1. You are the Future! Dr Cliona Ni Bhrolchain, CSAC Chair CCH Trainees Study Day 19.4.13 (With thanks to Martin McColgan and Jack Cornish for collating some of the figs in this presentation)

2. Where are we now? (The retirement time bomb) RCPCH 2011 Census

3. The retirement time bomb RCPCH 2011 Census

4. The retirement time bomb 50% of CCH consultants are > 50 RCPCH 2011 Census

5. Number of CCH consultants nearing retirement Age in yearsNumber of CCH Consultants 50 31 51 26 52 16 53 24 54 24 55 27 56 27 57 21 58 21 59 22 60 17 61 14 62 17 63 8 64 8 65+ 13 Approx 20 – 25 CCTs per year needed just to replace consultants Doesn’t include – Varying retirement ages – Expansion – Attrition e.g. overseas – SSASG post conversions Likely to need ~30 - 35 per year in total Martin McColgan personal communication

6. How many CCTs in CCH are awarded each year? YearNo. awarded 201015 201120 201210 (+5) = 15 Expected (24 CCT dates unknown) 201322 (+1) = 23 201416 201515 Vacancy rate for CCH posts = 4.3% (vs 7.3% in 2009) Vacancy rates for other posts = 2.4% (general paediatrics); 1.5% (tertiary specialists) Jack Cornish personal communication

7. What kind of posts are being advertised?

8. And last week… Another 6 posts advertised!! = 18 posts in 7 weeks

9. What about paediatric audiology? BACDA census 2005

10. Service lead Electrophysiological diagnostic follow up as part of the newborn hearing scheme Targeted follow up of babies with risk factors for late-onset hearing impairment Audiology services for older babies and children up to 3 years Medical diagnostic service for babies who are found to be hearing impaired in the early weeks of life Medical diagnostic service for children of any age No.% % % % % Audiological scientist6639.1%4929.0%4727.8%00.0%0 Consultant adult audiovestibular physician53.0%63.6%84.7%53.0%74.1% Consultant community paediatrician0*NA0*NA0*NA2816.6%2816.6% Consultant community paediatrician with an interest in audiology 116.5%169.5%1710.1%2213.0%2112.4% Consultant general paediatrician0*0.0%0*0.0%0*0.0%2011.8%158.9% Consultant paediatric audiovestibular physician127.1%1710.1%169.5%169.5%158.9% ENT consultant0*NA0*NA0*NA2011.8%2313.6% SSASG audiovestibular physician53.0%42.4%53.0%42.4%4 SSASG community paediatrician2213.0%3621.3%4124.3%3420.1%3420.1% Provided by another service3721.9%2514.8%2514.8%148.3%137.7% Other105.9%127.1%105.9%42.4%4 Not provided in this area10.6%42.4%00.0%21.2%53.0%

11. Clinical Supervisor for SSASGNo% Consultant adult audiovestibular physician99.2% Consultant community paediatrician4242.9% Consultant community paediatrician with an interest in audiology1616.3% ENT consultant1414.3% General paediatrician99.2% Other88.2% Total98100.0%

12. Why is this important? ‘Analysis …showed that audiovestibular physicians and paediatricians in audiology were more likely than other specialists to request level 1 (aetiological) investigations’ Rangan S, Borgstein B, Lowe J. Deafness in children: a national survey of aetiological investigations. BMJ Open 2012;2:e001174 doi:10.1136/bmjopen-2012-001174

13. What about combined posts? RCPCH Census 2001 - 11

14. What happens to CCT holders? 15 (4.7%) CCTs awarded in CCH – vs 21.6% of consultant workforce – All but 1 in substantive post Another 8 working in CCH with a CCT in general paediatrics i.e. not fully trained in CCH Why? – 198 (62.7%) CCTs in general paediatrics vs 41.4% of consultant workforce RCPCH 2010 CCT Holder Survey

15. What's changing? More training places being created to meet demand! Expanding East Midlands South (new post recognised) Mersey (competitive interviews: unable to accommodate 2 applicants) South West/Peninsula (seeking to expand) Wales (already expanding) Yorks & Humber South (seeking to re-establish CCH training in Sheffield) Reviewing posts South London North West W Midlands Top up Training needs CCT holder survey North West Re-entry programmes

16. How many CCH trainees are there? RCPCH Education & Training Support

17. Who encourages CCH trainees? RCPCH Education & Training Support

18. Getting the right people CCH is now a popular choice in many Deaneries! CCH is a shortage specialty and most trainees go straight into consultant posts (or are headhunted even before CCT!) We need to consider training capacity to meet the demand for consultants and SSASGs who will be retiring in the foreseeable future

19. Should we have a Grid? Positive National profile Like everyone else Competition National standard for recruitment More control of appointment and numbers Even out numbers Risks Lack of mobility might put off trainees with family commitments (? higher proportion of CCH trainees) A lot of time and effort for same result (past experience!)

21. Training programme

22. Training in CCH: basics Three year programme (not just a series of posts) Structure – 2 years in CCH – 1 year more flexible. Can be in CCH, a specific area of CCH or relevant specialty Curriculum Competency-based (except old-style SpR)

23. Allied subspecialties Paediatric neurodisability Child mental health Audiovestibular Medicine

24. CCH curriculum (specific areas) Child public health Behavioural paediatrics Safeguarding incl adoption & fostering Neurodisability incl audiology and visual impairment http://www.rcpch.ac.uk/training-examinations-professional-development/quality- training/curriculum/curriculum

25. What is a relevant specialty? Must be a specialty/placement that enhances competencies approved prospectively e.g. – Paediatric neurology – Paediatric audiology – Palliative care – DGH neuro/epilepsy (perhaps 3/12) – Enteral/parenteral feeding (perhaps 3/12) – Longterm ventilation (perhaps 3/12) – General paediatrics?? (depends on content)

26. Remember CCT in Paediatrics (CCH) MUST be competent in – Gen paediatrics – Neonatal paediatrics – CCH Not just CCH

27. But… Trainees complain their general/neonatal service commitments interfering with CCH training General/neonatal should be – no more than 1/3 of 48 hours and – try to preserve daytime clinical commitments as much as possible e.g. flexible days off, daytime urgent care to avoid rest period after nights

28. Supporting training Curriculum and assessment guidance Resource pack of ideas www.communitychildhealth.co.ukwww.communitychildhealth.co.uk Guidance on preparing CV Guidance on CESR requirements Deanery leads for CCH (all deaneries) Specialty Training Advisor (STA) for individual advice on CCT/CESR http://www.bacch.org.uk/training/trainees.php

29. Assessment WPBA Annual ARCP including trainer’s report START CCT application (assessed by STA) http://www.rcpch.ac.uk/training-examinations-professional-development/quality-training/quality- training

30. CCT requirements SpR Three-year programme Show they have covered the syllabus, incl. breadth and depth Satisfactory progression ST Competence-based but indicative three-year programme Show they have attained competences, incl. breadth and depth Satisfactory progression

31. Remember Still subspecialty trainees even w/o grid appt Expect 32/48 hours in the subspecialty Training needs should be met Quality of training should be paramount College (CSAC) role is to ensure quality

32. Quality

33. Ensuring quality Deanery questionnaire (should differentiate CCH) GMC questionnaire (should differentiate CCH) New consultant questionnaire BACCH ASM trainees meeting; other trainee mtgs Trainee rep on CSAC

34. Issues with quality assurance Unusual in that CCH has no grid – Grid is only an appointments process but were… Unable to identify trainees Unable to monitor trainees The solution – Work with Heads of School – Deanery leads for CCH – RCPCH database of all CCH trainees

35. CCH programme satisfaction 2007 & 2008-09 PMETB

36. Quality of training BACCH survey 2012 BACCH survey 2012 H Brewer & T Woodbridge

37. Trainee survey 2011 Did not differentiate CCH trainees

38. Another piece of the jigsaw Community paediatricians no more likely to be referred to NCAS than other paediatricians and not early in their careers

39. CCT Holder survey 2012 270/330 responded (81%) 91% in same post as their Specialist registration but… 8/xx (%) in CCH don’t have a CCT in CCH. All registered in general paediatrics CCTs awarded: – 15 CCH – 11 PND

42. Other routes to Specialist Register CESR (combined programme) – Includes overseas training CESR in CCT specialty: Paediatrics (CCH) – Training/qualifications/experience equivalent to CCT CESR in non-CCT specialty (CCH) – Must have overseas training/qualifications/experience to follow this route (currently)

43. CESR Must demonstrate training and experience lead to competency equivalent to CCT Standard required – CESR paediatrics = CCT – CESR CCH = ‘knowledge & skills consistent with practice as a consultant in the NHS’ http://www.rcpch.ac.uk/training-examinations-professional-development/certification/certificate- eligibility-specialist-regi

44. Suggestions given to HoS Establish expected workforce needs ( next 5 years ) Re-evaluate CCH training programme – Demand for places – Quality checklist – Trainee feedback Is your training programme fit for purpose?

45. If not… Expand training capacity – Use existing posts flexibly Reassess using checklist/’virtual visit form’ Get level 2 posts approved for Level 3 (needs CSAC approval) Consider > 1 Level 3 trainee together for support – Create additional posts Needs GMC approval only if centre not previously recognised Remember your SSASGs…

46. Mersey 8 CCH trainees – 6 FT – 2 LTFT 2 PND trainees (both LTFT) – 1 Academic 7 more wanting to start in Aug 2012 – Interviewing for the first time

47. Mersey programme Principle is that everyone gets at least 1 year block at AHCH with child protection on call 1 year block in periphery with general on call 6 months neurology Other 6 months ‘relevant specialty’ experience could be a community placement with CAMHS attachment, but should be able to offer flexibility in case they want to do safeguarding/public health or something else too.

48. Post 1Warrington NeurologyElectiveAHCH Post 2APH ElectiveNeurologyAHCH Post 3AHCH Warrington NeurologyElective Post 4AHCH APH ElectiveNeurology Post 5NeurologyElectiveAHCH Warrington Post 6ElectiveNeurologyAHCH APH (Post 7)Neurodisability grid post