A system dynamics approach to developing robust policies and its application to sustainable urban transition dynamics
Dr Graham Willis – Head of Research and Development
The CfWI produces quality intelligence to inform better workforce planning that improves people’s lives
1
Contents
1. Background2. Challenges3. Robust workforce planning4. Results5. Conclusions
1. Background
NHS budget per year?£109 billion
How many people employed?1.4 million
Years to train a hospital specialist?15 years
2. Challenges
Complex factors and feedbacks in the system
Many plausible but challenging futures
What are the critical uncertainties?
What is the most robust policy? What might push our chosen
policy off-course?
Forecasting is difficult, even when looking just a few days ahead, and the level of uncertainty rises the further forward we look. Workforce planning needs to take this into account, as planning timescales extend over many years, even decades for medical professions.
How much can we control?
Focalissue
Degree of influence
Lower Higher Lower
External uncertaintiesDriving forcesTEEPSEWhat we have no Influence over Health & social care
systemTransactions
Factors and issuesWhat we can influence
Our area of the systemKey question of concernPolicy leversWhat we can control
Reducing complexity
Detailed, quantified scenarios for modelling
Critical uncertainties
Assumptions
Data
Policy leversOutline
scenarios
Scope stakeholder
s
Identify future risks,
issues and Big Picture Challenges
Causal mapsCritical
uncertaintiesPre-determined
factors
High impact, high
uncertainty variablesEmerging
stories
Scenario stories
describing challenging
futures
Risks
Structured risks and
issues
Impact
Likelihood
Low
High
Cert
ain
tyIssues
Events
Driving forces
3. Robust workforce planning
Horizon scanning informs scenario generation (framing the uncertainty) and workforce modelling
Policy analysis shows the effectiveness of policy interventions across the range of scenarios
High degree of stakeholder involvement at every stage – including model development – workforce, trainees, employers, policy makers, lay people
System dynamics is the key
Better understanding – dynamic behaviour of system over time
Simplify complexity – rich picture of causality, feedback and delays
High stakeholder involvement – process provides as much value as end-product
Robust decisions – can model and avoid policies that lead to unexpected consequences
Health of the nation
Healthy diet
Exercise Quality of
healthcare
provision
Demand for
healthcare
Healthcare
provision per
person
The health and social care system can be considered as composed of a set of interrelated factors.The factors are linked to each other through cause and effect relationships. A change to a factor will influence one or more other factors in the system.
Formal model specification Independent testing Comparison with other
models Reviews with stakeholders Sensitivity & uncertainty
analysis
Stock and flow supply model
Medical school34,150
34,100
34,050
34,000
33,95010 15 20 25 30 35 40
Foundation 16,400
6,300
6,200
6,100
6,00010 15 20 25 30 35 40
Core training6,600
6,500
6,400
6,30010 15 20 25 30 35 40
Higher speciality training12,300
12,250
12,20010 15 20 25 30 35 40
Career post40,000
20,000
010 15 20 25 30 35 40
GP50,000
010 15 20 25 30 35 40
Foundation 26,400
6,200
6,000
5,80010 15 20 25 30 35 40
2011 = 34,069* 2011 = 6,081 2011 = 6,341 2011 = 6,524 2011 = 12,252
2011 = 35,803
2011 = 19,687
Run-through training7,500
7,400
7,30010 15 20 25 30 35 40
2011 = 7,346
GP training8,000
7,500
7,00010 15 20 25 30 35 40
2011 = 7,765
Trained hospital doctors100,000
50,000
010 15 20 25 30 35 40
2011 = 39,088
Medical SchoolEnglandStart Medical
School English
Start MedicalSchool From OOC
Medical SchoolAttrition
CompleteMedical School
Medical SchoolComplete Attrition
Leave System
FoundationYear 1
Start F1
Resit F1
FoundationYear 2
Start F2
Resit F2
Foundation 1Attrition
Foundation 2Attrition
Finish F1 Finish F2
Start F1 FromOES
Start F2 FromOES
SeekingTraining orCareer Post
Core TrainingHigher
SpecialtyTraining
Run ThroughTraining
GP Training
Career PostWithout CESR
GP
HospitalConsultant
Start GP TrainingFrom English
System
Start Core TrainingFrom English Medical
System
Start Run ThroughTraining From English
System
Complete CoreTraining
Start HigherSpecialty
Training fromEnglish Medical
System
Complete HigherSpecialty Training
Complete GPTraining
HospitalConsultant toGP Training
Start HospitalConsultant to GP
Conversion Training
Complete HospitalConsultant to GP
Conversion Training
Seeking GPPosition Start GP Position
Following Training
SeekingHospital
ConsultantPosition
Complete RunThrough Training
Start HospitalConsultant PositionFollowing Training
Start GP TrainingFrom OES
Start Core TrainingFrom OES
Start Run ThroughTraining From OES
Start HigherSpecialty Training
From OES
Start GP PositionFrom OES
Start HospitalConsultant Position
From OES
Start CareerPost
Career PostWith CESRCareer Post
Gains CESR
Career Post With CESRBecome Hospital
Consultants
Start Seeking Trainingor Career Post After
Career Post
Start SeekingGP Position
Complete GPTraining Leave
System
Complete HigherSpecialty Training
Leave System
Start Seeking HospitalConsultant Position after
Run Through Training
Complete RunThrough Training
Leave System
Complete CoreTraining Leave
System
Complete ConsultantTraining Core Start
Seeking Career Post
GP Training AttritionLeave Medical System
GP Run Through TrainingAttrition Rate Start Seeking
Training Or Career Post
Run Through TrainingAttrition Rate Leave
SystemRun Through TrainingAttrition Rate Start Seeking
Training Or Career Post
Higher SpecialtyTraining Attrition Rate
Leave System
Higher Specialty TrainingAttrition Start Seeking
Training Or Career PostCore Training
Attrition Rate LeaveSystem
Core Training AttritionStart Seeking Training
Or Career Post
Career Post AttritionRate Leave System
Career Post WithCESR Leave System
Start Career PostWith CESR From
OES
Start CareerPost From OES
GP AttritionLeave System
Hospital ConsultantAttrition Leave System
Complete F2 StartSeeking Training or
Career Post
Pass F2 LeaveSystem
Percentage of MedicalSchool Intake That Will Drop
Out
<100 Percent>
Percentage of the Studentsthat start F1 that will Drop
Out
<100 Percent>
Percentage Students FailFoundation 1 and Resit
<100 Percent>
Initial Foundation 1
<100 Percent>
Percentage Students FailFoundation 2 and Resit
<100 Percent>
Initial Foundation 2
Pass F2
Percentage Student PassF2 And Leave System
<100 Percent>
GP Attrition Rate
<100 Percent>
Initial GP
Initial Hospital Consultantsin GP training
Hospital Consultant AttritionRate
Initial Hospital Consultant
<100 Percent>
Percentage Career PostGain CESR Per Year
Initial Career Post
<100 Percent>
GP Training Attrition RateLeave Medical System
<100 Percent>
GP Training Attrition RateSeeking Training or Career
Post
<100 Percent>
Percentage Complete GPTraining And Leave System<100 Percent>
Time to find GP Position
Run Through TrainingAttrition Rate Leave Medical
System
<100 Percent>
Run Through TrainingAttrition Rate SeekingTraining or Career Post
<100 Percent>
Start SeekingHospital ConsultantPosition after Higher
Specialty Training
Percentage Complete RunThrough Training And Leave
System
<100 Percent>
Percentage CompleteHigher Specialty Training
And Leave System
<100 Percent>Time to find HospitalConsultant position
Initial Seeking HospitalConsultant Position
Initial Seeking GP Position
Core Training Attrition RateLeave Medical System
<100 Percent>
Core Training Attrition RateSeeking Training or Career
Post
<100 Percent>
<100 Percent>
Percentage Complete CoreTraining And Leave System
<100 Percent>
Higher Specialty TrainingAttrition Rate Leave Medical
System
Higher Specialty TrainingAttrition Rate SeekingTraining or Career Post
<100 Percent>
Initial Seeking Training orCareer Post
Initial Career Post WithCESR
Average Time to find CareerPost
<100 Percent>
<100 Percent>
<100 Percent>
Annual Medical SchoolIntake From England
FLAG StartAccademic Year
<Time>
<TIME STEP>
Accademic YearStart Date
Time Spent In MedicalSchool By DelayLength
Annual Medical SchoolIntake From Outside Of
Country
<TIME STEP>
<100 Percent>
1 Year
<100 Percent>
Complete F2Including Attrition
Percentage of the Studentsthat start F2 that will Drop
Out
<100 Percent>
<100 Percent>
<Percentage Students FailFoundation 1 and Resit>
<Percentage Students FailFoundation 2 and Resit>
<100 Percent>
GP Training LengthIncluding Delay Percentage
Start GPTraining
Start and Continue GPTraining By Remaining
Delay
<100 Percent>
<FLAG StartAccademic Year>
Complete GPTraining
Accademic Year
<TIME STEP>
<TIME STEP>
<TIME STEP>
<FLAG StartAccademic Year>
Complete GP Trainingand Progress To Next
Year
Start RunThrough Training
Start and Continue RunThrough Training By
Remaining Delay Run Through Training LengthIncluding Delay Percentage
<TIME STEP>
<FLAG StartAccademic Year>
<TIME STEP>
Complete RunThrough TrainingAccademic Year
<TIME STEP>
Complete Run ThroughTraining and Progress To
Next Year
<100 Percent>
Start CoreTraining
Start and ContinueCore Training ByRemaining Delay
<TIME STEP>
<FLAG StartAccademic Year>
<TIME STEP>
Complete Core TrainingAccademic Year
<TIME STEP>
Complete CoreTraining and Progress
To Next Year
<100 Percent>
Start HigherSpecialty Training
Start and Continue HigherSpecialty Training By
Remaining Delay
Higher Specialty TrainingLength Including Delay
Percentage
<100 Percent>
<FLAG StartAccademic Year>
<TIME STEP>
<FLAG StartAccademic Year>
<TIME STEP>
Complete HigherSpecialty TrainingAccademic Year
<1 Year>
Complete HigherSpecialty Training andProgress To Next Year
<100 Percent>
Foundation Year 2TOTAL
Seeking Training orCareer Post TOTAL
GP Training TOTAL
Run Through TrainingTOTAL
Core Training TOTAL
Higher SpecialtyTraining TOTAL
Career Post WithoutCESR TOTAL
Career Post WithCESR TOTAL
Seeking HospitalConsultant Position
TOTAL
Hospital ConsultantTOTAL
Hospital Consultant toGP Training TOTAL
Seeking GPPosition TOTAL
GP TOTAL
<TIME STEP>
<FLAG StartAccademic Year>
<100 Percent>
GP Training NewEntrants
<FLAG StartAccademic Year>
<TIME STEP>
Foundation TOTAL
Training RunThrough New
Entrants
<TIME STEP><FLAG Start
Accademic Year>
Higher Specialty TrainingNew Entrants
<TIME STEP>
<FLAG StartAccademic Year>
<TIME STEP>
<FLAG StartAccademic Year>
Number of CCTConsultant Per Year
<TIME STEP>
<FLAG StartAccademic Year>
Number CompletingCore Training
<TIME STEP>
<FLAG StartAccademic Year>
Start ConsultantTraining Core TOTAL
<TIMESTEP> <FLAG Start
Accademic Year>
Pass F2 TOTAL
<TIME STEP>
<FLAG StartAccademic Year>
Number of CompletingConsultant Training
HS
<TIME STEP>
<FLAG StartAccademic Year>
<100 Percent>
<Time>
<INITIAL TIME>
<Time>
<INITIAL TIME>
<INITIAL TIME>
<Time>
<INITIAL TIME>
<Time>
<INITIAL TIME>
<Time>
<INITIAL TIME>
<Time><INITIAL TIME>
<Time>
<100 Percent>
<100 Percent>
<INITIAL TIME> <Time>
<INITIAL TIME>
<Time> <INITIAL TIME>
<Time>
<100 Percent>
<INITIAL TIME>
<Time>
<INITIAL TIME><Time>
<INITIAL TIME><Time>
<INITIAL TIME>
<Time><TIME STEP>
<INITIAL TIME>
<Time>
<TIME STEP>
<Time>
<INITIAL TIME>
<Time>
Annual F1 Intake FromOutside Of English System
<TIME STEP><FLAG StartAccademic Year>
Annual F2 Intake FromOutside Of English System
<FLAG StartAccademic Year> <TIME STEP>
Annual GP Training IntakeFrom Outside Of English
System
<TIME STEP>
<INITIAL TIME>
<Time>
Annual Run Through IntakeFrom Outside Of English
System
<INITIAL TIME>
<TIME STEP>
<FLAG StartAccademic Year>
Annual Core Training IntakeFrom Outside Of English
System <INITIAL TIME>
<Time> <TIME STEP>
Annual Higher SpecialtyTraining Intake From
Outside Of English System
<INITIAL TIME><Time>
<TIME STEP>
Annual Career Post WithoutCESR Intake From Outside
Of English SystemAnnual Career Post With
CESR Intake From OutsideOf English System
Annual Hospital ConsultantIntake From Outside Of
English System
Annual GP Intake FromOutside Of English System
<FLAG StartAccademic Year>
<TIME STEP>
<TIME STEP>
<TIME STEP>
GP TOTAL By Gender
Start Consultant or GPTraining From Career
Post
Start Higher SpecialtyTraining From Career
Post
<TIME STEP>
Time to CompleteConsultant to GP
Conversion Training
Annual Hospital ConsultantStart GP Conversion
Training
<TIME STEP>
<INITIAL TIME>
CompleteConsultant Core
Training AvailableFor Higher
Specialty Training
<TIME STEP>
Start Consultant or GPTraining Core Career Post
TOTAL
<FLAG StartAccademic Year>
GP Training TOTALBy Gender
Career Post WithoutCESR TOTAL By Gender
Run Through TrainingTOTAL By Gender
Core Training TOTALBy Gender
<Initial Medical SchoolBy Completion Year>
<Start Core TrainingFrom F2>
<Start Core TrainingFrom Career Post>
<Start GP Training FromF2>
<Start GP TrainingFrom Career Post>
<Start Run ThroughTraining From F2>
<Start Run ThroughTraining From Career
Post>
<Initial GP Training ByDelay Length>
<FLAG StartAccademic Year>
<Initial Run ThroughTraining By Delay
Length>
<FLAG StartAccademic Year>
<Initial Run ThroughTraining By Delay
Length>
<Initial HigherSpecialty TrainingBy Delay Length>
<Initial Higher SpecialtyTraining By Delay
Length>
<Initial Core TrainingBy Delay Length>
Core Training LengthIncluding Delay Percentage
<Initial Core Training ByDelay Length>
Start GP PositionRejoiners
Annual GP Rejoiners
Start HospitalConsultant Position
Rejoiner
Annual Hospital ConsultantRejoiners
Start Career PostWith CESR Rejoiner
Annual Career Post WithCESR Rejoin
Start CareerPost Rejoiners
Annual Career Post WithoutCESR Rejoin
<FLAG StartAccademic Year>
InputStringTimeLine
<TIME STEP>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine> <InputString
TimeLine>
<InputStringTimeLine><InputString
TimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine> <InputString
TimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine> <InputString
TimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
<InputStringTimeLine>
Start Consultant C RT orGP Training RT FromCareer Post TOTAL
<TIME STEP>
Start Career PostTOTAL
<100 Percent>
Annual Career Post WithCESR Become Hospital
Consultants
<InputStringTimeLine>
<TIME STEP>
SeekingTraining orCareer Post
Core Trained
Seeking Training orCareer Post Completed
Core Training TOTAL
Career PostCompleted
Core Training
Career PostCompleted Core
Training Gains CESR
Career Post CompletedCore Training Attrition
Rate Leave System
Start Career PostCompleted Core
Training From OES
<100 Percent>
Initial Career PostCompleted Core Training
<100 Percent>
Annual Career PostCompleted Core TrainingIntake From Outside Of
English System
<FLAG StartAccademic Year>
Career Post CompletedCore Training TOTAL
By Gender
Start Career PostCompleted Core
Training Rejoiners
Annual Career PostCompleted Core Training
Rejoin
<InputStringTimeLine>
<InputStringTimeLine>
Start Career PostCompleted Core
Training
<Average Time to findCareer Post>
<Percentage Career PostGain CESR Per Year>
<100 Percent>
Initial Seeking Training orCareer Post Completed
Core Training <InputStringTimeLine>
<Number Start HigherSpecialty Training FromCareer Post Completed
Core Training>
Start Seeking HigherSpecialty Training From
Career Post
<TIME STEP>
<Number Start Higher SpecialtyTraining From Career PostCompleted Core Training>
Foundation Year 2TOTAL By Gender
<Start GP TrainingFrom Career Post>
<Start Run ThroughTraining From Career
Post>
<Start Core TrainingFrom Career Post>
Foundation Year 2TOTAL Gender Ratio
Start F2 TOTAL
<TIME STEP>
<FLAG StartAccademic Year>
Start F1 TOTAL
<TIME STEP>
GP Training GenderRatio
Career Post CompletedCore Training TOTAL
<Time>
Initial Seeking Training OrCareer Post Age Profile
<100 Percent>
Annual GP Training IntakeFrom Outside Of English
System Age Profile
<100 Percent>
Initial Seeking GP PositionAge Profile
<100 Percent>
Initial GP Age Profile
<100 Percent>
Annual GP Intake FromOutside Of English System
Age Profile
<100 Percent>
Start GP Position RejoinersAge Profile
<100 Percent>
Initial Hospital Consultant toGP Training Age Profile
<100 Percent>
Initial Hospital ConsultantAge Profile
<100 Percent>Annual Hospital Consultant
Intake From Outside OfEnglish System Age Profile
<100 Percent>
Annual Hospital ConsultantRejoiners Age Profile
<100 Percent>
Seeking Hospital ConsultantPosition Age Profile
<100 Percent>
Annual Career Post WithCESR Rejoin Age Profile
<100 Percent>
Annual Career Post WithCESR Intake From Outside
Of English System AgeProfile
<100 Percent>
Initial Career Post WithCESR Age Profile
<100 Percent>
Annual Career PostCompleted Core TrainingIntake From Outside Of
English System Age Profile
<100 Percent>
Annual Career PostCompleted Core Training
Rejoin Age Profile
<100 Percent>
Initial Career PostCompleted Core Training
Age Profile<100 Percent>
Initial Seeking Training orCareer Post Completed
Core Training Age Profile
<100 Percent>
Annual Career Post WithoutCESR Intake From Outside
Of English System AgeProfile
<100 Percent>
Annual Career Post WithoutCESR Rejoin Age Profile
<100 Percent>
Initial Career Post WithoutCESR Age Profile
<100 Percent>
Annual Core Training IntakeFrom Outside Of English
System Profile
<100 Percent>
<100 Percent>
Annual Higher SpecialtyTraining Intake From
Outside Of English SystemAge Profile
<100 Percent>
<100 Percent>
Annual Run Through IntakeFrom Outside Of English
System Age Profile
<100 Percent>
<100 Percent>
Career Post WithCESR Age Ratio
Career Post WithoutCESR Age Profile
<100 Percent>
Career PostCompleted Core
Training Age Profile
<100 Percent>
Number Complete CoreStart Seeking Career
Post
<TIME STEP>
<FLAG StartAccademic Year>
<Career PostCompleted Core
Training Age Profile>
<TIME STEP>
<TIME STEP>
<100 Percent>
AgingS TCP
AgingGP T
AgingGP T
AR LS
AgingGP TAR
SToCP
GP Training TOTALBy Age
AgingS GP Aging
GP
<TIME STEP>
GP TOTAL By COO
AgingRT T
Aging RT T AR STorCP
AgingRT TAR
SToCP
AgingHCtoGP T
Start Hospital Consultantto GP Conversion Training
TOTAL
Complete HospitalConsultant to GP
Conversion TrainingTOTAL
<100 Percent>
AgingHCAging
S HC
AgingCP
AgingCPw
CESR
AgingCPwCT
AgingSCPoT wCT
AgingCT T
AgingCT ARSTorCP
AgingCT AR
LS
AgingHS T
AgingHS T
AR LS
Aging HS T AR SCPoT
<InputStringTimeLine>
Career Post WithoutCESR Age Profile By
Age Band
Career Post Attrition Rate
<Career Post Attrition Rate>
<Career Post Attrition Rate>
<InputStringTimeLine>
Core Training TOTALBy Age
Core TrainingRATIO Age
GP TOTAL By AgeGP RATIO By Age
<100 Percent>
<Start Seeking HigherSpecialty Training
From Career Post>
<Seeking Training or Career Post>
Career Post WithoutCESR TOTAL By COO
GP Training NewEntrants From English
System
<TIME STEP>
<FLAG StartAccademic Year>
Training Run ThroughNew Entrants From
English System
<TIME STEP>
Start Core From EnglishSystem TOTAL
<TIME STEP>
<FLAG StartAccademic Year>
<FLAG StartAccademic Year>
<Percentage StartHigher Specialty
Training>
<FLAG StartAccademic Year>
Hospital ConsultantTOTAL By COO
Hospital ConsultantTOTAL By Gender
<Percentage Complete RunThrough Training And Leave
System>
<Percentage of theStudents that start F1 that
will Drop Out>
<Start and Continue GPTraining By Remaining
Delay>
<Career Post WithCESR>
<Career Post WithCESR Age Ratio>
<Percentage StartHigher Specialty
Training>
F1 CompleteAttrition Leave
System
<100 Percent>
Pass F1
<100 Percent>
<Percentage CompleteF1 And Leave SystemIncluding F2 Limits>
<Percentage CompleteMedical School And Leave
System Including F1 Limits>
<INITIAL TIME>
<Time>
<INITIAL TIME>
<Time>
Start Consultant CT FromCareer Post TOTAL
Start Consultant RT FromCareer Post TOTAL
Start Consultant GP TrainingRT From Career Post TOTAL
<FLAG StartAccademic Year>
<Time>
Annual Medical School IntakeFrom England Age Profile
Annual Medical SchoolIntake From Outside Of
Country Age Profile
<InputStringTimeLine>
Initial Foundation 1 AgeProfile
<InputStringTimeLine>
Annual F2 Intake FromOutside Of EnglishSystem Age Profile
<InputStringTimeLine>
Annual F1 Intake FromOutside Of EnglishSystem Age Profile
<InputStringTimeLine>
Initial Foundation 2 AgeProfile
<InputStringTimeLine>
<100 Percent>
<100 Percent> <100 Percent>
<100 Percent>
AgingF2
AgingF1
AgingMS
Start MedicalSchool
<FLAG StartAccademic Year>
Complete Study Yearand Progress To Next
Year
Start AndContinue Medical
School
<TIME STEP>
Foundation Year 2TOTAL By Age
Finish F2 TOTAL
<TIME STEP>
Sum Finish F2 AgeMS F
Sum Finish F2 AgeWorkforce
<Flag Aging Trigger>
<Flag AgingTrigger>
<Flag AgingTrigger>
<Flag AgingTrigger>
<Flag AgingTrigger>
<Flag AgingTrigger>
<Flag AgingTrigger> <Flag Aging
Trigger>
<Flag AgingTrigger>
<Flag AgingTrigger>
<Flag AgingTrigger>
<Flag AgingTrigger>
<Flag AgingTrigger>
<Flag AgingTrigger>
<Flag AgingTrigger>
<Flag AgingTrigger>
<Flag AgingTrigger>
<Flag AgingTrigger>
<Flag AgingTrigger>
<Flag AgingTrigger>
<Flag AgingTrigger>
<Flag AgingTrigger>
<Flag AgingTrigger>
<Flag AgingTrigger>
<Flag AgingTrigger>
<100 Percent>
<TIME STEP>
<Time>
<INITIAL TIME>
<GP Attrition Rate IncScn and Pol and Max
Age Adj>
GP Attrition RateTOTAL
<100 Percent>
<TIME STEP>
<1 Year>
<Hospital ConsultantAttrition Rate Inc Scn and
Pol and Max Age Adj>
<1 Year>
<Career Post AttritionRate Inc Scn and Pol and
Max Age Adj>
<Start Seeking Training orCareer Post After Career
Post>
<TIME STEP>
<1 Year>
<Career Post AttritionRate Inc Scn and Pol and
Max Age Adj>
<Career Post With CESRBecome Hospital
Consultants>
<TIME STEP>
<1 Year>
<Career Post Attrition RateInc Scn and Pol and Max
Age Adj>
<1 Year>
Pass F2 And StayIn System TOTAL
<TIME STEP>
Career Post With CESRBecome HospitalConsultant TOTAL
<TIME STEP>
<FLAG StartAccademic Year>
Foundation Year 2TOTAL By Gender
and COO
GP Training TOTALBy Gender and COO
GP TOTAL By Genderand COO
Run Through TrainingTOTAL By Gender and
COO
Core Training TOTALBy Gender and COO
Higher SpecialtyTraining TOTAL ByGender and COO
Hospital ConsultantTOTAL By Gender and
COO
Career Post WithoutCESR TOTAL By Gender
and COO Career Post WithCESR TOTAL ByGender and COO
Career Post CompletedCore Training TOTAL By
Gender and COO
Hospital Consultant to GPTraining TOTAL ByGender and COO
<Start GP Training ToMeet Desired Places>
<Time>
<TIME STEP>
<Start Run ThroughTraining To Meet Desired
Places>
<Start Core Training ToMeet Desired Places>
<Start Higher SpecialtyTraining To Meet Desired
Places>
HospitalConsultant
Attrition RateTOTAL
<100 Percent>
Hospital ConsultantTOTAL Percentage
Increase
<100 Percent>
<TIME STEP>
Number CompletingRun Through
Training
<TIME STEP>
<FLAG StartAccademic Year>
Number CompletingGP Training Core By
Gender
<TIME STEP>
<FLAG StartAccademic Year>
<FLAG StartAccademic Year>
<Percentage of theStudents that start F2 that
will Drop Out>
<Initial Hospital Consultant>
<Time>
GP Total By 10 YrAge Bands
Hospital ConsultantTOTAL By Age
Hospital ConsultantTotal By 10 Yr Age
Bands
Number CompletingGP Training Core By
Age<TIME STEP>
Number Completing GPTraining Core By AgeBy 10 Yr Age Bands
<Start Seeking HospitalConsultant Position after
Higher Specialty Training>
<Start Seeking HospitalConsultant Position after Run
Through Training>
<Start HospitalConsultant to GP
Conversion Training>
If this structure isimplemented may want toconsider using a different
delay type
<Initial GP Training ByDelay Length>
<Initial Run ThroughTraining By Delay
Length>
<Initial CoreTraining By Delay
Length>
<Initial Higher SpecialtyTraining By Delay
Length>
Hospital ConsultantAttrition Rate Fixed
for 12 Months
<100 Percent>
FlagAttritionTrigger
Fixed AttritionRate Start Date<Time>
<TIME STEP>
<INITIAL TIME>
GP Attrition Rate Fixedfor 12 Months
<FlagAttritionTrigger>
<100 Percent> <TIME STEP>
<1 Year>
Career Post WithCESR Attrition RateFixed for 12 Months
<FlagAttritionTrigger>
<100 Percent>Career Post WithoutCESR Attrition RateFixed for 12 Months
<FlagAttritionTrigger><100 Percent>
Career Post CompletedCore Training Attrition
Rate Fixed for 12 Months
<FlagAttritionTrigger>
<100 Percent>
GP TrainingAttrition Delayed by
1TS
<TIME STEP>
Run Through TrainingAttrition Delayed by
1TS
<TIME STEP>
Core TrainingAttrition Delayed by
1TS
<TIME STEP>
Higher SpecialtyTraining AttritionDelayed by 1TS
<TIME STEP>
Start HospitalConsultant PositionFollowing Training
TOTAL by Age
<TIME STEP>
<FLAG StartAccademic Year>
<1 Year>
<1 Year>
<1 Year>
<1 Year>
<Percentage TrainingEntrants From English
System Start GPTraining>
Complete F1TOTAL
<TIME STEP>
<FLAG StartAccademic Year>
Number Completing GPTraining Core
<TIME STEP>
Start GP TrainingFrom F2 TOTAL
<FLAG StartAccademic Year>
Start GP TrainingFrom Career Post
TOTAL
Start Run ThroughTraining From F2
TOTAL
<FLAG StartAccademic Year>
Start Run ThroughTraining From Career
Post TOTAL
Start CoreTraining From F2
TOTAL
<FLAG StartAccademic Year>
Start Core TrainingFrom Career Post
TOTAL
Number Start HST fromCareer Post
<FLAG StartAccademic Year>
Start HST fromEnglish System
TOTAL
<FLAG StartAccademic Year>
<TIME STEP>
<TIME STEP>
<Higher Specialty TrainingAttrition Start Seeking
Training Or Career Post>
<Complete ConsultantTraining Core Start Seeking
Career Post>
<TIME STEP>
<GP Run Through TrainingAttrition Rate Start Seeking
Training Or Career Post>
<Run Through TrainingAttrition Rate Start Seeking
Training Or Career Post>
<Core TrainingAttrition Start Seeking
Training Or CareerPost>
<Start Seeking HigherSpecialty Training From
Career Post>
<TIME STEP>
Full supply model
Segmented by age & gender Can include country of
origin/qualification, skill & competences
Includes attrition, delays, exits & returns, migration, full/part-time working
Sense checking
4. Results
70,000
65,000
60,000
55,000
50,000
45,000
40,000
35,000
30,000
2010 2015 2020 2025 2030 2035 2040
Year
FTE
Demand
Baseline
Supply
Supply after : 50:50 GP ratio
Sensitivity & uncertainty analysis
2010
2014
2018
2022
2026
2030
2034
2038
20000
25000
30000
35000
40000
45000
50000
90% Confidence75% Confidence50% Confidence
YearFTE
0 - 11 - 3
3 - 55+
0
5
10
15
20
25
30
35
40
L
M
H
VH
Impact
No ofvariables
Data quality
Policy analysis
1 2 3 4 5
Scen
ario
s
Key Negative
Neutral
Positive
Not robustMore robustMost robustIf D is unlikely
A
B
C
D
Policies
CostSupply-demand gapAge profile
Medical and Dental Student Intakes
Review of current intakes against likely future requirements Insight provided into what policies work best High degree of collaboration, including senior policy makers Significant decisions made
2 percent reduction in medical school intakes for one yearNo change to dental school intakes due to data quality issuesRolling cycle of reviews
See https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/127339/medical-and-dental-school-intakes.pdf.pdf
5. Conclusions
What worked well Stakeholder engagement Futures thinking Use of SD modelling
Where further work is needed Quantifying uncertain parameters Greater range of scenarios
Further research
Whole health & social care model supporting DH’s 20 year strategic vision
Workforce skills and competences Portfolio of scenarios and policies Improving stakeholder participation Information visualisation
Thank you!
Dr Graham Willis – Head of Research and Development
The CfWI produces quality intelligence to inform better workforce planning that improves people’s lives
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