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STPB 2007(01): Modernising Medical Careers: Specialty Training Project Board papers

SPECIALITY TRAINING PROGRAMME BOARD
FIRST MEETING
MONDAY 29 OCTOBER 2007
CONFERENCE ROOM B, ST ANDREW'S HOUSE, EDINBURGH

AGENDA

STPB 2007(02)

SPECIALITY TRAINING PROGRAMME BOARD

MMC: SPECIALITY TRAINING: SELECTION AND RECRUITMENT 2008

SCOTTISH GOVERNANCE

FOR INFORMATION

Objective

1. To establish a Scottish governance for framework developing policy on, and defining, directing, managing and monitoring the effective implementation of, selection and recruitment to junior doctors' postgraduate Speciality Training in Scotland in 2008, as part of a coordinated UK approach to selection and recruitment. UK Governance arrangements are shown at Annex A.

Customer/sponsor

2. The Scottish Government Directorate General for Health and Wellbeing, represented jointly by Dr Harry Burns (Chief Medical Officer) and Paul Martin (Chief Nursing Officer and Interim Director of Health Workforce) who will sign off jointly all policy, and key operational decisions relating to the project.

3. Dr Harry Burns, accompanied by others are necessary, will represent the Scottish Government at the MMCUK Coordinating Group and at related meetings/discussions between the Scottish Government and the other administrations.

4. The customer/sponsor will meet weekly with Malcolm Wright (Chief Executive, NES) and others as appropriate to review progress.

5. The customer/sponsor will be supported, and advised by 2 Boards:

Speciality Training Programme Board ( STPB)

Remit

To determine overall policy and objectives for the selection and recruitment to

postgraduate medical Speciality Training in 2008 and beyond, taking into account wider Scottish policy drivers and the relationship between the implementation of selection and recruitment in Scotland and the UK; to agree Scotland's input to UK governance arrangements and policy development; to approve the project definition,

and project plan for 2008, and any deviations from or modifications to them; to agree any necessary central financial provision; to give direction to, and make timely decisions in response to recommendations from, the Selection and Recruitment Delivery Board; to resolve any conflicts arising from the implementation of the project that cannot be resolved by the Selection and Recruitment Delivery Board; and to advise, inform and, where necessary, seek steers from the Cabinet Secretary for Health and Wellbeing.

To determine policy on any residual matters from selection and recruitment to postgraduate medical Speciality Training in 2007.

Selection and Recruitment Delivery Board ( SRDB)

Remit:

Reporting to the Speciality Training Programme Board ( STPB) to:produce a project definition, project plan and risk register for Speciality Training selection and recruitment in 2008; to implement Speciality Training selection and recruitment in 2008 in accordance with the agreed project plan; to devise and implement necessary processes for selection and recruitment, including arrangements for host Boards, application form design, short listing and interviewing, offers/allocation to programmes and other HR related matters; to agree, with the Scottish Government, relevant workforce numbers; to manage overall communications; to manage the relationship with regional workforce planners, Speciality Boards and Scottish Deaneries; to liaise with wider stakeholders; and to establish relevant sub-groups.

Other members tbc but to include those (from NHS Scotland, NES and the Scottish Government) with operational responsibility for delivery of selection and recruitment in 2008

It is expected that the Selection and Recruitment Delivery Board will establish sub-groups on Human Resources and on Communications.

ANNEX A

MMCUK GOVERNANCE - CONFIRMATION OF STRUCTURE

1. There is a continuing need for UK-ownership of the evolving agenda for postgraduate medical education, informed by close liaison with key stakeholders. There is also a need for each of the UK Health Departments to be responsive to their constituencies, with Ministers ultimately responsible for decision-making in each country.

2. To accommodate these different pressures, the governance structure shown at Appendix 1 is proposed. This shows single country Programme Boards (or equivalent) reporting directly to Ministers in each country. Membership of each Board will be a single country issue.

3. Programme Boards themselves will be advised by working groups comprising key stakeholders to advise on specific issues.

4. To ensure co-ordination of action across the UK, the Programme Boards (or equivalents) will link to the MMCUK Co-ordinating Group ( MMCUKCG). The purpose of the MMCUKCG will be to ensure excellent communication between Departments of Health; to identify commonalities; and to recognise and manage any proposed divergence in policy or implementation by Programme Boards. Each Programme Board (or equivalent) will defer engagement with their respective Ministers until the impact of any proposed policy or operational issue by them has been considered by the UKCG.

Appendix 1

STPB 2007(02)

( MMC Scotland: Postgraduate Medical Education

Roles, Responsibilities and Key Functions for 2007/2008 in:

Workforce Planning, Selection and Recruitment, Managing Delivery and Communication

Notes:
1. 4 HR teams each responsible for specific specialty programmes across Scotland working in an association with deaneries.
2. Employment contracts issued by Health Boards or lead Health Boards.

STPB 2007(04)

SPECIALITY TRAINING PROGRAMME BOARD

PROPOSALS FOR RECRUITMENT AND SELECTION IN SCOTLAND IN 2008

FOR DISCUSSION AND AGREEMENT

DRAFT

OVERVIEW

1. In light of decisions by programme Board in England that they do not want to have a national IT system and limits on applications for 2008 Scotland requires a recruitment and selection process that is stand-alone. There will be a broadly specified national timetable in England and given the UK wide nature of the workforce it would make some sense to work to a similar timetable in Scotland.

ADVERTISEMENT

2. The MMC Scotland website hosted by NES will be the main source of information on programmes and posts available in Scotland. Potential candidates will be advised by adverts in national press [ DN - BMJ, anywhere else?] to access the MMC Scotland site and register for regular e-updates that will be issued as changes occur.

3. As programme vacancy numbers are confirmed [ DN - can we give a date for this - sometime in December if at all possible] these will be made available on the site along with information on how to apply including person specifications, application forms and guidance on how to complete.

APPLICATION PROCESS

4. Application for Specialty Training 2008 will open on *January 2008. Closing date for applications will be ** January 2008.

5. Application will be by a structured application form. Forms are currently being designed by specialty Boards with advice and input from SGHD. The majority of the form will be generic and will comply with best practice and current employment law. It will also include specialty specific questions as requested by Specialty Training Boards. Guidance will require to be issued to candidates indicating how different questions relate to aspects of the person specification and giving indications of how those questions will be assessed and contribute to scores.

6. Candidates to Scotland will make a single application for each specialty declaring which Deaneries they would want to be considered in which order of preference.

7. Candidates will be limited to application to four different specialties within Scotland.

8. Application forms will be made available on/signposted from the MMC Scotland website and applicants will be asked to e-mail their applications to NES at a single address. Applicants will be offered option of sending hard copy of application if e-mail not available.

9. Applications will be entered onto database NES are currently building and the information for shortlisting only will be passed to lead deaneries for the specialties.

SHORTLISTING

10. If a decision is taken to implement guidance on assessing UK/ EEA applicant suitability first then only UK/ EEA applicants will be assessed for shortlisting initially.

11. Lead Deaneries for each specialty will run a national shortlisting process. This may differ between specialties due to different requirements and numbers involved. All shortlisting will be conducted by allocating a score to application form against the person specification. The methods each specialty will use for shortlisting are to be confirmed by end of November 2007.

12. Specialties will have to make decisions on numbers to shortlist based on their understanding of competition ratios for the particular posts they are recruiting. If only UK/ EEA applicants are considered initially this should allow a higher proportion of eligible applicants to be offered interviews. Specialties should also determine a cut-off point below which they would not consider candidates for appointment. These two scores may be quite different depending on competition ratios.

ROUND 1 INTERVIEWS / SELECTION METHODS

13. These will be determined by each specialty but will comply with PMETB requirements and also fit with best practice and employment law [ DN - do we want to restate the PMETB requirements].

14. Decisions on interview methods and provisional dates for first interviews to be determined by end of November 2007. First interviews in specialty to be completed by 7 ^th March 2008 to allow unfilled posts to be allocated in further interviews.

15. Candidates will be ranked using score from interview/selection process and score for application form. The relative weighting given to each of these will be determined by each specialty.

ROUND 1 OFFERS

16. Successful candidates will be offered posts and asked to confirm acceptance within 48 hours. Candidates will be asked to sign a declaration that in accepting the offered post they agree to withdraw from any other applications they have made for training posts in other parts of the UK. [ DN - can we do this? Also, can we say we would keep open option for them to improve their regional preference within Scotland if a space appears?]

ROUND 2

17. If there are vacancies in a specialty after offers have been cascaded through all appointable candidates interviewed in Round 1 a further series of interviews will be arranged. Any UK/ EEA nationals not shortlisted in round 1 but above the cut-off should be considered next. If there are insufficient such candidates then non UK/ EEA nationals would be shortlisted and considered in round 2.

18. The shortlisting and interviews for round 2 are to be completed by end of April 2008 to allow time for clearing and HR processes to take place for August start.

CONTINGENCY PLANNING / RISK ASSESSMENT

Risk: No agreement to or further legal challenge against the implementation of HSMP guidance.

19. Action: the total number of applications may not change very much if this happens but all applications would have to be included for shortlisting. This could result in huge amount of extra work for shortlisters at stage 1. We will know by early November whether this is going to happen or not. If so we will need to allow additional time for shortlisting and extend the first round of interviews, delaying offers. If this happens there will be no need for further shortlisting as we enter any subsequent rounds so second and possibly third tranches of interviews could be booked earlier to allow the whole process to complete on time.

Risk: Failure of electronic application - website fails or unable to accept e-mail applications

20. Action: Candidates would be informed and would have to contact lead deanery for specialty to request copy of application form and return completed form to them. Closing date might have to be extended to allow for this if happened late in process.

Risk: Volume of applications for shortlisting hugely exceeds posts.

21. Action - this is less likely if HSMP guidance implemented but still possible - particularly at higher levels in popular specialties where we might be offering posts in small numbers. Shortlisting would have to take place for all eligible candidates. Timescale for this may have to be extended in same way as if HSMP guidance not implemented but we will not have the same notice. We should try and anticipate specialties likely to have extreme competition ratios and monitor application rates closely through the application period.

STPB 2007(05)

SPECIALITY TRAINING PROGRAMME BOARD

PROPOSALS FOR COMPETITIVE ALLOCATION FROM CORE TRAINING TO SPECIALTIES IN SCOTLAND IN 2008

FOR DISCUSSION AND AGREEMENT

1. Trainees appointed to ST2 level in Core Medical Training programmes and ST3 in core Psychiatry programmes have been given educational contracts that run through to CCT but will need to undergo a process of selection into specialties for August 2008
2. It is our intention to appoint some additional candidates at these higher entry levels as part of the selection and recruitment process in 2008.
3. It is therefore proposed that the competitive allocation of current run-through trainees into specialty of their choice should run in tandem with the appointment of new Specialty registrars at those levels.

Proposed outline of mechanism for allocation

4. Current trainees in ST2 ( CMT) and ST3 ( CPT) will be asked to complete application forms for the specialties of their choice at ST3/4 level. Their number of specialties will be limited in same way as fresh ST 3 / 4 applicants and they will rank geographic preferences in same way. The significant difference is that they will be guaranteed an interview and an offer at the end of the process.
5. Current trainees will complete the same selection process as new applicants and will be scored accordingly.
6. Option 1 : A matching process will then take place with current run-thorough candidates and successful new applicants considered on an equal footing for specialty placement.. This mechanism will be dependent on specialties agreeing a generic scoring system and interview process that will allow transferability within Scotland.
7. Option 2 : A matching process will then take place for those holding run-through NTNs. Any remaining places will then be matched to suitable applicants in the specialties with remaining vacancies.
8. In either case matching will be based on candidate preferences for specialty and/or geography in order of their ranking. Candidates will receive their "best available" offer. Run-through trainees who reject such an offer would not be made a further offer and would lose any right to continuation of their run-through contract. Those who accept an offer may be offered an "upgrade" if a higher preference post is rejected by another candidate.
9. Option 1 offers the best opportunities for new joiners to be considered for the specialty of their choice but the complexity increases as the number of specialties involved rises. Without transferable scores or joint interviewing the only realistic option is option 2.
10. It seems likely that option 1 might be achievable in Psychiatry with a smaller number of specialties but with the larger number of specialties in Medicine the complexity will be such that option 2 will probably need to be applied. Specialty Training Boards should be asked to confirm this.

Recommendation

11. That the Specialty Training Programme Board agree this outline mechanism for competitive allocation to specialties and ask the relevant Specialty Training Boards to determine which methodology is most suitable for their specialties.

MMC 2007/2008 Milestones Plan

STPB 2007(08)

SPECIALITY TRAINING PROGRAMME BOARD

MANAGING UNPLACED DOCTORS AS AT 31 OCTOBER 2007
FOR INFORMATION

THIS PAPER CONSTITUTES ADVICE TO MINISTERS AND IS NOT FOR WIDER CIRCULATION BEYOND MEMBERS OF THE SPECIALITY TRAINING PROGRAMME BOARD

STPB 2007 (09)
SPECIALITY TRAINING PROGRAMME BOARD
MINUTES OF FIRST MEETING ON 29 OCTOBER 2007

Present:

Dr Harry Burns CMO (Chair)
Neil Douglas (Academy)
Dr Mike Watson ( NES)
Jean Allan ( NES)
Caroline Lamb ( NES)
Brian Cowan ( NHS Greater Glasgow and Clyde)
Katie MacLaren ( SJDC)
Dr Alastair Cook
Ricky Verrall
Jo Gillies
Roddy Angus (Secretariat)

1. Welcome and introductions

1.1 The CMO welcomed everyone to the first meeting of the Speciality Training Programme Board ( STPB). Apologies were noted from Paul Martin (co-chair), Malcolm Wright (co-chair of the Selection and Recruitment Delivery Board), Peter Terry ( BMA) and Frances Elliot (Brian Cowan was representing SAMD). CMO noted that a second co-chair for the Selection and Recruitment Delivery Board, who would automatically have a seat at the Programme Board, had not yet been nominated by NHSScotland Chief Executives but that it was vital for the Service to be fully engaged in both Boards.

2. Remit and relationship to the Selection and Recruitment Delivery Board: Papers STPB 2007(02) and STPB 2007(03)

2.1 The CMO introduced these papers. It was noted that although the current focus was very much on process and procedures for 2008, the STPB had a wider remit in considering residual issues from 2007 and future policy direction arising from, for example, the Tooke Review.

2.2 In response to a suggestion form Neil Douglas, it was agreed that a representative of the College Junior membership should join the Selection and Recruitment Delivery Board ( SRDB). Brian Cowan said that, subject to views for the NHSScotland Chief executives' group, he would be willing to co-chair the SRDB.

Action 1: The Academy to nominate a junior doctor representative for the SRDB to NES.

Action 2: CMO to speak to Fiona Mackenzie about the co-chair of SRDB.

3. Outcome of UK Coordinating Group ( UKCG)

3.1 CMO noted that the UKCG had met on 24 October. As a co-ordinating body, the UKCG was seeking to maintain alignment on MMC across the 4 administrations and to agree UK-wide approaches where this was in the collective best interests of the administrations. However, each administration was now responsible for taking its own decisions on future delivery of ST training in its respective territory. The key issue for the UKCG on 24 October had been what offer to make to ST1 and ST2 applicants in 2008 and whether this would involve decoupling.

3.2 In discussion the following points were made:

• Alastair Cook reported that England were looking at a mixed economy of run-through and decoupled offers. He suggested that in some specialties it would be helpful to offer core training that would count towards CCT but would not attract an NTN. It was reported that PMETB are content with such a proposal but confirmation of this would be required.
• Neil Douglas informed members that England were planning to offer 2 year programmes but had taken no final decision on de-coupling. Alastair Cook asked whether, if we have complete un-coupling, it would be reasonable to have a few more core training posts than speciality training posts available down the line. CMO asked whether we should carry on as last year and offer run through posts. Decoupling was a major step which needed to be fully discussed and agreed.

• If Scotland were to offer run through contracts and England did not then there was a risk that Scotland could be swamped by applicants
• It would be necessary to build in some cross recognition of training and transferable competencies
• Specialties should be able to recognise competencies gained in other specialties
• The CMO suggested that if there were changes for 2008 it would be highly desirable that there would be no surprises. More discussion was also required on transferable competencies.
• Further discussion was needed on whether there was a need to expand the number of ST posts. The capacity to train expanded numbers should also be a factor when setting requirements for ST posts.

• there was an issue about whether FTSTA 3 and 4 posts should be converted into ST posts which would result in fewer short term contracts. It was suggested that creating FTSTA 1 posts and loading the higher levels into ST posts would be a step in the direction of Tooke. Concern was expressed that FTSTA 1 and core training might replicate the previous "lost tribe" problem The effect of de-coupling and 2 year contracts was also discussed. It was suggested that there should be a generic FTSTA 1 course but it was decided that there was no need for that at this stage.

3.3 It was agreed that the STPB should consider these issues further in due course, following future discussion at the UKCG. In the meantime discussion should be held with workforce planners about the potential impacts of de-coupling and expanding the number of ST posts as FTSTAs are moved out of the system.

Action 3: Alastair Cook and Jo Gillies to liaise with workforce planners.

4 Proposals for selection and recruitment in Scotland in 2008; (paper STPB 2007(04))

4.1 CMO introduced paper STPB 2007(04) which was broadly agreed subject to the following comments:

• Mike Watson confirmed that the NES website was ready to go and that they had a system which would allow individuals to register for updates. Jo Gillies indicated that numbers of training places should be available by end November. The plan is for the website to open for applications on 4 January 2008.
• There was a discussion about the photocopying of applications and the administrative burdens this placed on selection boards. Similarly there was a discussion about what form the receipt for the application should take and when it should be issued. It was agreed that this issue was a matter for the SRDB.
• There was a discussion about whether there was a need to restrict the number of applications that can be made. It was suggested that this was not much of an issue in Scotland with very few applicants applying for 4 specialties, however there might be a problem with surgical specialties. It was agreed that no limit should be placed on applications but that guidance should be issued pointing out that multiple applications could lead to clashes of interview timings and that it would be up to individual applicants to decide on which interviews to attend.
• The CMO emphasised the importance of the SRDB coming to early decisions on short listing criteria and the first interview process. A possible requirement for applicants to accept offers within 48 hours was discussed. While it was agreed that while such a restriction could not used in the case of English offers, acceptance of a Scottish offer would result in the applicant's name being removed from other Scottish interview lists

4.2 There was a discussion about how many recruitment rounds there should be in 2008. In England they were proposing 3 rounds but CMO suggested an alternative of 2 rounds. It was agreed that the option should be given to speciality boards for them to decide. Jean Allan mentioned that multiple recruitment rounds may cause problems within HR teams due to the additional workload.

4.3 STPB 2007(04) will be amended as necessary and passed to the SRDB for action,

Action 4: NES to issue guidance on the possible consequences of multiple applications.

Action 5: NES to ensure that that SRDB comes to early decisions on short listing criteria and the first interview process

Action 6: NES to advise Speciality Boards that it is for those Boards to decide on the number of recruitment rounds in Scotland

Action 7: STPB 2007(04) to be amended

5. Competitive allocation from core programmes into ST3 (medicine) and ST4 (psychiatry): (Paper STPB 2007(05)

5.1 Alastair Cook introduced the paper. CMO was concerned with option 2 as option 1 seemed to be fairer. Neil Douglas queried how option 1 would work across 29 specialties and Mike Watson questioned whether the STs should take precedence with the FTSTAs taking the headroom jobs. It was agreed that FTSTAs should go in at the level their competencies deserved.

5.2 The CMO indicated that, due to the tight spending review settlement, there was little likelihood of the Government funding more training places and that better use will have to be made of the posts that are already in existence.

5.3 CMO raised the issue of a UK recruitment system for small specialties e.g. less that 25 posts and indicate that in order to avoid surprises a decision on handling needed to be made soon. National recruitment would mean that harmonisation would be required and therefore the UK Coordination Group would need to make a decision on who is taking the lead.

5.4 Concerns were raised that the English Programme Board may make decisions on an England only basis which might have a knock on effect on the other devolved administrations. Any decisions affecting more than England must be signed off by the UK Coordination Group.

Action 8: Board agreed that the process described in STPB 2007(05) should be followed as an outline but that each Specialty Board should consider the options and come to a view, by the end of November 2007, on which to follow and how to implement. NES to follow up with Speciality Boards.

Action 9: Alastair Cook to email DH, copied to Wales and Northern Ireland, asking that the UK Coordination Group consult before deciding on lead deaneries.

Action 10: CMO to speak to Martin Marshall about decisions taken by England but affecting the UK to be signed off by the UKCG.

6. Selection and recruitment in 2008: project plan and risk assessment: (paper STPB 2007(06) and STPB 2007 (07))

6.1 Jean Allen spoke to papers STPB 2007(06) and (07). Caroline Lamb asked if it would be possible to add the likelihood and impact of risk to STPB 2007(07).

6.2 The SRDB is due to meet on 8 and 19 November and a revised risk report, which addresses many of the work in progress/still unknown factors highlighted, will be available to the next meeting of the STPB on 22 November.

6.3 Jean Allan asked if GPRs would be treated the same as other specialties and what the timeline would be for their appointment process. Concern was expressed that some junior doctors had not been offered GP training positions because GP had not been their first choice speciality.

Action 11: NES to include likelihood of risk in STPD 2007 (07).

Action 12: NES to prepare updated project pan and risk assessment for the STPB on 22 November.

Action 13: CMO to speak to Martin Marshall about fairness in GP selection.

7. Managing unplaced doctors as at 31 October 2007: (paper STPB 2007(08))

As the paper constitutes advice to ministers the discussion that followed is deemed as being not suitable for publication and therefore covered by exemption under FOI.

8. Any other business

8.1 CMO mentioned that Sir John Tooke was visiting the Department on 19 November. Board members had been invited to meet with him.

9. Date of next meeting

Thursday 22 November 2007: 2.00 pm to 4.30 pm, conference room B St Andrew's House.

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