Your view on the Shape of Training

We were keen to ensure the review reflects the views of those involved with training. To this end we featured some short opinion pieces from people who want to tell us what the future shape of training means to them.

Our most recent opinion piece came from David Grantham, Director of Workforce and Organisational Development at Kingston Hospital NHS Foundation Trust.

Planning for the future – an employer’s perspective

David Grantham'As a Director of Workforce and Organisational Development (HR to the uninitiated) at Kingston Hospital NHS Foundation Trust, which is a medium sized District General Hospital on the outskirts of London and Britain’s newest Foundation Trust, the opportunity to fundamentally review the shape of postgraduate training, and by implication the roles and types of medical professional we are training for, is crucial. The case for change is, in my view, pressing.

'The Working Time Directive has introduced controls on hours – which are perfectly reasonable - and the NHS has not collapsed as vocal voices in the profession predicted. It is true that it has required different thinking and adaptation - something Sir John Temple’s review found that the NHS and medical profession are both good and bad at.

In some specialties we have an oversupply of doctors, in others, no or limited supply, with significant variations by geography. There is the huge, but largely ignored, issue of the numbers of doctors currently in training, which the Centre for Workforce Intelligence estimates could add £6 billion to the NHS pay-bill by 2020. There is also the issue of the flexibility and adaptability of the medical workforce (and indeed rest of the workforce) in the face of rapid technological advances, particularly in information.

'There is much to admire in the UK’s system of long apprenticeship medical training. However there is a lack of pace and realism about adapting it to meet changing needs, motivated no doubt by protecting what’s good about it. The Shape of Training review is an opportunity to overcome this and to examine the service’s future needs (and by that I really mean the needs of service users and taxpayers) and balance these with the expectations and aspirations of future medical professionals.

The opportunity lies in the fact that the review brings together so many of the key players and because the issues they have to address are becoming more pressing and real, creating the right climate for change.

'Key changes I would like to see are:

  • Bringing back greater generalism - better generalist/common skills across all specialities making more doctors safe in dealing with common acute conditions, whatever the setting.      
  • Opportunity for quicker progress through training for those who can demonstrate skills and competence – why does all our training seem to be longer compared to other countries (who often also seem to have better health outcomes?).    
  • A more easily adaptable system with recognition of core skills and competencies between specialties (so when we get our workforce planning wrong, as we inevitably will, a trainee does not have to start all over again).   
  • A system that is quicker to adapt to change – does our regulation of training need to focus so much on process rather than the outcomes expected to deliver a safe, competent and confident independent practitioner?

'Adaptability is key – we didn’t predict the last 30 years (I first heard in 1990 that DGH’s had had their day!) and nor will we the next 30. But we do need this review, which comes on the heels of Tooke, Temple and Collins, to at the very least initiate the process of change'.

The views reflected here are not representative of his employer but are the personal opinion of David Grantham.