Tim Davison Welcome

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PART 1
- Tim Davison Welcome Introduction - Dr Mike
Watson National picture strategic direction -
Dr Moya Kelly Planned changes to GP training -
Dr Stewart Irvine Quality issues
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Tim Davison

• Joint Chair, Regional Medical Training
  Distribution Sub Group

West of Scotland Regional Medical Workforce
Project Stakeholder Event 9th November 2007
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Background to Regional Group

• Concern about trainee numbers being based on
  inadequate Board projections for Cons / SAS
• Concern about top-down planning from the centre
  and silo planning within NHS Boards
• Concern about forecast reduction in trainee
  numbers
• Concern about national distribution of SpRs / STs
• Regional Planning Group agreed to establish and
  resource a Regional Medical Workforce Project
  looking forward to 2015

4
Project Infrastructure

• Project Board chaired by Tom Divers, including
  all MDs, FD, HRD, CEO, Postgraduate Dean, SGHD,
  NWU, Regional Planning
• Sub Group on 2007 intra-regional distribution,
  similar membership, co-chaired by Postgraduate
  Dean and Tim Davison

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Project Board Objectives

• Steer the future projections for the West Boards
• Strategic influence NES and SGHD
• Provide overall sign off of FTSTA numbers for the
  West for 2007
• Consider financial implications of workforce
  planning
• Oversee trainee distribution within the West

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Strategic Engagement

• With NES centrally
• Between Boards and Deanery within the region
• With the Specialty Training Boards and Training
  Programme Directors
• With SGHD

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In order to ..

• Improve projections
• Tangibly influence trainee numbers
• Get fair share of STs for West Region
• Deal with the anaconda bulge of FTSTA /
  Undergraduates
• Promote and influence debate about a sub
  consultant trained doctor grade

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Dr Mike Watson

• Medical Director,
• NHS Education for Scotland
• National Picture Strategic Direction

West of Scotland Regional Medical Workforce
Project Stakeholder Event 9th November 2007
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Dr Moya Kelly
Planned Changes to GP Training NHS Education for
Scotland
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• The way it was
• New programmes
• Impact in educational terms on hospital setting.

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The Way We Were.

• VTS v self construct
• In west, intake of 60 annually to schemes.

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GPST Programmes

• Applicable to all
• Responsible for the whole programme
• Intake in West of 140 at ST1
• Needed 283 posts in a range of specialties.

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Structure

• ST1 2 x 6month posts
• ST2 3x 4 month posts
• ST3 1 year in GP
• From Aug 2008 extra 6 months in GP in ST1.

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Implications

• Intake in Scotland at ST1 will be 300
• Return approx 150 posts back to service
• West returning 67 posts
• Range of specialties.

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Examples

• 2007
• AE 56
• Medicine 47
• Psychiatry 49
• Paediatrics 21
• TO 20
• Surgery 11
• OG 32

• 2008
• AE 31
• Medicine 47
• Psychiatry 42
• Paediatrics 21
• TO 0
• Surgery 0
• OG 31

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Impact on education

• Clinical supervisor
• Educational supervisor
• Programme director.

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Impact on education

• Release to practice for 6 half days
• Eportfolio.

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Assessment
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• Assessments
• Mini CEX x 6 a year
• Case based discussions x 6 a year.
• MSF x 2
• DOPS
• supervisors report at end of post.

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Impact on education - QM

• Trainee feedback
• PD report
• Eportfolio.

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Quality Management of Postgraduate Education and
Training in Scotland

• Dr Stewart Irvine
• Associate Postgraduate Dean
• SE Scotland Deanery
• Chair, NES Medical Quality Management Group

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Statutory Regulation of PGME
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PMETB Quality Framework
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PMETB Quality Framework
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PMETB / GMC Generic Standards
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PMETB / GMC Generic Standards for Training

• Domain 1. Patient safety
• Domain 2. Quality Assurance, Review and
  Evaluation
• Domain 3. Equality, Diversity and Opportunity
• Domain 4. Recruitment, selection and appointment
• Domain 5. Delivery of curriculum including
  assessment
• Domain 6. Support and development of trainees,
  trainers and local faculty
• Domain 7. Management of Education and Training
• Domain 8. Educational resources and capacity
• Domain 9. Outcomes

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Domain 1 Patient safety

• Responsibility Training deliverers (hospitals
  and other institutions where training takes
  place), clinical supervisors, trainees.
• The duties, working hours and supervision of
  trainees must be consistent with the delivery of
  high quality safe patient care.
• 1.2 Trainees must be appropriately supervised
  according to their experience and competence.
• 1.3 Those supervising the clinical care provided
  by trainees must be clearly identified, competent
  to do so, accessible and approachable by day and
  by night, with time for these responsibilities
  clearly identified within their job plan.
• 1.4 Trainees must be expected to obtain consent
  only for procedures which they are competent to
  perform.
• 1.5 Shift and on-call rota patterns must be
  designed so as to minimise the adverse effects of
  sleep deprivation.
• 1.6 Trainees in hospital posts must have
  well-organised handover arrangements ensuring
  continuity of patient care at the start and end
  of periods of day or night duties.

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Domain 2 Quality Assurance, Review and
Evaluation

• Postgraduate training must be quality controlled
  locally by deaneries, working with others as
  appropriate, but within an overall delivery
  system for postgraduate medical education for
  which Deans are responsible.
• 2.1 Programmes, posts, associated management, and
  data collection concerning trainees and local
  faculty must comply with the European Working
  Time Directive, Data Protection Act and Freedom
  of Information Act.

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Domain 3 Equality, Diversity and Opportunity

• Postgraduate training must be fair and based on
  principles of equality
• 3.1 At all stages training programmes must comply
  with employment law, the Disability
  Discrimination Act, Race Relations (Amendment)
  Act, Sex Discrimination Act, Equal Pay Acts, the
  Human Rights Act and other equal opportunity
  legislation that may be enacted in the future,
  and be working towards best practice.
• 3.3 Deaneries must take appropriate action to
  encourage trusts and other training providers to
  accept their fair share of doctors training
  flexibly.

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Domain 5 Delivery of curriculum including
assessment

• The requirements set out in the curriculum must
  be delivered.
• 5.1 Sufficient practical experience must be
  available within the programme to support
  acquisition of competence as set out in the
  curriculum.
• 5.3 Trainees must be able to access and be free
  to attend training days, courses and other
  material that forms an intrinsic part of the
  training programme.

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Domain 6 Support and development of trainees,
trainers and local faculty

• Trainees must be supported to acquire the
  necessary skills and experience through
  induction, effective educational supervision, an
  appropriate workload, personal support and time
  to learn.
• 6.1 Every trainee starting a post or programme
  must attend a departmental induction
• 6.9 Working patterns and intensity of work by
  day and by night must be appropriate for learning
  (neither too light nor too heavy).
• 6.10 Trainees must be enabled to learn new skills
  under supervision, for example during theatre
  sessions, ward rounds and outpatient clinics.
• 6.11 Trainees must not be subjected to, or
  subject others to, behaviour that undermines
  their professional confidence orself-esteem.
• 6.12 routine activities of no educational
  value should not present an obstacle to the
  acquisition of the skills required by the
  curriculum.

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Domain 6 Support and development of trainees,
trainers and local faculty

• Trainees must be supported to acquire the
  necessary skills and experience through
  induction, effective educational supervision, an
  appropriate workload, personal support and time
  to learn.
• 6.14 Access to Occupational Health services for
  all trainees must be assured.
• 6.15 Trainees must be able to attend relevant,
  timetabled, organised educational meetings or
  other events of educational value to the trainee,
  as agreed with the educational supervisor, and
  have time protected for this activity.
• 6.20 Trainees must be able to take study leave
  up to the maximum permitted in their terms and
  conditions of service.
• 6.23 Educational supervisors in hospital and
  community settings must have been trained and
  selected for the role.Resources and time must be
  available for this task to be carried out, and
  included in their job and personaldevelopment
  plans.

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Domain 6 Support and development of trainees,
trainers and local faculty

• Trainees must be supported to acquire the
  necessary skills and experience through
  induction, effective educational supervision, an
  appropriate workload, personal support and time
  to learn.
• 6.25 Trainees should be exposed during their
  training to the academic opportunities available
  in their specialty.
• 6.26 Trainees who recognise that their
  particular skills and aptitudes are well-suited
  to an academic career should be encouraged and
  guided in that endeavour.
• 6.27 Trainees who elect, and are competitively
  appointed to, follow an academic path must be
  sited in flexible programmes of academic
  training that permit multiple entry and exit
  points throughout training (from standard
  training programmes).

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Domain 7 Management of Education and Training

• Education and training must be planned and
  maintained through transparent processes which
  show who is responsible at each stage.
• 7.4 It is highly desirable that all employing
  organisations, providing postgraduate medical
  education and training, have an executive or
  non-executive director at Board level responsible
  for supporting training programmes, setting out
  responsibilities and accountabilities for
  training and for producing processes to address
  underperformance in medical training.
• 7.6 There must be clear accountability, a
  description of roles and responsibilities, and
  adequate resource available to those involved in
  administering and managing training and education
  at institutional level, such as Directors of
  Medical Education and Board level directors with
  executive responsibility, such as Medical
  Director, Finance Director,Director of Clinical
  Governance.

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Domain 8 Educational resources and capacity

• The educational facilities, infrastructure and
  leadership must be adequate to deliver the
  curriculum.
• 8.3 There must be a suitable ratio of trainers to
  trainees and in due course specialty specific
  standards will make reference to this.
• The educational capacity in the department or
  unit delivering training must take account of the
  impact of the training needs of others.
• With regard to trainers, including clinical
  supervisors, adequate time for training must be
  identified in their job plans.

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Surveys

• Trainees
• Trainers

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PMETB Trainee Survey 2006

• Overall Satisfaction
• Domain 1 Patient Safety
• Handover / Supervision / Workload
• Domain 2 Quality Assurance, Review and
  Evaluation
• EWTD Compliance
• Domain 5 Delivery of the Curriculum and
  Assessment
• Hours of Education / Adequate Experience
• Domain 6 Support and development of trainees,
  trainers, local faculty
• Supervision / Career Advice / Feedback /
  Induction
• Learning Opportunities / Consultant Bullying /
  Work Intensity
• Domain 8 Educational Resources and Capacity
• Access to educational resources

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PMETB Trainee Survey 2007
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PMETB / GMC Visits
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PMETB Visits
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Specialty Training Committees
North Deanery
East Deanery
SE Deanery
West Deanery
Cross Deanery STC e.g. Urology
Deanery STC Urology
Scottish National STC e.g. Cardiothoracic Surgery
18/57 Deanery based 39/57 Cross Deanery or
National
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(No Transcript)
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NES Medical Quality Management Group

• Deanery Representation (x4)
• Strategic
• Operational
• Specialty Representation
• Scottish Academy of Medical Royal Colleges
• NHS Service Representation
• Scottish Association of Medical Directors
• NHS Quality Improvement Scotland
• Trainee Representation
• Trainer Representation
• Lay Representation

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PART 2
Regional Medical Training Distribution Sub
Group - Patricia Leiser - Dr Bill Reid - Dr
Brian Cowan
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Patricia Leiser
Regional Medical Training Distribution Sub Group
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• Show the approach/work undertaken last year
• Bill Reid reflections on last year, what went
  well, what went less well and the lessons learned
• Brian Cowan how we plan to take it forward for
  2008

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2 main areas of focus last year

• Number of FTSTAs required across the West
• Distribution of training posts STs, FTSTAs,
  GPTs for the specialities common across all
  Boards in the West.
• Not about recruitment activity

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Identifying Number of FTSTAs

• Establishing our baseline as at October 2006
• Health Boards identified posts by speciality
  NES funded and HB funded
• Reconciled with the Deanery database and
  contract
• Aim - same number of doctors for August 2007 to
  maintain service and rota compliance
• Recognition of potential loss of
  skills/seniority level

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Identifying Number of FTSTAs

• Regions to identify number of FTSTAs
• By speciality compared Oct 2006 baseline numbers
  with STBs proposed 2007 STs number and GPTs.
  Where the 2007 number was less than the 2006
  number, FTSTAs were identified to match the 2006
  numbers
• e.g. If October 2006 baseline showed
• 50 SHOs 20 SpRs 70 posts
• Proposed 2007 numbers
• 30 STs 30 GPTs 60 posts
• 10 FTSTAs were therefore identified for that
  speciality to maintain 2006 numbers

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Finalising the FTSTA information

• Position continued to be refined and updated
• Level of FTSTAs required by NES
• Aim was to identify all posts expected for each
  Board - STs, GPTs, FTSTAs showing the levels by
  sites

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Distribution of Training Posts

• The Sub Group meetings reflected specialities
  covered by the STB
• Allowed consideration of service and rota
  compliance implications
• Agreed outcomes captured in agreed regional
  Template which were signed off by the Joint
  Chairs and distributed widely
• Templates identified the expected
  number/grade/level of each training post for each
  hospital site within each Board across the West,
  which would be progressed through recruitment

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Dr Bill ReidJoint Chair, Regional Medical
Training Distribution Sub Group

• Service and training - personal reflections on
  the interface at the coalface

West of Scotland Regional Medical Workforce
Project Stakeholder Event 9th November 2007
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Background

• Up till August 2005, deanery approved PRHO and
  SHO posts
• Allocated SpRs only on training grounds (though
  tried to accommodate service).
• PRHO and SHO posts stable entities
• SpR allocations to units were seasonal and
  varied.

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Background

• Introduction of FY1 painless
• FY2 involved converting SHO posts relatively
  painless
• Big Bang introduction of run through ST grade /
  FTSTAs exceedingly challenging
• For FIRST TIME service had to have a major say in
  training allocations

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Process

• Storming and Forming
• Parallel process of whats on the ground? and
  how can we use this post best?
• Over-reliance on SHO grade comes home to roost.
• Some posts found to be outside the system had
  to be incorporated or lost

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Process

• Service redesign labelling of posts had become
  dislocated (eg Gynaecology/ Dermatology)
• DGH reconfiguration

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Pendletons Rules

• What went well?
• What would you do to improve things next time?
• Summarise

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Went well

• After initial skirmishes, trust formed and work
  as team
• High level of commitment to good quality training
  and service provision
• Agreement to processes which allow ownership of
  decisions reached by group
• Co-operation at points of high tension

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What could you do better?

• Triangulate data sources use single, agreed
  data set on which to base decisions
• Earlier steer on overall numbers per
  specialty/direction of travel in staffing
• More transparency
• More joined up workstreams
• Roles responsibilities.

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Summary

• Intense period of activity on both sides that
  led to successful (with minor glitches) outcome
  on 1st August
• Formation of authoritative group/data for future
  manpower planning
• Powerful networks decisions facilitated on
  difficult questions

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Summary

• Deanery service both have vested interest in
  getting it right
• Service understanding of training needs
• Deanery understanding of service needs
• Joint responsibility
• Difficult decisions in next few years?

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Brian Cowan
Medical Director Greater Glasgow and Clyde
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Last Year

• Will there be enough doctors ?
• Will the service collapse ?
• Will the selection process work ?
• Where the hell is Inverness ?
• Does anyone believe the numbers ?
• Do they have any FTSTAs in Tayside ?
• Can I get 2 weeks annual leave around
• August 1st ?

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What has improved ?

• We understand the numbers
• There will be 'enough' doctors
• The regional distribution mechanism worked

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New Uncertainties

• GP numbers
• Scottish Process
• No MTAS do our own scheduling
• Timescale
• Funding of recruitment
• ST/FTSTA conversions
• Will everyone work as hard as before ?

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Rules of Engagement

• Training has precedence at all times
• Working in partnership
• Jointly chaired
• Take cognisance of service need
• Use all training opportunities in WoS

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Method

• STBs decide regional distribution
• Training Committee decides WoS distribution
• Deanery reconciles with numbers and checks
• Deanery circulates to regional group
• Medical Directors check
• Regional mtg takes views of all parties and
  records decisions

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What we need

• GP/FY2 numbers fixed ASAP
• Slight change to GP process/placements
• Overall regional numbers soon
• TPDs managing their process
• Everyone keeps to our agreed timescale

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Other Issues

• Understanding rotations
• Board funded FTSTAs
• Loss of SHO3
• Disadvantage of ST number rise in West
• Plan for ultimate loss of FTSTAs

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What we cannot do

• Solve all rota and EWTD problems
• Act as a policeman for every change of rotation
• Override training quality/opportunity concerns

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PART 3
Key Board Issues - Dr Alison Graham
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Dr Alison Graham
Medical Director NHS Lanarkshire
Issues identified by the Boards
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WoS Regional Issues

• Reconfiguration of training numbers
• Interaction with other Boards
• Balance of service delivery and training
• Redesign of services
• Reduction in numbers of doctors or not
• Meeting national targets
• Future of specific roles, for example Clinical
  Fellows

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WoS Regional Issues

• Joint workforce planning group
• Governance
• Co-operation between various partners
• Consistency with decisions
• Agreement reached is final
• Role of group v speciality Boards and NES
• Funding
• Transfer of resource

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Inter-Board Issues

• Allocation of posts 2007
• Future distribution of posts
• Redistribution
• Co-operation with LATs LAS sharing information
  and availability

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Human Resources

• Recruitment process early agreement
• Absence of locums
• Loss of flexibility in recruitment
• Timeliness of issuing contracts
• Manpower

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Manpower

• Reduction in trainees
• EWTD 2009
• Competence and skill mix
• Happy doctors in training?
• Consultant workforce
• current workload supervision
• future
• Other healthcare professionals

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Summary

• Boards welcome the WoS regional planning group
• Manpower concerns
• Learn from previous experience

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PART 4
Facilitated Discussion Debate / Conclusion -
Tim Davison - Dr Bill Reid
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Questions

• Do you feel the approach we are taking makes
  sense?
• What are the areas of agreement?
• What are the points of disagreement?
• Are we involving the right people?
• Would events like this be useful to repeat once
  we are clearer on the position?
• Any other points?