UK Shape of Training steering group: report

4. The work of the UKSTSG

4.1 In considering a strategy for implementing the 19 recommendations the UKSTSG was required to work within the following parameters:

• To ensure that any recommendations could apply to all four Countries of the UK while being consistent with and facilitative of the strategic priorities in any individual Country.
• To ensure that any change would be proportionate and capable of implementation while minimising service disruption.

4.2 A further challenge to the work of the UKSTSG is the fact that the service delivery landscape has changed since the publication of the SoTR report. In particular, the UK Health Departments have published their strategic plans for health. They differ with regard to detail but share the common theme that in the future more health care will require to be delivered by integrated multi-disciplinary teams in the community.

4.2.1 In England in 2014 the NHS Five Year Forward View was published. It proposed that "more care will be delivered locally" but that some services will be provided in specialist centres. The need to break down the barriers between family doctors and hospitals with out-of-hospital care delivered by multispecialty community provider units was emphasised ( NHS in England, 2014). Sustainability and transformation plans (5 year plans for the future of health and care services in local areas) have also been published ( NHS England, 2015).

4.2.2 In Scotland the National Clinical Strategy, published in February 2016, described a framework for future services that envisages more care will be delivered in the community. This will be planned around 'community hubs' underpinned by social care integration, the availability of multidisciplinary teams and extended roles for general practitioners in dealing with more complex cases. In secondary care it proposed that specialist interventions will be focused on fewer sites. Scotland also faces the challenge of delivering care to remote and rural communities (Scottish Government, 2016).

4.2.3 In Wales in 2015 a 5 year plan was launched entitled, "Together for Health: A five year vision for the NHS in Wales". It described a path towards a sustainable service that ensures better health for everyone, better patient access and experience, the provision of more local services and better health outcomes by improving safety and quality of services (Welsh Government, 2011). The Welsh NHS then published core principles that committed to putting patients first while creating a sustainable workforce (Welsh Government 2016). At the time of publication of this report there was an on-going review of health in Wales (Welsh Government, 2017).

4.2.4 In the North of Ireland, the Health Minister recently launched a 10-year vision to transform the health and social care system; "Health and Wellbeing 2026: Delivering Together". This outlines the immediate challenges to the delivery of health care arising from demographic change and the need to reduce health inequalities. It focuses both on disease prevention and the provision of high quality clinical services. It was also envisaged that an element of service reconfiguration might be required to provide the best possible outcomes for patients (Department of Health - Northern Ireland, 2016).

4.3 Other key partners have either published or are progressing work that is relevant to the implementation of the Shape of Training Review. The GMC is undertaking a consultation exercise regarding the development of a Medical Licensing Assessment ( MLA) and has published work describing generic professional capabilities and quality standards for curricula ( GMC, 2016) ( GMC, 2016). The GMC are also undertaking work to review the flexibility of training. The UK reference group in collaboration with HEE has undertaken work relating to moving the point of registration. This remains under consideration but is out with the remit of the UKSTSG. In England, HEE has taken forward initiatives that address some of the SoTR Report recommendations including the introduction of a Quality Framework for England, a review of the ARCP process and are committed to review the length of training placements (Health Education England, 2016) (Health Education England, 2016).

The consultation and interpretation process

4.4 The UKSTSG began the program of work by sponsoring 6 workshops that included a wide range of stakeholders and considered the following key recommendations arising from the SoTR report: the requirement for more generalists, the role of credentialing, the role of patients and employers in influencing the content of medical training, measures to blur the interface between primary and secondary care and to support the delivery of more care in the community, the academic pathway and measures to support the careers of SAS doctors.

4.5 These workshops were important because the SoTR had described a framework for change. The challenge for the UKSTSG was to determine how these broad concepts should be interpreted and applied in practice given the complexity of medical education and training and the parameters within which it was required to work.

For example, although the report stated that there is a requirement for more doctors with general skills it did not indicate the extent to which this should occur or how these doctors should be deployed to meet the needs of patients in each discipline. Similarly, the SoTR stated that there would continue to be a need for specialist doctors but it did not state which specialists and where they should be deployed in the context of on-going transformational change to the delivery of health services.

Attendees were also asked to identify the tangible benefits that might be anticipated to accrue for patients and service providers and the practical implications if each of the recommendations was implemented.

Principles adopted by the UKSTSG

4.6 The UKSTSG developed Principles to guide their further work based on their interpretation of the recommendations. These were informed by the output of the workshops and are shown in full in annex 3. In summary, the 4 Health Departments committed to working collaboratively to develop implementation actions arising from the Shape of Training review. These were required to take into account national strategies, policies and structures. Specifically, in relation to Medical Education and training the following principles were agreed.

• to train doctors to deliver safe, high quality and patient-centred medical care.
• to train doctors to meet the anticipated needs of patients and the service, including the capacity to deliver more broad-based care which addresses the needs of an ageing population and those with multiple co-morbidities.
• to ensure that medical education and training is flexible enough to adapt to the changing needs of the service and of patients, and to scientific innovation. This will include but not be limited to the recognition that previous learning, education and training should be based on the demonstration of capabilities and not simply upon time.
• to ensure that all doctors have the capabilities to pass on their skills and knowledge as mentors and trainers, and to undertake and analyse research as appropriate.
• to ensure that the outcomes of medical training must provide transparency for patients, their carer's, the public and the service about the level of capability doctors have attained.
• to instil in doctors a sense of professionalism and compassion.
• to embed and promote a career-long culture of continuous professional development.
• to ensure medical education and training is subject to robust governance and quality assurance arrangements.
• to deliver these objectives with the minimum structural change and service disruption.