Today saw the publication of the Tooke Report ‘Aspiring to Excellence: Findings and recommendations of the Independent Inquiry into Modernising Medical Careers’ which found its way onto our News Blog with this article from the Telegraph.

The report makes 45 recommendations:

Clarification of Policy Objectives

1. Need to redefine and reassert the underlying principles of medical education as defined in ‘Unfinished Business’. Need to recognise the interdependence between educational, workforce and service policies.
2. Policy should be evidence based and evidence should be sought where none exists.
3. DH should consult with the medical profession and service where policy shifts impact postgraduate medical education and service delivery.
4. Structural changes to postgraduate medical education should be consistent with policy objectives and conform to agreed guiding principles.

The Role of the Doctor

1. There needs to be a common shared understanding of the roles of the doctor in the contemporary healthcare team.  Education and training need to support the development of the redefined roles.

Policy Development and Governance

1. DH should strengthen policy development, implementation, and governance or medical education, training, and workforce issues, embracing strong project management principles.
2. When implementing the views of this report all relevant stakeholders should be involved, the best principles of project and change management include triallingshould be adopted and this must be subject to rigorous monitoring and valuation.
3. The interdependency of education, clinical service and research should be recognised with good interagency relations between government departments and providers with regular reports to Ministers detailing links.
4. At a local level Trusts, Universities and the SHA should forge functional links to optimise the health education sector partnership.
5. All four Departments of Health in the UK and the four Chief Medical Officers must be involved in any moves to change medical career structures.  At all times accountability should be explicit and every effort made to acknowledge the views of the four countries.

Workforce Planning

1.  A coherent model of medical workforce supply within which apparently conflicting policies on self-sufficiency and open-borders/overproduction should be publicly disclosed and reconciled.  The position with regard to the eligility for postgraduate training of overseas doctors should be explicit.
2. DH Workforce should urgently review its medical workforce advisory machinery to ensure that it receives integrated and independent advice on medical workforce issues to inform/complement SHA and local
   deliberations.  This should be adequately resourced.  Plans should be evidence based.
3. DH should work with the GMC to create robust databases that hold information on the registered/certificated status of all doctors practising in the UK. This will provide a knowledgebase of the contemporary skill base and number of trained specialists/subspecialists in the workforce as well as those in training for such positions to inform
   workforce planning.
4. The content of higher specialty training and the numbers of positions will be informed by dialogue between the Colleges, employers, and medical workforce advisory machinery and this will develop with new technology.
5. Explicit policies should be urgently developed and implemented to manage the transitional ‘bulge’, caused by the integration of eligible doctors into the new scheme, with appropriate credit for prior competency assessed
   experience.
6. Optimal use of the skills of the increased numbers of medical trainees commissioned must be planned for by the DH for the benefit of patients.
7. Career choices should be supported by historical data, workforce planning.  Medical schools should be proactive with their career advice and develop programmes to meet workforce needs.

Medical Professional Engagement

1.  A coherent mechanism to give advice to on matters affecting the entire profession, including postgraduate medical education and training needs to be developed.
2. Training in medical management in postgraduate years must be developed to endable an understanding of the interdependencies between clinicians and managers.
3. Doctors in training should be better represented in the management structures of Trusts.

The Commissioning and Management of Postgraduate Medical Education and Training

1. A suitably qualified Director level lead for medical education within DH should be identified and act as the reference point for interactions with the medical profession including postgraduate Deans. The relationship and
   accountability of this lead to the following should be explicit.
2. The importance of linking workforce supply and demand must be recognised with regard to SLAs held by SHAs.
3. Funding flows for postgraduate medical education and training should accurately reflect training requirements and the contributions of service and academia.
4. Medical Postgraduate Deanery function in England should be formally reviewed to address whether optimal relationships and accountabilities are in place and the present arrangements meet redefined policy objectives of optimal flexibility in postgraduate training and aspiration to excellence, and the NHS imperative of equity of access.
5. Postgraduate Medical Deans should have strong accountability links to Medical schools as well as SHAs in line with Follett appraisal guidelines for clinicians with major academic responsibilities.
6. Reflecting the fact that Postgraduate Medical Education and Training involves service, academic and workforce dimensions, it is proposed that the Foundation School concept be developed further as Graduate Schools,
   on a trial basis initially, where supported locally.
7. To incentivise Trusts to give education and training sufficient priority they should be integrated into the Healthcare Commission’s performance reporting regime.
8. Responsibility for the local delivery of postgraduate medical education and training should form part of the explicit remit of Medical Directors of Trusts.
9. Training implications relating to revisions in postgraduate medical education and training need to be reflected in appropriate staff development as well as job plans and related resources. Compliance with these requirements
   should form part of the Core Standards.

Streamlining Regulation

1. PMETB should be assimilated in a regulatory structure within GMC that oversees the continuum of undergraduate and postgraduate medical education and training, continuing professional development, quality assurance and enhancement.
2. The linkage between FY1 and FY2 should cease for 2009 graduates.
3. FY1 should be reviewed to ensure that i) harmonisation with year 5 is optimised; ii) the curriculum more clearly embraces the principles of chronic disease management as well as acute care; iii) competency assessments are standardised and robust.
4. Foundation Year 2 should be abolished as it stands but incorporated as the first year of Core Specialty Training.
5. At the end of FY1 doctors will be selected into one of a small number of broad based specialty stems: e.g. medical disciplines, surgical disciplines, family medicine, etc. During transition, ‘run-through’ training could be made
   available after the first year of Core, for certain specialties and/or geographies that are less popular than others. Core Specialty Training will typically take three years and will evolve with time to encompass six, six month
   positions.
6. For those doctors who do not know to which Core Specialty to commit at the end of FY1 there will be the capacity to take up to 2 years in hybrid rotations allowing experience in four main Core areas. Experience in the subsequently selected Core area will count towards the completion of Core Specialty training subject to successful competency assessment.
7. Colleges should work together with the Regulator and service to devise modularised curricula for Specialist Training to aid flexibility/transferability.  They should also devise common short-listing and selection processes that have been standardised across the country to allow sharing of assessments between Deaneries.
8. Satisfactory completion of assessments of knowledge, skills, attitudes and behaviours will allow eligibility for selection into Trust Registrar positions in the relevant area or selection into Higher Specialist Training.  Doctors in Higher Specialist Training will be known as Specialist Registrars, those selected into General Practice specialty training will be known as GP Registrars.
9. The newly named Trust Registrar position (formerly termed Staff Grade) must be destigmatised and contract negotiations rapidly concluded. The advantages of the grade (accrual of experience in chosen area of practice,
   consistent team environment) need to be made clear. Trust Registrars hould have access to training and CPD opportunities.
10. Doctors should be allowed to interrupt their training for up to one year (or by agreement longer) to seek alternative experience.
11. Selection into Higher Specialist Training to the role of Specialist Registrar will be informed by the Royal Colleges working in partnership with the Regulator.  Candidates will apply via Postgraduate Deaneries or Graduate Schools.
    Application will take place three times a year on agreed dates.
12. The current Academic Clinical Fellowships in England allowing 25% of programme time for research methodology training and development of research proposals should be integrated with Core Specialty Training. There
    will be a need to ensure that those entering an academic training path in the devolved nations are not disadvantaged when moving between research and clinical activities.
13. Clinical lecturer posts in England will normally be coincident with higher specialist training (ST3 and beyond).
14. Successful completion of Higher Specialty Training as confirmed by assessments of knowledge, skills and behaviours will lead to a CCT. Higher specialist exams, where appropriate, administered by the Royal Colleges, may be used to test experience and broader knowledge of the specialty and allow for credentialing of subspecialty expertise gained post CCT and aid selection to consultant positions.
15. To be eligible for a Consultant Senior Lecturer appointment, the applicant should possess a CCT in the relevant specialty area.
16. The length of training in General Practice should be extended to five years, bringing it in line with specialty training and the other developed European countries.