DRAFT – In Confidence

MODERNISING MEDICAL CAREERS

MAXIMISING EMPLOYMENT OPPORTUNITIES

Doctors at risk

1. There is an excess of applicants for training posts over places (both programmes
and fixed-term appointments) by about 10,000. If we are to define more precisely
the risk groups and the numbers in them, we need further analysis. In particular,
we doubt the accuracy of the free text response on the application form amongst
those who said they worked in the NHS. Amongst the 10,000, we will find many
on clinical attachments, professional locums, honorary post-holders and those
who already have substantive NHS career posts.

2. We believe the most vulnerable group is those Foundation graduates who may
not secure ST1s or FTSTA1s. It is difficult to quantify their numbers – there may
be some 500-1300 at risk. Our immediate first step is to put in place systems to
analyse risk groups more accurately as the recruitment exercise progresses.

Priorities

3. Since there is a range of doctors at risk, we need a proportionate response to

ensure that support is available to those who need it most and those who are
more likely to remain in the longer term in the UK labour market. Our concern will
be for:

 Priority 1: UK medical graduates and EEA nationals , who:

have made an application to MTAS and

have been in a training post before 5 February 2007 and

have completed a Foundation Programme or equivalent (SHOs) or

are unemployed or in a service post as a result of the MMC round 1 and 2 .
.

 Priority 2: Other non Uk and EEA nationals with right of residence,

unemployed or employed in a service post, since 5 February 2007, registered
with MTAS and seeking MMC training.

 Priority 3: non-UK /EEA nationals without employment – registered with the

GMC, passed PLAB.

4. We want to offer priority support to UK/EEA trained doctors because of the

investment we have made in them. They will get the most help, those further
down the list will get some help and those in the last category could have a very
limited access. The priorities will need to be checked legally before they are
agreed .
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5. There is one group (c.500 MTAS applicants) taking time out to do higher research
degrees. The Review Group may have a view on their priority and how they might
be defined: Held an academic fellowship or equivalent during the period of MTAS
recruitment Round 1 – that is, those who have been engaged in research leading
towards a recognised higher degree (PhD, MD, MS.) and can demonstrate
completion of F2 or equivalent?

6. We expect this overall approach will see a significant reduction from the notional
10,000 at risk. Work has started to develop support packages quickly as more
information emerges during Round 1 and Round 2.

Sources of support

7. Initial support and advice to vulnerable doctors who are employed in the NHS will
come from their employers with engagement from postgraduate deaneries. NHS
Employers are working with trusts to:

 ensure employers know that some of their employees will be in the vulnerable
group and that they should offer local support for them

 maximise the number of training and service vacancies available from the end
of Round 1 and to ensure that such vacancies are designed with the
potentially vulnerable groups in mind. This will include a review of temporary
staffing policies and review how we match Locum Appointments for Training to
the Priority group. Delivering 18 week waits would be a distinct lever by
linking service need with training opportunity

 employers will be asked to consider using career posts vacated, by those

moving into training, for those in Priority Group 1

 in the light of known future demand for training we will also review the
possibility of advancing the establishment of training posts plan need for 2008.

8. NHS Employers will communicate with trusts regularly to ensure that they can
offer initial advice and support locally.

Foundation trainees

9. The suitability of Foundation graduates for service posts is a major issue. In some
specialties, doctors are not suitable for orthodox career grade posts until ST3/4.
Employment for these doctors in the training system may depend on the
willingness and ability of local employers to work with deaneries to establish some
posts at ST1 level for these graduates. We identify this group as the most
vulnerable and in working with trusts and postgraduates deans we must give
them a high profile.

10. We are examining how deaneries can utilise empty FP2 slots to offer this group
some further experience. While such slots may offer trainees valuable tasters of
different specialties they would not offer a long-term job and offer only a limited
solution. These limited-term places might be translated into longer-term training
 DRAFT – In Confidence

posts – either programmes or FTSTAs - though any trainee entering either type of
training must be tested against the same standards as any other doctor.

11. Clearly where employers have the capacity to create extra training posts we
expect postgraduate deans to maximise the training opportunities available.
However, entry into FTSTAs creates a further pool of doctors who have the
expectation of entry into ST programmes and future employment as consultants.
This expectation is not easy to deliver. Training opportunities must therefore
reflect longer-term service needs. It may be that LATs are a more preferable
recourse for doctors at this level.

Locum Appointments for Training

12. Trainees at all levels will be suitable for Locum Appointments for Training. These
occur regularly and in significant numbers – perhaps 10% of the 15,000 SpR
places in any one year. The numbers arising in Specialty Training will also be
large and it is our intention to pool the vacancies and make them available in one
place. We will work with NHS Professionals to ensure that all such LAT vacancies
are advertised en bloc on NHS Jobs. We aim to offer LATs first to Priority 1
doctors but they could also be available to Priority 2 doctors where this would be
appropriate.

Other locum appointments

13. We have opened discussions with NHS Professionals who are keen to provide
help. They also have a bank of some 80 consultants who can be used as career
advisors. NHS professionals can provide good quality service locumships
(including longer-term ones matched to individual need). They will also support
doctors in securing NHS appraisal. They can offer fast-track access to our Priority
1 doctors. In the last six months NHS Professionals have advertised over 6000
vacancies.

Lessons from the Rural GP scheme in Scotland

14. We know that Scotland runs a GP rural doctors scheme designed to attract
doctors to the more remote areas. This is centrally-funded and only open to fully-
qualified GPs. It runs for a six-month fellowship. However, subject to funding
becoming available, the principle can be adopted in terms of a bursary to
accompany trainees especially at post-foundation level. It could be targeted to
encourage recruitment into General Practice or more widely but it is not seem a
major feature of a support package.

Academic support

15. As well as the support available to other groups we are working with the NHS
Institute to identify further academic opportunities in areas that would be of value
to the NHS and enhance the career prospects of the doctors concerned.
 DRAFT – In Confidence

Overseas placements

16. While it is second order, we have approached VSO to scope the possibilities of
placements for some doctors overseas – voluntary service posts. We have
received a very positive initial response from VSO. They caution, however, that
they are generally looking for doctors whose experience would tend at least to be
at the top end of SHO.

Underpinning support

17. Our first concern is to see the NHS itself working with vulnerable individuals and
groups. We also believe we can provide some core infrastructure support and we
will explore developing a new careers management website that will be in place
from July. ( See Annex2)

18. We have invited a proposal for managed `talent pools’ that will offer information
on job opportunities on for example NHS Jobs and raise the profile of candidates
with potential employers. Elements of this may be widely available but the high-
level managed aspect would be reserved for Priority 1 doctors. For them, a talent
pool captures key information on candidates and will enable direct communication
between registered candidates, deaneries and employers. Deaneries will be able
to communicate directly with candidates. Both SHAs and deaneries will have
immediate information on the job-seeking pool. Doctors will be able to renew their
stay in the pool as long as they need to.

19. We expect deaneries to offer keep in touch facilities to displaced doctors who may
be outside the training system but who are seeking to return. We have sought a
proposal from one deanery (Annex1) and we will develop it further.
 DRAFT – In Confidence

SUMMARY OF SUPPORT PACKAGES

Priority package 1

Features: Responsibility:

Access to a managed  Priority package on SHAs, deaneries,

talent pool NHS Jobs individual employers.
 Notification of NHS Professionals,
Access to keep in touch vacancies/raised NHS Institute
scheme profile with
employers
Fast-rack registration  Training and service
with NHS Professionals vacancies available
directly
Internet careers service  Direct
communication with
Jobs by email deaneries
 Internet support with
Appraisal by employer applications
 Advice on specialty
Access to academic
selection
opportunities for
 Priority access to
researchers
locum appointments
for training
Employers will be asked
to consider priority  Links with Associate
access to service Dean
vacancies  Help with portfolio
 Career support from
Placements with VSO NHS Professionals if
necessary
 DRAFT – In Confidence

Priority package 2

Features: Responsibility:

Registration with NHS  Access to locum NHS Professionals

Professionals opportunities
 Appraisal
Internet Careers Service  NHS P career Deaneries
support
Jobs by email from NHS  Internet advice on NHS Jobs
Jobs applications and
specialty selection
Career support and  Quick alerts from Employers
appraisal from NHS Jobs on
employers vacancies
 Support from
employers as
necessary.
 DRAFT – In Confidence

Priority package 3

Features: Responsibility:

Registration with NHS  Access to locum NHS Professionals

Professionals opportunities
 Appraisal by NHSP Deaneries (for Internet
Internet Careers Service  NHSP career Advice)
support
Jobs by email from NHS  Internet advice on NHS Jobs
Jobs applications and
specialty selection
 Alerts from NHS
Jobs on vacancies
 Support from
employers as
necessary.
DRAFT – In Confidence

Paper 5 - Annex 1
 DRAFT – In Confidence

Process for Support of Doctors (Priority 1 Group) without Training Posts after
MTAS Round Two – PROPOSAL FROM WESSEX DEANERY

Most Doctors without Training Posts after MTAS will want to continue to work in this
country. They will want to take up posts that will make them better prepared for the
appointments procedure in 2008. It is important that these doctors are supported
throughout so they have an improved opportunity to enter training in future years.

The unsuccessful applicants will fall into two groups:

1) Those who are unemployed
2) Those employed but in non-training posts.

Unemployed after MTAS

Although the total number of Doctors unemployed after MTAS could be in the region
of 10,000, the Department of Health has identified three “Levels of Priority” support
necessary for doctors unsuccessful in the MTAS appointment system. Priority 1
refers to “UK medical Graduates who have completed a Foundation Programme or
equivalent (that is, SHOs) with right of residence beyond 1 October 2007. Doctors
must be registered with MTAS. They must have been in a training post before 5
February 2007 (when MTAS applications closed). Also EEA Nationals who have
successfully completed a Foundation Programme in 2007. They must be
unemployed or in a Service Post as a result of the MMC recruitment exercise”.

By registering with the Deanery the doctor will access a managed “Talent Pool”. This
group of doctors will be offered a package of support, which is organised at Deanery
level. They will have regular and frequent access to the latest job and internet based
career information, a career appraisal and access to ring-fenced vacancies in Service
or LAT posts. Doctor in Priority levels 2 and 3 will have access to some of these
areas.

The Doctor in a Service Post

These doctors have applied through MTAS and, although unsuccessful in obtaining a
training post, have found Service Post employment. The options available appear to
be a recognised Career post, eg Staff Grade or a non-standardised position such as
Trust Grade, Trust registrar, Clinical Fellow or Research Fellow.

A structure needs to be in place to support and assist career

progression/development for these doctors. The Deaneries will need to institute and
oversee this process. The unsuccessful doctors will still need to register with their
local Deanery in what has been termed a “Talent Pool”. The Deanery will have links
with local Trusts to identify specific service posts or LAT posts. The links will be
through the Director of Medical Education
 DRAFT – In Confidence

All Doctors appointed to service posts will need a framework for implementation of
Educational Support. The Associate Dean will need to be in direct contact with a
Medical Education Lead at each Trust. The College or Specialty Tutors will allocate
individual Educational Supervisors whose role it will be to meet with their named
doctor and establish a learning needs portfolio appropriate for the individual. This
should include keeping an individual logbook, competencies both clinical and non-
clinical, use of study leave (needs to include study leave funding) and performing
audits. The educational package for these doctors will include access to in-house
teaching and subsequent appraisals and a RITA equivalent. In other words the
Educational package for these doctors should parallel as closely as possible
the STR Educational Package.

For both groups, those employed and unemployed

Special attention will be needed in two areas. The first is Portfolio development.
This is to allow better prospects of success at the next round of appointments in
2008. The second area is Career Advice and Career information. This needs to be
made available both at Trust and Deanery level. This should include information
about alternative specialities, in particular Shortage Specialities, as well as the
suitability for the current specialty. (In some situations there may be a possibility of
exposure to an alternative speciality.) There are some educational packages that
look at doctor’s aptitudes which could be useful in providing career advice.

Although a lot of the work will take place at Trust level, Deanery involvement to
support this should ensure overall a higher standard of support for these vulnerable
doctors. In particular, the Doctors in Difficulty group that Deaneries run could be
expanded to have a role in assessing these doctors as several of their support
networks offer some of the necessary skills.

Recommendations

1) The name “MTAS Transition Appointment” should be given to all these

posts. This is because many of the titled posts listed above do not come with
the package of Educational and Professional support and development we are
suggesting with these posts.

2) This is a new direction with new involvement of the Post-Graduate Education

Teams. The Deanery will require both Associate Dean lead and significant
administrative support. Appropriate funding will be available for this
development.

3) The support package would form part of the overall `keep in touch
arrangements’.

With these support mechanisms in place and working well, realistic outcomes at the
end of the first year for these doctors include competitive appointment to STR Run-
through training, possibly FTSTA Year 2, or a successful Change of Speciality.
 DRAFT – In Confidence

Paper 5 - Annex 2

NHS CAREERS & CAREER MANAGEMENT FOR DOCTORS

Scope of paper

This paper has been prepared in response to the request of the MMC/MTAS Review
Group. It details the current web based career tools available and possible future
solutions to help deliver more in-depth web presence to support career planning for
doctors in training in England. NHS Employers would be happy to discuss what
support might be needed by the other three countries separately.

Current tools

NHS Employers already offers, through NHS Careers , information to prospective

candidates on training in medicine, entry requirements, benefits of working within
the NHS and job vacancies. This is through an internet based web page system
which does not require registration .

The NHS Careers web pages www.nhscareers.co.uk have recently been expanded
with the input of Deans , specifically to support doctors in years 1 and 2 of the
foundation training programme approaching their period of specialist training. These
pages bring together the best available information on career structure, skill and
aptitude requirements, and advice on applying for training posts. It provides details
of each of the broad specialty groups, what is involved in training, overview of the
day to day work and the type of professional the doctor will be working with. It is
designed to complement existing Deanery information.

Over the next couple of months these pages will be expanded to support newly
qualified medical graduates entering foundation training. These additional pages will
include an overview of foundation training, what the doctor can expect to do day to
day, what the next steps will be and points for consideration to further doctors’
careers.

Web-based Open University Tool

Following feedback from junior doctors and deaneries ,NHS Employers would
recommend that the Sci 59 Online tool developed by the Open University is also
used. Sci 59 is a specialty choice inventory which covers the training options listed
by PMETB and a number of subspecialties. The programme is a professionally
constructed psychometric instrument designed especially for selection of medical
careers. It matches an individual's personal and professional characteristics and
aspirations to appropriate specialty choices and provides the user with suggestions
 DRAFT – In Confidence

for further research and information gathering. Sci59 Online can be used to help
individuals at any level of training to reflect on, or make, their own career choices;
and does not make the choice for them.Some deaneries have already started using
this tool and it has been well received .

Careers In Medicine Career Planning Programme

The Association of Medical Educators (ASME) Careers In Medicine programme

includes a web based tool developed by the Association of American Medical
Colleges (AAMC), This could be adapted for use by medical students to help them
choose their career pathways and medical specialties within the UK medical context.
Some Deans have already commenced discussions about how the UK could take
forward this model and have been positive about the potential it has.

The Careers in Medicine™ is a career planning program designed to choose the

medical specialty as well as selection and application to a specialty training
programme. It is a four-phase process which provides guidance through the
elements of career planning, including self-understanding, exploration of a variety of
medical careers, and finally the choosing of a specialty to meet career objectives. It
is designed to be a more “managed” system of support for candidates.