Health CommitteeWritten evidence from the Royal College of Radiologists (ETWP 37)

1. The Royal College of Radiologists (RCR) has approximately 8,900 members and Fellows worldwide in the disciplines of Clinical Oncology and Clinical Radiology. All members and Fellows of the College are registered medical or dental practitioners. The role of the College is to advance the science and practice of Clinical Oncology and Clinical Radiology through a range of activities, including setting and maintaining standards in the specialties of Clinical Radiology and Clinical Oncology. This includes defining training curricula, reviewing training standards, setting specialty examinations and developing and delivering the arrangements for continuing professional development (CPD) in both specialties.

2. The RCR welcomes the opportunity to submit evidence to the Health Committee. This response draws on the College’s expertise in the field of postgraduate medical education. We especially focus on:

The need to recognise the pivotal role of the medical Royal Colleges in defining quality standards in training, developing postgraduate medical training curricula and defining the standards for the quality assurance of medical training.

The need for protected time for clinicians to carry out this type of work on behalf of the wider NHS.

The need to preserve the role and function of the Deaneries.

How Health Education England should be an independent, impartial body providing national oversight of medical education in England. To avoid potential conflicts of interest, it must not be employer-led and should liaise with all appropriate organisations.

Adequate funding for medical training and education must be in place and should be controlled centrally.

The importance of research to the RCR’s two specialties.

The fundamental role of the colleges in the development of standards for and delivery of Continuing Professional Development (CPD).

How effective medical workforce planning is essential for the future of the NHS and must be carried out on a national basis.

3. The RCR would like to emphasise that we see significant potential dangers, risks and detriment to the structure of medical education and training in the proposals. The organisational changes and multiple supplier delivery of healthcare in England envisaged by the Health and Social Care Bill will exacerbate this. In particular, the Bill has serious flaws, and the consequences of the suggested changes appear not to have been thought through fully. This can only lead to lower quality and more inconsistent patient care. Furthermore, medical training in England would become less attractive which would be a major loss to the country as a whole. The RCR believes that the Bill requires serious modification before enactment. If this is not achievable, the sections of the Bill with implications for education and training should be withdrawn.

Education and Training

Quality standards and patient safety, curricula

4. Excellence in training is at the heart of a high quality NHS. High quality training ensures the highest standards of care and patient safety. Any loss of national standards for medical training will result in variable standards in medical care. High standards are essential and must evolve to meet the needs of patients as medicine advances.

5. The RCR supports the Academy of Medical Royal Colleges (AoMRC) in seeking an amendment to the Health and Social Care Bill to include an explicit duty on the Secretary of State to maintain a system for professional education and training incumbent on all providers as part of the comprehensive health service as promised in the Government response to the Future Forum.

The role of the medical Royal Colleges

6. The medical Royal Colleges have extensive and unique experience in developing quality standards in training and CPD. It is essential to use this expertise if future plans for education, training and workforce development are to result in the highest standards for UK healthcare.

7. The curricula for postgraduate medical training defined by the medical Royal Colleges are GMC-approved as fit for purpose for each discipline. They are constantly updated to reflect changes in practice and the changing healthcare needs of the nation. For example, the RCR Clinical Radiology curriculum has been updated to incorporate the new imaging modality of PET/CT.

8. Senior doctors who deliver and develop healthcare services are best placed to develop postgraduate medical curricula to ensure that junior doctors are appropriately trained. Senior doctors are also the only group who are able to determine accurately the level of expertise required to deliver excellence in medical care.

9. The colleges (with the GMC) are the only organisations with experience of defining the standards for quality assurance of medical training.

10. The colleges are informed, proactive, expert organisations and essential components in high quality medical training. The voluntary input doctors make via the colleges is a hugely beneficial resource to the NHS and a very cost effective way of delivering the work.

11. These activities must be recognised for the value they bring with employers allowing medical professionals the time to be involved. The RCR has been working with the AoMRC to seek an amendment to the Health and Social Care Bill to ensure protected time for clinicians to carry out such work on behalf of the wider NHS. This is necessary as the work of the colleges is pivotal in supporting the NHS to ensure optimum, safe medical care for all patients.

The role of the Deaneries

12. The RCR believes that the role and functions performed by Deaneries is essential and they must be preserved if quality assurance of training is to continue to be effective.

13. Deaneries provide essential input into medical training and education. Their role has evolved over many years and is now fully embedded and functioning well. They ensure comprehensive training in a variety of environments to meet the needs of the NHS.

14. With the demise of SHAs, a satisfactory regional structure must evolve which allows Deaneries to continue to function well, without reducing or compromising their resources.

Training and trainers

15. Medical training is almost entirely delivered by doctors.

16. The medical Royal Colleges are the professional focus for doctors with major roles in training, education and CPD. The RCR ensures that trainers are equipped to offer optimum training in clinical radiology and clinical oncology. Specific education and training is delivered whenever new teaching or assessment methods are introduced—eg introduction of workplace-based assessments in 2010. There is also a rolling programme of updates for trainers cascaded nationally.

17. The colleges maintain and set national standards to be achieved by doctors by the completion of training to permit entry to the specialist register. They advise the General Medical Council (GMC) whether doctors in training have met these standards to ensure safety and quality of care in the NHS. Only specialists in the relevant clinical area are in a place to undertake this role.

18. The colleges support the GMC by reviewing the quality of medical training nationally across specialties.

National oversight

19. The RCR firmly believes that independent, impartial oversight of medical training in England is essential. From experience of working with Medical Education England, we consider an appropriately structured Health Education England (HEE) with the appropriate governance structure can fulfil this role.

20. HEE must be free from any inappropriate dominating majority that would threaten its impartiality.

21. NHS Employers has recently stated (NHS Employers bulletin 07/11/2011) that it believes “the HEE Board should be employer led”. The RCR considers it would be wholly inappropriate for any constituent organisation to “lead” or dominate the Board.

22. Similarly, the RCR believes that, for medical education, NHS Employers statement that “commissioning of services and education must be locally managed if employers are to lead significant changes in how services are delivered” is seriously flawed:

Commissioning of training by those charged with hosting/providing it (Local Education Providers) would introduce inappropriate governance arrangements.

Employers may wish to support education, but there is a conflict of interest between service delivery and education. Experience has shown that education suffers when services are under pressure.

Employer organisations have no experience in the design or quality assurance of medical training.

As the Government wishes to put doctors and nurses at the forefront of NHS service development, it is logical and appropriate that they should therefore lead change and deliver the training required to facilitate change.

23. An independent HEE liaising with all interested parties, including the medical Royal Colleges would be capable of ensuring that training to staff national initiatives eg cancer networks, major trauma services etc, is taken into account. Training devolved to local level would have no such overview or mechanism for ensuring the totality of training requirements.

Funding for education and training

24. Adequate funding for medical training and education is essential. The RCR believes the Secretary of State for Health must take responsibility for ensuring this and funding must be nationally derived and transparent.

25. Funding should follow education and training outputs, ie funding must ensure that there is protected time for training and that training is a planned activity encompassed within the trainer’s job plan.

26. Specified time for doctors in training and education, both local and national, must form an integral part of the future NHS. Lack of designated, funded supervision of doctors in training is a serious risk to patient safety.

27. It is essential that doctors have time within their job plans throughout their careers to ensure that they can develop new knowledge and skills required to deliver optimal patient care through continuing professional development.

28. The value of training and education in the future NHS must be recognised. It must be planned and adequately funded. A national levy for training, though currently not perfect, is the best way forward.

29. Funding for medical training must not be devolved to local level where there is competition with funding for service delivery. The funding streams must be kept separate and distinct if standards of training are to be preserved.

Privatisation and competition

30. The RCR is concerned about private provision of medical education and training. It is untried and untested. Evidence suggests that non-NHS/non publicly funded providers are reluctant to become involved with no incentive for them to do so.

31. Privatisation of service delivery can lead to a reduction in training opportunities, despite independent providers being currently charged with providing this. In radiology this has occurred with outsourcing of image reporting and teleradiology.

32. All providers of health care, within the NHS or the private sector, should contribute to the cost of training and education.

Research and academia

33. Research is crucial for the NHS if it is to deliver world class healthcare. It drives healthcare advances and provides the evidence base for best clinical care. Training in research and research methodology is embedded in the curricula devised and implemented by colleges and approved by the GMC.

34. All doctors must be trained in research and able to support entry of patients into clinical trials if the NHS is to be at the forefront of treatment innovation. It is also essential that clinical academics are recognised for the value they bring to the NHS and supported by the necessary structure and funding.

35. Research is particularly essential to the RCR’s two specialties, with the re-emergence of radiotherapy as a leading cancer treatment, rapid advances in drug therapy for cancer and the constant development and technological innovation in imaging coupled with the central role it occupies in patient management. Our specialties are attractive to trainees because of this technological development and the pace of change.

36. National oversight of academic medicine and training is essential. HEE, in conjunction with the National Institute for Health Research and the Academy of Medical Royal Colleges, is in the best position to ensure that these needs are met and that local providers do not “opt out” in difficult circumstances. HEE, in facilitating a working relationship between medical and other health sciences researchers, should expand the use and implementation of evidence based practice.

Continuing Professional Development (CPD)

37. Medical Royal Colleges draw on the expertise of their members and Fellows to provide a range of training and educational activities for doctors post CCT, enabling them to offer optimal, up to date care to their patients. The RCR will facilitate this through a range of online CPD resources, along with a more traditional scientific programme of conferences and meetings.

38. The RCR is seeking to influence medical school curricula to ensure that newly qualified (Foundation) doctors have the necessary competencies to relate effectively with clinical oncology and clinical radiology. The RCR philosophy is to support a continuum of learning throughout a medical career.

39. Medical CPD has to be designed by the professions to be fit for purpose within a framework designated by the GMC for the maintenance of standards of practice and patient safety. The RCR has the expertise to support clinical radiologists and oncologists throughout their careers to ensure that they maintain and develop the new competencies required in the modern NHS. This cannot be devolved locally if national standards are to be maintained, although local practice of individuals must be taken into account during assessment.

Workforce Planning

40. Effective workforce planning is essential for the future of the NHS. It needs to be more responsive to change. We currently have clear examples of where the medical workforce needs to change (reduction in general surgery, increase in primary care and psychiatry), but where change is slow to be implemented.

41. Employers must be prepared to invest in the workforce by expanding and contracting trainee and consultant numbers where required.

42. Skills mix is only one aspect of the answer to the new workforce. The RCR is a staunch advocate for skills mix and multi-disciplinary working, but, whilst ensuring that professional resources are used to best advantage, it does not negate the primary need for a medical workforce of appropriate size and training.

43. The Centre for Workforce Intelligence (CfWI) is beginning to mature as an organisation in workforce planning. This process will improve with further collaborative working.

44. CfWI should be a data processing resource and not be involved in developing policy.

45. The RCR has identified a need for increased capacity in the training numbers for its specialties in order to fulfil the changing and growing demands in areas such as acute oncology, technical radiotherapy and diagnostic and interventional radiology.

46. Medical workforce planning cannot be devolved to local level, especially for small specialties, as a fragmented, dysfunctional service will result. It is impossible to develop reliable local workforce planning models. HEE should take the lead in developing workforce policy, with support and data from the Colleges.

December 2011

Prepared 22nd May 2012