Posts Tagged ‘Flexible trainees’

Breaking down the barriers to female medical leadership

By Mike Broad - 16th October 2009 6:12 pm

A new report, called Women Doctors: Making a Difference, identifies the barriers preventing female doctors from reaching senior positions and sets out how to address them.

It’s been produced by the National Working Group on Women in Medicine, which was set up in the wake of the Chief Medical Officer’s annual report in 2006. Sir Liam Donaldson’s report identified a shortage of women in leadership roles in the medical profession despite outnumbering men as medical undergraduates.

Donaldson expressed support for the report’s recommendations and said the Department of Health would consider each of them. Here’s a summary of the key recommendations:

1. Improve access to mentoring and career advice

In the next round of contract negotiation there should be an explicit facility for appropriately trained and skilled doctors (usually consultants) to undertake mentoring or career counselling as a programmed activity within their job plan.

To facilitate accessing mentoring or career management support, the future commissioners of medical education should maintain a register of all doctors who are skilled and are willing to undertake these tasks and make it more accessible to other doctors.

2. Encouraging women in leadership

Appointments to NHS, academic and clinical committees and boards should be advertised widely and have a transparent and democratic process rather than simply an appointment by nomination.

Committees should be encouraged to develop their ways of working to enable greater participation by doctors who are parents or carers.

There should be increased access for women to the committees and boards of major medical institutions, including the medical schools, postgraduate deaneries, medical royal colleges, NHS trusts and other NHS bodies. The Equality and Human Rights Commission should consider auditing the appointments process for all such posts.

3. Improve access to part-time working and flexible training

The postgraduate deaneries should maintain a list of doctors wishing to train part time in a slot‑share arrangement.

NHS Employers should develop guidance for meeting the costs of continuing professional development, including for those who are working less than full time.

The development of credentialling should be expedited, and there should be full recognition by the medical Royal Colleges that time alone does not indicate competence to practise independently.

The aspirational quota for part-time training should be abandoned in favour of a needs-assessed availability by strategic health authorities (SHAs). The newly formed Centre for Workforce Intelligence should be commissioned by each SHA to provide this needs assessment on a regional basis, and provision should be made to meet it.

4. Ensure that the arrangements for revalidation are clear and explicit

The GMC and the appropriate medical royal colleges should ensure that they have a clear set of re-licensing and recertification standards and assessment processes in place for doctors who have taken time out of training or the profession to return to work.

Responsible officers should coordinate refresher training for those who have taken time out of training to meet these standards. There should be funding for this within the NHS budget.

Trusts should offer ‘back-to-work’ and ‘taster’ sessions where those who have taken a career break can shadow working doctors to re-familiarise the doctor with procedures and work patterns, so that they are confident on return.

5. Women should be encouraged to apply for the Clinical Excellence Awards

The Advisory Committee for Clinical Excellence Awards (ACCEA) should provide greater feedback to applicants and advice as to where additional development might be necessary, and develop a network of mentors.

Selection panels should be gender balanced wherever possible; due consideration should be given to part time applicants, and ACCEA’s processes should be monitored for gender equality.

6. Ensure that the medical workforce planning apparatus takes account of the increasing number of women in the medical profession

NHS Medical Education England (NHS MEE) and the Centre for Workforce Intelligence should ensure that workforce models for the future clearly delineate the effect of a rising number of women in the workforce so that appropriate advice for the workforce planning apparatus can be given.

7. Improve access to childcare

The Conference of Postgraduate Medical Deans and the Department of Health should consider whether the model such as that in place in the North Western Deanery, which commissions a lead employer for all specialty trainees in the deanery, would be a practical and desirable model in the new education commissioner/provider landscape. The additional benefit of better facilitating access to government assistance for maternity benefits and childcare of this model is clear.

Postgraduate deaneries or their lead employers should plan ahead for the childcare needs of their trainees and facilitate arrangements between a trainee and the trusts during their rotation for access to childcare provision.

Trusts should appoint a childcare coordinator within their human resources department if they have not yet done so. Childcare coordinators should develop internet resources to act as both an information resource and message boards on local childcare options, including emergency cover.

Hospital-based childcare should move to extended opening hours.

The DoH should explore the costs and benefits of doctors who are parents paying for full-time or part-time childcare as a value-for-money solution for enabling doctors to progress their careers. On the basis of this analysis the DoH should submit a case to the Treasury to allow doctors to pay for childcare from their gross earnings. In addition, it should establish whether any central funding might be available for childcare assistance.

8. Improve support for carers

All postgraduate deaneries or their nominated lead employers and NHS trusts should have a lead person responsible for supporting carers.

9. Strenuous efforts should be made to ensure that these recommendations are enacted through the identification of champions

Trusts should identify a non-executive director to have responsibility at a local level for improving working patterns, giving advice and handling complaints. The director should work closely with a lead consultant for workforce planning.

Read the full report.

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NHS needs to prepare for more female doctors

By Mike Broad - 3rd June 2009 10:02 am

Women will become the majority of doctors within ten years presenting current challenges for workforce planning, Royal College of Physicians’ research shows.

The RCP’s two-year review, examining the changing gender balance in medicine, reveals that women are more likely to work part-time and focus on particular specialties.

A 15-year follow up of doctors after graduation suggests that, on average, taking into account career breaks and part-time working, women prove 60% of a full time equivalent doctor against 80% for men.

Women also prefer specialist fields that offer more predictable working hours and a relatively greater amount of patient interaction.

Women currently make up 40% of all doctors, representing 42% of GPs and 28% of consultants. On present trends, women will make up the majority of GPs by 2013 and the majority of the medical work force some time after 2017.

However, only 8% of consultant surgeons are women.

While women already account for 47% of UK-trained consultants aged 30 to 34, there are also very few women doctors on NHS trust boards as medical directors. In 2006, none of the six medical schools had female professors and just two of 34 medical school deans were women.

Professor Jane Dacre, chair of the working group, said: “This research has shown that women doctors will soon be in the majority and are now reaching consultant status in greater numbers. It is likely to lead to an increase in part-time working. Also, women on average make different specialty choices from men.

“The combination of these changes in the medical workforce will need to be examined to ensure the continued delivery of high quality care, and the best use of the considerable talent available in today’s medical profession.”

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How to become a flexible trainee

By Mike Broad - 27th May 2009 5:01 pm

Flexible trainees are part-time doctors in training. Flexible training provisions have been in existence in the NHS since 1969. But, impetus to improve access to flexible training only developed in the late 1990s, with new attitudes to work-life balance and introduction of the Part-Time Workers regulations in 2000.

Flexible training is seen as a way to recruit, retain and motivate doctors, who might otherwise quit the NHS because of other commitments. It’s particularly relevant to the medical profession because of the rising proportion of female trainees, who may want to have children, and the high staffing levels required to comply with the Working Time Directive. However, research by PMETB shows that demand for flexible training continues to be largely unmet.

Historical problems with becoming a flexible trainee

Trusts have perceived flexible trainees as expensive to employ. Pre-2005, a part-time doctor (doing out-of-hours work) was paid a full-time basic salary and an additional supplement of 5% or 25%.
Although slot shares increased, many flexible posts were supernumerary, making their employment more expensive still. Extra funding from the Department of Health was made available to help fund flexible training but expired in April 2004. In addition to cost issues, the flexible training scheme was administered differently from deanery to deanery, with inconsistent approaches and attitudes. 

Revised arrangements for flexible training

In 2005, revised arrangements were introduced to improve access to flexible training and make the roles more affordable for employers. These arrangements were outlined in two documents Principles underpinning the new arrangements for flexible training and Equitable pay for flexible training. The guiding principles were to retain doctors who are unable to train on a full-time basis; to promote work-life balance for doctors; to ensure training on a time equivalence (pro-rata) basis; and maintain a balance between educational requirements and service delivery in the reduced hours.

Flexible trainees now receive basic pay and a supplement for out-of-hours work. Basic salary is determined by the actual hours worked and the supplement is paid as a proportion of the calculated basic salary. Band FA attracts a 50% supplement, FB attracts 40% and FC attracts 20%. Flexible trainees who do no out-of-hours work do not receive a supplement.

The revised pay system brought hourly rates of pay in line with that of full-time trainees. And an independent appeals mechanism was introduced for cases where an application was rejected. The Department of Health in England agreed an additional £7million in recurrent funding to ensure its success.

Flexible training criteria

Trainees are required to undertake at least 50% of a normal working week. Day time working, on call and out-of-hours duties should be undertaken on a pro rata basis equivalent to full time trainees in the same specialty, provided they can do so. Trainees are normally expected to move between posts within rotations on the same basis as full time trainees but not necessarily at the same time. When full time trainees normally have an out-of-hours commitment, a flexible trainee will only be entitled to train without completing the out-of-hours commitment for a maximum period of six months subject to educational approval.

There are different ways of structuring flexible trainee roles. Slot sharing is where two flexible trainees are employed and paid as individuals (often for 60% or more) and work together. They share one place on a rota but not a contract and may overlap sessions. Job sharing is when two trainees share a full time post salary, work half the hours and receive 50% of the training opportunities. Then there are supernumerary posts that are additional to the normal complement of trainees on a rota. Sometimes trusts use a less than full-time trainee in a full-time role to avoid the additional expense of a supernumerary role. They typically work four rather than five days a week.

More information on flexible training.

Who is eligible to apply for flexible training?

While all doctors are theoretically eligible to apply, deaneries are prioritising two categories; the first, and most prescient, includes doctors in training with a disability or ill health, or responsibility for caring for children or an ill or disabled partner or relative.

The second category includes those doctors in training with unique opportunities for their own personal or professional development, such as representing their country in sport, or a short-term extraordinary responsibility, such as a national committee.

Religious commitments will also be considered and non-medical professional development, such as management or law courses. Other reasons may be considered but it would be dependent on the particular situation and the needs of the specialty.

How does a junior doctor apply to become a flexible trainee?

The trainee should seek advice on eligibility for flexible training in a meeting with the postgraduate deanery representative. If the trainee is not already working within the grade and specialty, appointment through open competition will be necessary. Potential applicants who do not discuss with the associate postgraduate dean their intention to train flexibly in advance of application to a post will find that funding is unlikely to be immediately available.

The trainee will need to agree a training programme with the deanery. Time for protected study and research should be included within a normal working week.

The regional specialty education committee or programme director will approve the training programme on behalf of the postgraduate dean and the appropriate Royal College. This approval should take no longer than six weeks to obtain. Approval will be given initially for one year subject to annual review.

Approval of the deanery and the employing trust will be necessary for funding of the post. As the recurrent funding available is limited, applicants considering flexible training should apply as early as possible and at least three months in advance of anticipated need.

Once all approvals have been obtained, the start date will be confirmed with the trainee, and the NHS trust requested to issue a contract.

More details

Case studies

Low availability of flexible training

The number of flexible trainees remains low. There are approximately 2,100 currently in the NHS, which represents around 6%. In 2005, the revised arrangements were anticipated to enable 20% of junior doctors to train flexibly by 2010. The Chief Medical Officer’s 2007 Annual Report called for more flexible training opportunities, as did the PMETB Survey of Trainees in 2007. It shows that 22% of female trainees would like to train flexibly but are not doing so currently.

Funding for flexible training currently comes partly from the trust where the doctor works and partly from the budget of the postgraduate medical deaneries. However, the proportion the trust pays is significantly higher than under the old arrangements. The BMA claims that many Category 1 doctors – those with a disability or ill health or caring responsibilities – are still being prevented access to flexible training. They continue to campaign on the issue.

More information:

Medical Careers

MMC

Flexible Careers Scheme

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