ࡱ>  @ 8bjbj ؝؝/*xxx  j&j&j&8&l'lHl':'''')))XHZHZHZHZHZHZH$gKRM~H,m)"),,~H''H,6.6.6.,''XH6.,XH6.6.8E(G'z' 0Quhj&-LEH<H<HE6gNh-gN,(GgN(G)/*r6.*\*)))~H~H .. NHS NEXT STAGE REVIEW: A HIGH QUALITY WORKFORCE BMA SUMMARY Background The NHS Next Stage Review, Our NHS, Our Future, was announced in July 2007 and was a wide-ranging review of the NHS in England, both at a local and national level. It was led by Lord Darzi, Parliamentary Under Secretary of State at the Department of Health (DH). A first interim report was published in October 2007 and a second in May 2008; BMA summaries of these reports are available at the following website address:  HYPERLINK "http://www.bma.org.uk/ap.nsf/Content/DarziReviewsNational" www.bma.org.uk/ap.nsf/Content/DarziReviewsNational A BMA position statement setting out our concerns over some aspects of the review process as a whole and the proposals made in the early stages of the review is available at the following website address:  HYPERLINK "http://www.bma.org.uk/ap.nsf/Content/Darzipositionstatement" www.bma.org.uk/ap.nsf/Content/Darzipositionstatement The report A High Quality Workforce was published on 30 June 2008; it is available at the following website address:  HYPERLINK "http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085840" www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085840 This is a BMA summary of the intentions and recommendations of the report. INTRODUCTION The NHS workforce is most effective when it reflects the needs of patients. As such, it should take into account service planning, be based on pathways of care and reflect complex co-morbidities. To succeed, working in partnership is essential and improved education and training will be developed. The document describes a system for workforce planning, education and training that will be sustainable for the long term. It is the result of the involvement of four working groups who considered the following questions: How will the roles played by healthcare professionals change and what will be the implications for career frameworks? How should workforce planning be done to secure the workforce of the future? How should education be commissioned and funded to ensure trainees and the NHS benefit from the highest quality education and training? How should the infrastructure and the content of education change so that they enable the highest quality care for patients? RESPONSE FROM SIR JOHN TOOKE Sir John Tooke welcomes the Governments commitment to medical education and training, in particular the creation of Medical Education England (MEE) along with the move to a tariff-based payments system. CHAPTER 1 - TOMORROWS CLINICIANS Quality of care and team working The NHS should deliver high quality care for patients and the public. The focus of this section of the report is on quality and team working. Achieving high quality care requires all health professionals across clinical, managerial and supporting roles to work together effectively with a shared focus. All members of the team should be valued. This approach underpins the proposed changes to workforce planning, education and training. What tomorrows clinicians can expect The core principles informing all the proposed changes are: Focus on quality Patient centred Clinically Driven Flexible Valuing people Promoting life-long learning There is also an explicit commitment to ensure that the proposals link directly to the eight care pathways identified as part of the regional/SHA reviews process. Education and Career framework It is acknowledged that clinicians want well-defined career frameworks that provide flexibility to change roles, develop new capabilities and respond to the changing healthcare environment. The education curricula and training programmes need to be integrally linked to current and emerging models of care and scientific and technological advances. Practitioner, partner, leader The role of the clinician should not be limited to practitioner or expert in their discipline. In future every clinician should have the opportunity to develop three core roles - practitioner, partner and leader. There is acknowledgement that the balance between these will differ depending on the role undertaken. Within the three: There is acknowledgement that the clinicians primary duty will be to their clinical practice, delivering high quality service to their patients. Clinicians must also be partners in the delivery of care, taking collective accountability for the performance of health services and to take appropriate stewardship and management of finite healthcare resources. Clinicians are also expected to offer leadership where they have the appropriate skills. Taking the work forward There is an undertaking to work with all key parties to support the development of the three core roles. Regulators will lead on this work in partnership with patients, educators, employers, and others including professional bodies. CHAPTER 2 - ROLES AND EDUCATION AND TRAINING PATHWAYS The main focus of this section is the quality of education and training. The report states that the roles of health professionals require clarification and leads on to detail the work on the role of the doctor and notes the BMAs involvement in this. It maintains that workforce planning and education and training should be clinically driven at a local level, with national oversight. It also mentions updating and monitoring the skills of the medical profession, signalling a strong commitment to credentialing and revalidation. Training pathways This section outlines the development of a reformed postgraduate training pathway for doctors which is explicit about the involvement of other organisations. MEE will be taking this work forward. Pre-registration This details moves towards new methods of recruiting to the Foundation Programme, developing a more reliable and valid selection method. MEE will take this work forward. A formal evaluation of the two-year Foundation programme will be commissioned. This evaluation will decide whether to continue with this model or move to an alternative linked to a wider reform of postgraduate medical education structures. Specialty training MEE will look at the merits of Core Training and finalise a training structure by 2010. The report reinforces that CCT holders are fully trained and eligible to apply for GP or consultant posts; it goes on to say that doctors may then choose to undertake fellowships to further their specialisation. GP training GP training programmes will be expanded by 800 places; there are moves to increase training places so that in future half of medical trainees will be in general practice. The RCGP, in partnership with MEE, will review the length and structure of GP training. Public Health There are moves to increase the number of public health trainees and seek dual accreditation for medics. This is in response to the increased need to tackle obesity, drug and alcohol misuse, health inequalities and the prevention of cancer and heart disease. Modular credentialing There are plans to introduce this for the medical workforce over the next decade. This means that the formal accreditation of capabilities will be defined at various points within the career pathway. Evidence suggests that this approach gives assurance to patients and the employer. These plans will be developed in partnership with key stakeholders. Leadership There are proposed changes to undergraduate, foundation and specialty training in order to introduce a leadership framework; it is hoped this will encourage medics into leadership roles in the NHS. In addition, educational supervisors in secondary care will be given mandatory training and review of their performance. Transforming pharmacy As the NHS focuses more on prevention, the accessibility of pharmacy will be better utilised. Plans for modernising pharmacy education, training, regulation and career pathways have already been published in the recent White Paper. These plans will be taken forward. Regulation A number of healthcare workers are not regulated by statutory bodies, for example clinical psychologists. Ensuring public safety is essential so appropriate local supervision, employer-based regulation or statutory regulation will be developed to cover all healthcare workers. The roles of the nurse, midwife, allied health professionals, healthcare scientist and the wider healthcare team are all detailed in Chapter 2. CHAPTER 3 - A SYSTEM FIT TO DELIVER The document sets out that quality is best served by devolving decision-making. It proposes that the following structure will be implemented: Workforce planning, education and training must be clinically driven, reflect service plans, and ensure that professionals are meaningfully engaged and involved in the development of plans and the assurance of quality. The workforce planning model: The workforce planning cycle begins with PCTs/local councils commissioning services to meet the health needs of local health populations Service providers have to demonstrate how they will ensure the workforce they need to deliver the services they are offering SHAs will combine PCT plans into a single regional plan and develop integrated service and workforce plans for their region. The plans will be sent to the new Centre for Excellence for synthesis and analysis and also to the relevant national and regional professional advisory bodies for quality assurance and advice. NHS MEE MEE will be an independent, advisory, non-departmental body and will take forward the Tooke recommendations in a number of areas. It is noted that the MEE will be chaired by an independent doctor who will be decided by the Appointments Commission and who will report to the NHS Medical Director. The new Director of MEE will have a remit that covers the full continuum of medical training: from undergraduate, through pre-registration and Foundation Programme training and specialty and GP training, up to the award of the CCT and certain aspects of CPD. MMC Programme Board The MMC Programme Board will become the MMC Implementation Committee and will move from a policy-making body to implementing the policy of MEE. The Director of MEE will now co-chair the Implementation Committee. A Centre of Excellence The report claims this will be a resource for health and social care systems, which will be hosted by one or more universities. It will support national and local workforce planning (collecting SHA plans) as well as look at long term views and horizon scan. It will also have links with other systems e.g. social care providers. This will report to the Director General for Workforce. Education commissioning and provision SHAs will continue to be accountable for education commissioning and quality assurance. To achieve a number of aims, including quality improvement, SHAs will engage with service providers and local health communities. Health Innovation and Education Clusters There are plans to enable providers of NHS services to enter into partnerships with the higher education sector and industry to form Health Innovation and Education Clusters. This is with a view to attracting more research funding and world class researchers. In time, these clusters will be able to be commissioned to provide education and training. The DH will invite bids for the approval of clusters and will provide some financial support. The criteria and rules of the bidding process will be announced shortly. Education funding The current arrangements (Medical Education and Training [MPET] budget) will be modernised and the introduction of a tariff-based system will allow the funding to follow the student or trainee. Detailed proposals will be developed over the coming months to support these core activities: student support, placement support, tuition support, preceptorship and workforce change. In general, there will be an increased focus on quality and the development of existing NHS staff, with the use of modern education techniques such as e-learning and the use of simulation suites. APPENDIX 1 This section details the MMC Inquiry recommendations in relation to this document.   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