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Good afternoon everyone. Um We'll just start our session now. Um We've got an exciting panel. I'm talking about the um training the next generation. So our first speaker is Miss Laura Manley. She's the current asset Vice president, uh working as a plastic plastics registrar in Cambridge. And she's gonna be here today talking as the Academy trainees Doctors Committee, vice chair. So I hand over to Lauren. I thank you so much Gina. It's a real pleasure to be up here actually with Miss Sa mclarty and Miss did Rick as well. Um So I'll try my best and start everyone off easy before, before you get into the good stuff. Um But as I mentioned, my name is Lara. I'm the current vice president, but I'm here in a very different role today, which is my role as vice chair of the ATG, which is the Academy trainee Doctors Committee, formerly known as the AT DG. How many people in the room have heard of the AT DG? Out of interest? There's a couple of hands. Um So what I'm hoping to talk to you about today is a little bit about what we do and sort of where we fit in uh in the grand scheme. And you'll notice a lot of what I talk about today is pretty relevant to the asset theme, which is the time is now. So there are a number of challenges uh experienced by doctors in training today. And we all know that staff are working under significant pressure with workforce shortages and increased demand on health care services, which as we know has been exacerbated by the pandemic. As a result, service delivery is taking up more and more of our time and that of our trainers. And so as such, there's been less protected training opportunities and some of those may be unevenly distributed. We've also experienced challenges in the delivery of recruitment processes over recent years and training programs still lack the flexibility. Trainees need to balance their clinical commitments with other commitments and training pathways can exact a significant non financial and financial toll on trainees. Again, this may be exacerbated by sub optimal working conditions and the current cost of living crisis. And we know that dissatisfaction amongst trainees is is perhaps demonstrated uh by the current industrial action that's affecting three out of the four devolved nations at the moment. And while pay is not within the remit of the A TDC, we do recognize that many of these issues may be contributing factors. So who are we and what do we do? So we're compromised of over 60 trainee representatives from across the medical colleges, the faculties, as well as trainee representative organizations such as you can see a list there demonstrating just how many members we have contributing to our committee at the moment. And our role is essentially to identify some of the challenges that I've spoken about and to develop consensus to represent and advocate on behalf of trainees on these key issues. We also work really closely with other stakeholders and lead on a number of projects to support doctors in training. So we are one of the committees of the Academy of Medical Royal Colleges who develop policy and recommendations to inform healthcare. They also engage with stakeholders to represent the views of their members. So some of you may have read or be aware of the academy fixing the NHS publication from a from a couple of years ago now. And this highlights the need for health care reform and it's really a call to action again in keeping with the fact that the time is now to expand the current workforce and ensure that all staff feel valued in order to drive recruitment and retainment. Crucially, it highlights the need for effective communication and collaboration in order to be able to drive change. And this is a key principle underpinning the work of the ac so many of you will be aware of the long term workforce plan. I'm sure spoken about a little bit more later, which outlines action plans to grow and retain and reform the current workforce. And we've produced documents highlighting the perspective and recommendations of trainees and its implementation and sit on the Academy Workforce Committee which advises on workforce policy and strategy moving forward. So last month we released our reform principles. So this is essentially identifying six key areas that affect trainees and how we can perhaps work on these to improve the current situation. So you can see this fits quite nicely with rotation. So making sure that we minimize disruption for those who are rotating as part of their training exams. So we're reviewing the number and value of exams and assessments that we take and seeing this on balance with financial costs to trainees. We're also focusing on flexibility in training to ensure that there are people are supported to go through alternate pathways or to re enter training after a time period away. We're also looking at organizational support to ensure that employers are able to support doctors to balance their work life better and recuperation as many of you know, rest areas and things that I was having this conversation last night that the doctor's mess doesn't exist everywhere. And so looking at ensuring we have appropriate rest facilities across the country. And then finally management, we all know that when we move a trust, we fill out the same documents every time. So we're currently looking at being able to maybe streamline this process and have a data sharing way. That means we don't have to do the same process every time we move. So some of the other things we've been doing to work towards this is looking at recruitment process checklists. We've done a review of an exa of exam processes and costs. We've also looked at reforms to interni transfer processes to try and make this as easy as possible. And finally, we've looked at benefits of protected self development time and you can see these are some of the headlines to some of the papers we've produced and you can access all of these online if you'd like some more information. So here are some of our additional work streams that we're currently working on. So support for neuro diverse trainees, particularly in the context of reasonable adjustments for assessments and now that many of our assessments are being outsourced, we want to make sure that those reasonable adjustments are accessible across all areas, looking at standard standardization of study budgets as well to ensure that people have access to finances, to support their educational development and also have more of a say in what that money is spent on. We've mentioned a bit about flexibility in training and equality and diversity and inclusion work. And this specifically, this year has included anti bullying and harassment work. There's also a space reactive responses to new challenges. We know that surgery is very dynamic and new issues do arise. And so it's really important as well that we hear from you on any issues that are affecting you. And we always love to hear what problems you're experiencing to see how we can help. So on that front, we're continuing with our political engagement. We have some meetings with members of government looking at how we can support rest and recuperation for doctors in training. And we're also continuing to collaborate with other key stakeholders. But the most important people really within this process is you change can and will happen. We just need to make sure we work together to continue to fight for it. So please do get in touch. I've left my contact details here as well as our workforce policy manager and I really look forward to hearing from you. Thank you very much. Thank you very much for that Lara. Um Just if anybody does have any questions for, for Lara or any of our speakers, if I just ask you to hold them just until the end and then we can kind of do a joint session if that's all right. So just to introduce our next speaker, um we've got the wonderful Miss Esther mclarty with us this afternoon. Miss mclarty is a consultant, neurological surgeon, specializing in advanced kidney cancer and neurological aspects of renal transplantation. Esther is the head of the Peninsula School of Surgery and Chair of the Confederation of Postgraduate Schools of Surgery in the UK or Cops. Ether represents Cops at JST, the Royal College of Surgeons of England Council and the Royal College of Surgeons of Edinburgh Council Development. Esther is also a mum to an eight year old rugby playing daughter and in her spare time she's our doctor, sailor and catches the occasional fish. Thank you very much. It's a real pleasure to be here today and thank you for inviting me. Um The heads of school are a sort of AAA mysterious bunch somewhere hidden between your, behind your college tutors, your TPD S and overarching. Looking over all your programs, we're actually quite good fun. Jenny also is the head of school for KSS. And a lot of what we do is about looking forward in training about how things are going to develop in the future and advising he sometimes the colleges and other interested parties about what will and won't work on the ground with surgical training. Now, let's have a little look at what's been going on. You will mainly, I think probably have seen these graphs before they come from the J CST. They're from your A CPS. It's where a lot of the data is collated from the hee systems. Those of you who've been training for a while will know that we have the COVID outcomes 10.1 and 10.2 and that these stopped last September 2023 which is about two thirds of the way a little bit towards the end there of the two bars down from the end of the graph, you'll see that what it showed was the outcome 10.1 s going down very quickly. Outcome 10.2 s which required an extension to training of six months, usually fairly stable. But as the 10.1 s and 10.2 s have come down, so the threes have gone up and this is perhaps not unexpected. There are many people in training now who have had a deficit in training at some point due to COVID, whether that was all the way back in their foundation program, whether that was through core and that can be cumulative, going on into um HST programs. Now outcome free are universally seen as penalizing by trainees. We call them developmental outcomes. They're extra time for people to develop to their full potential ACP. Outcomes vary a little bit depending on your specialty. You'll see that core as ever has the highest number of developmental outcomes closely followed by Max fax and pediatric surgery, plastics, neurosurgery. They seem to have an cardiothoracic, in fact, seem to have the highest number of outcome ones which is the standard go past, do not collect 200 lbs uh outcome from an ACP. It also depends a little bit on where you are and this may reflect the quality of the training you really want to go and train in Ireland, particularly Republic, Northern Ireland's pretty good. North west and Mersey west Midlands, Wales, east of England, East Midlands. All having more non standard or developmental outcomes. Now, one of the other things that we get involved in the cops is national selection. And we were really, really pleased to have assets support about changes that have been required over the last couple of years to national selection. We've particularly enjoyed your support about getting the trainers, the consultants out to interview and we managed it this year. We scraped it through having looked last year as though selection might fail. Now, in core national selection, the last two years have only been achieved because of the involvement of trainee groups, particularly acid. And I'd like to thank any of you and all of you sincerely who have helped out with core national selection in the last couple of years. The last portfolio appeals for core will be looked at this week and they've been slightly delayed because industrial action did hamper at least two days of core national selection. This year, there's bits and bobs of change going on within the schools of surgery, health education, England um are going through a period of rationalization, health education southwest up until now has had two schools of surgery Peninsula and seven and they are merging in the beginning of April. Now, why is this bigger is not always better? But what it may well let us do is put in mini rotations across the patch which will mean less travel. Now, we're aiming to do this in phase two because phase one or course surgery, you should already know where you're going when you apply. Phase two can be much more difficult, but we should be able to give you two or three hospitals you will rotate around. So you can put a pin in a map of where you're going to live. It's really difficult to do that for phase three or your specialty modules. And why is that? Well, firstly, when you apply to higher surgical training, you haven't yet often decided what super specialist area you might want to develop into. I don't know how many HB surgeons or colorectal surgeons. I'm going to have in phase three and five years time. So I can't plan and it ensures your flexibility at the moment in the offices of your local deaneries. As were there is up to a 60 per cent reduction in whole time equivalent staff. And that is due to the merger and rationalization and a freeze on recruitment. They are doing the absolute best they can but they will be slower to respond to your queries, slower to release rotations at time. Although they will do everything that they can to release them within the charter after April things should be looking up because the freeze and recruitment will be pretty much reversed. But the join with between the NHS and hee to form the N HSE WTE which absolutely trips off the tongue um is like the hip no better than the hip X ray I showed you last year and it's back again this year and I very much hope sooner or later, we'll be able to take that off the slides. The other big issue we're going to have is training capacity and we've had 1500 new foundation posts. We've got 1000 new specialty posts of which a significant number are in surgery across. And we expect the other nations to follow this in proportion. So he was because I cannot deal with that seven letter name. Now, looking at senior trainees and other healthcare professionals to fulfill educational and clinical supervisor roles. Now, I suspect as it will have a strong view on the other healthcare professional roles. But if we wish to supervise and train our own, then we are going to need support as a consultant body from SAS led and senior trainee doctors to support the foundation doctors of the future. And that's without the expansion noted in the long term workforce plan. And I haven't gone into that in great detail because it may change with a new government. Although the new government have, if we get a new government suggested they will follow the plan. One of the things that's been worrying cops particularly has been the fall in some of the JC specialty pass one rates. Now the bottom line is pediatrics. And in the last, I'm pleased to tell you it's very much better and on the way up. So, congratulations to all those senior pediatric trainees and trainers out there who worked really hard on the pediatric program. But you'll see there are other lines going down and it's purposely small so that we don't name and shame. What many of you may be aware, aware of is the CST hub which has been up and running for 18 months now. And I'm told you all love a QR code. So there's a very big one up there. And it's the first one I've ever presented on a slide. And this is the link to the core hub. So you can sign up. Now. This has got 1200 users across core surgery. Very few so extended to surgical team users. About 49 runs live on the last Thursday of the month for 2 to 3 hours. And it's available on catch up. In fact, all the episodes are there and this was our pilots and it took off extremely well. It uses the West Midlands virtual learning environment platform which even I can use. It's incredibly user friendly, it's based on the mood um software and this is the sort of thing that comes up for an August. And in fact, this one's been repeated for two Augusts because the last one coincided with a junior doctors strike. And that's just fine by the way. But we will provide education, whether you wish to turn up or you can watch it on catch up. That's fine. But we didn't really feel we could pull consultants and senior trainees, senior trainees out of the workplace if they wish to work on a, on a strike day or if they wish to strike for that matter. So as well as academic content that is mapped to the curriculum, there are games, there are how to edit an abstract, which is a particularly fun one to do. There are links to research, there are links to training opportunities, there are links to the things you need to know around the CP, around the exams etc. And it's been pretty universally um appreciated, I think by core trainees. Why? Because there is variation in the level of core education that is provided within training programs. But what isn't it? It is not a replacement for your face to face skill days. So you should still be getting face to face skills training through your schools and TPD S and regional educations face to face days are so important. They're so important for peer support, for networking, for finding out what's going on opportunities around and we're absolutely not trying to replace those. It's also not a forum for Masterclasses. This is aimed at your exam. So it's MRCS and when we come to the higher programs which are about to start, it's mapped onto the syllabus for the JC exams. Now, who out there is getting their local two hours teaching every week, week on week that you are supposed to get for your J CST quality indicators in your department routinely. Somebody back. Oh, no, you're it in your armpit. Thanks. No, nobody, nobody's getting it. It's in the quality indicators. So these national online training programs are there to replace that local teaching that people aren't getting and why aren't they getting it because of shift systems, a breakdown in the firm structure on call and the fact that consultants and trainees tend to move them e these days. So this is to replace what you should be getting on the ground and it can be either done live or it can be done as a catch up. So you don't have to miss the shoulder lift that you do every Thursday afternoon or every Tuesday afternoon whenever your program will happen to be. So we managed to get about 600,000 lbs over two years out of hee. And that was not easy. We have now appointed 11 national online training program directors plus co because Catherine Smith has done an excellent job of running core Y 11. Well, because's got one for the common curricular content that goes across all specialties. And what's really exciting is that we've had 120 applications from training doctors in training. That's lot above ST three for the national online fellows who will work with each of the TPD to produce and run the program. And that doesn't mean choosing all the content. It means I believe the word is curating these days. Anyway, so thank you for your enthusiasm, all of you because that's absolutely wonderful and it's gonna build on the success we hope for the CST hub and it should be the leading platform for online education of those attempting the JCI exams. And I have to say we have to say thank you to all four college presidents, all four colleges and all your specialty associations getting on board with this, particularly those specialty associations who already had online content behind a pay wall, who we are going to release stuff that is suitable for the JCI exams. So this is a structure. You've got Paul Sadler who's the lead dean for surgery. He happens to be an anesthetist, but we love him anyway and he's right behind surgical training. Do Furnas. He's the head of school for Thames Valley is the school of surgery lead and I have been helping him with that. We have now 10 National online TPD, Katherine Smith for core and Richard Bamford, who's one of my TPD for core down in health education. South West is going to be the national online TPD for common curricula content, which is a huge, huge area. And here's an interesting slide. These are your national online TPD S and you'll see that there are quite a few ladies there, but only one of the ladies sent me a photo of themselves and all the men did straight away. I will comment on that no further. OK? And lastly, you may remember that last year when I stood here and I told you about expansion and redistribution, the other things that were going on, I put up this slide and it said no training program should be so fragile that a period of industrial action threatens trainee progression. I've put it up again because I firmly believe this because there's no activity really going on on days when you lot are on strike. Ok? No training today. No surgeons tomorrow. But I really hope things will be resolved by next year and nobody will need to put this slide up again. And very lastly, I'd like to say thank you to all of you. Thank you to it. Your presidents and vice presidents and those of voter are unbelievably supportive to myself and my colleagues. They challenge us appropriately. They give us evidence when we need us, need it and they ask the right and difficult questions of us. Ok? You've got a super organization here, please cherish and support it. And the mask behind is a little mind map that I did when I was coming to the end as I am now as my tenure as a head of school and as copped chair about all the things that have gone on since I took over as head of school in 2018 when the world was a sunny shiny place and we all went out and played together through 2019 when COVID hit and I took over just in 2020. Um It's been a really interesting journey and the one thing that has made it fantastic is the people I've met and particularly the trainees and particularly those that have gone on to be consultant colleagues. You're really lucky. You're in the greatest profession in the world with the greatest colleagues anybody could wish for. And I wish you all really, really well in the future. Thank you. Thanks very much Ether for that very informative um cops update. Um It's now my pleasure to introduce our next speaker. Um Miss Jenny Brick, who's going to be giving a talk on the N HSE workforce expansion and distribution and Jenny Brewick as a consultant vascular surgeon at the East Kent Hospital University Foundation Trust. She undertook her undergraduate training at Barts qualifying in 1989 and subsequently trained in general and vascular surgery in the South East in London. Prior to being appointed as a consultant in 2005. She's currently head of School of Surgery for Ken Surry in Sussex, chair of the vascular surgery Specialist Advisory committee and a clinical advisor to the Medical Workforce Alignment Program in N HSE WTE. She has been an MRC S examiner since 2016 and was elected to Royal College of Surgeons of England Council in 2023. Diversity and inclusivity are extremely important to her. And she's the Chair of the R CS England Pride and Surgery Forum for LGBTQ plus Surgeons and allies of which she was a founding member in 2021. She is the mother of four Children, two of whom are autistic with severe learning disabilities and has been involved in regional and national projects, promoting recognition and help for her for new diverse trainees and better understanding of autism and learning disabilities in patients. And without further ado hand it over to her. Thank you. That's gonna be longer than my talk, I think. Um So I'm here to talk about the distribution and expansion which Ester touched on in her talk, there might be a little bit of overlap in what we talk about um which is good but cops are involved and cops are talking about this. Uh and just um those are the roles just within that. So there is no argument that we have an aging population and with increasing health inequalities across and within all the regions of England, what I'm talking about only is applicable to England. If you're in the other three nations, this isn't applicable to you. Although the health boards in those areas may be watching, we know they're watching what we're doing as far as this leveling up of care, access for patients. There's a clear relationship between the number of doctors you have the a and the access for patients, the care they get and the care they get for complex chronic conditions as well. Um And you'll hear this phase used a lot if you look at any documents from NHS at the moment talking about remote rural and coastal areas where all those inequalities are magnified. So this program started in 2018 and I've been involved with it since the end of 2022. And it was to look at, we understood that there is no over doctored region in the country. We know that, but where the doctors are, they're not spread out equitably amongst all the regions in the country. So how can you distribute the doctors in the country to give equal access of care to all the patients? But it isn't quite as simple as that because you actually need to look at the health needs of those areas. And health economics is a very interesting field which I knew nothing about before I got involved with this post. Very fascinating. I'm still a surgeon. I'm not into public health, but it's in that role of the more complex, the older, the more areas of deprivation and the needs that they have in comparison to those areas that aren't. We've got about 45,000 trainees over about 665 programs um in the, in the, in England. And that's sort of the numbers that you're talking about. But where these doctors have been placed hasn't been based on any scientific method methodology. It's very much on historic of who was running the programs at the time. And therefore most trainees are in cities and teaching hospitals. And if you're away from city areas, away from the teaching hospitals, as were, then there aren't many trainees and there aren't many doctors. So it's how do we move this resource around? There's another factor that's really important with this, that we know that where you train pretty much not for everyone, pretty much dictates where you're going to end up either as a consultant or a GP. So about 80 per cent of doctors become consultants or GP S within 50 miles of where they train. We're a predictable bunch. The long term workforce plan has been set up. It's an exciting document, although you may not want to read it, it's quite long, but it is an exciting document. It's one that's come along for the first time in many, many years to actually project the number of doctors we're going to need in the future to meet people about the pipeline that's needed of doctors for the future and the increasing care that people are going to require. So this graph was taken from Chris Witty's report CMO of England in 2023 and he's referred to this work in 2023 and in 2021 in 2023 his report was based around the health of an aging in an aging society. So this graph shows you the increase in our population um, um, aged over 75 years over the next 20 odd years. And you can see that the darker blue where it is, it is very much around the outside. It's not in the urban areas. It is in those remote, rural and coastal areas. And actually by 2043 if you're living in the south west or you're living in somewhere like Easter Anglia, over a third of the population will be of retirement age. And that brings its own complexities because obviously those, those um people have more complex needs, mo more comorbidities and have require higher access to health care. But we know that in those remote, rural and coastal, there's less doctors the other bit you need to factor into. It is actually deprivation and there is inequality of aging. We talk about the chronological age of a patient versus the biological age of a patient. And I'm sure you will use that. But your biological age and the rate that you're aging at is much faster, the older that you are, the more deprived area that you're in. So this shows those that are in the most deprived and those that are in the least deprived and shows first of all the shorter age, um the lifespan also if the shorter time of good health. So 52 years, if you're in the most deprived area, but you expect to be healthy for about 71 years, if you're in the least deprived area. It's main multi factorial health care is but one part of this picture within public health, but it is one part that we can actually do something about and is is in with our hands as doctors to change the long term workforce plan has three priorities in it to train retain and reform. Now there are some parts within the train, retain and reform. I'm aware are much more contentious. For example, in the reform part, the increasing of the allied healthcare professionals, the potential decrease in length of time of medical school training from five or six years to four years. These are the ones are applicable to this program of work for the expansion and distribution with the expansion of post to align with population health needs. So many of the new medical schools have been put in not in London have been put out in more remote rural areas in my own area. And Kss, that's in the Kent Medway in the Medway and Brighton in non traditional. And the hope is to encourage people who are local to go to these medical schools and then to train as postgraduate doctors and remain there as consultants and GPS from the train perspective. It's also that expansion. Those headlines that you would have seen doubling of numbers of medical students by 2031 to 15,000 a year from 7500 increasing the number of GP training posts from six, from 4000 to 6000. And then within the retained part that's talking about retaining us as old consultants, the Emirates consultant scheme trying to bring back retired consultants, how we can adapt the pension, how we can incentivize people to work now gold. And hello is a very much a double edged sword. You can give someone a double gold and hello to go and work somewhere and they might think why you've got to offer that to me, what's the problem with working there? Or they may think? Well, I'll go there and work for the amount of time I need to and then I'll leave. So incentivization has to be in different formats as to how you incentivize people with the retainers, also how to work with the ICB who also have this overview of the region of workforce and training and the health and well being links up to the people plan reforming, as I said is not only about reforming by numbers of allied healthcare professionals and by reducing medical training time in undergraduates, which I have my own personal opinion on, but it's looking at flexible training, flexibility where people are roed rotations using more digital technology and innovation and working more into the community. These are all the areas that when you're looking at expansion and distribution, you could choose to look at this program concentrates on the last bit which is in the specialty program. There are three phases, phase A B and C and by the dates at the top, you can see we're well into phase A because that's set to run from 2023 to 2025. The pace of change though, for moving all the posts within each program is over seven years. So actually the last moving of posts for phase A goes up to 2030. And therefore within some programs, you may be moving one or two posts a year, It sounds a lot when you say you're going to move 1010 posts. But if you move over seven years, that may be one or two posts a year within a region, I've highlighted there uh in purple because it made me feel a lot better to highlight the surgical specialties. Um Those that, that we have started on and those that we are about to course surgery is within phase B and the work for that should start later this year to start planning earlier, how that will happen prior to 2026 when the first movement of posts do occur. Sometimes we get some surprises. For example, when we started with neurology planning, we didn't realize that a lot of them do stroke medicine and we had to bring stroke into the same phase because you couldn't move the neurology without moving the stroke and working at the same time, other things that have occurred, it was in vascular and we didn't have the right numbers. Um because of the historical badging of many of them under general surgery. So it was a really big piece of work to try and get all the numbers right. I hate to say that, that, that uh N HSE did not have the right number of training posts. It sounds crazy as a vascular surgeon, I'm gonna show you the vascular surgery maps. And essentially the first one is where the posts are. Now, these are tariff funded posts only not trust funded training posts. The second box along is the recommended redistribution. So essentially, if it's gone yellow, it means they're a donor region. If it's gone green, they're a gaining region. And Esther and I have done well there. The um this is on a complex model taking into account population needs aging deprivation, but also has an amount taken into account for specialist commissioning. So specialist commissioning for those specialist procedures, something like OBS and Gynae and GP have a very low amount of specialist commissioning with something like vascular cardiology, you can imagine has a high percentage. And that means that it's undertaken in a tertiary center. And that has to be factored into the modeling of where the trainee posts are. We then had expansion and expansion has been good. We didn't know expansion was going to happen when distribution was first planned, but that's gone a long way to buffer some of the losses within regions. And the last graph shows you the actual distribution as is and will occur over the um phase of, of um movement phase. A former orthopedics is in phase B and so they've already had the expansion so that slightly changes how the modeling is undertaken, but it just shows you where the posts are anticipated to be lost, which is in the North West London and where some of the big gainers are such as east of England. So if you're planning to apply for higher specialist training in orthopedics, you might want to think of where there's going to be some more posts. This is the whole number, the whole establishment of trainees. So we have about 85 per cent of posts are tariff funded, which means that pays about 40 per cent of the salary, but there are about 15 per cent, 20 to 15 per cent of posts are trust funded. So they have a number, but the trust pays for them. In totality, we've had an expansion of both tariff funded and of trust funded in this last year. The total numbers do include foundation, but you can see that there's also the numbers for the specialty trainees. It may confuse you to see the distribution where it comes to a number of 11 at the bottom and it should really be naught if you're moving posts around. But that means that there's actually been 11 more posts accepted than we're able to donate that will even up in the years to come. Dr Jack Haywood. He's a public health trainee and he was a fellow within the within this department department. Last year, he did a piece of work to engage with trainees to understand your perceptions of this work, what you thought about what your priorities were. So we could be sure that, that we were aligned with that and where there were deficits and there were some common themes um that he came up with. The top one was your concern for delivery and quality of care, which is to your credit, the, the main four areas from us for this program with the program itself and understanding it, the impact on recruitment and the impact on training and supervision. So for us, this was the key learning from that work that he undertook. Um And he did that er as two national um meetings and eight face to face meetings around the region around the country. Um And it was that we probably need to repeat this to ensure that our message is getting across, that we're still listening to you that as this process is undertaken, that those fears and concerns that you've had as we've started, it are um have been taken away and that you're happier with what you're seeing happen. Our communications were poor and that's one of the reasons why I'm here to ensure that you've heard about the program just because you haven't seen a QR code to come to our, one of our webinars and that you're able to ask those questions as with the feedback from the task and finish groups, educational capacity was raised as a real concern. And that for us meant to accelerate that working to ensure that educational supervision is there in the recipient regions and those with expansion and to look at those non workplace factors such as traveling, even study leave rotations, et cetera within this. So our next steps, well, as I've said in educational capacity, we want to look to see that there are enough educational supervisors and it has to be quality of educational supervisors, not just quantity. And that involves training. Educational supervisors involves knowing that they've got that time in their job plan to do it, to give you that quality supervision and that there are enough of them. You can't just put trainees into one region and suddenly expand the educational supervisors. So there have been some pilots undertaken in remote virtual using retired consultants, the using allied healthcare professionals, not so much for core or higher, that's been looked more at foundation or in community placements. We had a project in KSS, which was to look at ST seven S and eight S to see whether they could supervise foundation. And actually, that was very, very well. And that sort of model meant that those trainees from KSS who have already been a supervisor as soon as they become a consultant will be able to be an educational supervisor rather than the usual lag. We're developing a document, the medical educated capacity, which will have the good points and the bad points but allow people to look at it. It's not a one size fits all. Some things will work in one region that don't work in other regions. And we've developed that to try and help increase that capacity. The educated workforce strategy was one of the last strategies that was, was published by he at the end of March before it merged with N and that's very much about how to nurture and increase and value. The educator workforce. Too often, medical education is seen as that soft bit that doctors do without recognition, done within our own time. And that's wrong. It should be valued because it is after all producing the future workforce, we are undergoing yearly evaluations with the phase A groups task and finish so that we get those yearly updates to ensure that everything's proceeding smoothly and no new issues that are arising. And there will be an equality impact assessment. Although that's been a sort of a casualty time wise to commission because of the merger in the long term. How do you evaluate this? Do you evaluate it by where the doctors are, where they become consultants, where they become GPS by increased in the very long term, by increase the health of our population. So there are many different ways of how we may do that or do snapshots into different regions, phase B planning is going to commence. Primary care is in phase C and actually primary care is a very different category than the surgery or surgical and medical specialties because their biggest problem is estate and where to put people and they have a very different contract as to how education is undertaken. So we're going to start that early. These are the key messages I would hope, I hope that you can take away from what I've said. If you listen to nothing else, just to look at this, that's why it's purple that it is about distributing our specialty training posts and the investment that the makes into this equitably for leveling up of care for our patients. It does take into account, it's a very extensive modeling to take into account local population needs understanding that all regions are different. We have had expansion which has mitigated some of this distribution. We don't know what the expansion is going to be like in the future. Uh I think that's going to take the next general election for us to know whether there will be more and where there will be the long term workforce plan actually doesn't take it further than two years because it's an iterative document and thereby, that means stakeholders will be involved to try and plan and decide where those posts should be. So I hope ait will be involved with that planning. It does highlight the challenges of remote rural and coastal and that not everyone lives in a city and that we need to have doctors where the patients need them. And it's a way of addressing the biases that have been present in our system over the last few decades. Um And to align things from it was done that way just because it was done that way, actually doing things because that how it is, how it should be done and what the patients need. And the most important part of this is trainees don't move. If you are in a program, you will stay in that program until you finish that program. A post does not move until it is vacant until someone has finished with their training. And that's what gives that variation of why there's been 11 more posts accepted into regions than donated by regions this year because of extensions for trainees. So the post hasn't moved because the trainee still needs that number. I've gone on better than Ester Cos I made this QR code. So this is for the next webinar which is next week. And if you, there are still places I check before I put this slide up. If you want to attend the webinar, a Adan Fowler and Adrian Brook will be talking on there and they do take questions during the webinar virtually. Thank you. Thank you very much, Miss Brick. So we've got time for just a couple of questions. Um So we're gonna start by opening things up to the floor, if anyone's got questions for all three of our speakers. Thank stunned silence. Ok. Do you want to ask a question? Yeah. Um ok, it's alright. Um I had a question for kind of open to both of you at the moment. It's a really challenging time as we know with um and with the recent kind of foundation program issues and moving trainees, et cetera, there'll be some trainees, there'll be some medical students, be some foundation trainees sitting in the audience. What words of sort of, I suppose, motivation or optimism or what things are in the pipelines that as behind the scenes, um sort of seniors that you're aware of that they can look forward to and um sort of to just, you know, um look to the future to feel. So, so the um movement towards mini rotations at phase two should really help those coming through. That's going to take a lead in period of 1 to 6 years depending on where you are. So you shouldn't have to rotate as often. And you may ask me why you have to rotate at all. You can read my introduction to your yearbook, but essentially rotation lets you see different cultures, stops poor cultures developing and stops people being kept in units where there may be elements of bullying and harassment, et cetera or where your face doesn't fit. So there's many rotations. The other thing is that we're looking at increased flexibility of training. The current entry to ST three and core means it's very unlikely that somebody who has come out of foundation and then maybe had six years of intermittent work while they had three Children is actually going to manage to get into a surgical training program. And that's clearly wrong. It's also clear that people for whatever caring responsibility need to take repeated times out of training might just be better taking six years out and then coming back in. So we're looking at increased flexibility across the board if you were suitable for, for surgical training, and then you had quite a long period out for caring responsibilities or health responsibilities, whatever it is, it's unlikely you're not going to be suitable for training at a later stage in life. It is however less likely that your CV will have progressed over that period of time. But should that matter? The other thing that's coming forward are the different pathways to Caesar and that's not apply to an awful lot of people in this room. But it might become so and so there are challenges there, but there are also potentially opportunities for those of you who don't wish to go along a traditional training pathway. It's a so sorry. Um I think all of that, I mean, it is a lot of uncertainty at the moment. I think there's a lot of uncertainty for all of us because of where we are politically at the moment, waiting for the next election wanting to know which, which way the world is going to go and where the money is gonna go and what's gonna happen to the NHS. So for every doctor, I would say there's an element of uncertainty, but I find the long term workforce plan actually very positive because it is committing to expansion in a way that hasn't been committed to before. And a lot of what we want to see is an expansion of doctors and that's what this commits to and that should make our working lives better and also make care of our patients better from surgery as a profession. I think it's a very, we we're in a very good place. Um We are tackling the culture very positively. Um So to be a surgeon, it's an, it's a good time because the culture is changing and um working practices are changing and we will see that bullying undermining harassment is being very positively tackled. We've got lots of positive role models um for people. Um and look at all the innovation that's going on. I mean, it's just incredible when you look and see all the interesting things that are being done in surgery um where you're going to be and what you're gonna be doing. II always thought when I first became a surgeon that in 100 years time people would laugh that we actually open patients up. What do you mean you open them up, you cut them open, it's gonna happen earlier than that. So there's so much there. That's exciting and brilliant. And you're gonna, gonna have brilliant. I can't, I mean, Esther said you're gonna have great careers. We're coming to the end of ours. Um, and I think it's a good time to do surgery and be a surgeon with all the changes happening. Mhm. Brilliant. Thank you very much, uh, for, for, for answering those. Um We've probably got time for just one quick question. I can see a hand up uh sort of just towards the middle there. So I think we're gonna bring a a microphone round to you. Hello, I'm Dan. I'm a surgical in Yorkshire ST six. Thanks for your talk. It, it may be slightly irrelevant in the sense of this is all about training numbers. But how does this all relate to getting a job at the end? You know, if I want to do OG cancer? Um I can't remember. It's countless times I've been told that there is no job. I have to wait for my boss to die. Move along or, you know, even at this stage, I have to start planning for where I'm going to work. Um And with that, that then uh you then have to start planning where your training places are going to be because if I don't work with the bosses, they're not going to know who I am from. Adam. Uh I'm not going to get the job. Um And so that then begs the question as to whether I'm going to be an OG or bariatric or if I fall into the slot of doing EEG S, um, how does it all to the end game? I don't know, it's sometimes hard to know the end game if you've not already decided to subspecialty, but we all want a job at the end. We don't want to get trained, spend 15 years and not get a job. Thank you for reminding me about one sentence. I meant to say my talk and didn't. Um So there is actually, I've just asked for some data last week because some of the feedback from the task and finish groups from the phase A well is going to be consultant expansion where the consultant jobs because there's no point expanding at foundation co hier and there's not an expansion at consultant. And actually what we want to know is it's not only a case of having to watch the BMJ obituaries to see where there's a job coming up that you can expand because health care demands are expanding. We know in vascular is 2.5 per cent per year, we've accurately mapped it. So we've actually accurately mapped how many consultants we need extra to those that are retiring and there's going to be a bulge of retirements as well. So that data has been factored into this. So that we can do that matching and by regions the other bit. That's quite exciting is the n the national consultant information portal and discussions with them about how we can map the volume of procedures being undertaken in each region by where trainees are, where consultants are map the curriculum and do this oversight much more accurately rather than just sort of giving a best guess of where things might happen in that way. So it is all factored in because there's no point training you and you're not having a consultant job at the end. But that's why working with the IBS is really important because they'll be the people that have the money to provide those consultant posts in my region. I have a 25% deficit in consultant urologists. We don't have 100s of posts out there being advertised because there is nobody to take those up. Um We're getting some extra expansion from some additional cancer money as well. Um But often jobs are not advertised until the right person comes along or that we know that there are people who are available because it is a pointless and expensive undertaken to interview for posts that then you don't fail. So it has always been thus that it's been a really uncertain time come to the end of training as to where a consultant job has been. And I have to say for me, I found that more stressful than my FRCS exam and I think there's an awful lot of people who feel like that most people do end up in the job for them. And there are very few employable surgeons without a job. And I think that your concerns from our point of view have been raised by lots of your colleagues as well. This is certainly something that we've written about as part of the AC to make sure that anything that is implemented as part of a workforce plan has that long term consideration for if you're increasing medical student posts, for example, you then increasing foundation posts. And so it goes on, um they are available on, on the HDG website. So please do take a look um because you might find it at least reassuring that you're not the only one feeling that way. So we fought quite heavily against quotas in things like general surgery for breast versus colorectal versus resectional upper gi to give you the flexibility to train as you wish. Clearly, there isn't some areas, there are a limited number of posts to reach your CCT competencies. But as a group of heads of school, we've fought quite hard to limit anything like that to give you all the opportunities that you possibly can to develop the surgeons that you want to be perfect. Thank you very much, everybody. I think we're gonna run that session to a close. So I'd just like to thank all the speakers for their time and on behalf of us and allowing us to engage with you so that our members are heard. Uh and we help to train the next generation. Um So we're gonna start the next session in just a couple of minutes. Um And thank you very much for coming. That's ok. It's not good.