1. Royal College of Surgeons – Regional Representatives Event Future medical workforce: Employer views 5 November 2009 David Grantham Head of Programmes, NHS Employers

2. The role of NHS Employers Represents NHS organisations in England on workforce issues: employer representation negotiation on behalf of the NHS good practice and knowledge sharing promotion of careers in the NHS

3. Why do employers’ views matter? Roles and the training for them must reflect future service (i.e. patient) need Service determines available career opportunities Need to set out for all aspirant doctors future requirements and expectations – aligned with service and professional requirements Employer views should influence regulators, educators and service commissioners

4. Why should employer views matter? Not just negative – real issues to address

5. What influences employer views? Pursuit of quality, responsiveness and value for taxpayer Population and workforce demographics Healthcare need Workforce supply Technology and innovation Policy and priorities set Finance Legislation, standards and regulation Timeframes

6. What happened in the last 10 years?

7. Factors influencing the next 10 years? Commitment to expand care outside hospital New roles and care pathways – need for flexibility Increased GP training opportunities ‘Oversupply’ in some specialties – eg surgery Globalisation – healthworker mobility Impact of demographics – eg feminisation, generation Y etc Revalidation and regulation

8. Employer views – training in general Responded favourably to ‘Tomorrow’s Doctors’ Support for Foundation Programme Mixed views on run-through – majority favoured a split ‘Big bang’ recruitment remains a concern – but recognise the economies and benefits of a national process Anxiety that CCT holder is no longer the same as before – capable, but lack experience Challenge balancing training and service

9. Surgical training Want to stick to principle of ‘broad based general specialist training’ 2 or 3 years, as evidenced – but not both A ‘mixed economy’ runs the risk of inequity and inflexibility, for trainees and the service Needs time to plan (at least a year?) Talk now about what to do in 2011

10. Specialist supply issue - surgery

11. Employer views - Consultants and Specialists Service wants an alternative specialist grade: Role between CCT and consultant appointment to gain experience, broaden leadership skills and maintain progression Hierarchy within the consultant grade: New consultant (focussed on service delivery) More established (training and service leadership / management roles) Senior consultant (Clinical Director, Medical Director etc)

12. Why a new specialist role? Different work (more of what junior doctors did) Different CCT product – capable of consultant appointment but not the same as before Affordability - a key issue Maintenance of career progression incentive Dissatisfaction with elements of current consultant contract

13. Employer views - General issues Increasing flexibility – allowing doctors to adapt to service change Standards of accreditation/credentialing – points between license to practice and CCT Employers to determine their own structures Improving workforce planning Creating a modest oversupply in the workforce against anticipated demand

14. Revalidation Support for principle Engaged about design and process Concerned about complexity Want to ‘build up’ from current practices and systems Need to develop ‘remediation’ models

15. Concluding remarks Real challenges lie ahead Productivity is a key issue Employers concerns are real and should be debated Are there alternatives? – if so are these affordable?