MMC and the demise of MTAS

Dr Celia Gregson

Specialist Registrar in Elderly and Internal Medicine

Frenchay Hospital, Bristol

Objectives – 6 crucial questions:

1. What is MMC?2. What was MTAS?3. Why do I need to know about all this?4. How is MMC going to affect my getting a

job in the UK?5. How is MMC going to affect the training I

get in the UK?6. How is MMC going to affect the future of

the NHS?

To develop a workforce of trained doctors working within clinical teams, who provide the majority of front-line medical management and care for patients.

Vision of MMC

MMC objectives

MMC aims to:

• Ensure that more patient care is delivered by trained doctors rather than doctors in training

• Develop streamline postgraduate medical training focused on the service required by the NHS and delivered to explicit standards

Life before MMC…my life….Year of Training Grade Speciality

0 Graduated from Medical School

1 Junior House Officer Medicine / Surgery

2 Resident Medical Officer A&E - Australia

3 – Med Rotation Senior House Officer CoE / Cardiology

4 – Med Rotation Senior House Officer *MRCP Resp / HIV

5 Clinical Fellow

LAT Specialist Registrar

ITU / Oncology

Elderly / Internal Med

6 Specialist Registrar Year 1 Elderly / Internal Med

7 Specialist Registrar Year 2 Elderly / Internal Med

8 Specialist Registrar Year 3 Elderly / Internal Med

9 Specialist Registrar Year 4

Research - PhD

Elderly / Internal Med

10 Research - PhD

11 Research – PhD

12 Research – PhD

Specialist Registrar Year 5 Elderly / Internal Med

13 CCT Consultant

Life before MMC….the perception..

• CMO ‘Unfinished business’

• SHOs lost in the system

• Lack of skilled doctors

• Excessively long and unfocussed training

• Bottle-necks for skilled doctors

• Multiple applications all year around

• Perceived favouritism

UK MMC Career Framework, 2006

Arrows indicate competitive entry

Specialist and GP training programmes(Run-through training)

Medical school – 4-6 years

Specialty training inSpecialist/GP training “schools”

Career posts

F1

F2

Postgraduate Medical Training

Senior medical appointmentsSenior medical appointments

Continuing professional development

Fixed term specialisttraining

Specialist and GP RegistersArticle 14/11 route

Continuing professional development

Undergraduate medical training in medical school

CCT route

Principles

• Fair peer group competition

• Unique training number (= NTN)

• Entry points to the new programmes

Life after MMC……Year of Training

New Grade

0 Graduation from Medical School

1 JHO FT1 – Foundation Training

2 SHO FT2 – Foundation Training

ST1 Selection

3 SHO ST1 – Specialist Training Core Training

4 SHO ST2 – Specialist Training

ST3 Selection

5 SpR ST3 – Specialist Training

6 SpR ST4 – Specialist Training

7 SpR ST5 – Specialist Training CCT AIM Consultant AIM

8 SpR ST6 – Specialist Training CCT Other Speciality Consultant Speciality

Run-through training

• From 2007, a single specialty training grade will be introduced, combining the SHO and SpR grades

• A doctor in the new grade will be a Specialty Registrar(StR). Doctors appointed to an StR run-through trainingprogramme will get a national training number (NTN)

• New curricula approved by PMETB reflects structure of “run-through” training - specialty training year 1 (ST1) through to specialty training year 8 (ST8) [depending on the specialty]

Modernising Medical Careers

• Phase 1 – Foundation Training– August 2005

• Phase 2 – Speciality Training– August 2007

What’s changed under MMC?

• Foundation Programme – 2 year training programme

• National process– National timeline

– UK-wide online application system

– Application form piloted with F1 doctors

– National scoring guidance

– Fair and open competitive process

Foundation Training Programme

• National Curriculum:– Acute emergencies– NHS skills– Team working– Clinical Governance– Risk Management– Occupational Health

• Preparation for Specialty Training

Foundation Training Programme• National Assessments

– 6 per year Minicex– 4-6 per year DOPS– 2 per year Multiscore Feedback (Mini – Pat Tab)– 6-8 per year Case discussions

• National e portfolio

No. Only doctors who have not completed an internship (or equivalent training) are eligible for F1 posts. As you’ve had house officer experience and are entitled to register with the GMC, it is likely you have already gained competences comparable to the F1 year. You will be able to apply for F2 posts when they are advertised. These standalone posts are not recruited to through MTAS, but will be advertised locally.

If I am settled in the UK and have house officer experience, can I apply to F1, rather than F2 training posts?

What is transition?

New specialty

curriculum

Old specialty

curriculumTransition

StartsNew curriculum

approvedRecruitment begins

Ends Last trainee on old curriculum

completes training

•For most specialties, new curricula commences August 2007•Entry to SHO grade will be closed from August 2007•Recruitment to Specialist Registrar grade ended in December 2006

What if I need to train less than full-time?

• Check your eligibility for flexible training with your local deanery

• Any existing flexible training arrangements will not be automatically carried forward to a new training programme –you must apply for entry into specialty training unless you already hold an NTN

• Indicate on your application that you would like to train less than full-time (this will not be seen by the appointments panel but will remain confidential)

• If you are selected into a programme you will need to discuss your requirements with the appropriate postgraduate dean

Completion of programmes

• Successful completion of a training programme is subject to satisfactory progress. Trainees will be assessed by the PMETB-agreed assessment programme for each specialty and this will lead to a Certificate of Completion of Training (CCT) or application for a Certificate of Eligibility for Specialist Registration (CESR)

• The length of each programme is dependant on the specialty. Specialty curricula on the relevant royal college website will give indicative durations

Longer term

• new consultant posts?

• new career posts?

• others ways of delivering the service?

MTAS

How does it all work?

• Single online application (MTAS)• Application form divided into the following sections

– Personal • Name and address

– Preferences • You must rank 26 foundation schools

– Key questions• There will be 8 questions with a maximum of 150 words each.

– References • Your references must be clinicians

– Equality & diversity• will be used by employers to build a demographic profile of their workforce.

– Submit• Confirm application is completed and all information is correct and your own

work

• You will be able to save your application at any time and come back to it at a later date during the application timeframe

Things to consider

“I only want to do cardiology” (1 specialty):Apply to 4 Units of Application [UoAs] (a deanery or cluster of deaneries)

“I must live in Manchester” (1 geographic area):Apply to 4 specialties in North Western UoA

“I want to spread my options”:Apply to 2 different specialties in 2 different UoAs

Which is more important to you, specialty or geography?

Do your homework

• Learn as much as you can about the specialty and its curriculum by looking at the relevant royal medical college website

• Keep your options as flexible as possible and consider a range of specialties which might suit you

• In the early years of the new specialty programmes there are a large number of training opportunities available in a range of specialties

• You might want to consider a Fixed Term Specialist Training Appointment (FTSTA)

Preparing your application

• Person specifications for all levels are available on the MMC website

• A comprehensive Applicant’s Guide is available via the MMC website

• You will need to provide evidence of having achieved the competences as described in the person specification

• Royal college websites offer advice about the sort of evidence you could offer

Specialties with entry at ST1, 2, 3 and 4 [some]

• Medicine• Surgery• Psychiatry• Acute care common stem [ACCS] • General practice• Paediatrics• Obstetrics & gynaecology• Ophthalmology• Anaesthetics• Neurosurgery• Oral & maxillofacial surgery (OMFS)

Specialties with entry at ST1 only

• Radiology

• Medical microbiology/virology

• Chemical pathology

• Histopathology

• Public health

Medicine [see JCHMT website for further advice]

ST1• Medicine in

General

ST2• Medicine in

General

• Allocation / competitive process to ST3

ST3• Allergy• Audiological medicine• Cardiology• Clinical genetics• Clinical neurophysiology• Clinical oncology• Clinical pharmacology &

therapeutics• Dermatology• Endocrinology & diabetes• Gastroenterology• General internal medicine

(acute medicine)• Genito-urinary medicine• Geriatric medicine• Haematology

• Immunology• Infectious diseases• Medical oncology• Medical ophthalmology• Neurology• Nuclear medicine• Occupational medicine• Palliative medicine• Paediatric cardiology• Rehabilitation medicine• Renal medicine• Respiratory medicine• Rheumatology• Sports & exercise

medicine• Tropical medicine

Doctors with the ST1 and ST2 competences in medicine and with the existing entry requirements for SpR training

Foundation doctors & others without the ST1 competences and with < 1 year’s experience in medical specialties

Doctors with the ST1 competences and with 12 – 36 months experience in medical specialties.

Surgery [see the JCHST website for further advice]

ST1• Generic

programmes in Surgery in General

• Themed programmes

Foundation and other doctors who do not have the ST1 surgical competencesand with < I year ofexperience in surgery

ST2• Themed programmes in:

Cardiothoracic surgery General surgery Otolaryngolgy (ENT) Paediatric surgery Plastic surgery Trauma & Orthopaedic

surgery Urology

Doctors with ST1 surgical competences and with 12 – 36 months experience in surgery

ST3• Cardiothoracic surgery

• General surgery

• Otolaryngology (ENT)

• Paediatric surgery

• Plastic surgery

• Trauma & orthopaedic surgery

• Urology

Doctors with the ST1 and ST2 competences and the existing entry requirements for SpR training

Acute Care Common Stem (ACCS)

ST1• Appointed to one of 3 themed programmes

in ACCS: Emergency medicine Anaesthetics Acute medicine

Foundation and other doctors withoutthe ST1 competences and with <12 months’experience in the relevant specialties

ST2• Acute Care Common Stem in

one of three themed programmes:

Emergency medicine Anaesthetics Acute medicine

• Doctors will continue in designated specialty at ST3 in

Emergency medicine Acute medicine or one of the

medical specialties Anaesthetics, continue at ST2

Doctors with required ST1 competences and 12 – 36 monthsof relevant experience

Psychiatry[see the website of the RC Psych for further advice]

ST1• Psychiatry in

General

Foundation and

other doctors who

do not have the

ST1 psychiatry

competences or

with < I year of

experience in

psychiatry

ST3• Psychiatry in

General

• Allocation / competitive process to ST4

Doctors with ST2

competences and

with < 48 months’

experience in

psychiatry

ST4• Child & adolescent

psychiatry

• Forensic psychiatry

• General adult psychiatry

• Psychiatry of learning disability

• Old age psychiatry

• Psychotherapy

Doctors with the ST1, ST2 and

ST3 competences and the

current entry requirements for

SpR training

ST2• Psychiatry in

General

Doctors with ST1

Psychiatry

competences and

with 12 – 36

months’ experience in

psychiatry

Basic Neuroscience Training• 2 year training post Foundation Training, i.e. ST1

& ST2– Neurology– Neurosurgery– Neurophysiology– Neuroradiology– Neuropaediatrics– Stroke medicine– Rehabilitation– Psychiatry– Geriatrics– ?GP

Other possible posts….

1. Academic Run Through Training

2. Fixed Term Specialty Training Appointments (FTSTAs)

3. Career Posts - previously referred to as Non-Consultant Career Grades (NCCGs).

UK MMC Career Framework, 2006

Arrows indicate competitive entry

Specialist and GP training programmes(Run-through training)

Medical school – 4-6 years

Specialty training inSpecialist/GP training “schools”

Career posts

F1

F2

Postgraduate Medical Training

Senior medical appointmentsSenior medical appointments

Continuing professional development

Fixed term specialisttraining

Specialist and GP RegistersArticle 14/11 route

Continuing professional development

Undergraduate medical training in medical school

CCT route

MMC Anxieties…..• What was wrong with the old system?• Fears of Service• Costs – direct and indirect (consultant supervision and time)• Disappearing SHOs• Is it truly a fair appointment system• Inexperienced F2 trainees• How do you take time out

– Research– Abroad– Personnel

• Reduction in Study time and allowances• Who really benefits – Doctors / Patients / Politicians?

MMC Selection processes

• National, e based, deanery, speciality assessments

• ? The role of the CV

• The role of Royal College Membership exams?

PMETB• Postgraduate Medical Education Training

Board

• www.pmetb.org.uk

• 4th April 2003 – Order of Parliament

• 30th Sept 2005 – went ‘live’

• ‘Independent’, reports to Parliament

• Regulatory body: setting and maintaining standards for education and training

Summary – 6 crucial questions:

1. What is MMC?2. What was MTAS?3. Why do I need to know about all this?4. How is MMC going to affect my getting a

job in the UK?5. How is MMC going to affect the training I

get in the UK?6. How is MMC going to affect the future of

the NHS?

www.mmc.nhs.ukwww.bmjcareers.com

Any questions?