Clinical placements in undergraduate medicine in London: A review of the current placement programme
OCTOBER 2016
Produced on behalf of London Medicine, this report outlines the current position regarding undergraduate medical clinical placements in London, and suggests ways in which the system could adapt to best meet the needs of the various stakeholders. The paper has been informed by colleagues from across the five London medical schools, as well as colleagues from commissioners, employers and stakeholders in London (listed in Annex 4).
This report forms part of a series of work within the Vital Signs programme. Vital Signs addresses a range of challenges pertaining to both higher education and health policy which are likely to impact the provision of health education and training over the next five years. Theme 1: Clinical Placements in Undergraduate Medicine aims to maximize the potential of clinical placements in London whilst gaining a better understanding students’ perspectives of their clinical placement.
London Medicine is the group bringing together the five schools of medicine, three schools of dentistry and schools of clinical academic disciplines in London. London Medicine is a division of London Higher, the body representing nearly 50 universities and higher education colleges in London, working to identify the opportunities and address the challenges of working in London.
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Contents
Section 1: Background Setting the scene Page 3 Specific challenges for clinical placements Page 4
Section 2: The Current System Funding Pages 5-7 Placement quality and educational outcomes Pages 8-9 Primary care and care in the community Pages 9-10 Capacity Pages 10-11 Establishment of private medical schools Page 11 The role of private health providers Page 12
Section 3: Discussion and Questions for the Future New developments and the current system Pages 13-15 Systems Pages 15-16
Annex 1: Clinical Placements – Background Pages 17-18 Annex 2: Tariff Guidance Pages 19-20 Annex 3: Medical and Dental Target Intakes 2015-16 Page 21 Annex 4: Partners Page 22 References Pages 23-24
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Section 1: Background
Setting the scene
London’s diverse population is witnessed in its health outcomes. Its workforce, and its medical students, benefit from being exposed to a diverse population and range of health conditions that may not be seen so frequently in other areas of the country. In addition to the wide variety of health conditions, London is tackling an ageing population, which is placing an increasing demand on the healthcare system.
These characteristics of the capital mean that there is a strong need for multi-professional education and training that thoroughly prepares medical students for the integrated healthcare system that they will work in as doctors. As such the requirements from the health service are changing with a need to be adaptable in order to cope with the increase in demand and the type of services being offered. Additionally, the Five Year Forward View1 and new Sustainability and Transformation Plans2 (STPs) propose a new way of working for the NHS.
With the ongoing finance constraints on the NHS and the introduction of a new higher education bill, health education and training in London is entering a dynamic new phase. NHS England has a goal to achieve a net increase of 5,000 new GPs in the next 5 years3. The Department for Education is introducing legislation to more closely monitor the quality of teaching provision. These imperatives are being driven by the ultimate goal to shift a greater delivery of healthcare into community settings, an aspiration that must become a reality if England is to meet the chronic health challenges of its ageing population. In October 2016, the Government announced proposals to expand the student medical training cap to 7,500, an increase of 1,500 students per year. It will be 2024 before any benefits of this increase are seen in real terms.
A core element of the current education and training curriculum, both in terms of budget and learning outcomes, is the well-established placement system. This paper looks at a number of challenges inherent in the current system of the management of placements, in particular as they pertain to the shift towards more community care, and also to changes to the quality agenda.
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Specific challenges for clinical placements - recent and ongoing policy developments include:
Funding pressures on the NHS, in particular the increasing deficits run by most NHS Trusts, and the public drive for improvements in performance and efficiencies may impact on the quality and quantity of placements.
The demands of an integrated healthcare system, and the move towards greater provision of community care, require re-thinking the learning and teaching framework, career pathways and placement contexts. Linked to this, the Shape of Training4 report argues for broader medical training at the start of a medic's career.
There is a UK-wide recruitment problem in General Practice. There is going to be increased demand for GP services, so it is essential that more students are encouraged to pursue this career route.
The introduction of a Teaching Excellence Framework5 (TEF), and how the metrics used can fairly recognise and/or evaluate the time spent on student placements.
The development of new medical schools, and increased competition for placements, in an already close to saturated market.
The expansion of the private providers of healthcare, and whether they provide placements to medical students.
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Section 2: The Current System
Funding
The commissioners for London are Health Education England’s London and South East Local Education and Training Board (LETB). They manage the funds to commission medical clinical placements from NHS Trusts for undergraduate students. The LETB acts as the intermediary between the Trusts and the universities regarding undergraduate clinical placements. Undergraduate clinical placements for medical students attract a national tariff from the commissioners.
The Service Increment for Teaching (SIFT) was historically provided to fund the additional cost to the NHS that is incurred as a result of provision of teaching for medical undergraduates. SIFT has been transitioning to the Tariff payment since April 2013, a process which is nearly complete and has seen a significant reduction in overall funding, particularly to Teaching Hospitals. The Tariff is not a payment for teaching services but is designed to meet the extra costs incurred, compensating for the loss of service incurred through teaching; SIFT is paid directly to the institution to cover these costs. The current value (2016/17) of the Tariff is £33,286 + MFF (Market Forces Factor) for undergraduate medicine6. The Tariff covers funding for all direct costs involved in delivering education and training by the provider. The value of the Tariff was frozen for 2016/17 and its status for 2017/18 and beyond is unknown at present. The Tariff does not as yet cover medical placements in primary care (further detail outlined in Annex 2).
Currently, although universities act as the broker for the funding, they do not receive any of the funding themselves. Through our preliminary discussions with medical schools it appears that there are current processes within this system which are not ideal. The universities hold all of the responsibility for their students’ clinical placements, whilst not being accountable as they are not the commissioner. Typically the Trusts are working under two contracts. The LDA (Learning Development Agreement) with the commissioner - the contract in which the funds are attached, and a separate contract between the university and the Trust. There is variation in these two contracts and some have discussed a lack of clear deliverables, quality assurance and accountability lines.
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Some medical schools have developed a ‘minimum standards’ document which they use as a shared document between Trusts and the university to address some of these issues and prevent disparity between the two contracts.
Typically SIFT/Tariff funding is absorbed into the Trust’s finances. Trusts use the money differently; our discussions have shown that in newer Foundation Trusts more of the money is seen to be spent on the educational activities, whereas in older Trusts the money lines are not so transparent. There is wide disparity between Trusts regarding the transparency of funding. There can also be variation between Trusts regarding the value they place on the teaching component; the time and ability of the clinician in charge; plus other factors in the service setting.
Medical schools do carry out an annual inspection/quality visit of placements, however if problems are found it can be a long process to get things improved. Also, in some cases even if a university may prefer to discontinue with a placement that they are unhappy with, it may not be possible for the placement to be moved elsewhere if there is not the capacity in the system to do this. Additionally universities may be reluctant to disrupt the system in this way. Ultimately the funding follows the student, so if there is capacity and need, placements can be altered if necessary.
On the whole there are generally good relationships between commissioners, providers and universities in London. In order to improve and make better use of the current system, better liaison with all parties regarding the health professional workforce requirements are desirable. Clearer expectations and set boundaries, for example between medical schools and commissioners, may improve working practices and encourage closer working. In particular this may help strengthen multi-professional working as opposed to the current uni-professional approach.
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Case Study: Allocating funding to clinical service lines
At the Royal Free London NHS Foundation Trust Paul Dilworth, UCL Medical School Sub Dean, has helped set up and implement a new process of tracking monies in clinical departments, devolving to service lines. The process began in 2015 and has been fully implemented from 01 April 2016. Historically undergraduate teaching through clinical placements has been conducted by goodwill. Increased clinical and academic pressures are making this goodwill less tenable and transparency of funding for teaching is very persuasive. Enhancing transparency has been a key part of this new process. It will also aim to facilitate job planning, recognize service line contribution to undergraduate teaching and incentivise quality of teaching.
The process of mapping the money differs between departments, modules, service lines and teaching plans and can vary from a straightforward simple process to one which is more complex. The processes do require ongoing staff time but these will reduce once the initial setting-up has taken place. Currently the allocation to service lines has been calculated by:
-80% of the income allocation for each service line, based on student numbers -20% on the delivery of educational targets (10% consultant job planning; 10% student feedback)
The key objective for an outcome from student feedback will be in the form of a traffic light system (green, amber or red rating) in the overall rating question on the end of module feedback form. Two red ratings out of three in the previous academic year will result in income not being allocated.
This new system is building in a new way of working, moving away from the threat of moving students away from placements, and ultimately improving the placements themselves. It allows the university to have more control and has improved the efficiency and effectiveness of teaching programmes within the Trust.
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Placement quality and educational outcomes
There are complications around the term 'placement quality' as without standardised measurable outcomes, it is difficult to measure and to make comparisons across the range of placements. Typically all medical schools have a process in place whereby they assess the quality of placements, carry out inspections and collect and collate student feedback. Some medical schools have experienced issues with a poor response rate, however other universities have reported that they have a high response rate. With the advent of the TEF5, the issue of student feedback will become increasingly important. Additionally, it can be time-consuming for medical schools to fully analyse the student feedback received and be completely responsive to it.
Trusts have to adhere to the LDA in order to receive funding. However, it can be unclear as to where ultimate responsibility for the quality of placements lies in the system. Key issues include how the General Medical Council’s (GMC) standards7 articulate with universities, also how do universities work with the health providers to ensure that they deliver good quality placements. Do regulators (GMC) and commissioners (DH/HEE) have sufficiently sensitive measurement tools in place to ensure that placements meet the expected quality standards in order to receive the national tariff?
How the introduction of the TEF5 interacts with clinical placements is an issue that universities will need to consider. Will the metrics used in the TEF adequately recognise and/or evaluate the time spent on student placements? There may be a danger of universities being judged on elements that are beyond their day-to-day control.
Some of the questions above lead into broader issue of how to measure quality in education.
In addition to the quality of the educational elements of their placement, students will also consider other aspects of their placement experience, such as the accommodation that is provided for them in particular placements, when evaluating their placements. If students consider these other factors as poor quality then this will impact on their overall opinion of placement quality.
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To gain further insight into the question of student perception, London Medicine are hosting a survey open to all London medical school undergraduate students, the results of which will be published in Spring 2017.
Primary care and care in the community
There are UK-wide recruitment problems in General Practice. There are perceptions of primary care as less prestigious, less well-paid and more hard work than some other areas of medicine. However, there are going to be increased demand for GP services in the future, so it is important that more students are encouraged to pursue this route. An essential aspect of ensuring that General Practice is attractive to students is through the provision of good quality placements in primary care.
In contrast to the system of placements within hospitals in which the funding for placements is paid by HEE to the hospital/Trust, there is currently a ring-fenced allocation from HEE to each medical school, from which they pay for primary care placements (Primary Care Tariff).
The Primary Care Tariff is not covered by current nationwide guidance. Work is ongoing to develop medical education and training tariffs for placements in GP practices. At present, the tariff paid for undergraduate medical placements in GP practices varies across England.
There are issues with having enough placements in primary care as the tariff is seen by GPs as being relatively low, meaning that not many surgeries are willing to take on undergraduate medical students. Also, GP placements could be considered expensive as surgeries only have a capacity for small numbers of students. The recruitment and retention of GP placements can be an issue for universities. If demand for placements outstrips supply in one region, what happens? Are placements found outside the region, or do some students miss out on particular placement types?
Commuting to GP placements can be a particular problem for students as, by their nature, GP placements are located in the community.
There are however placement opportunities in community settings additional to primary care which currently are under-utilised. If we are to work towards the Five Year Forward View1 and a new way of
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working, we should consider moving some placements out of hospitals and into community settings. Whilst this would indeed require some upfront investment (in terms of student facilities), it would offer a wider range of multi-professional education and training opportunities and allow students to witness a broader range of health conditions, and experience a broader range of health settings, whilst on placement.
Capacity
Capacity issues within universities’ clinical placements can impact more broadly on an ability to make real choices when it comes to student satisfaction and education quality. As has previously been mentioned, if placements are particularly poor, universities may not have alternative options if there is no other provider for that placement.
However, lack of capacity is not the only issue. Although some universities and their Trust partnerships are at full capacity, there are sites which could take on additional capacity. With the current cap on the number of home and overseas students presently in place, it is difficult for universities to have flexibility around capacity given the consequential financial loss to a Trust at a time of constrained funding. The Government’s recent proposals to increase the cap will help to provide some flexibility in some cases.
An additional issue can be when a medical school deliberately places only a few students in one placement location in order to ensure that these students receive a high quality placement, but then other medical schools view this ‘low’ level of students as spare capacity and so then attempt to utilise what they view as spare capacity in the system. Transparency is this area will aid universities when planning their placements.
The explicit targets for medical schools’ intake are inclusive of overseas numbers, and presume that 7.5% of the medical numbers would be overseas students. There has been discussion as to whether the overseas numbers should be removed from the cap. This appears less likely for the immediate future given the Ministerial target for England to be self-sufficient in doctors by 2025. Given the recent proposals to increase the number of home student medical places at universities, it remains unknown what will happen to the overseas cap.
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An additional issue related to capacity is the placement ‘footprint’ of each medical school – the geographical area covered by placements by each medical school. In some cases there are geographical areas where more than one medical school will place students. Naturally, medical schools are aware to some extent of these ‘footprints’, how they may overlap, and of collaborative working between medical schools when it comes to placing students in the same location for a medical placement. London Medicine are in the process of compiling a London-wide map detailing these ‘footprints’, which we hope will be of use to medical schools and other stakeholders. We aim to publish this mapping exercise in autumn 2017.
Establishment of private medical schools
There is a real likelihood of new private medical schools being established in London or near London. Their establishment will have an impact on existing medical schools, and on the relationship between medical schools and their relationships with Trusts.
The entry of new private medical schools will impact on existing London medical schools, potentially threatening to devalue the current value of the Tariff if clinical placements can be offered to Trusts at a lower cost.
Buckingham University8, a private provider, launched its medical school in January 2015. A second private course started in September 2015 at the University of Central Lancashire9, and a third is due to begin at Birmingham’s Aston University10 in 2017. Private medical schools will charge in the region of £35,000 a year in fees, which must be covered privately by the student, with no government subsidy.
There will be an impact on current clinical placements. New private medical schools may offer what they consider to be competitive rates to Trusts which currently have strong relationships with state funded medical schools. Such “competitive” rates take no account of the subsidy in terms of facilities, laboratories etc. provided by the NHS. This risks not only potentially devaluing the Tariff but creates competition as to where universities can place students, particularly in areas which are currently at full capacity. There is a finite number of placements, specifically in specialist areas which may only take a few students each year.
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The role of private health providers
GMC guidance states that where a clinical placement is not taking place within the NHS, the medical school should ensure that it still meets the GMC’s guidelines7. Shape of Training4 states that “training should be limited to places that provide high quality training and supervision, and that are approved and quality assured by the GMC.”
HEE does contract with private health providers, where there is a shortage of supply within the NHS. If the curriculum content required cannot be delivered within the NHS then HEE will contract elsewhere. This has happened with Ophthalmology, for example, and it requires GMC approval. In some cases HEE will engage with the NHS who then channel the funding to a private provider. A further example is mental health - in some parts of the UK services are provided by independent providers such as The Priory Group. Within the NHS there is a duty on Trusts to include education and training e.g. provide placements. It is a legislative requirement for NHS providers to offer clinical placements, however this does not apply to private providers of healthcare.
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Section 3 – Discussion and Questions for the Future
This review of the current clinical placements system has highlighted that whilst there is excellent work ongoing in this field, there is some disparity between the perspectives of the medical schools in London and the Trusts they work with. There are many areas of shared concern as well as areas where there is opportunity to share good practice.
Below we highlight a number of particular questions that have arisen from our work and from recent developments.
New developments: Expansion of medical school training places
a) Does London have capacity to increase the number of medical students they train and provide placements? b) Should overseas students receive the Tariff for their clinical placements?
The current system: Funding Should there be a single placement contract to govern the relationship and expectations between HEIs and Trusts?
c) Is the Tariff sufficient to continue working within this system? d) Is it appropriate for universities to be responsible but not accountable for clinical placements? e) Would transparency of funding services make the placement system easier or more efficient?
Placement quality and educational outcomes Should there be a standardised contract with measureable outcomes attached?
a) Are the tools for measuring quality meeting the needs of: i. Universities
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ii. HEE iii. Trusts b) How do the GMC’s standards articulate with universities and placement providers? c) How should universities work with health providers to ensure that they deliver good quality placements? d) What feedback from students is useful to improve quality?
Primary care Should the Primary Care Tariff be increased (and agreed) to enable more students to undertake GP speciality training?
a) In order for placements within GP settings to be improved a Primary Care Tariff must be agreed, however this will have cost implications. What is the current and future status of the Primary Care Tariff and what are the timelines? b) Does the current placement system sufficiently prepare students for working in an integrated multi-professional system? c) What can we do to encourage more students to choose to work in community settings? d) How can we encourage more community providers to take on more students?
Capacity What issues arise with capacity in specialist areas of practice in London?
a) Are there particular pressures in specific geographical locations? b) Is there extra capacity to move students? c) Are students able to experience placements in the full range of settings?
Private medical schools What are the opportunities and threats by private medical schools using a lower Tariff?
a) Will the increased provision of private medical schools threaten or destabilise the current system in any way?
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b) Would the provision of private medical schools provide opportunities for collaboration with existing medical schools? c) What are the particular problems in London?
Private health providers Should private providers supply placements for university students?
a) Are there opportunities for collaboration between private health providers and other providers, or between private health providers and universities? b) How can we use private providers more effectively?
Systems
In addition to these questions, this paper has opened up queries regarding the current clinical placement system. In particular whether it is the most suitable system in which to train doctors who will be working in a multi-professional, integrated health system, that is less focused on individual specialisms than has been the case historically.
It is understood that changing the system will be difficult, if not impossible in some respects. However, our findings have isolated a number of elements which together might represent a type of ideal system.
The schematic below demonstrates a possible system, based on greater collaboration and cohesion of the London medical schools, which could result in the creation of a more effective and efficient student feedback system for joint use across the London medical schools. Additionally, the creation of an annual audit and reporting system would pave the way for HEIs to have greater accountability over funding and enable the system to be more responsive to student feedback.
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Improving clinical placements
Clearer, defined standards and SLAs
Clearer Greater Common way accountability collaboration of presenting lines between HEIs data to HEE
Commonality between transparency models of funding
Although this particular system may be difficult to implement, the schematic does highlight certain key areas and interconnections which could be looked at across London to permit the development of a more multi-professional, student focussed, cohesive system.
We are working in a health system which is still finding its feet regarding new way of working. With the advent of the Five Year Forward View1 and STPs2, the system will have to change and most importantly be adaptive and responsive to continuing change. Looking to the future it is important that we harness the opportunities students have in London by working collaboratively, not only in hospitals but also in the community and in mental health settings, and most importantly multi-professionally in order to establish real change.
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ANNEX 1
Clinical Placements – Background
A clinical placement can be defined as any arrangement in which a medical student is present in an environment that provides healthcare or related services to patients or the public. Placements can take place in primary, secondary or community healthcare or social care settings. Students can be actively involved in patient care or they can be observing health or social care processes. Clinical placements take place in a range of clinical settings including: teaching hospitals; private hospitals and clinics; community health centres; specialist areas, such as early childhood services, or drug and alcohol services7.
Students on placements learn through a number of settings and activities including11: consultant ward rounds – learning from the way consultants deal with patients, from their examination techniques and their clinical reasoning skills; attending ward rounds with doctors in training – learning about the day-to-day tasks of working in a hospital; ward rounds or clinics with specialist nurses or other healthcare professionals; operating theatres – to observe surgical and anesthetic procedures; outpatient clinics with consultants or junior doctors; GP surgeries and home visits – learning how GPs manage their time and make diagnoses, decide when to refer patients to specialists etc.; multidisciplinary team meetings – these may comprise nurses, social workers, physiotherapists.
Medical schools’ curricula should include practical experience of working with patients throughout all years. It also states that the level and duration of contact with patients should increase throughout the duration of their studies7.
The curriculum will include practical experience of working with patients throughout all years, increasing in duration and responsibility so that graduates are prepared for their responsibilities as provisionally registered doctors. It will provide enough structured clinical placements to enable students to demonstrate the ‘outcomes for graduates’ across a range of clinical specialties, including at least one student assistantship period12.
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Placements need to have genuine educational value – this can be difficult for medical schools. The relationship with local NHS services can be challenging, especially at a time when budgets for all services are under pressure. Nevertheless schools and the NHS should acknowledge that they have a shared interest in enabling new medical graduates to enter practice safely and efficiently7.
A student assistantship is a type of clinical placement, undertaken towards the end of the student’s undergraduate course. It should be designed to increase the preparedness of the medical student to start practice as an F1. Although some direct care of patients is implicit and necessary, it is primarily an educational experience which should provide a number of hands-on learning experiences that allow the medical student to work within clinical settings and to practise clinical skills. A student assistantship means a period during which a student acts as assistant to a junior doctor, with defined duties under appropriate supervision7.
The GMC provides general advice on clinical placements to HEIs, including:
“Clinical placements must be planned and structured to give each student experience across a range of specialties, rather than relying entirely upon this arising by chance. These specialties must include medicine, obstetrics and gynaecology, paediatrics, surgery, psychiatry and general practice. Placements should reflect the changing patterns of healthcare and must provide experience in a variety of environments including hospitals, general practices and community medical services12.”
Medical schools should have formal, written agreements with all clinical placement providers13. Where the placement is not taking place within the NHS, the medical school should ensure that it still meets the relevant requirements in Tomorrow’s Doctors12. Close ongoing links between the medical school and the placement provider are essential.
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ANNEX 2
Tariff Guidance6
The tariffs cover funding for all direct costs involved in delivering education and training by the provider, for example:
Direct staff teaching time within a clinical placement Teaching and student facilities, including access to library services Administration costs Infrastructure costs Education supervisors Pastoral and supervisory support Trainee study leave and time for clinical exams Health and well-being (excluding any occupational health assessments that are carried out by the university and funded separately) Course fees and expenses (as required to achieve professional registration) Student/trainee accommodation costs In-course feedback and assessment Formal examining Staff training and development relating to their educational role
The transitional tariffs for undergraduate medical placements do not cover:
Placements in hospices Medical placements in GP practices
Work is on-going to develop medical education and training tariffs for placements in GP practices. The Department of Health and HEE are working with a group of experts in general practice looking at education and training with a sample of training practices to collect information about the costs of providing placements in GP practices. This will enable us to develop appropriate tariffs for this activity. It is
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anticipated that these tariffs will distinguish between delivering different types of placements, for example, for medical students, foundation trainees and specialty registrars.
At present, the price paid for undergraduate medical placements in GP practices varies across the country. Like with the secondary care placements, this approach creates inequities in funding.
The proposed introduction of a national tariff aims to address the inequities in funding and create a fair playing field. While this work is underway, providers will continue to be funded using existing arrangements.
2016/17 tariff prices6:
2016/17 tariff Tariff for Additional payment for all placement prices Type of placement activity in 2016/17 placement activity 2016/17
Non-medical £3,112 + MFF
Undergraduate £33,286 + MFF medical Payment equivalent to 2.0408% of £12,152 + MFF placement tariff + MFF
Plus a Postgraduate contribution to medical basic salary costs as per Annex A
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ANNEX 3
Medical and dental total target intakes for entry in 2015-1614:
Intake Target (home Anticipated home Anticipated and overseas) overseas Institution Medical Dental Medical Dental Medical Dental University of Birmingham 374 71 346 67 28 4 Universities of Brighton and Sussex 138 n/a 128 n/a 10 n/a University of Bristol 251 71 232 67 19 4 University of Central Lancashire n/a 29 n/a 28 n/a 1 University of Cambridge 292 n/a 270 n/a 22 n/a University of East Anglia 167 n/a 154 n/a 13 n/a Universities of Hull and York 141 n/a 130 n/a 11 n/a Imperial College 322 n/a 298 n/a 24 n/a Keele University 129 n/a 119 n/a 10 n/a King’s College London 403 148 373 141 30 7 Lancaster University 54 n/a 50 n/a 4 n/a University of Leeds 258 76 239 72 19 4 University of Leicester 241 n/a 223 n/a 18 n/a University of Liverpool 307 72 284 68 23 4 University of Manchester 371 71 343 67 28 4 University of Newcastle 343 71 317 67 26 4 University of Nottingham 327 n/a 302 n/a 25 n/a University of Oxford 184 n/a 170 n/a 14 n/a University of Plymouth 86 58 80 55 6 3 University of Exeter 130 n/a 120 n/a 10 n/a Queen Mary, University of London 316 71 292 67 24 4 St George’s Hospital Medical School 259 n/a 240 n/a 19 n/a University of Sheffield 237 71 219 67 18 4 University of Southampton 242 n/a 224 n/a 18 n/a University College London 322 n/a 298 n/a 24 n/a University of Warwick 177 n/a 164 nT/a 13 n/a TOTAL 6071 809 5615 769 456 40
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ANNEX 4
Partners
London Medicine would like to thank the following colleagues who were consulted in producing this paper:
Debasish Banerjee, INTO-SGUL Higher Education Academic Director, St George’s University of London
Michael Baty, SIFT Development and NHS Liaison Officer, King’s College London
Stuart Carney, Dean of Medical Education, King’s College London
Paul Dilworth, UCL Medical School Sub Dean, Royal Free London NHS Foundation Trust
Louise Dubras, Deputy Dean of Medical Education, King’s College London
Andrew Frankel, Postgraduate Dean, Health Education South London
Deborah Gill, Director of the UCL Medical School, UCL
Chris Harris, Head of Programme Management, Imperial College London
Jo Harris, Deputy Head of Undergraduate Medicine, Imperial College London
Jenny Higham, Principal, St George’s University of London
Melanie Hill, SIFT Manager, UCL
Kathryn Jones, Dean of Healthcare Professions, Health Education North West London
Andy Kent, Dean of the Faculty of Healthcare, St George’s University of London and Kingston University London
Peter Kopelman, Emeritus Professor of Medicine, St George’s University of London
Martin Lupton, Head of Undergraduate School of Medicine, Imperial College London
David Noyce, Higher Education Consultant
Anne-Marie Reid, Dean of Teaching and Learning, St George’s University of London
Antony Senner, Deputy Director of Education, Royal Free London NHS Foundation Trust
Philippa Tostevin, Course Director for Medicine MBBS, St George’s University of London
Anthony Warrens, Dean for Education, Barts and The London School of Medicine and Dentistry, Queen Mary University of London
Julia Whiteman, Postgraduate Dean, Health Education North West London
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REFERENCES
1. NHS England, Five Year Forward View (2014). Accessed at: https://www.england.nhs.uk/ourwork/futurenhs/nhs-five-year-forward-view-web-version/5yfv- exec-sum/
2. Health Education England. Sustainability and Transformation Plans (STPs) (2016). Accessed at: https://www.england.nhs.uk/ourwork/futurenhs/deliver-forward-view/stp/
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4. Greenaway, David, The Shape of Training (2013). Accessed at: http://www.shapeoftraining.co.uk/static/documents/content/Shape_of_training_FINAL_Report.pdf _53977887.pdf
5. Department for Education. Teaching Excellence Framework: year two specification (2016). Accessed at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/556355/TEF_Year _2_specification.pdf
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8. The University of Buckingham. Medical School (2016). Accessed at: http://www.buckingham.ac.uk/medicine
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9. University of Central Lancashire. School of Medicine (2016). Accessed at: http://www.uclan.ac.uk/schools/medicine/index.php
10. Aston University. Aston Medical School (2016). Accessed at: http://www.aston.ac.uk/aston-medical- school/
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12. General Medical Council, Tomorrow’s Doctors: Outcomes and standards for undergraduate medical education (2009). Accessed at http://www.gmc- uk.org/Tomorrow_s_Doctors_1214.pdf_48905759.pdf
13. General Medical Council, Developing teachers and trainers in undergraduate medical education. Advice supplementary to Tomorrow’s Doctors (2009). Accessed at: http://www.gmc- uk.org/Developing_teachers_and_trainers_in_undergraduate_medical_education___guidance_und er_review_0815.pdf_56440721.pdf
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