1. The Shape of Training
4th March 2015

2. Not Another Review
Medical Education England (MEE) commissioned an independent review
2011 Steering Group identified “issues”
February 2012 – Greenaway appointed
July st meeting of the Expert Advisory Group
All before the bulk of 1st tranche of post-MMC specialty trainees reach CCT

3. Gathering Evidence 1st call for evidence Nov 2012 – Feb 2013
400 submissions of written evidence
10 site visits
16 workshops
59 oral evidence sessions
Then a short 2nd round with key stakeholders

4. Key messages Patients and the public need more doctors who
are capable of providing general care in broad
specialties across a range of different settings. This
is being driven by a growing number of people
with multiple co-morbidities, an ageing population,
health inequalities and increasing patient
expectations.
We will continue to need doctors who are trained
in more specialised areas to meet local patient and
workforce needs. l

5. Key messages Local workforce and patient needs should drive
opportunities to train in new specialties or to
credential in specific areas.
Doctors in academic training pathways need a
training structure that is flexible enough to allow
them to move in and out of clinical training while
meeting the competencies and standards of that
training.
Postgraduate training needs to adapt to prepare
medical graduates to deliver safe and effective
general care in broad specialties.
Medicine has to be a sustainable career with
opportunities for doctors to change roles and
specialties throughout their careers.

6. Key messages Full registration should move to the point of
graduation from medical school, provided there
are measures in place to demonstrate graduates
are fit to practise at the end of medical school.
Patients’ interests must be considered first and
foremost as part of this change.
Implementation of the recommendations must be
carefully planned on a UK-wide basis and phased
in. This transition period will allow the stability of
the overall system to be maintained while reforms
are being made.

7. Theme 1: Patient needs drive how we must train doctors in the future
Service
changes
Training
Theme 1: Patient needs drive how we must train doctors in the future
Which
should be
the
primary
driver?
2033: 65% increase in those >65 yo
Multiple comorbidities
A less healthy population
Increasing demand
Medical workforce must be responsive to uncertain future trends

8. Theme 1: Patient needs drive how we must train doctors in the future
More doctors in secondary care contributing to community-based health teams
“Postgraduate training will have to train ALL doctors to provide care in community and acute care settings”
Patients should be more involved in education & training

9. Theme 1: Patient needs drive how we must train doctors in the future
Generalist generic doctor people
More flexible training structure
“better prepared … to meet local requirements … and flexible enough to later change their scope of practice as service and patient needs change over time”

10. Theme 2: Changing the balance between specialists & generalists
Patient & service demands will drive the specialties in which doctors work
Medical Schools must provide realistic career advice
More doctors to work in remote & rural environments

11. Theme 3: A broader approach to postgraduate training
Full registration should move to the point of graduation from medical school
Rigorous standards to ensure graduates are fit to practice at full registration level
Limit training to centres that provide high quality training & supervision as approved by GMC

12. Theme 3: A broader approach to postgraduate training
Generic capabilities framework across all curricula based on GMP
Time served should not be a proxy for competency = shorter training
Recognition that assessment should be less bureaucratic – less “box ticking”
Placements might be longer – at least a year towards end of training

13. Theme 3: A broader approach to postgraduate training
Apprentice-based relationship with trainers
Not all doctors should be trainers
The Foundation Programme should continue

14. Theme 3: A broader approach to postgraduate training
Level 1 – Doctors who have completed the Foundation Programme
Level 2 – Doctors with a Certificate in Specialist Training in a broad theme only
?subconsultant
Level 3 – Doctors with additional in-depth specialty training in a field of practice via a formal credential
?consultant

15. Theme 4: Tension between service & training
Variable consultant contracts
A training structure driven by employers & linked to local needs (determined by employers)
UK-wide standards still would be set by GMC

16. Theme 5: More flexibility in training
Some specialty and all subspecialty training to be acquired through credentialing
Employers, and other organisations, to develop credentials based on local need
Must be transferable between employers

17. The current model

18. 13 November, 2018

19. Delivery of Recommendations
Formation of a UK-wide Delivery Group
Make necessary regulatory change for CST
Review requirements to move registration
Develop credentialing/curricula framework

20. Delivery of Recommendations
Legally award Certificate of Specialist Training – years
Shift all curricula towards broad-based themes – years
Put in place structure to support credentialing – years

21. Our view Reject stated principles of Review
A failure in acute service delivery
Cost saving
Deregulation of training
Many specialties already “general”
Extra time spent in “general training” really just for service provision – “sump of SHOs”
Idea of broad-based themes poorly thought out

22. “Greenaway” consultants
Credentialing
Facilitates subconsultant grade
Employers to control the gateway
Could offer opportunities to SAS grade - unclear
“Greenaway” consultants
25% less time in training
Less experienced, cheaper, “flexible”
Unattractive career
Poorer care and outcomes
Too early, too little consultation, very rushed
Destabilising current care paradigms
Service change via training change never tried
Grossly lacking in detail

23. Statement by 15 Associations
Association of British Neurologists Trainees
Association of Clinical Pathologists trainees group
Association of Otolaryngologists in Training
Association of Palliative Medicine trainees group
Association of Surgeons in Training
National Dermatology Trainee Committee
British Junior Cardiologists Association
British Medical Association Junior Doctors Committee
British Orthopaedic Trainees Association
British Society of Gastroenterology Trainees' Committee
Oncology Registrar Forum
Royal College of Obstetricians and Gynaecologists Trainee Committee
Royal College of Ophthalmologists Ophthalmic Trainees Group
Royal College of Radiologists Junior Radiologists Forum
Young Diabetologists' and Endocrinologists' Forum

24. Statement by 15 Associations
We therefore reject the current direction of travel for Shape of Training and call for:
11.1 a pause in any implementation of the Shape of Training recommendations;
11.2 a full evaluation of the impact of Modernising Medical Careers before considering a further overhaul of training;
11.3 a recognition that with improved resources, enhanced GP training, and a significant expansion of the workforce, UK general practice can help to address the pressures posed by changing demographics and rising co- morbidity;
11.4 further research and evidence on the balance between generalism and specialism within hospitals, before any consideration is given to the proposed shortening of specialist training; and
11.5 full engagement with stakeholders including those delivering education locally.

25. UK SHAPE OF TRAINING STEERING GROUP STATEMENT
those aspects of the current training system that have been shown to work well and are fit for purpose should remain;
 any significant changes to medical training should be consistent with the key principles outlined within the Greenaway report, and taken forward in a measured and incremental way to avoid service and training disruption;
 any significant changes to medical training such as alterations to curricula must reflect the UK basis of medical training and be approved by the GMC;
 Groups should be developed in each country with appropriate stakeholder representation, with the remit to develop proposals as agreed by Ministers through the STSG, taking account of the different strategic priorities and requirements in each country; and
 to expand its membership to include representation from the BMA, Employers, Patients, doctors in training and Chairs of each countries groups.

26. UK SHAPE OF TRAINING STEERING GROUP STATEMENT
a) further work will be undertaken to describe how doctors’ training can be more generic to better meet the current and future needs of patients. This will include a mapping exercise led by the Academy of Medical Royal Colleges and supported by the GMC to look at the extent to which Colleges have or can develop the generic components of their curricula
b) measures to be scoped out, based on evidence collected through pilots, how to further develop the careers of doctors who are outside formal postgraduate training and who are not consultants, such as SAS grade doctors;
c) measures to better prepare doctors to work across the interface between primary, secondary care and the community with more flexibility in training between the sectors ; and
d) the STSG will support the GMC as they develop and pilot credentialing working with all stakeholders with an interest in this aspect of Shape of Training.

27. UK SHAPE OF TRAINING STEERING GROUP STATEMENT
Patients, service users and healthcare professionals should be assured that any proposed changes to training will be properly considered, modelled and costed and consulted upon before any changes are made

28. If there is a problem: Evolve
First, learn the lessons from MMC
Improve medical registrar role using RCP/BMA recommendations
Deal with structural problems in acute hospital care
Deliver preventative medicine strategies to lighten the load on unplanned services
Transition fully to competency- rather than time-based training

29. And importantly…
Uphold high current consultant standards to maintain patient care and continue to attract and brightest and best to fulfilling careers in medicine and surgery in the UK.

30. Questions