. . .and it isn’t! Assembling Higher Specialist Training Programmes
that meet the requirements of Royal Colleges and PMETB (not to mention
the service) and finding the SHO and SpR posts to create the
programmes is proving a complex operation, and this at a time when
SHAs and PCTs are being reconfigured, deaneries are being reshaped,
the training budget (MPET) is being squeezed to support service and
many trusts are wrestling with large financial deficits. And the next
hike in the European Working Time Directive is beginning to appear on
the horizon.
Where have we got to?
One of the first tasks has been to take stock of all SHO posts, as
these are the ones that will be converted into the first and second
years of HST (ST1&2) in the new Single Training Grade. Even this is
far from easy, as returns from specialties don’t always tally with
those from trusts, and deanery and finance records are often at odds.
However, with each iteration the gaps become narrower, and we are now
pretty confident that we know the current situation.
At the same time we have been talking to each specialty through its
Training Committee and Programme Director to establish what the new
programmes will look like – how long they will be, how many trainees
they can accommodate and what experience they will require or accept
in the ST years. In some cases this is relatively straightforward: for
example, Paediatrics will have a programme which consists of nothing
but Paediatric posts, Radiology likewise and the same for O&G. Other
specialties are much more complex and will share common-stem training
with other programmes and accept basic training from a variety of
early experiences.
What is fundamental is that once accepted onto a training
programme, trainees are guaranteed, subject to satisfactory progress
through assessments, sufficient experience to gain their CCT. There
may be movement between subspecialties
What next?
We need to have all programmes and their component posts identified
by September. This is when we have to notify the Workforce Review Team
of our plans.
We shall soon be approaching trusts to start discussions about
which posts will be required for each specialty programme. Early
indications are that not all SHOs posts will be required for MMC
Single Training Grade (STG) programmes, although early scare stories
about numbers were probably exaggerated. Those that are not required
will create problems, and perhaps opportunities for trusts. Funding
from these posts could be used for Fixed Term Training Appointment (FTTA)
posts (the turquoise box), Staff Grades, F2s, or more radically,
non-medical appointments. The obvious problems are those of
maintaining patient services and compliant rotas with, in all
probability, fewer medical posts. However, this could be a good time
to undergo a thorough review of rotas, staffing levels and skill
mixes. We do not underestimate the difficulties and will work with
trusts to help them find the best solutions. All the same, we cannot
create programmes that are unsustainable.
Funding of posts
We understand that ST1&2 posts will be funded on the same basis as
current SHO posts – ie 50% deanery and 50% plus banding by trusts.
There are ugly rumours that the training budget (MPET), which still
hasn’t been announced, is under further threat and could be
significantly less than we had anticipated. If this becomes reality
then we cannot make any guarantees about the levels of funding.
Schools
The Deanery has been working with a number of specialties to set up
schools. So far plans are well advanced for Schools of Emergency Care,
Psychiatry, Medicine, and Surgery. The function of a school is to
bring together all those involved in setting up and maintaining
training programmes. Because of the complexity of the new system,
there is a pressing need to have a forum which cuts across specialties
and subspecialties – for instance to set up common stem programmes.
Once programmes are in existence, they will be key to functions such
as recruitment, assessment and QA.
If, as seems likely, the Deanery and the workforce function of the
SHA merge, schools may take on a multi-professional function so that
they can help to integrate the planning and training of the whole
workforce.
Some detailed news
The Acute Care Common Stem (ACCST) programme is a two year basic
training programme (ST1&2) for those wishing to train in Emergency
Medicine (A&E), Anaesthetics/ICM or General Acute Medicine. It will be
the sole route to Emergency Medicine but the other specialties will
have alternative pathways.
The Basic Neurosciences programme is aimed at doctors wishing to be
Neurologists or Neurosurgeons. It will consist of one year of
Neurology and Neurosurgery (6 months of each) followed by a second
year of either General Medicine OR General Surgery.
Dental SHOs. Most of the 40 dental SHOs, even those labelled as Max
Fax (OMF) are required for general professional training for dental
graduates. For some these lead to specialist training in the dental
specialties such as Orthodontics, Paediatric Dentistry and Dental
Pathology, which are not part of MMC and the single training grade. We
(with the support of the Chief Dental Officer) are encouraging trusts
to maintain these posts, without which there would be no platform for
training in these specialties. A small number of OMF SHO posts are
occupied by dually qualified doctors (dental and medical) who are
intending to continue training as OMF surgeons. These will become part
of MMC OMF programmes.
The School of Psychiatry is well on the road to being set up and has
identified a shadow board to oversee the creation of the Psychiatry STG programme.
The Acute Trusts in Bath and Swindon, who have historically related to
the Wessex Deanery (now Institute) have decided that, for a variety of
reasons, including the new SHA configurations, geography and their
relationship with the Bristol Medical School, they should in future
receive deanery services from the Severn Deanery. We recognise that
this has not been an easy decision, given a long history of successful
working with Wessex and the good relationships that have been forged
over time. However, we feel that is the right decision and look
forward to working with those in Swindon and Bath.
As a result, the planning of STG programmes that involve posts in
these trusts will be handled by Severn, but existing SpRs’ programmes
will not normally be disrupted, and they will continue to be
managed by Wessex
