MMC and the demise of MTAS Dr Celia Gregson Specialist Registrar in Elderly and Internal Medicine Frenchay Hospital, Bristol
Jan 10, 2016
MMC and the demise of MTAS
Dr Celia Gregson
Specialist Registrar in Elderly and Internal Medicine
Frenchay Hospital, Bristol
Objectives – 6 crucial questions:
1. What is MMC?2. What was MTAS?3. Why do I need to know about all this?4. How is MMC going to affect my getting a
job in the UK?5. How is MMC going to affect the training I
get in the UK?6. How is MMC going to affect the future of
the NHS?
To develop a workforce of trained doctors working within clinical teams, who provide the majority of front-line medical management and care for patients.
Vision of MMC
MMC objectives
MMC aims to:
• Ensure that more patient care is delivered by trained doctors rather than doctors in training
• Develop streamline postgraduate medical training focused on the service required by the NHS and delivered to explicit standards
Life before MMC…my life….Year of Training Grade Speciality
0 Graduated from Medical School
1 Junior House Officer Medicine / Surgery
2 Resident Medical Officer A&E - Australia
3 – Med Rotation Senior House Officer CoE / Cardiology
4 – Med Rotation Senior House Officer *MRCP Resp / HIV
5 Clinical Fellow
LAT Specialist Registrar
ITU / Oncology
Elderly / Internal Med
6 Specialist Registrar Year 1 Elderly / Internal Med
7 Specialist Registrar Year 2 Elderly / Internal Med
8 Specialist Registrar Year 3 Elderly / Internal Med
9 Specialist Registrar Year 4
Research - PhD
Elderly / Internal Med
10 Research - PhD
11 Research – PhD
12 Research – PhD
Specialist Registrar Year 5 Elderly / Internal Med
13 CCT Consultant
Life before MMC….the perception..
• CMO ‘Unfinished business’
• SHOs lost in the system
• Lack of skilled doctors
• Excessively long and unfocussed training
• Bottle-necks for skilled doctors
• Multiple applications all year around
• Perceived favouritism
UK MMC Career Framework, 2006
Arrows indicate competitive entry
Specialist and GP training programmes(Run-through training)
Medical school – 4-6 years
Specialty training inSpecialist/GP training “schools”
Career posts
F1
F2
Postgraduate Medical Training
Senior medical appointmentsSenior medical appointments
Continuing professional development
Fixed term specialisttraining
Specialist and GP RegistersArticle 14/11 route
Continuing professional development
Undergraduate medical training in medical school
CCT route
Principles
• Fair peer group competition
• Unique training number (= NTN)
• Entry points to the new programmes
Life after MMC……Year of Training
New Grade
0 Graduation from Medical School
1 JHO FT1 – Foundation Training
2 SHO FT2 – Foundation Training
ST1 Selection
3 SHO ST1 – Specialist Training Core Training
4 SHO ST2 – Specialist Training
ST3 Selection
5 SpR ST3 – Specialist Training
6 SpR ST4 – Specialist Training
7 SpR ST5 – Specialist Training CCT AIM Consultant AIM
8 SpR ST6 – Specialist Training CCT Other Speciality Consultant Speciality
Run-through training
• From 2007, a single specialty training grade will be introduced, combining the SHO and SpR grades
• A doctor in the new grade will be a Specialty Registrar(StR). Doctors appointed to an StR run-through trainingprogramme will get a national training number (NTN)
• New curricula approved by PMETB reflects structure of “run-through” training - specialty training year 1 (ST1) through to specialty training year 8 (ST8) [depending on the specialty]
Modernising Medical Careers
• Phase 1 – Foundation Training– August 2005
• Phase 2 – Speciality Training– August 2007
What’s changed under MMC?
• Foundation Programme – 2 year training programme
• National process– National timeline
– UK-wide online application system
– Application form piloted with F1 doctors
– National scoring guidance
– Fair and open competitive process
Foundation Training Programme
• National Curriculum:– Acute emergencies– NHS skills– Team working– Clinical Governance– Risk Management– Occupational Health
• Preparation for Specialty Training
Foundation Training Programme• National Assessments
– 6 per year Minicex– 4-6 per year DOPS– 2 per year Multiscore Feedback (Mini – Pat Tab)– 6-8 per year Case discussions
• National e portfolio
No. Only doctors who have not completed an internship (or equivalent training) are eligible for F1 posts. As you’ve had house officer experience and are entitled to register with the GMC, it is likely you have already gained competences comparable to the F1 year. You will be able to apply for F2 posts when they are advertised. These standalone posts are not recruited to through MTAS, but will be advertised locally.
If I am settled in the UK and have house officer experience, can I apply to F1, rather than F2 training posts?
What is transition?
New specialty
curriculum
Old specialty
curriculumTransition
StartsNew curriculum
approvedRecruitment begins
Ends Last trainee on old curriculum
completes training
•For most specialties, new curricula commences August 2007•Entry to SHO grade will be closed from August 2007•Recruitment to Specialist Registrar grade ended in December 2006
What if I need to train less than full-time?
• Check your eligibility for flexible training with your local deanery
• Any existing flexible training arrangements will not be automatically carried forward to a new training programme –you must apply for entry into specialty training unless you already hold an NTN
• Indicate on your application that you would like to train less than full-time (this will not be seen by the appointments panel but will remain confidential)
• If you are selected into a programme you will need to discuss your requirements with the appropriate postgraduate dean
Completion of programmes
• Successful completion of a training programme is subject to satisfactory progress. Trainees will be assessed by the PMETB-agreed assessment programme for each specialty and this will lead to a Certificate of Completion of Training (CCT) or application for a Certificate of Eligibility for Specialist Registration (CESR)
• The length of each programme is dependant on the specialty. Specialty curricula on the relevant royal college website will give indicative durations
Longer term
• new consultant posts?
• new career posts?
• others ways of delivering the service?
MTAS
How does it all work?
• Single online application (MTAS)• Application form divided into the following sections
– Personal • Name and address
– Preferences • You must rank 26 foundation schools
– Key questions• There will be 8 questions with a maximum of 150 words each.
– References • Your references must be clinicians
– Equality & diversity• will be used by employers to build a demographic profile of their workforce.
– Submit• Confirm application is completed and all information is correct and your own
work
• You will be able to save your application at any time and come back to it at a later date during the application timeframe
Things to consider
“I only want to do cardiology” (1 specialty):Apply to 4 Units of Application [UoAs] (a deanery or cluster of deaneries)
“I must live in Manchester” (1 geographic area):Apply to 4 specialties in North Western UoA
“I want to spread my options”:Apply to 2 different specialties in 2 different UoAs
Which is more important to you, specialty or geography?
Do your homework
• Learn as much as you can about the specialty and its curriculum by looking at the relevant royal medical college website
• Keep your options as flexible as possible and consider a range of specialties which might suit you
• In the early years of the new specialty programmes there are a large number of training opportunities available in a range of specialties
• You might want to consider a Fixed Term Specialist Training Appointment (FTSTA)
Preparing your application
• Person specifications for all levels are available on the MMC website
• A comprehensive Applicant’s Guide is available via the MMC website
• You will need to provide evidence of having achieved the competences as described in the person specification
• Royal college websites offer advice about the sort of evidence you could offer
Specialties with entry at ST1, 2, 3 and 4 [some]
• Medicine• Surgery• Psychiatry• Acute care common stem [ACCS] • General practice• Paediatrics• Obstetrics & gynaecology• Ophthalmology• Anaesthetics• Neurosurgery• Oral & maxillofacial surgery (OMFS)
Specialties with entry at ST1 only
• Radiology
• Medical microbiology/virology
• Chemical pathology
• Histopathology
• Public health
Medicine [see JCHMT website for further advice]
ST1• Medicine in
General
ST2• Medicine in
General
• Allocation / competitive process to ST3
ST3• Allergy• Audiological medicine• Cardiology• Clinical genetics• Clinical neurophysiology• Clinical oncology• Clinical pharmacology &
therapeutics• Dermatology• Endocrinology & diabetes• Gastroenterology• General internal medicine
(acute medicine)• Genito-urinary medicine• Geriatric medicine• Haematology
• Immunology• Infectious diseases• Medical oncology• Medical ophthalmology• Neurology• Nuclear medicine• Occupational medicine• Palliative medicine• Paediatric cardiology• Rehabilitation medicine• Renal medicine• Respiratory medicine• Rheumatology• Sports & exercise
medicine• Tropical medicine
Doctors with the ST1 and ST2 competences in medicine and with the existing entry requirements for SpR training
Foundation doctors & others without the ST1 competences and with < 1 year’s experience in medical specialties
Doctors with the ST1 competences and with 12 – 36 months experience in medical specialties.
Surgery [see the JCHST website for further advice]
ST1• Generic
programmes in Surgery in General
• Themed programmes
Foundation and other doctors who do not have the ST1 surgical competencesand with < I year ofexperience in surgery
ST2• Themed programmes in:
Cardiothoracic surgery General surgery Otolaryngolgy (ENT) Paediatric surgery Plastic surgery Trauma & Orthopaedic
surgery Urology
Doctors with ST1 surgical competences and with 12 – 36 months experience in surgery
ST3• Cardiothoracic surgery
• General surgery
• Otolaryngology (ENT)
• Paediatric surgery
• Plastic surgery
• Trauma & orthopaedic surgery
• Urology
Doctors with the ST1 and ST2 competences and the existing entry requirements for SpR training
Acute Care Common Stem (ACCS)
ST1• Appointed to one of 3 themed programmes
in ACCS: Emergency medicine Anaesthetics Acute medicine
Foundation and other doctors withoutthe ST1 competences and with <12 months’experience in the relevant specialties
ST2• Acute Care Common Stem in
one of three themed programmes:
Emergency medicine Anaesthetics Acute medicine
• Doctors will continue in designated specialty at ST3 in
Emergency medicine Acute medicine or one of the
medical specialties Anaesthetics, continue at ST2
Doctors with required ST1 competences and 12 – 36 monthsof relevant experience
Psychiatry[see the website of the RC Psych for further advice]
ST1• Psychiatry in
General
Foundation and
other doctors who
do not have the
ST1 psychiatry
competences or
with < I year of
experience in
psychiatry
ST3• Psychiatry in
General
• Allocation / competitive process to ST4
Doctors with ST2
competences and
with < 48 months’
experience in
psychiatry
ST4• Child & adolescent
psychiatry
• Forensic psychiatry
• General adult psychiatry
• Psychiatry of learning disability
• Old age psychiatry
• Psychotherapy
Doctors with the ST1, ST2 and
ST3 competences and the
current entry requirements for
SpR training
ST2• Psychiatry in
General
Doctors with ST1
Psychiatry
competences and
with 12 – 36
months’ experience in
psychiatry
Basic Neuroscience Training• 2 year training post Foundation Training, i.e. ST1
& ST2– Neurology– Neurosurgery– Neurophysiology– Neuroradiology– Neuropaediatrics– Stroke medicine– Rehabilitation– Psychiatry– Geriatrics– ?GP
Other possible posts….
1. Academic Run Through Training
2. Fixed Term Specialty Training Appointments (FTSTAs)
3. Career Posts - previously referred to as Non-Consultant Career Grades (NCCGs).
UK MMC Career Framework, 2006
Arrows indicate competitive entry
Specialist and GP training programmes(Run-through training)
Medical school – 4-6 years
Specialty training inSpecialist/GP training “schools”
Career posts
F1
F2
Postgraduate Medical Training
Senior medical appointmentsSenior medical appointments
Continuing professional development
Fixed term specialisttraining
Specialist and GP RegistersArticle 14/11 route
Continuing professional development
Undergraduate medical training in medical school
CCT route
MMC Anxieties…..• What was wrong with the old system?• Fears of Service• Costs – direct and indirect (consultant supervision and time)• Disappearing SHOs• Is it truly a fair appointment system• Inexperienced F2 trainees• How do you take time out
– Research– Abroad– Personnel
• Reduction in Study time and allowances• Who really benefits – Doctors / Patients / Politicians?
MMC Selection processes
• National, e based, deanery, speciality assessments
• ? The role of the CV
• The role of Royal College Membership exams?
PMETB• Postgraduate Medical Education Training
Board
• www.pmetb.org.uk
• 4th April 2003 – Order of Parliament
• 30th Sept 2005 – went ‘live’
• ‘Independent’, reports to Parliament
• Regulatory body: setting and maintaining standards for education and training
Summary – 6 crucial questions:
1. What is MMC?2. What was MTAS?3. Why do I need to know about all this?4. How is MMC going to affect my getting a
job in the UK?5. How is MMC going to affect the training I
get in the UK?6. How is MMC going to affect the future of
the NHS?
www.mmc.nhs.ukwww.bmjcareers.com
Any questions?