Supporting secondary care doctors

In April 2021, HEE put forward a national initiative, the Postgraduate Medical Education (PGME) Recovery Programme, to minimise and mitigate against disruption to training from COVID-19. Since the start of the pandemic, by managing risks to medical workforce wellbeing, numbers, and future provision, the programme has mitigated against and minimised the risk of further disruption to postgraduate medical education. The pandemic resulted in a diminished training experience for doctors and the progression of up to half of doctors in training was identified as being at risk in 2020. By the start of the 2021/22 academic year, this had been reduced to 14% of doctors in training. 

Interventions delivered through training recovery funding have included simulation training, bootcamps, educator backfill and wellbeing sessions for educators and doctors in training.   

Expansion of the mental health and cancer and diagnostics medical workforce remains a priority for us and we will see growth in the number of posts in relevant specialties from 2023 to 2025.  Running in parallel will be an expansion in posts in acute medical and surgical specialties to create a surge in the number of trained doctors entering trusts in these fields. For 2023/24 there will be 76 expansion posts across the south west and a further 55 in 2024/25. 

The distribution programme aims to ensure that HEE funded specialty training posts are distributed equitably in a bid to help tackle health inequalities across the country and the south west will gain additional training posts as a result of the programme. 

Whilst expansion posts will only run for one training cycle, resulting in one additional trained consultant in each specialty, the distribution posts will become a permanent part of that training programme’s establishment.  

Specialties for distribution have been split into three phases with the first phase focusing primarily on medical, surgery and mental health programmes. For 2023/24 we plan to place 29 additional posts in the region, starting from August 2023 and a further 29 posts in 2024/25.

Several schemes have been introduced across the region to improve the working lives of doctors in training.  

These include:  

Out of programme pause (OOPP) 

OOPP has now moved from a pilot project to business as usual and allows doctors in training to step out of the rigours of formal training for up to 12 months. Doctors in training can undertake an NHS or other patient facing UK based non training post, having any capabilities gained assessed upon their return to the training programme.   

This flexibility initiative is a vital tool to support the wellbeing of doctors in training. You can find out more about OOPP on our website. 

Less than full time (LTFT) training  

Since August 2022 all doctors in training have the right to apply to train LTFT, this includes for wellbeing reasons or through personal choice. You can find out more about LTFT working on our website. 

Evaluating rotations within programmes 

We are currently undertaking work to review regional programmes and rotations. Rotations within programmes are usually necessary to meet curricular needs, however, rotating between trusts over a wide geographic area is a disruptive and costly exercise for doctors (doctors can reclaim the financial costs incurred through relocation and excess travel in line with the HEE framework). 

The review of rotations within training programmes has three key aims:  

   - To improve the experience and wellbeing doctors in training. 

   - To attract doctors in training to settle permanently in the region. 

   - To configure training rotations that are fit for purpose to the local population health needs (alignment to rural and remote localities is being undertaken in collaboration with ICBs). 

Working nights before a rotation 

To enable a smooth transition between trusts as part of a training rotation, HEE does not expect doctors in training to be on call the evening or night prior to starting at a new trust. If the published rota of the current hospital unintentionally allocates an evening or night shift to a doctor rotating out of the department, then all reasonable steps should be taken to reallocate the shift to a doctor staying within the trust.