mmc and the world after mtas

MMC and the World after MTAS

Ian R. Hastie

MMC and the World after MTAS

Ian R. Hastie

Dean of Postgraduate Medicine, London

MMC and the World after MTAS

Ian R. Hastie

Dean of Postgraduate Medicine, London

Consultant Geriatrician

"MMC and the World after MTAS"

A Personal View

Modernising Medical Careers: why?

• PRHO competences not consistent

• “Lost Tribes” of SHOs: some wasted time

• Variable supervision at SHO level

• Changing workload – EWTD

• Changing disease patterns, new technologies and new drugs

• Rising patient expectations

• Difficulty in planning careers

• Snakes and ladders of career progression

Time from Graduation to SpR (UK SpRs in London May 2006)

0

50

100

150

200

250

300

350

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3 4 5 6 7 8 9 10

medicinepaedsanaesthsurgery

Modernising Medical Careers

“ ……..the end product of the training process, whether a hospital doctor or

general practitioner, should be a highly qualified, well trained and accredited doctor who can deliver the care and

treatment patients need in the modern NHS.”

Postgraduate Training Programmes in Medicine -August 2007

F1 F2 ST1 ST2

BasicMedicalTraining (2 years)

Higher SpecialistTraining Program.

(3-6 years)

Foundation Programme

(2 years)

graduationFullRegistration CCT

ST3 ST4 ST5 ST6

AllocationAppointment

RUN-THROUGH

2007 after Rounds 1&2

Posts All 15,684

RT 11,880

FTSTA 3627

Academic 177

2007 after Rounds 1&2

Posts All 15,684

RT 11,880

FTSTA 3627

Academic 177

Eligible Applicants 27,849

Success Rates after Round 1

% Successful %Unsuccessful

All UK (andEquiv)Graduates

71.9% 28.1%

AllInternationalGraduates

31.3% 68.7%

Decision on HSMPs

Lines of Responsibility

P rog ram m es an d Tra in ees

D ean ery

S H A

M M C B oard -in c lu d es rep s from th e B M A , A cad em y o f M ed ica l R oya l C o lleg es , N H S

D H

Learning from 2007 - DH• Criticism included

– Big Bang– Rushed consultation– IT development not sufficiently controlled

• Wide Consultation BUT;– Didn’t penetrate stakeholder community– Consultees didn’t take responsibility or own the product

(nobody blameless: IRHnobody blameless: IRH)– DH didn’t hear some messages

• Lessons learned from Review Group include– the need to address concerns– the power of stakeholder collective responsibility

“A national online application system has considerable merit and could potentially be more efficient

than previous systems…..”

“A national online application system has considerable merit and could potentially be more efficient

than previous systems…..”

BGS Oct 2007

?2008• No National IT system

• National Person Specs.

• Local Application Form – Less ‘white space’ and more CV

• Local Deanery Appointments (?interference)

• Very Tight Timescale

• Academic Posts

• HSMPs

2008 Recruitment Process• Most specialties will be local recruitment• A few will be national eg GP and Histopath• Separate Academic Recruitment• Mixture of Run-Through and Uncoupled in

2008• Can apply for as many as want• Recruitment phase one 5th Jan to 16th May• Up to 3 recruitment exercises per year

– Most ST1/2 in first exercise– ST3 spread across year depending on NTN

availability

?Clinical resource requirements in one deanery for 2008 recruitment

• Across all specialties with 2008 recruitment, it is estimated:

• 522 Consultants will be needed to shortlist 50 application forms each (assuming double scoring of 13,678 applications)

• 528 days of consultant time will be needed for interviews (assuming panels of six consultants interviewing a maximum of 30 applicants per day).

Competition in 2008• 2007 RT trainees will progress to ST3

– Many ST2/3 will be taken by RT

• Therefore competition more severe in 2008 for remainder (numbers not totally known), – ?3:1 , can not give priority to UK trained– 5800 ST1 and 5000 coming out of FP– 2000 ST2 and 1200 FTSTA1s completing– ?900 ST3 posts with 2000 FTSTA2s completing

What about Run-Through?

• Trainees Appointed to RT in 2007

• ST1 --> ST2

• How do we move from ST2 -->3 ?

Most Popular Medical Specialties and would move

location

• Cardiology 16%

• Respiratory 10%

• Gastro 10%

Leave London rather than accept :

• Allergy

• Audiology

• Chem Path

• Oncology

• Genetics

• GUM

• Immunology

• Nuclear Med

• Paediatric Cardiology

• Rehab. Med

• Occup. Med

• GERIATRIC MEDICINE

How do we move from ST2 -->3 ?

• Which specialties?

• Open or Closed appointment ?

• Local or National appointments ?

Proposal for ST2-->3 for Medicine

• Majority placed locally by closed appointment

• 10-20% of posts put forward for ‘Headroom’

• ‘Headroom’ posts appointed in Open Competition– Local?– National?

TOOKE!!

• Split Foundation

• 3 year core training programmes

• Uncouple Run-Through**

• PMETB:GMC

• Universities control postgraduate training

• Set up Postgraduate Schools**

• Profession to have more say**

Postgraduate Training Programmes in Medicine - ?August 2008 and Beyond

F1 F2 CT1 CT2

CoreMedicalTraining (2/3 years)

Higher SpecialistTraining Program.

(3-6 years)

Foundation Programme

(2 years)

graduationFullRegistration CCT

ST3 ST4 ST5 ST6

AppointmentAppointment

http://www.mmc.nhs.uk/pages/programme_board  

 You may find it useful to read a paper on the outcome of consultation and decision on recruitment to specialty

training in England in 2008:  http://www.mmc.nhs.uk/pages/news/article?45B74A2F-

AF7C-4963-8ED1-D4D5A9D76CF5 

Thank You for Listening(and not throwing anything)

ihastie@londondeanery.ac.uk