Doctors will be incentivised to work in unpopular trusts

The arm’s-length body will launch a number of foundation priority programmes during 2019-20 and 2020-21. These are designed to attract and retain trainees in remote, rural and coastal geographies and shortage specialties, with psychiatry as the initial priority.

Doctors will be offered “additional educational components, leadership development, fellowships, longitudinal study and enhanced employer offers” in unpopular areas and specialties. The programmes may also offer opportunities for foundation doctors to lengthen or broaden their training to help reduce stress.

“[The programmes] will maximise the opportunity for applicants who wish to be located in less popular areas and therefore improve supply for speciality training and beyond,” said the report – Supported from the start; ready for the future – which examined the post graduate medical foundation programme in England.

HEE added it will “preferentially distribute” the 1,500 foundation doctor training places in the “geographies where the NHS most needs them”.

Other recommendations in the report included:

• Educational supervisors of foundation doctors should have specific knowledge of foundation training and the role of the doctor in training across the NHS;
• Foundation schools should expand access to less than full-time training and allow access to a greater variety of working patterns, as a pilot offering this style of training to emergency medicine trainees found improved levels of job satisfaction and less burn-out;
• HEE should explore with the Academy of Medical Royal Colleges and devolved administrations possible mechanisms for providing a single college for foundation programme training;
• HEE should work with the AoMRC to develop plans for the role of senior trainees as mentors; and 
• HEE should work with NHS Employers to develop a foundation doctor charter defining how local education providers will support foundation training.

HEE will consult on how some of the proposals will work in practice and an implementation plan for the proposals will be published in due course. 

Director of education and quality Wendy Reid told the HEE board yesterday the review was an “enormous piece of work” but stressed there is “a lot more work to be done in this space”. 

“We have an appetite to address health inequalities through our investment in these doctors,” Professor Reid said.

She also said she hoped the medical schools would take responsibility for changing the last year of medical school and better prepare trainee doctors for work.

“It is unacceptable we have graduates saying at the end of graduate training they are not confident and competent to work in the NHS,” she said. “I don’t think we’ve explored that until this report.”

HEE chair Sir David Behan described the issue of widening access to medical foundation training as “hugely important” and he stressed the organisation’s “responsibility to promote social mobility”.

Sir David described the parts of the review tackling geographical and speciality distribution of doctors as “hugely controversial” but stressed HEE is “engaging people in conversations and looking for a solution”.