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MS Esther mcclarty, who will be giving us an update on Cops, which is a Confederation of post graduate School of Surgery. MS mcclarty is a consultant neurologist with an interest in renal cancer and transplantation. She is also the head of Peninsula School of Surgery and chair of the Confederation of post graduate School of Surgery. Thank you very much. Good afternoon, everybody. Um Thank you so much for welcoming here today. Um It's been amazing to see the energy in the room and see so much enthusiasm. Now, you've just heard from the architects of surgical training, those who design it and the heads of school, the schools of surgery are there to deliver your surgical training within the constraints of the NHS. Now recruitment, do people still want to be surgeons? Yes, they do. Um Surgery CST fill rates have been at 100% for the last couple of years, slightly low in northern Ireland and Wales. But that's really people dropping out and this is really important because it doesn't mean we do have capacity to expand but not limited capacity to expand court surgical training because we have to make sure that core surgery posts have the quality that people can progress and we don't go back to the bad old days of having surgical S H O s everywhere with poor quality training and no possibility of progression CST recruitment for 2023. Well, I'm going to apologize on behalf of D D R s who are responsible for recruitment. There were many changes poorly communicated at the last moment and I'm, I'm really sorry for that and the distress that quite a lot, I think of people applying for call surgery felt by now those invited to interview and well done should be aware that there will be no interviews on doctors' strike days. And I'd like to thank all the senior trainees amongst you who volunteered to interview C A C T S because that has enabled us to building capacity. So we should get everybody through on the planned interview dates, being able to move those people away from the junior doctor strike date. So that's great. The portfolio stations going to be part of the interview again in 2024. So we can ask you about items in your portfolio H S T recruitment as ever again, the fill rate is 100% for everything in surgery other than max facts, which of course is a very special case as you need to primary degrees. And we can't necessarily produce extra trainees quickly in that specialty. If you look at some of the medical specialties, which is the table on the right of the slide. You can see that not all specialties are quite as lucky to be as popular as surgery. Um And therefore, again, there is potential capacity to expand. If we have the quality training posts and if we have the consultant positions to put people into, you'll be aware that there's been over production of consultants and various specialties over year, which is a huge waste of resource and talent expansion. And redistribution is a big program within hee only at the moment. So it's excluding Scotland, Wales and Northern Ireland. This is about the government's levelling up policy and moving medical training places to where senior doctors are needed and where there are health inequalities. It's a multi specialty H E U program where people train is absolutely crucial to the distribution of the workforce of the future. And that's because 80% of doctors in training, when they get their C C T, they settle within about 50 miles of their base hospital, which means where you train means where you're going to end up for the most majority of doctors. Therefore, training predominantly potential in the Southeast isn't going to improve the workforce elsewhere. And this is going to have great impact on the future workforce supply and play a part in addressing both health inequalities and different geography ease across England. Now, just for an example, I'm going to show you the current plans in general surgery and general surgery as part of the first tranche in surgery that is going to occur up until about 2026. General cardiothoracic smacks fax, vascular plastics and E N T R the first tranche. So if, well, if we look on the right is a table about expansion and this is one program. And if you look at my school, which is the Southwest, I'm gaining two trainees at H S T at General Surgery in 2023 they're already in post and two in 23 24. And this is also enabling us to sort of change the model because those two trainees in 22 23 I think, get a guarantee of geographical certainty for the first two years. We're very much hoping to use this program to be able to give trainees much more certainty about where they're going to be, especially in the first few years of higher surgical training. If you look on the right, this is the redistribution, this is the politically charged stuff and you'll see London is losing 33 trainees over the course of the program and five will be coming to the Far Southwest for those of you don't know where Peninsular is. It's that like football bit in the right hand corner there. So we're getting five across Peninsula and seven. And this is being mocked up for the every specialty in across medicine and every surgical specialty looking at their the West middens particularly is a great gainer in general surgery. I want to reassure, you know, actual physical trainee will be moved. These posts will come through as people come off the top of the program. At ST eight, the S T three will be moved into another Dean Ary. So you'll be able to apply for that S D three post because the post has been moved know people. Again, there's a big process around quality assurance of posts and rotations, the opportunity rethink rotations. But there are implications for the availabilities of the I D T s. These regions that are losing, trainees will have limited capacity to take I D T s for the next five years. Probably. So if you're a general surgeon and you want to I D T to London, you may want to think a little bit more widely about whether KSS would fulfill your needs because they are generally a net gain. Er We're also going to suffer with training capacity in the next few years. We've got 1500 new foundation posts, which is great. 1000 new specialty posts an H year actively looking at using senior trainees and some other healthcare professionals to mentor and the educational supervisors for the new foundation posts. And this is great because actually the best trainers, often, foundation doctors are good core and H S T S. And if you're interested in education, it's a great starting point. So we really want you in next year's hee budget, there is a decrease in faculty funding. That's for people like me, you're training program directors, uh your educational leads. But and I think this is fantastic news. There is an increase in the budget for less than full time trainees give more people the option even if they just want to go full time because it suits their lifestyle or their wishes and even more important to. There's an increase in the supernumerary budget. The supernumerary budget is the excess funding we use when we put two trainees into one training post. So if we put a 10.6 trainee or 0.6, that's the whole time equivalent and a 0.7 trainee into one post, the denial will pay the 10.3 excess to that trust and this means that this is great for trainees because slot share NG is good. It's great for rotors. It's great for patient's because they're not actually having a reduction in their whole time equivalent training numbers, the other elephant in the room for people like me, particularly, which may not have affected you yet is the NHS merger with H S E sorry, N H H T merger with N H S E. So for about six months now, there's been a freeze and recruitment of staff into the hee back green functions that you don't necessarily see. So that's your education program manager and their support and the professional support unit in some offices were now down to 40% of the staff level, working up to the merger on the first of April. So I'm pleased to you all. Please be kind to the people on the phone in the Dean Ary, they're doing their best. They main, we're working well outside their area of usual practice. And at the moment, the merger of H E with the NHS looks a little bit like the X ray on the right and there's no prizes for spotting the difficulty there. Even for the layman, Keith, just talk about the new curriculum. But from ahead of schools perspective, almost all of you who should have transferred have cardiothoracic for some reason in a little bit reticent, but you need to have transferred or got your C C T by August 2023. And the catch for this is for those particularly have done things like phds had three years out or protected maternity leave who may not have realized they're going to have to transfer 10 point twos are going to cease for September 2023. Those are the extra six month training for those who had a training deficit due to COVID. It's going to be kept as an option for future pandemics disasters, but you won't be getting an ercp outcome of 10.2 from after September 2023. But we know trainee operative numbers are still well down on pre pandemic levels. Even Amanda Pritchard has said that the NHS is only running at 80% of elective capacity. And that does mean that every single operation needs to be a training opportunity, needs to have a trainee involved somewhere along the line. And it's really important that if you're not getting into hubs, if you're not getting excluded by payment by results lists that you talk to your T P D so we can try and look at it and incentive. I'd it financially if necessary to the trust's the other thing that's hit my desk this week. And many of my peers is the G M C document on tackling disadvantage in medical education. This is totally unacceptable on every level to be standing here in 2022 with the G M C finding that your race affects your exam results is unacceptable. A black doctor in the least deprived quintile. So that's looking at deprivation of people in with the UK primary medical qualification, a black doctor in the least deprived quintile has a 10% lower pass rate than a white doctor in the most deprived quintile. Now, this is for all higher surgical exams, not just surgery, but the fact that this is still present in 2022 is a national disgrace and that myself hee people who look at this sort of thing need to work on this and we need to redouble our efforts towards it. Exams are actually the remit of the colleges, but preparing trainees for exams is our remit talking of exams, the J C I A pass rates have got a worrying decline in some specialties and this is really likely to be a hangover from COVID from the cancellation of regional training from the lack of culture that's developed of local training. And there are many steps that may need to be put in to readdress this situation. I'm not going to go into the suitability of these exams for surgical training in the modern day. But they are there. They are our benchmark there, what we need to work with. We're builders were not designers. One of the things that we hope will have help with the MRCS particularly is the core surgical training hub. And this is one of the great innovations that have come from Covid Catherine Smith, who's the T P D in East Midlands leads it. It is national online training program to deliver the didactic teaching around the core curriculum happens every fourth Thursday of the month in the afternoon and it's gone down really well. We've got about 900 people signed up to it now, which is almost all of the trainees across the four nations. It's open to all. It's got live webinar, catch up. It um has academic collaboration projects on it, calendars, knowledge about the eye SCP curriculum exams, that sort of thing. The first one went out in August the 25th, 2022 it was your 101 for on call and you can see the stats below. There's good feedback and the program has been maintained. So this this thing is really good news as a way forward. It means your regional training days can be used for skilled debt skills sessions, high level thinking case discussion, you're not having to get through the bread and butter. Of course, surgical theory, we're working on the H S T hub. The structure we have in place is that underneath the li Dean, um Don Furniss who's head of school for Thames Valley is going to lead a program where we're going to have a lead for each surgical specialty with a national online training fellow from the other specialties from each specialty as well and a common core curriculum. And we're very much hoping to open this, not just to trainees but to all doctors who are working in the NHS and potentially outside who would want to progress along a Caesar or training route aiming at the level of the J C eye exams. So your F R C s and last year, I just like to say this. Although H E R strictly neutral on the strike, no training program should be fragile enough that a period of industrial Axion threatens trainee progression. Okay. There won't be training going on in hospitals anywhere. We're pretty much going to go to a Christmas Day service. But I would say that if you do tell your consultants where your picket line is we might just get baking over the weekend and bring some sustenance out to you. So thank you so much for having me to talk today. Really happy to take some questions later. Thank you very much for summarizing some of those upcoming changes in highlighting some of the issues surrounding training and progression that is so important to many of us in this room.