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Forging Foundations Together Andrew Frankel Postgraduate Dean Health Education South London

Forging Foundations Together Andrew Frankel Postgraduate Dean Health Education South London. Foundation Training 2005 - 2014 - beyond. Foundation Schools Foundation Curriculum Foundation Reference Guide Foundation e-portfolio Foundation Trainers ARCP IFS Transfer/Special circs

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Forging Foundations Together Andrew Frankel Postgraduate Dean Health Education South London

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  1. Forging Foundations Together Andrew Frankel Postgraduate Dean Health Education South London

  2. Foundation Training 2005 - 2014 - beyond • Foundation Schools • Foundation Curriculum • Foundation Reference Guide • Foundation e-portfolio • Foundation Trainers • ARCP • IFS Transfer/Special circs • Good Practice Click to edit Master text styles Second leve Third level Fourth level Fifth level www.hee.nhs.uk www.southlondon.hee.nhs.uk

  3. Foundation Training 2005 - 2014 - beyond • Foundation Schools • Foundation Curriculum • Foundation Reference Guide • Foundation e-portfolio • Foundation Trainers • ARCP • IFS Transfer/Special circs • Good Practice • Foundation Faculties • Foundation Doctors Click to edit Master text styles Second leve Third level Fourth level Fifth level www.hee.nhs.uk www.southlondon.hee.nhs.uk

  4. North West Thames1 South West Thames1 South East Thames1 LCMDE Lead Provider Provider Support North East Thames1 Specialty Schools London Deanery journey, from 1993 to 2014 Shared Services 1993 2001 2013 2010 1995 HENCEL HESL LCMDE Training structures in London have always been in evolution South Thames Deanery North Thames Deanery London Deanery HENWL Click to edit Master text styles Second leve Third level Fourth level Fifth level Click to edit Master text styles Second leve Third level Fourth level Fifth level Lead Provider Specialty Schools (2008) 4 Regional Health Authorities 2 Regional Health Authorities 5 SHAs / 5 WDCs2 (2001) NHS London (2006) • Deaneries have always been ‘organisations in the middle’. They occupy a complex space between service, the professions, higher education, government, regulators, Royal Colleges, employers and the unions. As such, they have been subject to a succession of policies, reports and proposals over the last three decades have recommended a variety of organisational forms and reporting relationships. They also taken on many new and important functions (e.g., recruitment) 1 Deaneries included home counties from Bedfordshire to Kent 2 Workforce Development Confederations www.hee.nhs.uk www.southlondon.hee.nhs.uk

  5. Education and training for better healthcare Click to edit Master text styles Second leve Third level Fourth level Fifth level Health Education England (HEE) is the new national leadership organisation responsible for ensuring that education, training, and workforce development drives the highest quality public health and patient outcomes. Local education and training boards (LETBS) are responsible for educating and training doctors, dentists, nurses and all health professionals and supporting them at every stage in their career Together HEE and LETBs will deliver a better health and healthcare workforce for England. www.hee.nhs.uk www.southlondon.hee.nhs.uk

  6. Further redesign ahead Click to edit Master text styles Second leve Third level Fourth level Fifth level • May be changes to LETB structures • Regional “Hubs” • Uncertain whether this will alter the role of LETBs which are enshrined in statute www.hee.nhs.uk www.southlondon.hee.nhs.uk

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  8. Shape of Training Review • Medical training needs for next 30 years UK-wide • 5 themes: • Patient needs • 2 Workforce needs • 3 Breadth and scope of training • 4 Training and service needs • Flexibility of training • Undergraduate to postgraduate transition • Clinical/Academic training interface Click to edit Master text styles Second leve Third level Fourth level Fifth level www.hee.nhs.uk www.southlondon.hee.nhs.uk

  9. Shape of Training Review Click to edit Master text styles Second leve Third level Fourth level Fifth level www.hee.nhs.uk www.southlondon.hee.nhs.uk

  10. Shape of Training Review: Changing patient needs Click to edit Master text styles Second leve Third level Fourth level Fifth level • 42% have a long-term condition • 23% have multiple conditions • Onset 10-15 years earlier if socioeconomic deprivation www.hee.nhs.uk www.southlondon.hee.nhs.uk

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  14. Shape of Training 1 • Relevant organisations must provide clear advice to medical students about what they should expect from a career • Medical Schools must ensure that graduates are fit for practice at point of registration • Full registration will move to point of graduation Click to edit Master text styles Second leve Third level Fourth level Fifth level www.hee.nhs.uk www.southlondon.hee.nhs.uk

  15. Point of Registration • Oversupply and economic problem • Not yet decided and needs change in law • Has support of MSC who are working up the details • Still M/S finals • Also a competitive/ranking selection process • What is really changing? • How will this affect revalidation - ?for all 1 year out of M/S Click to edit Master text styles Second leve Third level Fourth level Fifth level www.hee.nhs.uk www.southlondon.hee.nhs.uk

  16. Shape of Training 1 • Relevant organisations must provide clear advice to medical students about what they should expect from a career • Medical Schools must ensure that graduates are fit for practice at point of registration • Full registration will move to point of graduation – • Relevant organisations need to introduce a generic capabilities framework for curricula based on GMP eg communication, leadership, quality improvement etc • Relevant organisations must produce processes including assessments that allow doctors to progress at their own rate through training within the overall timeframe of the programme (?end of time based) • Relevant organisations including employers must produce longer placements in training to work in teams and with supervisors including putting in place apprenticeship based arrangements Click to edit Master text styles Second leve Third level Fourth level Fifth level www.hee.nhs.uk www.southlondon.hee.nhs.uk

  17. Shape of Training 2 Click to edit Master text styles Second leve Third level Fourth level Fifth level • Postgraduate training must be structured within broad speciality areas based on patient care themes and defined by common clinical objectives. There may be an opportunity to specialise within this broad area as you move through • Relevant organisations must review content of curricula to ensure that they are fit to deliver broad speciality training, generic capabilities, transferable competencies and patient and employer involvement • Relevant organisation should develop credentialed programmes for some specialities and all sub speciality programmes which will be approved and QA by the GMC www.hee.nhs.uk www.southlondon.hee.nhs.uk

  18. Shape of Training Click to edit Master text styles Second leve Third level Fourth level Fifth level • Fundamentally about the right doctors to treat future patients • Formal training does not stop at a CST • No change to foundation • No big bang • Must get credentialing real • Genuinely trying to make careers more flexible www.hee.nhs.uk www.southlondon.hee.nhs.uk

  19. Shape of Training Review: CPD (15) & Credentials (16) Click to edit Master text styles Second leve Third level Fourth level Fifth level F2 Medical School F1 Credential Credential Credential Continuous Professional Development Certificate of Specialty Training Full Registration www.hee.nhs.uk www.southlondon.hee.nhs.uk

  20. MEDICAL STAFFING BUNDLESIMPACT ASSESSMENT Care of the elderly – Greenaway and Tooke • Medical Graduate enters Foundation training • Basic higher training modules ēx RCP, RCGP, RC Psych  Certificate. • Enter workforce as a consultant in care of the Elderly (1º+2º integration) who can work across the care network/pathway under the Trust’s Chief of Staff – Elders’ Services. • Some will go onto higher clinical specialist training, e.g. Dementia, Cardiology, Pharmaco-Genomics. • Some will go onto alternative higher specialist training, e.g. Management, Research, Policy-making.

  21. MEDICAL STAFFING BUNDLESIMPACT ASSESSMENT Women’s Care – Greenaway and Tooke • Medical Graduate enters Foundation training • Basic higher training modules ēx RCP, RCO&G, RCGP, RCS, RC Psych  Certificate. • Enter workforce as a Consultant in Women’s Care (1º+2º integration) who can work across the care network/pathway under the Trust’s Chief of Staff – Women’s Services. • Some will go onto higher clinical specialist training, e.g. Cancers, Pharmaco-Genomics, Surgery. • Some will go onto alternative higher specialist training, e.g. Management, Research, Policy-making.

  22. The Future Hospital Commission • Consistent with principles of Shape of Training • Augmentation and modernisation of Urgent Care and General Medical Take • Patients are not discharged but care seamlessly passed on • Medical division – with Chief of Medicine with responsibilities extending into the community – Chief Resident and Central Control Room • The Generalist Physician • We will need to develop training programmes that facilitate the principles of the Future Hospitals Commission Recommendations Click to edit Master text styles Second leve Third level Fourth level Fifth level www.hee.nhs.uk www.southlondon.hee.nhs.uk

  23. Evolution of a Specialist Click to edit Master text styles Second leve Third level Fourth level Fifth level Core Trainee Late Medical School School Child The Specialist Foundation Doctor Early Medical School Specialist Trainee www.hee.nhs.uk www.southlondon.hee.nhs.uk

  24. Broadening the Foundation programme Click to edit Master text styles Second leve Third level Fourth level Fifth level • From Collins report • 3 years in gestation www.hee.nhs.uk www.southlondon.hee.nhs.uk

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  26. Broadening - Challenges Click to edit Master text styles Second leve Third level Fourth level Fifth level • Likely to see considerable movement of Foundation posts from acute trusts to community and to psychiatry • Where is the service in the community that can accommodate Foundation Doctors • How do we make the Broadening Posts educationally viable and purposeful • What about the acute trusts • Backfill rotas and ward work • Funding streams and indemnity www.hee.nhs.uk www.southlondon.hee.nhs.uk

  27. Broadening - Opportunities Click to edit Master text styles Second leve Third level Fourth level Fifth level www.hee.nhs.uk www.southlondon.hee.nhs.uk

  28. Broadening - Opportunities Click to edit Master text styles Second leve Third level Fourth level Fifth level www.hee.nhs.uk www.southlondon.hee.nhs.uk

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