Leadership roles for clinicians get a boost from Darzi

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Lord Darzi's workforce strategy unveils sweeping reforms to workforce planning and education.

The changes, outlined in A High Quality Workforce, include a boosted clinician manager role, a new workforce planning structure, an education tariff and a clutch of new organisations to streamline training.

The report also highlights action following Sir John Tooke's inquiry into the failures of Modernising Medical Careers.

Speaking before the launch of the report, Lord Darzi said the reforms had the "strong support" of professional bodies. He said: "To produce the high quality of care that I will describe in the next stage review, we also need high quality doctors."

The health minister acknowledged MMC's failure: "Things went badly wrong. A lot has been learned from that process."

The report recommends formal leadership positions to be created for clinicians at different levels with "a new obligation to step up work with other leaders both clinical and managerial and change the system where this would benefit patients".

It says: "The NHS needs to harness the skills of professionals in making tough decisions in the clinical arena and bring that expert judgement to bear on tough resource and management decisions."

The review proposes a new structure with most workforce planning taking place at local provider level - including social care.

Primary care trusts and councils will commission services, ultimately using the commissioning assurance system, ensuring providers have workforce strategies.

Providers will have to produce integrated service and workforce plans which also incorporate strategic workforce change. From these plans, PCTs will produce combined service and workforce plans for their local health economies.

Strategic health authorities will combine PCT plans into single regional plans with a longer-term perspective. These will be analysed by a new Centre of Excellence before scrutiny by national and regional professional advisory boards.

SHAs remain accountable for education commissioning and quality assurance, but deaneries' commissioning functions will be transferred to SHAs while their provider functions sit alongside new non-compulsory health innovation and education centres run jointly by universities and NHS organisations.

The report proposes a "tariff", under which training funds will follow the student, meaning they will be able to move if dissatisfied with their training.

It announces 800 new GP training places and an expansion of the public health workforce, with clinicians given the opportunity to train as both clinical and public health specialists, for example in cardiology and health promotion.

The document also pledges to investigate regulating more staff - specifically highlighting clinical psychologists.

Sir John Tooke welcomed more flexibility in workforce strategy, but said: "Any solution they try should be subject to rigorous evaluation."

Highlighting concerns that the government's response to the final MMC inquiry had "kicked many of the issues into the long grass", he said most of the problems had been tackled. "I particularly welcome the recognition of the important role of doctors in defining educational pathways and workforce planning."

New organisations will oversee education and workforce planning backed by a Centre of Excellence

An array of new bodies will oversee different aspects of education and workforce planning.

NHS Medical Education England, originally proposed by Sir John Tooke in his inquiry into the disastrous Modernising Medical Careers programme, will be "the interface at which there is professional scrutiny and professional involvement", Lord Darzi has said.

Chaired by a doctor and accountable to the NHS medical director, it will work with professional bodies, healthcare providers and a new Centre of Excellence to determine training pathways.

Its first tasks will be an evaluation of the foundation training programme for doctors, the development of a new postgraduation training programme by 2010 and an assessment of the balance between generalist and specialist training for doctors.

The Centre of Excellence, hosted by "one or more" universities, will gather intelligence on workforce planning and analyse strategic health authority reports.

It will give SHAs, primary care trusts, commissioners and providers in health - and ultimately social care -supply and demand analysis, forecasting intelligence, and notification of anticipated changes such as technological advances and care delivery models.

New advisory boards will provide professional scrutiny.

Non-compulsory health innovation and education clusters, formed of partnerships between NHS providers and universities, will provide training, to be commissioned and quality assured by SHAs.

Sir John Tooke said Medical Education England needed robust governance.