey showed the following implementation rates for F1 shadowing.

Lowest Highest

Warwick            48%Cambridge         45%Oxford               42% Keele                42% Birmingham      37%

Belfast              96%Glasgow            86% Aberdeen         81% Barts                 78% Dundee            78%

Definition of the standardised admission ratio for applicants to medical school

No of admissions from a particular population subgroup as a proportion ofall admissions___________________________________Proportion of the general population that belongs to that subgroup

Kieran Seyan et al BMJ 2004

Kieran Seyan et al BMJ 2004Asians Social Class 1 6.07Whites 0.73Blacks Social Class IV 0.07No black people from Social Class V were

admitted to Medical SchoolFemales 1.15

Data from 1996-2000

“In our year the ratio is about 2:1, females:males. In my seminar group of 20, for example, 14 are female and 6 are male. This is the same with the majority of seminar groups.”__________________Third year Medical Student at Newcastle University, Tyne Clinical Base Unit

“I could not find any information on male to female ratio of current medical students at Newcastle medical school . Grateful for any information”

Gender balance in Medical Schools

Graduate entry into MedicineNormal mode of entry in USA for many years1997 Four Australian Medical Schools

changed exclusively to graduate entryIreland has now changed to graduate entry

GP Analysis:There is a clear risk of an undersupply of GPsAnalysis with impact of supply side variation

Comparison of forecast GP demand and supply(medium demand & various supply scenarios)

25,000

30,000

35,000

40,000

45,000

50,000

55,000

60,000

65,000

FTE

s

Demand (medium) Supply (low) Supply (medium) Supply (high)

22 Apr 2023 Not intended for publication 16

The magnitude of the likely GP undersupply depends on supply assumptions, e.g.:

Future participation; Future attrition; Future retirements.

The GP age profile suggests an imminent retirement bulge.

Early indications from modelling development suggest the higher end scenarios may be more likely as supply assumptions are updated

Specialist Analysis:There is a clear risk of an oversupply of CCT holders Analysis with impact of supply side variation

Comparison of forecast CCT holder demand and supply(medium demand & various supply scenarios)

25,000

30,000

35,000

40,000

45,000

50,000

55,000

60,000

65,000

FTE

s

Demand (medium) Supply (low) Supply (medium) Supply (high)

22 Apr 2023 Not intended for publication 17

The magnitude of the likely CCT oversupply depends on supply assumptions, e.g.:

Future participation; Future attrition; Future retirements.

The demand profile is dependent on skill mix: moving towards a trained doctor delivered service may result in increased CCT holder demand in the short term.

HIECsHealth Innovation and Education Clusters

(HIECs) are aimed at more rapidly translating research and innovation into clinical practice, and linking workforce planning to a quality framework of education.

HIECs could be one of the key ways in which MEE is ‘plugged in’ at a local level

HIECsA partnership between

NHS organisations (primary, secondary and tertiary)

HE sector (universities and colleges)Industry (healthcare and non-healthcare)

Principles of HIECsSpan settings (Trusts, FTs, private sector;

primary, secondary and tertiary care)Span sectors (NHS, HE, Industry)Span professions (i.e. Multi-professional)Deliver measurable impact in innovationFocus on qualitySupport the purchaser-provider split in

education and training

HIEC 2009 timetableMay distribution of national prospectus to

outline HIEC’s concept, application processMay- July regional stakeholder events run by

SHAEarly September completion of pre-

qualification questionnaireOctober submission of formal applicationsNovember presentations to National

selection panelDecember first wave of HIECs announced

“I explained that a general reduction to a 48-hour week would in our view have profound consequences for the provision of local services and training. Many medium-sized and small hospitals would not have sufficient staffing levels to maintain rotas. Surgical services would become unsustainable and of course without surgical cover accident and emergency departments would have to close. The increasing demands on consultants to keep emergency services going would inevitably have a serious impact on elective surgery, with little hope of meeting government targets on waiting times.”

EWTD: John Black’s February Newsletter ‘Carpe Diem’

EWTD: ASiT survey Jan 2009ASiT suggest that to ensure optimal training,

with adequate time for exposure and high quality patient care with increased continuity, it is necessary to return to a working week of approximately 65 hours. For higher specialty trainees (ST3 and above), on-call rotas rather than shift working would best protect training opportunities, and would be the optimal arrangement where workload permits.

Professor Michael ErautUniversity of Sussex

JCST discussion document of the Eraut report“..disturbing insight into the current

condition of surgical training in the UK. Many factors are identified as being responsible for this unwelcome state, not all of them obviously remediable.”

“Allowing for the environmental factors identified in the Eraut report is the ISCP ‘fit for purpose’ as a curriculum for surgical training?” (these factors included the EWTD and the MTAS disaster)

Annual Specialty Report Overview JCST ISCP:

“despite its many strong points, the ISCP continues to generate a degree of discontent amongst some trainees and trainers, and engagement with both groups, in some areas, is less than the JCST would wish to see”

Opportunities for training in operative surgery: 29% ST1 trainees have access to less than two operating

sessions per week; “JCST would like to see a commitment to innovative training methods such as simulation to help offset this reduction in clinical experience”

Support for trainers: “..widespread evidence that surgical trainers are poorly

supported by their employing Trusts. Urgent action is needed to correct this before consultant surgeons become completely disengaged from the training process”.

SummaryThe creation of MEE is an opportunity to

produce a more coherent approach to manpower planning and the promotion of excellence in the education and training of doctors, dentists, pharmacists and healthcare scientists

If we are to tackle the very challenging agenda then the MEE Board and Subcommittees will need to work closely together to produce a consensus which best represents the interests of the professions, trainees and, above all, patients