Dr Iain Wilkinson is the BGS Vice President Education and Training. He works as a consultant geriatrician and is the Clinical Director of Frailty at Surrey and Sussex Healthcare NHS Trust. Iain is the clinical lead for the East Surrey Ageing Well group for Surrey Heartlands ICS, as well as being a Training Programme Director within Kent, Surrey and Sussex. He also runs a weekly movement disorder clinic.
There are two important surveys taking place at the moment that, as BGS members, you need to know about. As you will all no doubt be aware, there is a review taking place of postgraduate training in England, which is being led by Professor Steven Powis. The review is starting with a data collection/listening exercise. I would encourage you as BGS members to contribute your views, whether you are a doctor in training or a consultant in England. You can do this either via local deanery-based engagement or via the national call for evidence. The latter survey is open until 20 May.
In addition, and linked to the training review, the Royal College of Physicians (RCP) is running its own survey as part of the Nextgen review of education, which is open to all parts of the UK until 5 May.
I would urge you all to have your say and use the evidence that you are aware of to encourage a richness of discussion within these surveys. I know personally that I need to think about these things in some detail before submitting my thoughts and linking to the evidence behind them, and a heads-up often helps me order my thoughts before starting a survey. Below is an idea of the sort of things the surveys cover.
The national review is going to focus on three key areas:
- Whether or not postgraduate medical training meets the needs and expectations of healthcare services and postgraduate doctors.
Geriatricians make up the largest group within the RCP, and the number of geriatricians per head of population varies across the country. There is a need to level up and ensure equity of access to specialist care. Linked to this is the training we offer doctors, which can vary considerably between different areas (e.g. whether there is access to training in specialist continence services).
The distribution of training posts does not reflect where older people live. Do Integrated Care Systems (ICSs) know enough about the number of trainees within a region to be able to plan local workforce development to meet the needs of the neighbourhoods of tomorrow? How has the shortened time in specialist training affected things, and what ‘generalist’ skills do the workforce need to care for their local population of older people living with multimorbidity, complex health and social care needs and advancing frailty/cognitive impairment?
As a trainee, you might also want to consider how posts are assigned within a given geographical area and how that relates to the specialty and the educational opportunities on offer. Do some areas manage this better than others? If so, why? Something I’m thinking about are deaneries where there is a single employer and the potential benefits this offers. Would a Multi-Specialty Recruitment Assessment (MSRA) enable a more coordinated and effective process? Would this improve fill rates at Internal Medical Training (IMT) for doctors who wish to become geriatricians? The current application process is, I feel, relatively academically weighted and there may be scope for something that takes a more rounded look. Then, once in post, what does good training look and feel like?
- How training is delivered and if it is flexible and adequate for a modern workforce with the current demands of the service we work within
In this section, questions are looking at the system of postgraduate education and whether this leads to a high-quality learning environment. Is the current system equitable and inclusive? There are, for example, significant differences in attainment in exams. How should this be addressed?
Another focus of this area will be education time in job plans. How can the need to deliver high-quality education and supportive supervision to trainees be balanced with the ever-increasing demands of service delivery? Are there examples of this from your areas you could share with the national team?
- The three NHS strategic shifts – from hospital to community, from analogue to digital and from sickness to prevention.
As a specialty caring for a large and diverse patient community, we are well-positioned to have a view on these shifts set out by the Government. Our teams work in both acute and community settings and see the effect of significant health inequalities. I would encourage you to think about these three shifts and how they might affect where and how doctors might work in the future. What are the implications of this for training and for the skills they will need to develop as effective clinicians and leaders of tomorrow's health service?
Collectively, we have a strong voice as the BGS, and I know we all have our patients’ best interests at heart. This is our first opportunity for some time to impact and influence how our future workforce is trained and the skills that will be needed to look after our older patients, and ultimately, ourselves, in future. Let’s use it wisely!