Health CommitteeWritten evidence from the Faculty of Sexual and Reproductive Healthcare (ETWP 116)

In responding to the Committee’s inquiry, the FSRH has addressed selected areas of relevance instead of the entirety of the inquiry.

Introduction

1. Effective training, ongoing education, and maintenance of skills are essential to achieve high quality and safe care. For the provision of contraceptive care, this delivers cost averted, personal and public health benefits through the prevention of unplanned pregnancies. This does require that all women requesting contraception are offered a choice of all contraceptive methods by trained clinicians. The most effective contraceptive methods, which are the long acting methods (LARCs) require specific training to be able to fit them. Evidence shows that without properly trained clinicians to fit, follow-up, and reassure women about their contraceptive choice, women often do not continue with their contraceptive method for long enough for the NHS to realise those savings.

The future of postgraduate deaneries

2. The Government response to the NHS Future Forum report June 2011 highlights that the post-graduate Deans and SHA staff involved in planning and developing the workforce will continue to manage education and training. The FSRH welcomes this assurance.

The proposed role, structure, governance and status of Health Education England/Local Education and Training Boards

3. The Royal Medical Colleges, Faculties and professional associations play a large part in setting the quality standards in education and training which are set within an overarching governance framework, and the FSRH welcomes the commitment by the Government that Health Education England (HEE) will work with colleges and other professional bodies to maintain and improve national standards for the content and delivery of education and training.

4. As part of quality improvement, there are plans to develop a national education and training outcomes framework, setting out the outcomes that HEE would expect providers to meet. Further detail on how this outcomes framework will work is required.

5. We do know that at the local level, Local Education and Training Boards (LETBs) will be instrumental in the coordination and commissioning of training, and as part of this it is vital that sexual and reproductive health (SRH) is represented at these boards. Further clarity is needed on how LETBs will work together with Local Authorities to plan and implement training for those services which fall under the remit of public health.

6. Concern has also been raised about whether HEE and the LETBs will be truly multi-professional with appropriate representation for all professionals.

The proposed role, structure, status, size and composition of local Provider Skills Networks

7. It is currently unclear how training will be coordinated for those medical specialties which, under the new system, will sit across both the NHS and the Public Health Services. In the case of SRH, which will be provided by both GPs sitting in the NHS, and by sexual and reproductive health consultants based in the community, and commissioned by the Public Health Service, it is not very clear how ongoing training and education will be managed or commissioned at the local level. Furthermore, it is currently not clear where the responsibilities for coordinating training will lie, how needs mapping exercises to assess levels of training need will be overseen, how funding will flow between the two service sectors, and where ownership of essential administrative coordination of training posts will lie.

8. Clearly, the multi-professional healthcare provider skills networks (PSNs) will be instrumental in coordinating and managing training at the local level, and the FSRH welcomes the reassurance in Government response to the NHS Future Forum report June 2011 that, as part of these networks, the post-graduate deans and SHA staff involved in planning and developing the workforce will continue to manage education and training. However, it is vital that systems are put in place to ensure that training for services provided across the NHS and public health, as is the case for SRH services, is joined up.

9. Finally, the FSRH welcomes the assurance that SHA and Deanery successor organisations, such as PSNs, will remain part of the NHS and will have regard to the NHS Constitution and NHS values.

Implications for a more diverse provider market within the NHS

10. With an increasing service provider population, robust reporting mechanisms must be put in place to ensure the collection of comprehensive workforce and needs assessment data at the local level, which will help ensure a workforce capable of meeting the future challenges of the NHS.

11. It is essential that, unless alternative provision is made, all providers, NHS, third sector and private, have training included specifically within their contracts. This obviously requires the competence to deliver and provide recognized training.

12. It is also important that education and training in sexual and reproductive health meets nationally recognised standards. Royal Medical Colleges and Faculties must be actively involved in advising and approving education and training provided by all service providers.

13. Where training is required for services provided across both the public health service and the NHS, training must be co-ordinated in a joined up approach, taking into account local needs and training requirements across all sectors involved in service delivery.

How future healthcare workforce needs are being forecast

14. Using the example of the fitting of contraceptives, many Primary Care Trust (PCT) areas do not have a record of the number of trained clinicians working in the locality, and needs mapping exercises were not routinely being carried out to inform the commissioning of training posts. Without consistent, high quality workforce information to underpin effective workforce planning, it is almost impossible to identify skills shortages and training needs. The FSRH recommends that all local authority areas are required to carry out needs mapping exercises, so that targets to increase capacity accordingly could be set and sufficient training provided.

15. The commissioning and coordination of training, for services that operate across both the public health service and the NHS, need to be joined up both locally and regionally. This should be facilitated through the new “Local NHS Education and Training Boards” (LETBs).

16. All commissioners for SRH training must be appropriately trained and sufficiently knowledgeable in the area of SRH to ensure the smooth commissioning, coordination and provision of training. Therefore commissioning plans for training must be developed with input from the local sexual health lead consultant, who is best placed to understand the requirements of training at the local level.

The place of overseas educated healthcare staff within the workforce

17. As stated in their Future Forum response on Training and Education, The Royal College of Obstetricians and Gynaecologists (RCOG), is concerned about the viability of the Medical Training Initiative if the Home Office reduces its length of appointment to a year of attachment in the UK. International Medical Graduates play a crucial role in the NHS and in Obstetrics and Gynaecological (O&G) service provision. They plug the gaps unfilled by local doctors. The UK has a long and respected tradition of training overseas doctors and gains much from the contribution of these professionals. These doctors will pursue other opportunities elsewhere if the MTI process is unattractive.

How public health workforce will be affected by the proposals

18. With increased pressure to deliver efficiency savings in the NHS, the FSRH is concerned about the effect that this may have on training budgets, and thus the quality of and scope of education and training provided. This will be accentuated if the transition of Public Health commissioning to Local Authorities occurs without clarification on how education and training in cross sector disciplines like Sexual Health can be co-ordinated, funded and managed. There is a risk that with sexual health commissioning being fragmented between the National Commissioning Board, CCGS and local public health that training could also be fragmented.

About the Faculty of Sexual and Reproductive Healthcare

The Faculty of Sexual and Reproductive Healthcare (FSRH) has a membership of nearly 16,000 doctors, approximately 80% of whom work in General Practice, the remainder working in the specialties of Community Sexual & Reproductive Health, Genitourinary Medicine or Obstetrics & Gynaecology. The FSRH sets training and clinical standards in sexual and reproductive healthcare in the UK, including the specialty of Community Sexual & Reproductive health.

In 2010 the medical specialty of “Community Sexual and Reproductive Health” was established, to enhance leadership in community based women’s health services.

Although primarily a medical organisation, in response to requests from our nursing colleagues the FSRH has Associate Nurse Members and is working with them to actively support the development of nurse training and education in the specialty of sexual & reproductive healthcare.

January 2012

Prepared 22nd May 2012