The needs of patients and their expectations of healthcare services and those who deliver them are changing. The nature of these changes is well known and includes the fact that people are living longer and with multiple long-term conditions. Other drivers for change include rapid developments in medical science, pharmaceuticals, information technology and patient-centred legislation. Meanwhile, as in other workplaces, the medical workforce has changing career aspirations, expectations and requirements.
Across the UK, Governments have responded by publishing strategic plans that differ in detail but with the common theme that more care requires to be delivered by integrated teams in the community. There is a transformational agenda that is well underway. It is timely therefore to review whether medical education and training is producing the type of doctor that patients and service providers need, and to ensure that the training of the doctors of tomorrow remains relevant and fit for purpose.
The Shape of Training review ( SoTR), led by Professor Sir David Greenaway, was undertaken for this purpose. His report recognises that the way UK medical education and training is designed and functions is complex; it exists and functions within multi-layered structures, with many representative groups, operating in a multi-professional environment and competing for financial resources. Professor Greenway's report offered ideas and solutions in the form of a broad framework as to how the education and training of medical professionals must adapt if it is to remain relevant and fit for purpose.
His report concluded that there is a clear need for change and made 19 recommendations. In response, UK Health Ministers convened the UK Shape of Training Steering Group ( UKSTSG) to consider the review and its recommendations and to bring forward policy proposals as to how it could be implemented. This report describes the work of the UKSTSG and makes a number of recommendations.
The challenge for the UKSTSG was that the SoTR report described a broad framework for change. It did not consider the practical implications of implementing the recommendations within the complex structures of medical training and clinical service delivery that exist across the UK. Consequently, the challenge was to interpret many aspects of the SoTR recommendations, ideas and concepts and to reach consensus on what was reasonable, logical and practical to implement. Further, we were required to ensure that any recommendations made could be implemented with the minimum of service disruption and would be facilitative of the strategic plans of the four UK Health Departments to transform healthcare delivery. This report seeks to give the reader an understanding of the approach adopted by the UKSTSG, and the extent of the work that has been undertaken to fulfil its task. This report also seeks to explain how we worked collaboratively to reach our conclusions.
In all our considerations we were guided by the principles that we set for ourselves. First and foremost was that medical education and training must be configured to meet the needs of patients. The second was that medical education operates within a UK-wide regulatory framework and that any recommendations must ensure that it is delivered to a common high standard across the UK.
We were also mindful of the need to ensure that medical careers remain sustainable and fulfilling, and that central to the delivery of high quality care are those who work and aspire to work in our healthcare services. There are many hard-working, compassionate and dedicated professionals, training, learning and delivering high quality care day in, day out in order to ensure that those who need care and support receive it. What doctors, and all health professionals, do in support of patients is highly valued and we would be remiss if we did not say so in a report of this significance.
Also of relevance is that our work has taken place against a background of increasing anxiety and dissatisfaction amongst trainee doctors. While this has many facets, it is right that we acknowledge that in part this relates to how current medical training is organised and delivered, and that trainees have sought improvements not only in the quality of training provided, but that their career ambitions and choices should be considered in planning how we deliver training programmes. Policy makers across the UK have recognised that there is a need for improvements and action has already commenced.
On the basis of the work we have undertaken, we have reached the point where we are able to describe and recommend a pragmatic, proportionate and practical way to implement the key elements of the SoTR with the minimum of service disruption, while maintaining UK agreed standards and curricula and delivering tangible benefits for patients. This approach also allows for elements of medical education and training to respond to local strategic plans and patient needs across the UK. It is widely accepted that more flexibility is required to current training pathways. It is of note that in this respect our proposals closely align with those outlined in the GMC's review of "flexibility in training".
We are living in an age of unprecedented demand, change and innovation. This especially impacts on the delivery of health care, and requires us to respond. It is important therefore that medical education and training adapts to meet these challenges, and this report describes how that can be achieved. We are able to recommend that the curricula changes that we have set in train with the Medical Royal Colleges on a UK basis should be developed and submitted to the GMC for approval with an indicative start date of August 2018. Thereafter it will be for each of the 4 UK nations to oversee the detailed aspects of implementation that fit local needs and strategic priorities.
Overall, we believe that the approach we have described will be incremental, requiring "evolution" rather than "revolution" but, given the length of medical training programmes, if we are to meet the future needs of patients in transformed services it is important that this process of change starts now.
Email: Dave McLeod, Dave.McLeod@gov.scot
Phone: 0300 244 4000 – Central Enquiry Unit
The Scottish Government
St Andrew's House