Update on the Three Counties Medical School

Dear Colleague You are receiving this because you have previously expressed interest in the formation of a Three Counties Medical School (TCMS). This is intended to give you an update on progress.

The Course To start with a few basics, the course will be:

• Four year, graduate-entry course • 100 students/year • First admissions September 2021 • Course based on that of Swansea who are the ‘contingent partner’ • Entry criteria o 1 or 2i degree in any subject o Pass GAMSAT (Graduate Medical School Admission Test; basic science related to health) to a requisite level o Interview • Widening participation is a key objective • Emphasis on primary care and psychiatry o But must graduate pluri-potential doctors Clinical Environment The TCMS is based at the University of Worcester. The University has significant strengths in a range of health-related subjects, including Physician Associates, and its graduates are well regarded in the local health services. The area of TCMS covers the counties of Herefordshire, Gloucestershire and Worcestershire and the NHS facilities in all of these will be essential in providing the clinical, and some basic medical science, learning and teaching. This may be extended to the contiguous areas if the environment is suitable. Clinical placements will be in approximately equal numbers in the community and in secondary care. The ‘community’ is taken to include both primary care and specialist care provided out with the major hospitals. It is anticipated that ‘hubs’ of community hospitals, their associated general practitioners and the related health care team will provide a suitable framework.

Course Structure In its initial years the TCMS will deliver a course which aligns with that delivered by Swansea Medical School (SMS). SMS will be acting as TCMS’s contingent partner during the GMC approval process and we have to ensure that the learning outcomes and assessment align in case students need to transfer to Swansea. The Swansea course is divided into Phase 1 and Phase 2 each comprising two years. Phase 1 is largely campus-based with lectures, practical sessions and small group work. Consultation skills training (history, examination, clinical reasoning and basic procedures) take place each week. Clinical placements comprise 20 days in primary care over 2 years and 5 weeks in secondary care in Year 1 and 10 weeks in Year 2. Phase 2 is almost entirely on placement. Year 3 is undergoing some revision but will probably consist largely of long-term community-based placements. Year 4 consists of placements in medicine surgery and primary care, a ‘shadowing’ period and an elective. The aim of all the placements is that they should be as ‘immersive’ as possible.

Major Processes There are two quite distinct processes in setting up a medical school. These derive from:

• The GMC • HEE and the Office for Students (OfS) (previously HEFCE – Higher Education Funding Council for England) The GMC is concerned with educational standards as reflected in two main documents, Outcomes for Graduates (2018) and Promoting Excellence (2015). It does not concern itself with workforce planning issues or how the course is funded, apart from evidence of financial viability. The process of the GMC approval is lengthy, extending over about 3 years before the students arrive and continuing until the first cohort graduates. There are several stages. TCMS has completed Stage 1 of the GMC process, and Stages 2 and 3 (the most significant) are underway. Our internal deadline for submission for Stage 3 is October 2019. HEE and OfS together provide the funding over and above the student fees. The contribution from HEE is the larger. Both are concerned with getting value for money in terms of the educational environment and workforce planning. The TCMS bid to HEE/HEFCE (now the OfS) in November 2017 was unsuccessful but the feedback received was good; the application was judged ‘too soon’. The University was encouraged to pursue its aims in the expectation of more funded places. The current understanding is that these will be released but the timing is uncertain. However, TCMS’s planning process will be much further on when the opportunity to bid arises than they were in November 2017. Funding As mentioned, funding streams are from both the Office for Students and HEE. The former, with student fees, supports campus-based teaching and HEE placement-based teaching. HEE funding, formerly SIFT but now the ‘Tariff’, is distributed to trusts and to GP practices by a formula using ‘student weeks’ as the unit. At one time, hospitals received ‘block grants’ for teaching but for new schools financial modelling has normally identified transparent income streams supporting individual consultant or general practitioner sessions. This funding is normally at a level which would recompense the trust or the practice for clinical work not undertaken.

Governance There is no doubt that the success or otherwise of a medical school depends on the quality of the engagement with the NHS. The University has formal responsibility for the degree but it cannot exercise that without full engagement from clinicians at every level. This is particularly true in the Three Counties, and some surrounding areas, where the University is relatively small but the NHS serves a large dispersed area. There are various possible models but the learning environment for the bulk of the course will be the clinical areas, not the classroom. Although the curriculum is based on one at Swansea Medical School, there is a major opportunity for the local clinicians to shape the learning to the needs of the local community, with the hope that graduates will remain to serve the area. Indeed early involvement by clinicians is built into the Swansea curriculum. This will give the ‘scholars’ in the various trusts, of which there will be many, the freedom to use their abilities in new and exciting ways. Scholars think carefully about what they do, reflect on their strengths and weaknesses, read widely, base their decisions on evidence whenever possible, and teach others (and are taught by others) at all levels. To make this effective there needs to be appropriate governance arrangements in place. A high level Partnership Group has therefore been formed with representatives of the trusts, CCGs and HEE and of the university and will meet for the first time in October.

New Appointments The University will want, in due course, to appoint a number a basic scientists and related staff. However most of the academic management of the course and the teaching will be by clinicians. In turn most of those clinicians will have substantive contracts with the NHS, honorary contacts with the University and teaching sessions ‘brought out’ either by the University or HEE as appropriate. These appointments will need to be made by a joint process involving the University and trusts.

Want to know more? Ask the Development Dean, John Cookson, MD, FRCP at [email protected]

September 2018

The University of Worcester Masters in Health Professions Education (MHPE) is designed for all those actively involved in facilitating the education and development of other healthcare professionals, either as a practitioner or manager.

The course will help you expand and enhance the theoretical and practical foundation of your teaching and can be taken flexibly according to your professional commitments. It is designed to support you as you reflect on and develop your practice and is open to all healthcare professionals in active practice, or eligible to be so, with access to learners and educational environments.

Contact Kay Mohanna via [email protected]