mmc presentation (including new competition ratios)
TRANSCRIPT
Modernising Medical Careers
www.mmc.nhs.uk
The workforce of the future: Realistic career planning
Dr Alison CarrDean AdviserMMC England
www.mmc.nhs.uk
From recent trainee feedback
Training should be seen as a
journey, not a forced route, not a race.
www.mmc.nhs.uk
What’s in this presentation?
• A view of the long-term• Possible future structures for postgraduate
medical education & training• Short term view - latest competition data?• Brief recap on organisational changes – MEE• Your views
www.mmc.nhs.uk
A view of the long termChanging needs of patients and the serviceSome pointers from the NHS Next Stage Review
demand in primary care & community – GP up to 60% of training posts
•ore emphasis on “health” public health workforce, dual accreditation e.g. in cardiology,
diabetology
Paediatrics
Generalists - adaptable
•entralisation- Development of super-specialist
•anagement and leadership skills
www.mmc.nhs.uk
A view of the long termChanging needs of patients and the serviceSome pointers from the NHS Next Stage Review
• Clearer pathways for career progression with more flexibility
• Modularised training• Modular credentialing – formal accreditation at defined
points – knowledge, skills, attitudes, experience & capabilities
• Funding tariff based – money follows the trainee• More recognition for doctors in non-training posts• Career planning – even more individual!
www.mmc.nhs.uk
Possible future structures of Education
Tooke Report recommended :
• “Splitting” Foundation Programme,• developing broad-based beginnings concept
with four core specialty stems,• followed by competitive entry (in all specialties)
to post-core training
www.mmc.nhs.uk
Tooke Inquiry Model
www.mmc.nhs.uk
4 Core Specialty Stems3 Years
FOUNDATION PROGRAMME
Higher Specialty Training
1 Year
Selection
Selection
Selection
Possible future structures of Education
Health Committee and NSR recommended:
• No change to Foundation Programme pending full evaluation
• Continuing with the “mixed economy” training structure (until 2010)
www.mmc.nhs.uk
“Mixed economy” model
www.mmc.nhs.uk
FOUNDATION PROGRAMME
Core Training2-3 Years
Higher Specialty Training
Run Through Training
2 Years
Selection
Selection
Selection
Selection
Possible future structures of education: Current Thinking
www.mmc.nhs.uk
FOUNDATION PROGRAMME
Core Training2-3 Years
Higher Specialty Training
Run Through Training
Selection
Selection
Selection
Selection
3 YearsThemed
Broad BasedTraining
Possible future structures of education: Current Thinking
www.mmc.nhs.uk
FOUNDATION PROGRAMME
Core Training2-3 Years
Run Through Training
3 Years Broad Based Training
Themed
Higher Specialty Training
Credentialing
Credentialing
Service Posts
Flexibility
Recognition that training postsprovide different amounts of experiential learning
Short term view – latest competition data?• Current excess of ‘core posts’ over higher specialist
training posts in medicine & surgery– Surgery up to 3:1, Medicine up to 2:1
• Historic geographic disparity between ‘core posts’ & HST posts – (e.g. better chances in Oxford, lower in Midlands)
• General surgery and T&O producing excess CCT holders – likely to reduce posts
• 400 additional GP posts in 2009 and more to follow
www.mmc.nhs.uk
14
General Surgery Workforce Forecasts
1,000
1,500
2,000
2,500
3,000
3,500
4,000
1996
1999
2002
2005
2008
2011
2014
2017
2020
2023
FT
E
RCSENG Estimated requirements
Historical growth
WRT Baseline Forecast
Modify training numbers to match requirements
Modelling of RCSENG proposals
Reduce 100 ST3 posts for next 5 yrs
www.mmc.nhs.uk
T&O Workforce Forecasts
1000
1500
2000
2500
3000
3500
1996
1998
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2022
FT
E
RCSENG Estimated Requirements
Historical growth
WRT Baseline Forecast
Modelling of ST3 2007 expansion
Reduce training to match requirements
Modelling of RCSENG proposals
Reduce 100 posts for next 6 years
www.mmc.nhs.uk
Workforce Planning is inexact science• Medical School Expansion and long lead in time…. • Feminisation of workforce• Participation rates• EWTD, reduced working hours• CCT holders’ bulge over next few years (Hutton
NTNs)• Ratio of GP to hospital specialty training numbers • Ageing population• Choice, access, expectations• IMGS• NCCG, specialist, “subconsultant” • Skill mix (doctor substitution)
www.mmc.nhs.uk
• Risk of long term undersupply of GPs despite planned intake• Confirms current plans to change ST1 balance towards GP
training• Even in the high supply scenario, demand is larger than supply
Comparison of forecast GP demand and supply(medium demand & medium supply scenarios)
25,000
30,000
35,000
40,000
45,000
50,000
55,000
60,000
65,000
2005
/06
2006
/07
2007
/08
2008
/09
2009
/10
2010
/11
2011
/12
2012
/13
2013
/14
2014
/15
2015
/16
2016
/17
2017
/18
2018
/19
2019
/20
2020
/21
2021
/22
2022
/23
2023
/24
2024
/25
2025
/26
2026
/27
2027
/28
2028
/29
2029
/30
2030
/31
FTEs
Demand (medium) Supply (medium)
• Risk of long term oversupply of CCT holdersBut will be differences between specialties
• Supports current plans to change ST1 balance towards GP training
• For the medium demand scenario, even with low supply there is an oversupply of CCT holders
Comparison of forecast CCT holder demand and supply(medium demand & medium supply scenarios)
25,000
30,000
35,000
40,000
45,000
50,000
55,000
60,000
65,000
2005
/06
2006
/07
2007
/08
2008
/09
2009
/10
2010
/11
2011
/12
2012
/13
2013
/14
2014
/15
2015
/16
2016
/17
2017
/18
2018
/19
2019
/20
2020
/21
2021
/22
2022
/23
2023
/24
2024
/25
2025
/26
2026
/27
2027
/28
2028
/29
2029
/30
2030
/31
FTEs
Demand (medium) Supply (medium)
Implications:Current training number plans
*
FP Intake
ST1 Intake
GP CCT *
2008 5,900 2,300 3,650
2009 6,100 2,700 2,900
2010 6,150 2,900 3,000
2011 6,300 3,200 3,000
www.mmc.nhs.uk
+ additional non-ST1 posts e.g. uncoupled specialty posts at ST3
Competition Ratios 2007
www.mmc.nhs.uk
• 37,000 applicants made 129,000 applications for 17,887 posts
• Competition ratio overall 2:1 (applicants: posts)• Applications per post
– Cardiothoracic surgery 53.8:1 – Trauma & Orthopaedics 22.5:1 – Core Medical Training 6.3:1
Competition Ratios ST3/4 03 07www.mtas.nhs.uk
Specialty No posts No 1st choice applications Comp Ratio
T & O 147 862 5.9
General Surgery 205 1089 5.3
Plastic Surgery 55 262 4.8
Cardiology 100 433 4.3
Ophthalmology 86 239 2.8
Neurosurgery 21 58 2.8
Dermatology 30 85 2.8
Obs & Gynae 384 949 2.5
Haematology 54 112 2.1
Anaesthesia 503 933 1.9
Psychiatry (ST4) 365 651 1.8
Emergency Medicine 187 291 1.6
Paediatrics (ST4) 300 482 1.6
Acute Medicine 121 128 1.12558 67029661 1st choice applications for 4022 ST3 posts
Competition Ratios ST1 03 07
www.mtas.nhs.uk
Specialty No posts No 1st choice applications
Competition Ratio
Public Health 69 368 5.33
Clinical Radiology 184 846 4.60
Medical Micro & Virology 26 101 3.89
Ophthalmology 110 257 2.34
OFMS 25 58 2.32
Neurosurgery 35 77 2.20
Obs & Gynae 289 513 1.78
Chem Path 11 19 1.73
ACCS 458 782 1.71
Surgery in General 850 1434 1.69
CMT 1338 1927 1.44
Anaesthesia 525 641 1.22
Psychiatry 594 711 1.20
Paediatrics 458 512 1.12
4972 824612807 1st choice applications for 7577 ST1 posts
Competition Ratios ST1 SIG- Gen Surg & Generic
UoA No Posts
CR UoA No Posts
CR
Mersey 7 4.43 Northern Ireland (Generic)
22 1.55
West Midlands (Generic/ Gen Surg)
3/22 3.0/1.86 S Yorks & Humber (Generic/ Gen Surg)
6/8 0.33/1.38
Scotland 20 2.8 LNR 7 1.29
London/KSS 24 2.5 Oxford (Generic/ Gen Surg)
12/8 0.67/1.25
Yorkshire (Generic/ Gen Surg)
24/48 2.13/ 0.69
SW Peninsula 17 1.12
Northern 18 2.11 Eastern 30 0.97
North Western 30 2.07 Wales (Generic) 26 0.42
Wessex (Generic/ Gen Surg)
8/4 2.0/1.5 Trent 14 0.29
Severn 8 1.88
Competition Ratios 2007
• 85,201 applications made for 9,666 posts• Average of 4.8 applications per applicant• Applications per post
● At ST1 8.9: 1 ● At ST2 7.8: 1 ● At ST3/4 10.3:1
Competition Ratios 2008
• 37,000 applicants made 129,000 applications for 17,887 posts
• Competition ratio overall 2:1 (applicants: posts)• Applications per post
– Cardiothoracic surgery 53.8:1 – Trauma & Orthopaedics 22.5:1 – Core Medical Training 6.3:1
● CT Surgery 12.4: 1 ● T&O 54.4: 1 ● CMT 9.1: 1
www.mmc.nhs.uk
Programme Posts Apps Ratio
Paediatric surgery* 1 39 39
Clinical radiology 156 5,055 32.4
ACCS – All 390 8902 22.8
Obstetrics and gynaecology* 242 1,503 6.2
Histopathology* 60 317 5.3
Paediatrics* 388 1,728 4.5
General practice* 2,301 7,020 3.1
Short term view – latest competition data?Application ratios for ST1 in 2008
* Are competition ratios as 1 application made per applicant
Short term view – latest competition data?
• Applications appear to have shifted in choice of location from 2007 competition data
• Deaneries in 2008 with low no. applicants per post:– London– Northern– Wessex
• Deaneries in 2008 with high no. applicants per post:– East Midlands– Oxford
www.mmc.nhs.uk
Short term view – latest competition data?
Patterns show links between following specialties:• ACCS – CMT – GP• Anaesthesia – ACCS• General surgery/ Surgical specialities – surgery
in general• Psychiatry – GP
www.mmc.nhs.uk
Brief recap on organisational changes
NHS Medical Education England (NHS MEE):
• Also covers healthcare science, dentistry & pharmacy• Reform/ review postgraduate training pathways• Advise DH on medical education and training• Assure quality of workforce planning• Formal evaluation of Foundation Programme• Work with SHAs on commissioning education and
training• Regional MEEs for each SHA
www.mmc.nhs.uk
Brief recap on organisational changes
• Finalise structures of PGME • Review extension of GP training, with RCGP• Review curricula, assessment processes & trainer
accreditation• (Workforce) Centre of Excellence to advise on building
workforce capacity • Health Innovation and Education Clusters
– Partnerships e.g. of universities, trusts, industry– Focus on improving patient care (innovation)– May provide postgraduate education, subject to local
agreement
www.mmc.nhs.uk
Your Views?Your Questions?
www.mmc.nhs.ukwww.mmc.nhs.uk
Modernising Medical Careers
www.mmc.nhs.uk