The NHS Future Forum's report: Education and Training – next stage makes many suggestions about structural changes to the education of health care professionals, aptly summarised in the OnMedica article ‘Beefed up role for clinicians in developing workforce’ (Tuesday 10th January). As always it is hard to read documents of this kind, laden as they are with politically correct phrases like ‘robust and transparent governance’ and ‘partnership arrangements’. Even the summary is five pages long and contains 27 bullet points. There are however some encouraging recommendations in it, as well as some that may be problematic to implement and which have potentially negative consequences. I’ll consider both of these, starting with the possibly bad news.
The major change heralded in this document is the ‘transitioning’ of deaneries to Local Education and Training Boards (LETB’s) answerable to Health Education England. [...] The envisaged transitioning is likely to cause a lot of work and potentially reduce the quality of training for a while. I am not aware of any particular problems with the current set up, so one can’t help asking, ‘if it ain’t broke, why try to fix it?’
The major change heralded in this document is the ‘transitioning’ of deaneries to Local Education and Training Boards (LETB’s) answerable to Health Education England, the national body responsible for regulating medical education. Now there is no particular logic to the existence of deaneries, they are just the product of how post-graduate medical training had evolved in this country, being essentially geographically based around major teaching hospital centres. However they have developed considerable educational expertise and resource and a usually very positive culture of learning and teaching, together with rich networks of relationships that support this. If the transition to LETB’s results in the dismantling of these things, that would have a considerable and negative impact on post-graduate training. During my long professional life as GP training programme director my own deanery has had a number of different configurations mirroring the myriad and continual changes in NHS statutory bodies, and each one has meant considerable adjustment and the forming of new relationships. All of this draws energy away from the central task of running training programmes. So the envisaged transitioning is likely to cause a lot of work and potentially reduce the quality of training for a while. I am not aware of any particular problems with the current set up, so one can’t help asking, ‘if it ain’t broke, why try to fix it?’
If the hurdle of ‘transitioning’ deaneries to LETB’s can be overcome [...] there is much to look forward to with optimism.
Turning to the positives in this document, I’m pleased to see that there are a number of these. The forum recommends that care, compassion and the ability to treat people with dignity be made central and essential parts of all medical education curriculae. Alongside this, it says, there should be training in leadership, team working and personal development, as well as exposure to multi-disciplinary working so that all health professionals gain an appreciation of the skills and roles of others outside their own discipline. These are all good points, and interestingly some result from the input of patients to the data-gathering carried out by the forum. The need for on-going input from patients and carers to the education of health professionals is also stressed.
The recommendation [...] that General Practice training be extended to five years [...] has been something that the RCGP and GP training programme directors have been advocating for many years, and it is good to see it reinforced here.
Then there is the recommendation, following the Tooke report, that General Practice training be extended to five years. This has been something that the RCGP and GP training programme directors have been advocating for many years, and it is good to see it reinforced here. The increasing trend to manage patients with many complex medical conditions in the community, and the continuing super-specialisation of the various medical and surgical disciplines mean that it is essential to have a longer training period for what is now an extremely complex and multi-faceted generalist job. Also, I continue to hear from trainees depressing accounts of how some hospital specialists still regard GP’s as a lower form of medical life, and that GP is not a suitable career for the brightest students. Only when the length of GP training equals that of other specialities will this long-held and deeply embedded prejudice finally be laid to rest, to the benefit of the profession as a whole.
The report also recommends that the GMC be responsible for developing a national final undergraduate examination in Medicine. This is surely a long overdue idea.
The report also recommends that the GMC be responsible for developing a national final undergraduate examination in Medicine. This is surely a long overdue idea and would ensure parity and transparency of quality across all the university medical schools who currently are responsible for their own finals. It would also appropriately mirror the situation in post-graduate training where the Royal Colleges set the curriculae and run and quality assure the final examinations whilst the deaneries (soon to be LETB’s) run the training programmes. The separation of training and formative assessment from external, national and public accreditation examinations has got to be a good thing and should help drive up standards and maintain consistency across the nation’s medical schools.
Many who choose a hospital speciality would like to be able to practise at a lower level of responsibility than that required by consultant grade, and the present system makes little allowance for that.
Another good recommendation is that both the pathways and endpoints of postgraduate medical training programmes should be flexible. Not every doctor wants to be a consultant or a general practitioner. In particular many who choose a hospital speciality would like to be able to practise at a lower level of responsibility than that required by consultant grade, and the present system makes little allowance for that. Increased flexibility of training would also be a good thing. I have personally experience much frustration when trying to help trainees who have spent time working in developing countries, often acquiring all kinds of skills and knowledge which they would not have done if they’d stayed in the NHS. On return to the NHS there is very little that can be done to get that experience recognised and counted towards their required experience in our training programmes. A more enlightened approach to this would be good, and would encourage a wider and more mature approach to post-graduate training that could only benefit patient care.
LETB’s are to be charged with allocating a minimum percentage of funding for Continuing Professional Development.
There is much else that is good in the report. A final positive thing to comment on is that LETB’s are to be charged with allocating a minimum percentage of funding for Continuing Professional Development. They say, ‘CPD needs to be recognised by clinicians and employers alike as necessary (linked to appraisal) but also essential for maintaining high standards in clinical practice (developing the individuals and the service). All staff should participate in an appraisal system that is linked to their own personal development as well as meeting the needs of their employer. The formation of the LETBs offers an opportunity to acknowledge this and embed the principles set out in both the NHS Constitution and Care Quality Commision’s essential standards on CPD from the outset.’
So all in all this is a mixed bag, but if the hurdle of ‘transitioning’ deaneries to LETB’s can be overcome with minimum disruption of training provision and the recommendations above are put into practice, there is much to look forward to with optimism.