You are the Future!
Dr Cliona Ni Bhrolchain, CSAC Chair
CCH Trainees Study Day
19.4.13
(With thanks to Martin McColgan and Jack Cornish for collating
some of the figs in this presentation)
Where are we now?
(The retirement time bomb)
30.0%
25.0%
20.0%
Specialist
15.0%
General
Community
10.0%
5.0%
0.0%
<35
35-39
40-44
45-49
50-54
55-59
RCPCH 2011 Census
60-64
65+
The retirement time bomb
30.0%
25.0%
20.0%
Specialist
15.0%
General
Community
10.0%
5.0%
0.0%
<35
35-39
40-44
45-49
50-54
55-59
RCPCH 2011 Census
60-64
65+
The retirement time bomb
30.0%
50% of CCH
consultants are > 50
25.0%
20.0%
Specialist
15.0%
General
Community
10.0%
5.0%
0.0%
<35
35-39
40-44
45-49
50-54
55-59
RCPCH 2011 Census
60-64
65+
Number of CCH consultants
nearing retirement
Age in years Number of CCH Consultants
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65+
31
26
16
24
24
27
27
21
21
22
17
14
17
8
8
13
Martin McColgan personal communication
• Approx 20 – 25 CCTs per
year needed just to
replace consultants
• Doesn’t include
–
–
–
–
Varying retirement ages
Expansion
Attrition e.g. overseas
SSASG post conversions
• Likely to need ~30 - 35
per year in total
How many CCTs in CCH are
awarded each year?
Year
No. awarded
2010
15
2011
20
2012
10 (+5) = 15
Expected (24 CCT dates unknown)
2013
22 (+1) = 23
2014
16
2015
15
•
•
Vacancy rate for CCH posts = 4.3% (vs 7.3% in 2009)
Vacancy rates for other posts = 2.4% (general paediatrics);
1.5% (tertiary specialists)
Jack Cornish personal communication
What kind of posts are being
advertised?
Consultant posts advertised
1996, 2001, 2011 and 2013
30
25
20
15
10
5
0
1996
2001
2011
2013
And last week…
• Another 6 posts advertised!!
• = 18 posts in 7 weeks
What about paediatric audiology?
Cumulative retiral as a % of current workforce
100
90
80
70
60
50
40
30
20
10
0
Consultant
Associate
Specialist/SCMO
Staff Grade/CMO
Specialist Registrars
BACDA census 2005
Service lead
Electrophysiological
Targeted follow up of
diagnostic follow up as
babies with risk factors
part of the newborn
for late-onset hearing
hearing scheme
impairment
Medical diagnostic
Audiology services for
service for babies who
Medical diagnostic
older babies and
are found to be hearing
service for children of
children up to 3 years
impaired in the early
any age
weeks of life
No.
%
No.
%
No.
%
No.
%
No.
%
Audiological scientist
66
39.1%
49
29.0%
47
27.8%
0
0.0%
0
0.0%
Consultant adult audiovestibular physician
5
3.0%
6
3.6%
8
4.7%
5
3.0%
7
4.1%
Consultant community paediatrician
0*
NA
0*
NA
0*
NA
28
16.6%
28
16.6%
11
6.5%
16
9.5%
17
10.1%
22
13.0%
21
12.4%
Consultant general paediatrician
0*
0.0%
0*
0.0%
0*
0.0%
20
11.8%
15
8.9%
Consultant paediatric audiovestibular physician
12
7.1%
17
10.1%
16
9.5%
16
9.5%
15
8.9%
ENT consultant
0*
NA
0*
NA
0*
NA
20
11.8%
23
13.6%
SSASG audiovestibular physician
5
3.0%
4
2.4%
5
3.0%
4
2.4%
4
2.4%
SSASG community paediatrician
22
13.0%
36
21.3%
41
24.3%
34
20.1%
34
20.1%
Provided by another service
37
21.9%
25
14.8%
25
14.8%
14
8.3%
13
7.7%
Other
10
5.9%
12
7.1%
10
5.9%
4
2.4%
4
2.4%
Not provided in this area
1
0.6%
4
2.4%
0
0.0%
2
1.2%
5
3.0%
Consultant community paediatrician with an interest
in audiology
Clinical Supervisor for SSASG
No
%
Consultant adult audiovestibular physician
9
9.2%
Consultant community paediatrician
42
42.9%
Consultant community paediatrician with an interest in audiology
16
16.3%
ENT consultant
14
14.3%
General paediatrician
9
9.2%
Other
8
8.2%
Total
98
100.0%
Why is this important?
‘Analysis …showed that audiovestibular
physicians and paediatricians in audiology were
more likely than other specialists to request
level 1 (aetiological) investigations’
Rangan S, Borgstein B, Lowe J. Deafness in children: a national survey of aetiological
investigations. BMJ Open 2012;2:e001174 doi:10.1136/bmjopen-2012-001174
What about combined posts?
Proportion of combined posts 2001 - 2011
(All career grades)
Number of combined posts 2001 - 2011
(All career grades)
12%
400
10%
350
300
8%
250
6%
200
150
4%
100
2%
50
0
2001
2003
2005
2007
2009
2011
0%
2001
RCPCH Census 2001 - 11
2003
2005
2007
2009
2011
What happens to CCT holders?
• 15 (4.7%) CCTs awarded in CCH
– vs 21.6% of consultant workforce
– All but 1 in substantive post
• Another 8 working in CCH with a CCT in
general paediatrics i.e. not fully trained in CCH
• Why?
– 198 (62.7%) CCTs in general paediatrics
• vs 41.4% of consultant workforce
RCPCH 2010 CCT Holder Survey
What's changing?
More training places being created to meet demand!
Expanding
• East Midlands South (new
post recognised)
• Mersey (competitive
interviews: unable to
accommodate 2 applicants)
• South West/Peninsula
(seeking to expand)
• Wales (already expanding)
• Yorks & Humber South
(seeking to re-establish CCH
training in Sheffield)
Reviewing posts
• South London
• North West
• W Midlands
Top up Training needs
• CCT holder survey
• North West
• Re-entry programmes
How many CCH trainees are there?
Number of trainees 2012 n=58
Number of trainees 2013 n=89
Northern Deanery
London Deanery
Oxford Deanery
Northern Deanery
Mersey Deanery
Severn Deanery
Severn Deanery
Mersey Deanery
London Deanery
West Midlands Deanery
East Midlands Deanery (North)
North Western Deanery
West Midlands Deanery
Wales Deanery
East Midlands Deanery (South)
East Midlands Deanery (North)
Wales Deanery
Oxford Deanery
North Western Deanery
East of England Deanery
Peninsula Deanery
East Midlands Deanery (South)
Northern Ireland
Yorkshire and Humber Deanery
Scotland (all deaneries)
Scotland (all deaneries)
East of England Deanery
SW/Peninsula Deanery
Kent, Surrey and Sussex…
Wessex Deanery
Wessex Deanery
Kent, Surrey and Sussex Deanery…
Yorkshire and Humber Deanery
Northern Ireland
0
5
10
15
20
RCPCH Education & Training Support
0
5
10
15
20
Who encourages CCH trainees?
Percentage of total trainees
training in CCH 2012
Percentage of total trainees
training in CCH 2013
Oxford Deanery
Northern Deanery
Northern Deanery
Severn Deanery
Mersey Deanery
Mersey Deanery
Severn Deanery
Wales Deanery
East Midlands Deanery (North)
North Western Deanery
SW/Peninsula Deanery
East Midlands Deanery (North)
East Midlands Deanery (South)
West Midlands Deanery
Northern Ireland
SW/Peninsula Deanery
Wales Deanery
East Midlands Deanery (South)
North Western Deanery
Oxford Deanery
West Midlands Deanery
London Deanery
Scotland (all deaneries)
East of England Deanery
East of England Deanery
Wessex Deanery
London Deanery
Scotland (all deaneries)
Wessex Deanery
Kent, Surrey and Sussex…
Kent, Surrey and Sussex…
Yorkshire and Humber Deanery
Yorkshire and Humber Deanery
Northern Ireland
0.00
2.00
4.00
6.00
8.00
RCPCH Education & Training Support
0.00
2.00
4.00
6.00
8.00
Getting the right people
• CCH is now a popular choice in many Deaneries!
• CCH is a shortage specialty and most trainees go
straight into consultant posts (or are headhunted
even before CCT!)
• We need to consider training capacity to meet
the demand for consultants and SSASGs who will
be retiring in the foreseeable future
Should we have a Grid?
Positive
• National profile
• Like everyone else
• Competition
• National standard for
recruitment
• More control of
appointment and numbers
• Even out numbers
Risks
• Lack of mobility might put
off trainees with family
commitments (? higher
proportion of CCH trainees)
• A lot of time and effort for
same result (past
experience!)
Training programme
Training in CCH: basics
• Three year programme (not just a series of
posts)
• Structure
– 2 years in CCH
– 1 year more flexible. Can be in CCH, a specific
area of CCH or relevant specialty
• Curriculum
• Competency-based (except old-style SpR)
Allied subspecialties
• Paediatric neurodisability
• Child mental health
• Audiovestibular Medicine
CCH curriculum (specific areas)
• Child public health
• Behavioural paediatrics
• Safeguarding incl adoption & fostering
• Neurodisability incl audiology and visual
impairment
http://www.rcpch.ac.uk/training-examinations-professional-development/qualitytraining/curriculum/curriculum
What is a relevant specialty?
• Must be a specialty/placement that enhances
competencies approved prospectively e.g.
– Paediatric neurology
– Paediatric audiology
– Palliative care
– DGH neuro/epilepsy (perhaps 3/12)
– Enteral/parenteral feeding (perhaps 3/12)
– Longterm ventilation (perhaps 3/12)
– General paediatrics?? (depends on content)
Remember
• CCT in Paediatrics (CCH)
• MUST be competent in
– Gen paediatrics
– Neonatal paediatrics
– CCH
• Not just CCH
But…
• Trainees complain their general/neonatal
service commitments interfering with CCH
training
• General/neonatal should be
– no more than 1/3 of 48 hours and
– try to preserve daytime clinical commitments as
much as possible e.g. flexible days off, daytime
urgent care to avoid rest period after nights
Supporting training
• Curriculum and assessment guidance
• Resource pack of ideas www.communitychildhealth.co.uk
• Guidance on preparing CV
• Guidance on CESR requirements
• Deanery leads for CCH (all deaneries)
• Specialty Training Advisor (STA) for individual advice on
CCT/CESR
http://www.bacch.org.uk/training/trainees.php
Assessment
• WPBA
• Annual ARCP including trainer’s report
• START
• CCT application (assessed by STA)
http://www.rcpch.ac.uk/training-examinations-professional-development/quality-training/qualitytraining
CCT requirements
SpR
• Three-year programme
• Show they have covered the
syllabus, incl. breadth and
depth
ST
• Competence-based but
indicative three-year
programme
• Show they have attained
competences, incl. breadth
and depth
• Satisfactory progression
• Satisfactory progression
Remember
• Still subspecialty trainees even w/o grid appt
• Expect 32/48 hours in the subspecialty
• Training needs should be met
• Quality of training should be paramount
• College (CSAC) role is to ensure quality
Quality
Ensuring quality
• Deanery questionnaire (should differentiate CCH)
• GMC questionnaire (should differentiate CCH)
• New consultant questionnaire
• BACCH ASM trainees meeting; other trainee mtgs
• Trainee rep on CSAC
Issues with quality assurance
• Unusual in that CCH has no grid
– Grid is only an appointments process but were…
• Unable to identify trainees
• Unable to monitor trainees
• The solution
– Work with Heads of School
– Deanery leads for CCH
– RCPCH database of all CCH trainees
CCH programme satisfaction
2007 & 2008-09 PMETB
Quality of training
BACCH survey 2012
How well have the following elements of your training prepared
you for your current post?
20
18
16
14
Very well
12
Well
10
Satisfactorily
8
Poorly
6
Very poorly
4
2
0
General
paediatrics
Community
Child Health
Neonates
In a DGH
BACCH survey 2012
H Brewer & T Woodbridge
In a Specialist
Hospital
Trainee survey 2011
• Did not differentiate CCH trainees
Another piece of the jigsaw
• Community paediatricians no more likely to be
referred to NCAS than other paediatricians
and not early in their careers
CCT Holder survey 2012
• 270/330 responded (81%)
• 91% in same post as their Specialist
registration but…
• 8/xx (%) in CCH don’t have a CCT in CCH. All
registered in general paediatrics
• CCTs awarded:
– 15 CCH
– 11 PND
Other routes to Specialist Register
• CESR (combined programme)
– Includes overseas training
• CESR in CCT specialty: Paediatrics (CCH)
– Training/qualifications/experience equivalent to
CCT
• CESR in non-CCT specialty (CCH)
– Must have overseas
training/qualifications/experience to follow this
route (currently)
CESR
• Must demonstrate training and experience
lead to competency equivalent to CCT
• Standard required
– CESR paediatrics = CCT
– CESR CCH = ‘knowledge & skills consistent with
practice as a consultant in the NHS’
http://www.rcpch.ac.uk/training-examinations-professional-development/certification/certificateeligibility-specialist-regi
Suggestions given to HoS
• Establish expected workforce needs (next 5 years)
• Re-evaluate CCH training programme
– Demand for places
– Quality checklist
– Trainee feedback
• Is your training programme fit for purpose?
If not…
• Expand training capacity
– Use existing posts flexibly
• Reassess using checklist/’virtual visit form’
• Get level 2 posts approved for Level 3 (needs CSAC
approval)
• Consider > 1 Level 3 trainee together for support
– Create additional posts
• Needs GMC approval only if centre not previously
recognised
• Remember your SSASGs…
Mersey
• 8 CCH trainees
– 6 FT
– 2 LTFT
• 2 PND trainees (both LTFT)
– 1 Academic
• 7 more wanting to start in Aug 2012
– Interviewing for the first time
Mersey programme
Principle is that everyone gets at least
• 1 year block at AHCH with child protection on call
• 1 year block in periphery with general on call
• 6 months neurology
• Other 6 months ‘relevant specialty’ experience could
be a community placement with CAMHS attachment,
but should be able to offer flexibility in case they
want to do safeguarding/public health or something
else too.
Post 1
Warrington Warrington Neurology
Elective
AHCH
AHCH
Post 2
APH
APH
Elective
Neurology
AHCH
AHCH
Post 3
AHCH
AHCH
Warrington Warrington Neurology
Elective
Post 4
AHCH
AHCH
APH
APH
Elective
Neurology
Post 5
Neurology
Elective
AHCH
AHCH
Warrington Warrington
Post 6
Elective
Neurology
AHCH
AHCH
APH
(Post 7)
Neurodisability grid post
APH
What effect has rotating through posts in different
hospitals/locations had on your training?
Very positive
Positive
Neutral
Negative
Very negative
What effect has rotating through posts in different hospitals/locations
had on your personal life?
Very positive
Positive
Neutral
Negative
Very negative