MMC: What’s changing?

How will the new training programmes work?

Most programmes will be initially broad-based (eg medicine), becoming more specialty focused over time (eg cardiology). The introduction of run-through training means trainees no longer need to apply for individual elements of training. In addition, since more doctors will be able to complete their training, more NHS patient care will be delivered by fully trained doctors.

Every specialty will have a run-through training programme, lasting from approximately three years in general practice to five-seven years in other specialties. The medical royal colleges are producing national curricula for each training programme that will meet the standards required by the Postgraduate Medical Education and Training Board (PMETB). The curricula will state the competences to be gained by following the programme; provide explicit standards and guidance for assessment; and will be the basis upon which a doctor progresses through training.

Doctors successfully completing a specialty training programme will receive a CCT and become eligible for entry to the General Practice / Specialist Register.

How will this affect my career?

Doctors will compete for places in specialist training programmes with other doctors at similar levels of experience and competence.

During the first year of transition in 2007, competitive entry to specialty will be available at a number of levels, so that doctors who currently have different ranges of experience and competences can enter run-through at the most appropriate level. Those who are completing foundation training and with limited SHO experience will compete for entry at the beginning of specialist training (ST1), while doctors with more experience in a specialty will have the opportunity to compete to enter the programmes at appropriately advanced stages (ST2, ST3, ST4).

Doctors who already hold a National Training Number (NTN) may complete their training under the current specialist curriculum. There will also be the opportunity for trainees to transfer to the new curriculum in some specialties, subject to discussions with the local specialty training committee. If such transfers do occur, doctors will remain as either Type 1 (holding an NTN) or Type 2 (fixed-term appointment) specialty trainees, reflecting their current situation.

Doctors who are unsuccessful in their application to specialty training programmes may apply for fixed-term specialist training appointments (FTSTA), or if they have the required competences they can apply for a career post.

Statement of the four UK Health Departments on transition into specialty training

The four UK Health Departments have agreed the principles of transition. These are set out in the annex. Implementation will be approached flexibly in each country.
The new model of specialist "run-through" training programmes will begin in August 2007 (the term specialist is used here to cover GP programmes).
There will be specialist/GP competitive run-through training opportunities for doctors:
- successfully completing the Foundation Programme in July 2007 or in the case of non-UK graduates demonstrating equivalence.
- currently in Senior House Officer (SHO) or Non-Consultant Career Grade (NCCG) posts.
There will be entry points at different levels into programmes. This will allow doctors who do not hold a national training number to compete with those of similar experience and training to get into the new programmes at a level suitable for their educational needs. This will mean, for example, that more experienced SHOs will compete with other SHOs with broadly the same level of training and experience. They will not enter programmes at the bottom in competition with doctors graduating from Foundation Programmes but will be able to take up places at a higher level. For instance, those with the necessary training and experience may be able to compete for places at the second year or third year of specialist training.
Not everyone will get into run-through training programmes or into the specialty of their choice as this is a competitive process. This has always been the case.
Doctors unsuccessful in getting into a run-through programme will be able to apply for fixed-term specialist training appointments (FTSTAs*), or career posts if they have appropriate experience and training. There will be further competitive opportunities for them to enter run-through training.
*The UK Health Departments have asked the UK Strategy Group to decide on the job titles for both run-through training places and FTSTAs.
From now on, Employers should not appoint to SHO posts with contracts which extend beyond 31 July 2007. From August 2007, entry to the SHO grade will be closed.
Doctors currently in Specialist Registrar (SpR) posts will have their contracts honoured while they are completing their training programmes. Recruitment to substantive SpR jobs will cease by late 2006.
After successfully completing a run-through training programme, doctors will be eligible for entry to the General Practice or Specialist Registers.
The transition to run-through training is an opportunity for the NHS to align service and training in the light of these changes and the Working Time Directive.
There will be a single start date in August 2007 for the new programmes. Employers should have plans in place to ensure a smooth transition and to ensure high quality patient care.

Selection and recruitment

Doctors will apply to specialist/GP training programmes through a simplified, co-ordinated process that will cut down on the present complex multi-application system.
For the first time, there will be national, standardised documentation (for example, application forms and person specifications).
The timetable for recruitment and selection will be nationally co-ordinated so that successful 'foundation doctors' will be able to enter a specialist/GP training programme directly from the Foundation Programme. There will be a simultaneous application process for SHOs and others.
Recruitment and selection will be fair, open and legally robust. Selection methods will be specialty specific, but the minimum requirement will be a formal interview. The methodology is being designed by leading educationalists and recruitment specialists.

NCCGs

The four Health Departments have agreed to work together to take forward the principles of Choice and Opportunity for non-consultant career grade doctors.

ANNEX B.1 - OVERARCHING RULES TO FRAME DEVELOPMENT OF DETAILED GUIDANCE

All information on transition, as agreed by the four UK Health Departments, to be communicated clearly, widely and in good time.
From August 2007, entry into all Specialist Registrar (SpR) training programmes will be closed. No National Training Numbers in any specialty should be recruited to after 1 January 2007. This is to develop capacity for recruitment into the specialty training programmes that will deliver the curricula approved by the Postgraduate Medical Education and Training Board (PMETB). Recruitment to fill short-term vacancies arising in SpR programmes, for example, Locum Appointments - Training (LATs) and Locum Appointments - Service (LASs) may continue. Preferably, contracts for LATs should not extend beyond the end of July 2007.
From August 2007, entry to the Senior House Officer (SHO) grade will be closed. Any substantive SHO appointments from now on must have an end date of July 2007 at the latest.
All recruitment will then be into:
- Specialist/GP training programmes designed to deliver the curricula approved by PMETB.
- Fixed Term Specialty Training Appointments (FTSTAs) - at Specialist Training 1 (ST1) and Specialist Training 2 (ST2) level.
Recruitment will be based on person specifications following the work being undertaken on selection methodology requested at the March meeting of the MMC UK Strategy Group.
All SpRs currently in Type I (Certificate of Completion of Training - CCT) programmes or Type II (Fixed-Term Training Appointment - FTTA) programmes will complete training in those programmes, subject to satisfactory progress, but will have the option, in discussion with their local Deanery Training Committee, to access the new curricula in full (Type I trainees) or in part (Type II trainees) in completing their programmes.
All trainees not already in SpR (Type I) training programmes who wish to enter programmes leading to the award of a CCT will have to compete for a place in the new training programmes designed to deliver the curricula approved by PMETB.
Pending clarification from PMETB, it is recommended that there will be two or more entry levels in each specialty, one at the successful completion of foundation programme training and others at a more advanced level to take account of trainees at a later stage of training such as SHOs or applicants from the Non-Consultant Career Grade. This will enable fair competition between trainees in their peer groups to take place.
Everyone appointed as a trainee in the new MMC specialist training programmes leading to a CCT will be allocated a unique training number.

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