Madingley MMC Update Jonathan Waller

MODERNISING MEDICAL CAREERS - An Update: 

MODERNISING MEDICAL CAREERS - An Update Dr Jonathan Waller Associate Dean for MMC Eastern Deanery

THE PAPER TRAIL: 

THE PAPER TRAIL “UNFINISHED BUSINESS - Proposals for the reform of the SHO Grade” - August 2002 COLLATION OF RESPONSES “MODERNISING MEDICAL CAREERS - The response of the four UK Health Ministers.” - February 2003 “MODERNISING MEDICAL CAREERS - The next steps” - April 2004

Modernising Medical Careers : 

Modernising Medical Careers 2 year Foundation Programmes (Basic Speciality Programmes Higher Specialist Training Programmes leading to CCST) Run Through Speciality Programmes leading to CCT

Foundation Programmes will be:: 

Foundation Programmes will be: The bridge between undergraduate medical training and specialist and general practice training

What we know about Foundation Programmes: 

What we know about Foundation Programmes Will be 2 year structured programmes incorporating the current PRHO year (FP1) and the current first year SHO training (FP2) A requirement for all UK graduates after August 2005 Be competency/outcome based A range of robust assessment methods will be employed to measure progress

What we know about Foundation Programmes: 

What we know about Foundation Programmes To develop generic personal, professional and general clinical skills To provide experience of a range of spheres of practice in a variety of settings Prepare trainees to make their career choice “To offer the possibility that elements of the Foundation years might count towards specialist or GP training”

What we know about Foundation Programmes - FP1: 

What we know about Foundation Programmes - FP1 To demonstrate that trainees are fit for full registration by the GMC Full registration will be granted on the basis of acquisition of competencies required by Good Medical Practice Full registration dependant on demonstration of these competencies

What we know about Foundation Programmes - FP2: 

What we know about Foundation Programmes - FP2 Exit from FPs supervised by PMETB Programmes must have defined learning outcomes Learning outcomes must be patient- centred Programmes must include generic learning outcomes required by PMETB

What we know about Foundation programmes: 

What we know about Foundation programmes Discussions ongoing regarding “themed” programmes Career counselling, regular appraisal, assessment of competencies will place increased burden on trainers and tutors in terms of time and suitable skills PMETB will determine if any experience from FPs can count towards BST

What we know about Foundation programmes: 

What we know about Foundation programmes Care of the Acutely Unwell - trainees at end of FPs to be ‘emergency safe’ a ‘meaningful experience General Practice’ expected to be included for majority of Foundation Programmes Core competences defined by GMC for FP1 and FP2 by PMETB Curriculum to deliver core competencies being defined - due May 2004

AMRC recommendations for core competencies for FPs: 

AMRC recommendations for core competencies for FPs Defined generic and clinical core competencies Defined 9 levels of performance for each. Could be formatted as a summative assessment tool Curriculum will be designed to support this

Core Competencies for FP2 : 

Core Competencies for FP2 Generic Skills: 1.Good Clinical Care - x6 2.Communication Skills - x3 3.Maintaining Good Medical Practice-x3 4.Professional Behaviour and Probity 5.Ethical and Legal Issues 6.Teaching

Core competencies for FP2 - clinical: 

Core competencies for FP2 - clinical Clinical Skills: 1.Acute Care - x13 2.Resuscitation - x2 3.Organisation and Teamwork 4.Investigations

Recruitment to Foundation Programmes : 

Recruitment to Foundation Programmes Foundation Schools will be established based on a medical school(s) and its associated DGHs 4 or 5 Foundation Schools will cover the Eastern Deanery and the northern part of the London deanery, namely:

Foundation Schools within the Eastern Deanery: 

Foundation Schools within the Eastern Deanery Cambridge/Norwich Foundation School(s) North East Thames Foundation School North Central Thames Foundation School North West Thames School

Foundation Schools: 

Foundation Schools Will set up two year programmes from the FP1 and FP2 posts available from its contributing Trusts These must ideally at least equal the expected graduate output from its Medical School(s) Failing this the eventual aim is for parity within each current PRHO ‘cluster’

Recruitment to Foundation Schools: 

Recruitment to Foundation Schools Medical students may apply to one Foundation School - usually their ‘home’ school Special dispensation from the Dean of the Medical School may be required for those applying elsewhere EU and overseas graduates eligible for provisional registration may apply to one Foundation School Appointment to a Foundation School will comply with employment law and equal opportunities legislation

Foundation Programmes: 

Foundation Programmes Recruitment process will vary between Foundation Schools but once accepted into one, a trainee will be guaranteed a two year programme Subsequently they will be selected for their FP1 year post Selection for FP2 posts will occur half way through FP1

NEXT STEPS FOR TRUSTS: 

NEXT STEPS FOR TRUSTS Local champions, CTs, MDs, College Tutors etc to liase locally with colleagues to agree their local proposals - ?set up local implementation team Trusts to give particular consideration to the increased time commitment required to implement and deliver FPs and recognise this in Contract Negotiations with Consultant trainers

NEXT STEPS FOR TRUSTS: 

NEXT STEPS FOR TRUSTS Trusts to ensure that all existing PRHO posts are part of a 12 month rotation to provide FP1 Every Trust with existing PRHO posts in the Eastern Deanery to devise FP2 posts Each Trust to create FP2 placements = FP1 placements plus 20% FP2 programmes should be capable of delivering the skills and competencies required for FPs

Next steps for Trusts: 

Next steps for Trusts FP2 rotations can be: within hospitals with other hospitals with general practice with mental health Trusts with community Trusts within targeted specialities

Next steps for Trusts: 

Next steps for Trusts Trusts to agree how to implement the curriculum in order to provide training for the core competencies Trusts to agree who will undertake educational supervision, appraisal and career advice Trusts to agree how to implement the assessment process (due Autumn 2004?)

NEXT STEPS FOR TRUSTS: 

NEXT STEPS FOR TRUSTS Trusts to report progress to the Deanery through their local champion Trusts that implement programmes early may benefit in terms of available support and sorting out of teething problems Trusts to deliver final programmes in time for recruitment to Foundation programmes commencing in August 2005 (February 2006 for Cambridge) See London and Eastern Deanery Timelines

MODELS FOR FP2 YEAR: 

MODELS FOR FP2 YEAR 3x4 month posts vs 4x3 month vs 6x3x3 month posts. Acute Care provided in A&E,MAU,SAU, or Critical Care London Model - all posts based in A&E with secondments to other specialities Rotations through Paediatrics, O&G, Psychiatry, Palliative Care,GP, Public Health, Pathology etc

Uncertainties Around Foundation Programmes: 

Uncertainties Around Foundation Programmes Exit from FPs will be based on assessment of competencies and outcomes but - which, what, where, how and by whom? How to fund innovative posts? What will be the position of overseas doctors?

Uncertainties around Foundation Programmes: 

Uncertainties around Foundation Programmes What will be the mechanism for those failing to successfully complete FP2? What happens if a trainee wants to take time out after FP1? Other than the usual methods of managing change, will the be any central pressure on Trusts to co-operate

What is the scale of the challenge?: 

What is the scale of the challenge? 21 acute Trusts in the whole Deanery 415 PRHOs in 2004/5 188 in NSC, 103 in Beds & Herts, 124 in Essex Add 15 - 20% for overseas graduate = 500 FP2 posts or 25 per Trust/associated PCTs/Mental Health Trust

What resources do we have?: 

What resources do we have? 1447 existing SHO posts Approx 1000 Trust Grade posts Some existing GP, A&E, paediatric and Psychiatric placements in FP1 programmes Existing 3x4months FP1 programmes based on Addenbrookes Deanery funded local MMC champions in Acute Trusts Strong Clinical Tutor network

The Challenges to Service Delivery and Workforce Planning: 

The Challenges to Service Delivery and Workforce Planning Implementation and Recruitment to FPs Maintaining cover 24/7 with FP trainees, EWTD, increased training/supervision commitments of Trainers What will be the impact of run-through training programmes? What will the service look like when there is a mixture of existing CCST and new CCT holders to integrate within the system?

Challenges to Service Delivery and Workforce Planning : 

Challenges to Service Delivery and Workforce Planning What will happen to overseas trainees - will the post MMC model be more or less attractive to them? How will the reorganised NCCG help to deliver service? Will MMC actually deliver the medical workforce that the service requires????

MODELS FOR FP2 YEAR: 

MODELS FOR FP2 YEAR FP2 posts = FP1 Posts + 20% Excess of FP2 over FP1 to allow for returnees, trainees “with difficulties” and overseas graduates FP2 posts to be identified from: 1.SHO year 1 posts, 2.Trust grade SHO posts, 3.Stand alone SHO posts, 4.New posts for EWTD compliance 5.Innovative posts

Postgraduate Medical Careers: 

Postgraduate Medical Careers PRHO year - GMC - The New Doctor SHO - The Lost Tribe SpR - Calman Training - CCST NCCG Consultants - New Contract, Annual Appraisal and Revalidation

BACKGROUND: 

BACKGROUND Shipman Bristol - The Kennedy Report Alder Hay Public expectations - competence and probity Rising litigation

BACKGROUND: 

BACKGROUND The New Deal EWTD Consultant Expansion The NHS Plan Clinical Governance CNST

“If you have come to help me you are wasting my time - but if you have come because your journey is bound with mine - then, come, walk with me”: 

“If you have come to help me you are wasting my time - but if you have come because your journey is bound with mine - then, come, walk with me” Aboriginal saying

BACKGROUND : 

BACKGROUND Half of all trainees are SHOs Rapid expansion of “trust grade” doctors poor job structure no defined end point to grade Inadequate supervision, assessment,appraisal and career advice Inadequate training in and assessment of generic and core skills and competencies

Modernising Medical Careers : 

Modernising Medical Careers Trainee centred competency assessed service based quality assured flexible coached structured and streamlined