cfwi sd boston v1

Robust workforce planning for the English medical workforce

Dr Graham Willis - Head of Research and Development Dr Andrew Woodward - Lead ModellerDr Siôn Cave - Decision Analysis Services LtdThe CfWI produces quality intelligence to inform better workforce planning that improves people’s lives

Contents

1. The challenge of workforce planning in the health sector

2. Background to the MDSI project3. Overview of CfWI’s robust workforce planning

framework4. Application of the framework to the MDSI project5. The MDSI System Dynamics model 6. Impact of MDSI project and benefits of the

planning framework

Workforce planning in healthcare Workforce planning is ensuring “The

right people, with the right skills, in the right places, at the right time”

The English National Health Service employs:1.4 million people140,000 Doctors370,000 Nurses

Why do workforce planning?

Cost of workforce – training and employment is expensive, we want to reduce wastage.

Productivity – getting the most from our investments

Safety – as patients we demand a safe service

Quality – we all want the best possible outcomes

Challenges of health workforce planningSupply – based on current stock and the

pipeline in/out.

Complicated by factors such as: +60 specialties with 15 yrs of training Delays Attrition Part time working, work/life balance

Challenges of health workforce planningDemand – assessing affordable need for the

future workforce

Influenced by factors such as: patient population patient lifestyle who delivers the care,

doctors/nurses/others? where will care be delivered? Community vs

hospital The unknown

Contents




planning framework

MDSI goals

To ensure an adequate and affordable supply of good quality trained doctors and dentists

To advise on future total intakes to undergraduate medical and dental training in England

Approach

Long-term planning to 2040

Recognise uncertainty

Generate challenging futures

Quantify the key factors

Robust workforce planning

Contents




planning framework

Robust workforce planning framework

Robust workforce planning

framework

Workforce models require...

Facts we know – like current training numbers and workforce

Assumptions we make – where data is missing or poor quality, like attrition during training

Parameters we can control – policy levers like intake to training or retirement age

Uncertainties we can quantify – which vary between different futures, like workforce attrition

Contents




planning framework

Application to the MDSI projectProject started August 2011Horizon scanning Jan 2012 – 44 experts interviewedScenario generation Jan to Feb 2012 – two 2-day workshops with 30

participants; over 200 drivers identified April to May – 58 people involved in Delphi processWorkforce modelling Jan to Oct 2012 –Vensim models developed for medicine &

dentistryPolicy analysis Jul to Oct 2012 –stakeholder meetings and formal HENSE

review group presentationFinal report published on DH website Jan 2013

SD modelling is integral to the framework

Horizon scanning

Scenario generation

Workforce modelling

Policy analysis

System dynamics…• Better understanding – dynamic behaviour of a system over time• Simplify complexity – rich picture of causality, feedback and delays• High stakeholder involvement–process provides as much value as

end product• Robust decisions – avoid policies and futures that lead to

unexpected consequences

Contents




planning framework

WORKFORCE MODELLING

Policy Analysis

Analyse the scenarios, and the impact of the levers we can control (potential strategies or policies) across scenarios

Specification

Specify the purpose of the workforce model, the scope and boundaries

Documentation and Testing

Full model documentation and independent validation and verification (V&V)

Development

Develop the supply and demand model using the System Dynamics method

We apply a rigorous approach to SD modelling

17

Model Requirement

• Calculate supply and demand for the medical and dental workforces to 2040

• Segment the workforce by age and gender

• Represent the training pipeline from entering university through to delivering service as fully qualified doctors and dentists

• Represent the complex career paths for doctors and dentist following qualification

• Execute rapidly and produce outputs that can be readily analysed

• Be fully tested and documented, with an audit trail for all assumptions

Data Availability

Scenario / Policy Questions

Specification

Specification

Specify the purpose of the workforce model, the scope and boundaries

18

Stakeholders

• DH’s Workforce Data and Analysis Team

• Health and Social Care Information Centre

• BMA• GMC and specific deaneries• UCAS• NHS Pensions• Medical project reference group• + National road shows….

Medical school Foundation 1

Career post

Foundation 2 Core training

Run-through training

GP training GP

Higher specialty training

Trained hospital doctors

10 15 20 25 30 35 40

33,90033,95034,00034,05034,10034,150

10 15 20 25 30 35 40

5,9006,0006,1006,2006,3006,400

10 15 20 25 30 35 40

5,600

5,800

6,000

6,200

6,400

10 15 20 25 30 35 40

7,0007,2007,4007,6007,8008,000

10 15 20 25 30 35 40

7,300

7,350

7,400

7,450

7,500

10 15 20 25 30 35 40

6200

6300

6400

6500

6600

10 15 20 25 30 35 40

122001222012240122601228012300

10 15 20 25 30 35 40

01000020000300004000050000

10 15 20 25 30 35 40

020000400006000080000

10 15 20 25 30 35 40

05000

10000150002000025000

2011 = 34,069* 2011 = 6,081 2011 = 6,341

2011 = 7,765 2011 = 35,803

2011 = 7,346

2011 = 6,524 2011 = 12,252 2011 = 39,088

2011 = 19,687

* Based on the sum of inflows – course drop outs accounted for at the end of the course

Development


19

Medical SchoolEnglandStart Medical

School English

Start MedicalSchool From OOC

Medical SchoolAttrition

CompleteMedical School

Medical SchoolComplete Attrition

Leave System

FoundationYear 1

Start F1

Resit F1

FoundationYear 2

Start F2

Resit F2

Foundation 1Attrition


Finish F1 Finish F2

Start F1 FromOES

Start F2 FromOES

SeekingTraining orCareer Post

Core TrainingHigher

SpecialtyTraining

Run ThroughTraining

GP Training

Career PostWithout CESR

GP

HospitalConsultant

Start GP TrainingFrom English

System

Start Core TrainingFrom English Medical

System

Start Run ThroughTraining From English

System

Complete CoreTraining

Start HigherSpecialty

Training fromEnglish Medical

System

Complete HigherSpecialty Training

Complete GPTraining

HospitalConsultant toGP Training

Start HospitalConsultant to GP

Conversion Training

Complete HospitalConsultant to GP

Conversion Training

Seeking GPPosition Start GP Position

Following Training

SeekingHospital

ConsultantPosition

Complete RunThrough Training

Start HospitalConsultant PositionFollowing Training

Start GP TrainingFrom OES

Start Core TrainingFrom OES

Start Run ThroughTraining From OES

Start HigherSpecialty Training

From OES

Start GP PositionFrom OES

Start HospitalConsultant Position

From OES

Start CareerPost

Career PostWith CESRCareer Post

Gains CESR

Career Post With CESRBecome Hospital

Consultants

Start Seeking Trainingor Career Post After

Career Post

Start SeekingGP Position

Complete GPTraining Leave

System


Leave System

Start Seeking HospitalConsultant Position after

Run Through Training


Leave System

Complete CoreTraining Leave

System

Complete ConsultantTraining Core Start

Seeking Career Post

GP Training AttritionLeave Medical System

GP Run Through TrainingAttrition Rate Start Seeking

Training Or Career Post

Run Through TrainingAttrition Rate Leave

SystemRun Through TrainingAttrition Rate Start Seeking


Higher SpecialtyTraining Attrition Rate

Leave System

Higher Specialty TrainingAttrition Start Seeking

Training Or Career PostCore Training

Attrition Rate LeaveSystem

Core Training AttritionStart Seeking Training

Or Career Post

Career Post AttritionRate Leave System

Career Post WithCESR Leave System

Start Career PostWith CESR From

OES

Start CareerPost From OES

GP AttritionLeave System

Hospital ConsultantAttrition Leave System

Complete F2 StartSeeking Training or

Career Post

Pass F2 LeaveSystem

Percentage of MedicalSchool Intake That Will Drop

Out

<100 Percent>

Percentage of the Studentsthat start F1 that will Drop

Out

<100 Percent>

Percentage Students FailFoundation 1 and Resit

<100 Percent>

Initial Foundation 1

<100 Percent>


<100 Percent>


Pass F2

Percentage Student PassF2 And Leave System

<100 Percent>

GP Attrition Rate

<100 Percent>

Initial GP

Initial Hospital Consultantsin GP training

Hospital Consultant AttritionRate

Initial Hospital Consultant

<100 Percent>

Percentage Career PostGain CESR Per Year

Initial Career Post

<100 Percent>

GP Training Attrition RateLeave Medical System

<100 Percent>

GP Training Attrition RateSeeking Training or Career

Post

<100 Percent>

Percentage Complete GPTraining And Leave System<100 Percent>

Time to find GP Position

Run Through TrainingAttrition Rate Leave Medical

System

<100 Percent>

Run Through TrainingAttrition Rate SeekingTraining or Career Post

<100 Percent>

Start SeekingHospital ConsultantPosition after Higher

Specialty Training

Percentage Complete RunThrough Training And Leave

System

<100 Percent>

Percentage CompleteHigher Specialty Training

And Leave System

<100 Percent>Time to find HospitalConsultant position

Initial Seeking HospitalConsultant Position

Initial Seeking GP Position

Core Training Attrition RateLeave Medical System

<100 Percent>

Core Training Attrition RateSeeking Training or Career

Post

<100 Percent>

<100 Percent>

Percentage Complete CoreTraining And Leave System

<100 Percent>

Higher Specialty TrainingAttrition Rate Leave Medical

System

Higher Specialty TrainingAttrition Rate SeekingTraining or Career Post

<100 Percent>

Initial Seeking Training orCareer Post

Initial Career Post WithCESR

Average Time to find CareerPost

<100 Percent>

<100 Percent>

<100 Percent>

Annual Medical SchoolIntake From England

FLAG StartAccademic Year

<Time>

<TIME STEP>

Accademic YearStart Date

Time Spent In MedicalSchool By DelayLength

Annual Medical SchoolIntake From Outside Of

Country

<TIME STEP>

<100 Percent>

1 Year

<100 Percent>

Complete F2Including Attrition


Out

<100 Percent>

<100 Percent>

<Percentage Students FailFoundation 1 and Resit>


<100 Percent>

GP Training LengthIncluding Delay Percentage

Start GPTraining

Start and Continue GPTraining By Remaining

Delay

<100 Percent>

<FLAG StartAccademic Year>

Complete GPTraining

Accademic Year

<TIME STEP>

<TIME STEP>

<TIME STEP>


Complete GP Trainingand Progress To Next

Year

Start RunThrough Training

Start and Continue RunThrough Training By

Remaining Delay Run Through Training LengthIncluding Delay Percentage

<TIME STEP>


<TIME STEP>

Complete RunThrough TrainingAccademic Year

<TIME STEP>

Complete Run ThroughTraining and Progress To

Next Year

<100 Percent>

Start CoreTraining

Start and ContinueCore Training ByRemaining Delay

<TIME STEP>


<TIME STEP>

Complete Core TrainingAccademic Year

<TIME STEP>

Complete CoreTraining and Progress

To Next Year

<100 Percent>


Start and Continue HigherSpecialty Training By

Remaining Delay

Higher Specialty TrainingLength Including Delay

Percentage

<100 Percent>


<TIME STEP>


<TIME STEP>

Complete HigherSpecialty TrainingAccademic Year

<1 Year>

Complete HigherSpecialty Training andProgress To Next Year

<100 Percent>

Foundation Year 2TOTAL

Seeking Training orCareer Post TOTAL

GP Training TOTAL

Run Through TrainingTOTAL

Core Training TOTAL

Higher SpecialtyTraining TOTAL

Career Post WithoutCESR TOTAL

Career Post WithCESR TOTAL

Seeking HospitalConsultant Position

TOTAL

Hospital ConsultantTOTAL

Hospital Consultant toGP Training TOTAL

Seeking GPPosition TOTAL

GP TOTAL

<TIME STEP>


<100 Percent>

GP Training NewEntrants


<TIME STEP>

Foundation TOTAL

Training RunThrough New

Entrants

<TIME STEP><FLAG Start

Accademic Year>

Higher Specialty TrainingNew Entrants

<TIME STEP>


<TIME STEP>


Number of CCTConsultant Per Year

<TIME STEP>


Number CompletingCore Training

<TIME STEP>


Start ConsultantTraining Core TOTAL

<TIMESTEP> <FLAG Start

Accademic Year>

Pass F2 TOTAL

<TIME STEP>


Number of CompletingConsultant Training

HS

<TIME STEP>


<100 Percent>

<Time>

<INITIAL TIME>

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<INITIAL TIME>

<INITIAL TIME>

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<100 Percent>

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<INITIAL TIME>

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<Time>

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<Time>

Annual F1 Intake FromOutside Of English System

<TIME STEP><FLAG StartAccademic Year>


<FLAG StartAccademic Year> <TIME STEP>

Annual GP Training IntakeFrom Outside Of English

System

<TIME STEP>

<INITIAL TIME>

<Time>

Annual Run Through IntakeFrom Outside Of English

System

<INITIAL TIME>

<TIME STEP>


Annual Core Training IntakeFrom Outside Of English

System <INITIAL TIME>

<Time> <TIME STEP>

Annual Higher SpecialtyTraining Intake From

Outside Of English System


<TIME STEP>

Annual Career Post WithoutCESR Intake From Outside

Of English SystemAnnual Career Post With

CESR Intake From OutsideOf English System

Annual Hospital ConsultantIntake From Outside Of

English System

Annual GP Intake FromOutside Of English System


<TIME STEP>

<TIME STEP>

<TIME STEP>

GP TOTAL By Gender

Start Consultant or GPTraining From Career

Post

Start Higher SpecialtyTraining From Career

Post

<TIME STEP>

Time to CompleteConsultant to GP

Conversion Training

Annual Hospital ConsultantStart GP Conversion

Training

<TIME STEP>

<INITIAL TIME>

CompleteConsultant Core

Training AvailableFor Higher

Specialty Training

<TIME STEP>

Start Consultant or GPTraining Core Career Post

TOTAL


GP Training TOTALBy Gender

Career Post WithoutCESR TOTAL By Gender

Run Through TrainingTOTAL By Gender

Core Training TOTALBy Gender

<Initial Medical SchoolBy Completion Year>

<Start Core TrainingFrom F2>

<Start Core TrainingFrom Career Post>

<Start GP Training FromF2>

<Start GP TrainingFrom Career Post>

<Start Run ThroughTraining From F2>

<Start Run ThroughTraining From Career

Post>

<Initial GP Training ByDelay Length>


<Initial Run ThroughTraining By Delay

Length>



Length>

<Initial HigherSpecialty TrainingBy Delay Length>

<Initial Higher SpecialtyTraining By Delay

Length>

<Initial Core TrainingBy Delay Length>

Core Training LengthIncluding Delay Percentage

<Initial Core Training ByDelay Length>

Start GP PositionRejoiners

Annual GP Rejoiners


Rejoiner

Annual Hospital ConsultantRejoiners

Start Career PostWith CESR Rejoiner

Annual Career Post WithCESR Rejoin

Start CareerPost Rejoiners

Annual Career Post WithoutCESR Rejoin


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Start Consultant C RT orGP Training RT FromCareer Post TOTAL

<TIME STEP>

Start Career PostTOTAL

<100 Percent>

Annual Career Post WithCESR Become Hospital

Consultants


<TIME STEP>


Core Trained

Seeking Training orCareer Post Completed

Core Training TOTAL

Career PostCompleted

Core Training

Career PostCompleted Core

Training Gains CESR

Career Post CompletedCore Training Attrition

Rate Leave System

Start Career PostCompleted Core

Training From OES

<100 Percent>

Initial Career PostCompleted Core Training

<100 Percent>

Annual Career PostCompleted Core TrainingIntake From Outside Of

English System


Career Post CompletedCore Training TOTAL

By Gender


Training Rejoiners

Annual Career PostCompleted Core Training

Rejoin




Training

<Average Time to findCareer Post>

<Percentage Career PostGain CESR Per Year>

<100 Percent>

Initial Seeking Training orCareer Post Completed

Core Training <InputStringTimeLine>

<Number Start HigherSpecialty Training FromCareer Post Completed

Core Training>

Start Seeking HigherSpecialty Training From

Career Post

<TIME STEP>

<Number Start Higher SpecialtyTraining From Career PostCompleted Core Training>

Foundation Year 2TOTAL By Gender



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Foundation Year 2TOTAL Gender Ratio

Start F2 TOTAL

<TIME STEP>


Start F1 TOTAL

<TIME STEP>

GP Training GenderRatio


<Time>

Initial Seeking Training OrCareer Post Age Profile

<100 Percent>


System Age Profile

<100 Percent>

Initial Seeking GP PositionAge Profile

<100 Percent>

Initial GP Age Profile

<100 Percent>


Age Profile

<100 Percent>

Start GP Position RejoinersAge Profile

<100 Percent>

Initial Hospital Consultant toGP Training Age Profile

<100 Percent>

Initial Hospital ConsultantAge Profile

<100 Percent>Annual Hospital Consultant

Intake From Outside OfEnglish System Age Profile

<100 Percent>

Annual Hospital ConsultantRejoiners Age Profile

<100 Percent>

Seeking Hospital ConsultantPosition Age Profile

<100 Percent>

Annual Career Post WithCESR Rejoin Age Profile

<100 Percent>

Annual Career Post WithCESR Intake From Outside

Of English System AgeProfile

<100 Percent>

Initial Career Post WithCESR Age Profile

<100 Percent>


English System Age Profile

<100 Percent>


Rejoin Age Profile

<100 Percent>


Age Profile<100 Percent>


Core Training Age Profile

<100 Percent>



<100 Percent>

Annual Career Post WithoutCESR Rejoin Age Profile

<100 Percent>

Initial Career Post WithoutCESR Age Profile

<100 Percent>


System Profile

<100 Percent>

<100 Percent>


Outside Of English SystemAge Profile

<100 Percent>

<100 Percent>


System Age Profile

<100 Percent>

<100 Percent>

Career Post WithCESR Age Ratio

Career Post WithoutCESR Age Profile

<100 Percent>


Training Age Profile

<100 Percent>

Number Complete CoreStart Seeking Career

Post

<TIME STEP>


<Career PostCompleted Core

Training Age Profile>

<TIME STEP>

<TIME STEP>

<100 Percent>

AgingS TCP

AgingGP T

AgingGP T

AR LS

AgingGP TAR

SToCP

GP Training TOTALBy Age

AgingS GP Aging

GP

<TIME STEP>

GP TOTAL By COO

AgingRT T

Aging RT T AR STorCP

AgingRT TAR

SToCP

AgingHCtoGP T

Start Hospital Consultantto GP Conversion Training

TOTAL


Conversion TrainingTOTAL

<100 Percent>

AgingHCAging

S HC

AgingCP

AgingCPw

CESR

AgingCPwCT

AgingSCPoT wCT

AgingCT T

AgingCT ARSTorCP

AgingCT AR

LS

AgingHS T

AgingHS T

AR LS

Aging HS T AR SCPoT


Career Post WithoutCESR Age Profile By

Age Band

Career Post Attrition Rate

<Career Post Attrition Rate>



Core Training TOTALBy Age

Core TrainingRATIO Age

GP TOTAL By AgeGP RATIO By Age

<100 Percent>

<Start Seeking HigherSpecialty Training

From Career Post>

<Seeking Training or Career Post>

Career Post WithoutCESR TOTAL By COO

GP Training NewEntrants From English

System

<TIME STEP>


Training Run ThroughNew Entrants From

English System

<TIME STEP>

Start Core From EnglishSystem TOTAL

<TIME STEP>



<Percentage StartHigher Specialty

Training>


Hospital ConsultantTOTAL By COO

Hospital ConsultantTOTAL By Gender

<Percentage Complete RunThrough Training And Leave

System>

<Percentage of theStudents that start F1 that

will Drop Out>

<Start and Continue GPTraining By Remaining

Delay>

<Career Post WithCESR>

<Career Post WithCESR Age Ratio>


Training>

F1 CompleteAttrition Leave

System

<100 Percent>

Pass F1

<100 Percent>

<Percentage CompleteF1 And Leave SystemIncluding F2 Limits>

<Percentage CompleteMedical School And Leave

System Including F1 Limits>

<INITIAL TIME>

<Time>

<INITIAL TIME>

<Time>

Start Consultant CT FromCareer Post TOTAL

Start Consultant RT FromCareer Post TOTAL

Start Consultant GP TrainingRT From Career Post TOTAL


<Time>

Annual Medical School IntakeFrom England Age Profile


Country Age Profile


Initial Foundation 1 AgeProfile


Annual F2 Intake FromOutside Of EnglishSystem Age Profile






<100 Percent>

<100 Percent> <100 Percent>

<100 Percent>

AgingF2

AgingF1

AgingMS

Start MedicalSchool


Complete Study Yearand Progress To Next

Year

Start AndContinue Medical

School

<TIME STEP>

Foundation Year 2TOTAL By Age

Finish F2 TOTAL

<TIME STEP>

Sum Finish F2 AgeMS F

Sum Finish F2 AgeWorkforce

<Flag Aging Trigger>

<Flag AgingTrigger>

<Flag AgingTrigger>

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<100 Percent>

<TIME STEP>

<Time>

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<GP Attrition Rate IncScn and Pol and Max

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GP Attrition RateTOTAL

<100 Percent>

<TIME STEP>

<1 Year>

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<1 Year>

<Career Post AttritionRate Inc Scn and Pol and

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<Start Seeking Training orCareer Post After Career

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<TIME STEP>

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<Career Post With CESRBecome Hospital

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<TIME STEP>

<1 Year>

<Career Post Attrition RateInc Scn and Pol and Max

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Pass F2 And StayIn System TOTAL

<TIME STEP>

Career Post With CESRBecome HospitalConsultant TOTAL

<TIME STEP>



and COO

GP Training TOTALBy Gender and COO

GP TOTAL By Genderand COO

Run Through TrainingTOTAL By Gender and

COO

Core Training TOTALBy Gender and COO

Higher SpecialtyTraining TOTAL ByGender and COO

Hospital ConsultantTOTAL By Gender and

COO


and COO Career Post WithCESR TOTAL ByGender and COO

Career Post CompletedCore Training TOTAL By

Gender and COO

Hospital Consultant to GPTraining TOTAL ByGender and COO

<Start GP Training ToMeet Desired Places>

<Time>

<TIME STEP>

<Start Run ThroughTraining To Meet Desired

Places>

<Start Core Training ToMeet Desired Places>

<Start Higher SpecialtyTraining To Meet Desired

Places>

HospitalConsultant

Attrition RateTOTAL

<100 Percent>

Hospital ConsultantTOTAL Percentage

Increase

<100 Percent>

<TIME STEP>

Number CompletingRun Through

Training

<TIME STEP>


Number CompletingGP Training Core By

Gender

<TIME STEP>




will Drop Out>

<Initial Hospital Consultant>

<Time>

GP Total By 10 YrAge Bands

Hospital ConsultantTOTAL By Age

Hospital ConsultantTotal By 10 Yr Age

Bands


Age<TIME STEP>

Number Completing GPTraining Core By AgeBy 10 Yr Age Bands

<Start Seeking HospitalConsultant Position after

Higher Specialty Training>

<Start Seeking HospitalConsultant Position after Run

Through Training>

<Start HospitalConsultant to GP

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If this structure isimplemented may want toconsider using a different

delay type



Length>

<Initial CoreTraining By Delay

Length>


Length>

Hospital ConsultantAttrition Rate Fixed

for 12 Months

<100 Percent>

FlagAttritionTrigger

Fixed AttritionRate Start Date<Time>

<TIME STEP>

<INITIAL TIME>

GP Attrition Rate Fixedfor 12 Months

<FlagAttritionTrigger>

<100 Percent> <TIME STEP>

<1 Year>

Career Post WithCESR Attrition RateFixed for 12 Months


<100 Percent>Career Post WithoutCESR Attrition RateFixed for 12 Months

<FlagAttritionTrigger><100 Percent>


Rate Fixed for 12 Months


<100 Percent>

GP TrainingAttrition Delayed by

1TS

<TIME STEP>

Run Through TrainingAttrition Delayed by

1TS

<TIME STEP>

Core TrainingAttrition Delayed by

1TS

<TIME STEP>

Higher SpecialtyTraining AttritionDelayed by 1TS

<TIME STEP>


TOTAL by Age

<TIME STEP>


<1 Year>

<1 Year>

<1 Year>

<1 Year>

<Percentage TrainingEntrants From English

System Start GPTraining>

Complete F1TOTAL

<TIME STEP>


Number Completing GPTraining Core

<TIME STEP>

Start GP TrainingFrom F2 TOTAL


Start GP TrainingFrom Career Post

TOTAL

Start Run ThroughTraining From F2

TOTAL


Start Run ThroughTraining From Career

Post TOTAL

Start CoreTraining From F2

TOTAL


Start Core TrainingFrom Career Post

TOTAL

Number Start HST fromCareer Post


Start HST fromEnglish System

TOTAL


<TIME STEP>

<TIME STEP>

<Higher Specialty TrainingAttrition Start Seeking

Training Or Career Post>

<Complete ConsultantTraining Core Start Seeking

Career Post>

<TIME STEP>

<GP Run Through TrainingAttrition Rate Start Seeking


<Run Through TrainingAttrition Rate Start Seeking


<Core TrainingAttrition Start Seeking

Training Or CareerPost>

<Start Seeking HigherSpecialty Training From

Career Post>

<TIME STEP>

Development


20

Medical SchoolEnglandStart Medical

School English

Start MedicalSchool From OOC

Medical SchoolAttrition

CompleteMedical School

Medical SchoolComplete Attrition

Leave System

FoundationYear 1

Start F1

Resit F1

FoundationYear 2

Start F2

Resit F2



Finish F1 Finish F2

Start F1 FromOES

Start F2 FromOES


Core TrainingHigher

SpecialtyTraining

Run ThroughTraining

GP Training

Career PostWithout CESR

GP

HospitalConsultant

Start GP TrainingFrom English

System

Start Core TrainingFrom English Medical

System

Start Run ThroughTraining From English

System

Complete CoreTraining

Start HigherSpecialty

Training fromEnglish Medical

System


Complete GPTraining

HospitalConsultant toGP Training

Start HospitalConsultant to GP

Conversion Training


Conversion Training

Seeking GPPosition Start GP Position

Following Training

SeekingHospital

ConsultantPosition



Start GP TrainingFrom OES

Start Core TrainingFrom OES

Start Run ThroughTraining From OES


From OES

Start GP PositionFrom OES


From OES

Start CareerPost

Career PostWith CESRCareer Post

Gains CESR

Career Post With CESRBecome Hospital

Consultants

Start Seeking Trainingor Career Post After

Career Post

Start SeekingGP Position

Complete GPTraining Leave

System


Leave System

Start Seeking HospitalConsultant Position after

Run Through Training


Leave System

Complete CoreTraining Leave

System

Complete ConsultantTraining Core Start

Seeking Career Post

GP Training AttritionLeave Medical System

GP Run Through TrainingAttrition Rate Start Seeking


Run Through TrainingAttrition Rate Leave

SystemRun Through TrainingAttrition Rate Start Seeking


Higher SpecialtyTraining Attrition Rate

Leave System

Higher Specialty TrainingAttrition Start Seeking

Training Or Career PostCore Training

Attrition Rate LeaveSystem

Core Training AttritionStart Seeking Training

Or Career Post

Career Post AttritionRate Leave System

Career Post WithCESR Leave System

Start Career PostWith CESR From

OES

Start CareerPost From OES

GP AttritionLeave System

Hospital ConsultantAttrition Leave System

Complete F2 StartSeeking Training or

Career Post

Pass F2 LeaveSystem

Percentage of MedicalSchool Intake That Will Drop

Out

<100 Percent>


Out

<100 Percent>


<100 Percent>


<100 Percent>


<100 Percent>


Pass F2

Percentage Student PassF2 And Leave System

<100 Percent>

GP Attrition Rate

<100 Percent>

Initial GP

Initial Hospital Consultantsin GP training

Hospital Consultant AttritionRate

Initial Hospital Consultant

<100 Percent>

Percentage Career PostGain CESR Per Year

Initial Career Post

<100 Percent>

GP Training Attrition RateLeave Medical System

<100 Percent>

GP Training Attrition RateSeeking Training or Career

Post

<100 Percent>

Percentage Complete GPTraining And Leave System<100 Percent>

Time to find GP Position

Run Through TrainingAttrition Rate Leave Medical

System

<100 Percent>

Run Through TrainingAttrition Rate SeekingTraining or Career Post

<100 Percent>

Start SeekingHospital ConsultantPosition after Higher

Specialty Training

Percentage Complete RunThrough Training And Leave

System

<100 Percent>

Percentage CompleteHigher Specialty Training

And Leave System

<100 Percent>Time to find HospitalConsultant position

Initial Seeking HospitalConsultant Position

Initial Seeking GP Position

Core Training Attrition RateLeave Medical System

<100 Percent>

Core Training Attrition RateSeeking Training or Career

Post

<100 Percent>

<100 Percent>

Percentage Complete CoreTraining And Leave System

<100 Percent>

Higher Specialty TrainingAttrition Rate Leave Medical

System

Higher Specialty TrainingAttrition Rate SeekingTraining or Career Post

<100 Percent>

Initial Seeking Training orCareer Post

Initial Career Post WithCESR

Average Time to find CareerPost

<100 Percent>

<100 Percent>

<100 Percent>

Annual Medical SchoolIntake From England

FLAG StartAccademic Year

<Time>

<TIME STEP>

Accademic YearStart Date

Time Spent In MedicalSchool By DelayLength


Country

<TIME STEP>

<100 Percent>

1 Year

<100 Percent>

Complete F2Including Attrition


Out

<100 Percent>

<100 Percent>



<100 Percent>

GP Training LengthIncluding Delay Percentage

Start GPTraining

Start and Continue GPTraining By Remaining

Delay

<100 Percent>


Complete GPTraining

Accademic Year

<TIME STEP>

<TIME STEP>

<TIME STEP>


Complete GP Trainingand Progress To Next

Year

Start RunThrough Training

Start and Continue RunThrough Training By

Remaining Delay Run Through Training LengthIncluding Delay Percentage

<TIME STEP>


<TIME STEP>

Complete RunThrough TrainingAccademic Year

<TIME STEP>

Complete Run ThroughTraining and Progress To

Next Year

<100 Percent>

Start CoreTraining

Start and ContinueCore Training ByRemaining Delay

<TIME STEP>


<TIME STEP>

Complete Core TrainingAccademic Year

<TIME STEP>

Complete CoreTraining and Progress

To Next Year

<100 Percent>


Start and Continue HigherSpecialty Training By

Remaining Delay

Higher Specialty TrainingLength Including Delay

Percentage

<100 Percent>


<TIME STEP>


<TIME STEP>

Complete HigherSpecialty TrainingAccademic Year

<1 Year>

Complete HigherSpecialty Training andProgress To Next Year

<100 Percent>

Foundation Year 2TOTAL

Seeking Training orCareer Post TOTAL

GP Training TOTAL

Run Through TrainingTOTAL

Core Training TOTAL

Higher SpecialtyTraining TOTAL

Career Post WithoutCESR TOTAL

Career Post WithCESR TOTAL

Seeking HospitalConsultant Position

TOTAL

Hospital ConsultantTOTAL

Hospital Consultant toGP Training TOTAL

Seeking GPPosition TOTAL

GP TOTAL

<TIME STEP>


<100 Percent>

GP Training NewEntrants


<TIME STEP>

Foundation TOTAL

Training RunThrough New

Entrants

<TIME STEP>


Higher Specialty TrainingNew Entrants

<TIME STEP>


<TIME STEP>


Number of CCTConsultant Per Year

<TIME STEP>


Number CompletingCore Training

<TIME STEP>


Start ConsultantTraining Core TOTAL

<TIMESTEP> <FLAG Start

Accademic Year>

Pass F2 TOTAL

<TIME STEP>


Number of CompletingConsultant Training

HS

<TIME STEP>


<100 Percent>

<Time>

<INITIAL TIME>

<Time>

<INITIAL TIME>

<INITIAL TIME>

<Time>

<INITIAL TIME>

<Time>

<INITIAL TIME>

<Time>

<INITIAL TIME>

<Time><INITIAL TIME>

<Time>

<100 Percent>

<100 Percent>

<INITIAL TIME> <Time>

<INITIAL TIME>

<Time> <INITIAL TIME>

<Time>

<100 Percent>

<INITIAL TIME>

<Time>



<INITIAL TIME>

<Time><TIME STEP>

<INITIAL TIME>

<Time>

<TIME STEP>

<Time>

<INITIAL TIME>

<Time>


<TIME STEP><FLAG StartAccademic Year>


<FLAG StartAccademic Year> <TIME STEP>


System

<TIME STEP>

<INITIAL TIME>

<Time>


System

<INITIAL TIME>

<TIME STEP>



System <INITIAL TIME>

<Time> <TIME STEP>


Outside Of English System


<TIME STEP>


Of English SystemAnnual Career Post With

CESR Intake From OutsideOf English System

Annual Hospital ConsultantIntake From Outside Of

English System



<TIME STEP>

<TIME STEP>

<TIME STEP>

GP TOTAL By Gender

Start Consultant or GPTraining From Career

Post

Start Higher SpecialtyTraining From Career

Post

<TIME STEP>

Time to CompleteConsultant to GP

Conversion Training

Annual Hospital ConsultantStart GP Conversion

Training

<TIME STEP>

<INITIAL TIME>

CompleteConsultant Core

Training AvailableFor Higher

Specialty Training

<TIME STEP>

Start Consultant or GPTraining Core Career Post

TOTAL


GP Training TOTALBy Gender


Run Through TrainingTOTAL By Gender

Core Training TOTALBy Gender

<Initial Medical SchoolBy Completion Year>

<Start Core TrainingFrom F2>


<Start GP Training FromF2>


<Start Run ThroughTraining From F2>


Post>




Length>



Length>

<Initial HigherSpecialty TrainingBy Delay Length>


Length>

<Initial Core TrainingBy Delay Length>

Core Training LengthIncluding Delay Percentage

<Initial Core Training ByDelay Length>

Start GP PositionRejoiners

Annual GP Rejoiners


Rejoiner

Annual Hospital ConsultantRejoiners

Start Career PostWith CESR Rejoiner

Annual Career Post WithCESR Rejoin

Start CareerPost Rejoiners

Annual Career Post WithoutCESR Rejoin


InputStringTimeLine

<TIME STEP>





TimeLine>

<InputStringTimeLine><InputString

TimeLine>




TimeLine>




TimeLine>
















































Start Consultant C RT orGP Training RT FromCareer Post TOTAL

<TIME STEP>

Start Career PostTOTAL

<100 Percent>

Annual Career Post WithCESR Become Hospital

Consultants


<TIME STEP>


Core Trained

Seeking Training orCareer Post Completed

Core Training TOTAL

Career PostCompleted

Core Training


Training Gains CESR


Rate Leave System


Training From OES

<100 Percent>


<100 Percent>


English System



By Gender


Training Rejoiners


Rejoin




Training

<Average Time to findCareer Post>

<Percentage Career PostGain CESR Per Year>

<100 Percent>


Core Training <InputStringTimeLine>

<Number Start HigherSpecialty Training FromCareer Post Completed

Core Training>

Start Seeking HigherSpecialty Training From

Career Post

<TIME STEP>

<Number Start Higher SpecialtyTraining From Career PostCompleted Core Training>




Post>


Foundation Year 2TOTAL Gender Ratio

Start F2 TOTAL

<TIME STEP>


Start F1 TOTAL

<TIME STEP>

GP Training GenderRatio


<Time>

Initial Seeking Training OrCareer Post Age Profile

<100 Percent>


System Age Profile

<100 Percent>

Initial Seeking GP PositionAge Profile

<100 Percent>

Initial GP Age Profile

<100 Percent>


Age Profile

<100 Percent>

Start GP Position RejoinersAge Profile

<100 Percent>

Initial Hospital Consultant toGP Training Age Profile

<100 Percent>

Initial Hospital ConsultantAge Profile

<100 Percent>Annual Hospital Consultant

Intake From Outside OfEnglish System Age Profile

<100 Percent>

Annual Hospital ConsultantRejoiners Age Profile

<100 Percent>

Seeking Hospital ConsultantPosition Age Profile

<100 Percent>

Annual Career Post WithCESR Rejoin Age Profile

<100 Percent>

Annual Career Post WithCESR Intake From Outside


<100 Percent>

Initial Career Post WithCESR Age Profile

<100 Percent>


English System Age Profile

<100 Percent>


Rejoin Age Profile

<100 Percent>


Age Profile<100 Percent>


Core Training Age Profile

<100 Percent>



<100 Percent>

Annual Career Post WithoutCESR Rejoin Age Profile

<100 Percent>

Initial Career Post WithoutCESR Age Profile

<100 Percent>


System Profile

<100 Percent>

<100 Percent>


Outside Of English SystemAge Profile

<100 Percent>

<100 Percent>


System Age Profile

<100 Percent>

<100 Percent>

Career Post WithCESR Age Ratio

Career Post WithoutCESR Age Profile

<100 Percent>


Training Age Profile

<100 Percent>

Number Complete CoreStart Seeking Career

Post

<TIME STEP>


<Career PostCompleted Core

Training Age Profile>

<TIME STEP>

<TIME STEP>

<100 Percent>

AgingS TCP

AgingGP T

AgingGP T

AR LS

AgingGP TAR

SToCP

GP Training TOTALBy Age

AgingS GP Aging

GP

<TIME STEP>

GP TOTAL By COO

AgingRT T

Aging RT T AR STorCP

AgingRT TAR

SToCP

AgingHCtoGP T

Start Hospital Consultantto GP Conversion Training

TOTAL


Conversion TrainingTOTAL

<100 Percent>

AgingHCAging

S HC

AgingCP

AgingCPw

CESR

AgingCPwCT

AgingSCPoT wCT

AgingCT T

AgingCT ARSTorCP

AgingCT AR

LS

AgingHS T

AgingHS T

AR LS

Aging HS T AR SCPoT


Career Post WithoutCESR Age Profile By

Age Band

Career Post Attrition Rate




Core Training TOTALBy Age

Core TrainingRATIO Age

GP TOTAL By AgeGP RATIO By Age

<100 Percent>

<Start Seeking HigherSpecialty Training

From Career Post>

<Seeking Training or Career Post>

Career Post WithoutCESR TOTAL By COO

GP Training NewEntrants From English

System

<TIME STEP>


Training Run ThroughNew Entrants From

English System

<TIME STEP>

Start Core From EnglishSystem TOTAL

<TIME STEP>




Training>


Hospital ConsultantTOTAL By COO

Hospital ConsultantTOTAL By Gender

<Percentage Complete RunThrough Training And Leave

System>


will Drop Out>

<Start and Continue GPTraining By Remaining

Delay>

<Career Post WithCESR>

<Career Post WithCESR Age Ratio>


Training>

F1 CompleteAttrition Leave

System

<100 Percent>

Pass F1

<100 Percent>

<Percentage CompleteF1 And Leave SystemIncluding F2 Limits>

<Percentage CompleteMedical School And Leave

System Including F1 Limits>

<INITIAL TIME>

<Time>

<INITIAL TIME>

<Time>

Start Consultant CT FromCareer Post TOTAL

Start Consultant RT FromCareer Post TOTAL

Start Consultant GP TrainingRT From Career Post TOTAL


<Time>

Annual Medical School IntakeFrom England Age Profile


Country Age Profile










<100 Percent>

<100 Percent> <100 Percent>

<100 Percent>

AgingF2

AgingF1

AgingMS

Start MedicalSchool


Complete Study Yearand Progress To Next

Year

Start AndContinue Medical

School

<TIME STEP>

Foundation Year 2TOTAL By Age

Finish F2 TOTAL

<TIME STEP>

Sum Finish F2 AgeMS F

Sum Finish F2 AgeWorkforce

<Flag Aging Trigger>

<Flag AgingTrigger>

<Flag AgingTrigger>

<Flag AgingTrigger>

<Flag AgingTrigger>

<Flag AgingTrigger>

<Flag AgingTrigger> <Flag Aging

Trigger>

<Flag AgingTrigger>

<Flag AgingTrigger>

<Flag AgingTrigger>

<Flag AgingTrigger>

<Flag AgingTrigger>

<Flag AgingTrigger>

<Flag AgingTrigger>

<Flag AgingTrigger>

<Flag AgingTrigger>

<Flag AgingTrigger>

<Flag AgingTrigger>

<Flag AgingTrigger>

<Flag AgingTrigger>

<Flag AgingTrigger>

<Flag AgingTrigger>

<Flag AgingTrigger>

<Flag AgingTrigger>

<100 Percent>

<TIME STEP>

<Time>

<INITIAL TIME>

<GP Attrition Rate IncScn and Pol and Max

Age Adj>

GP Attrition RateTOTAL

<100 Percent>

<TIME STEP>

<1 Year>

<Hospital ConsultantAttrition Rate Inc Scn and

Pol and Max Age Adj>

<1 Year>


Max Age Adj>

<Start Seeking Training orCareer Post After Career

Post>

<TIME STEP>

<1 Year>


Max Age Adj>

<Career Post With CESRBecome Hospital

Consultants>

<TIME STEP>

<1 Year>

<Career Post Attrition RateInc Scn and Pol and Max

Age Adj>

<1 Year>

Pass F2 And StayIn System TOTAL

<TIME STEP>

Career Post With CESRBecome HospitalConsultant TOTAL

<TIME STEP>



and COO

GP Training TOTALBy Gender and COO

GP TOTAL By Genderand COO

Run Through TrainingTOTAL By Gender and

COO

Core Training TOTALBy Gender and COO

Higher SpecialtyTraining TOTAL ByGender and COO

Hospital ConsultantTOTAL By Gender and

COO


and COO Career Post WithCESR TOTAL ByGender and COO

Career Post CompletedCore Training TOTAL By

Gender and COO

Hospital Consultant to GPTraining TOTAL ByGender and COO

<Start GP Training ToMeet Desired Places>

<Time>

<TIME STEP>

<Start Run ThroughTraining To Meet Desired

Places>

<Start Core Training ToMeet Desired Places>

<Start Higher SpecialtyTraining To Meet Desired

Places>

HospitalConsultant

Attrition RateTOTAL

<100 Percent>

Hospital ConsultantTOTAL Percentage

Increase

<100 Percent>

<TIME STEP>

Number CompletingRun Through

Training

<TIME STEP>



Gender

<TIME STEP>




will Drop Out>

<Initial Hospital Consultant>

<Time>

GP Total By 10 YrAge Bands

Hospital ConsultantTOTAL By Age

Hospital ConsultantTotal By 10 Yr Age

Bands


Age

<TIME STEP>

Number Completing GPTraining Core By AgeBy 10 Yr Age Bands

<Start Seeking HospitalConsultant Position after

Higher Specialty Training>

<Start Seeking HospitalConsultant Position after Run

Through Training>

<Start HospitalConsultant to GP

Conversion Training>

If this structure isimplemented may want toconsider using a different

delay type



Length>

<Initial CoreTraining By Delay

Length>


Length>

Hospital ConsultantAttrition Rate Fixed

for 12 Months

<100 Percent>

FlagAttri tionT rigger

Fixed AttritionRate Start Date<Time>

<TIME STEP>

<INITIAL TIME>

GP Attrition Rate Fixedfor 12 Months

<FlagAttri tionT rigger>

<100 Percent> <TIME STEP>

<1 Year>

Career Post WithCESR Attrition RateFixed for 12 Months


<100 Percent>Career Post WithoutCESR Attrition RateFixed for 12 Months

<FlagAttri tionT rigger><100 Percent>


Rate Fixed for 12 Months


<100 Percent>

GP TrainingAttrition Delayed by

1TS

<TIME STEP>

Run Through TrainingAttrition Delayed by

1TS

<TIME STEP>

Core TrainingAttrition Delayed by

1TS

<TIME STEP>

Higher SpecialtyTraining AttritionDelayed by 1TS

<TIME STEP>


TOTAL by Age

<TIME STEP>


<1 Year>

<1 Year>

<1 Year>

<1 Year>

<Percentage TrainingEntrants From English

System Start GPTraining>

Complete F1TOTAL

<TIME STEP>


Number Completing GPTraining Core

<TIME STEP>

Start GP TrainingFrom F2 TOTAL


Start GP TrainingFrom Career Post

TOTAL

Start Run ThroughTraining From F2

TOTAL


Start Run ThroughTraining From Career

Post TOTAL

Start CoreTraining From F2

TOTAL


Start Core TrainingFrom Career Post

TOTAL

Number Start HST fromCareer Post


Start HST fromEnglish System

TOTAL


<TIME STEP>

<TIME STEP>

<Higher Specialty TrainingAttrition Start Seeking


<Complete ConsultantTraining Core Start Seeking

Career Post>

<TIME STEP>

<GP Run Through TrainingAttrition Rate Start SeekingTraining Or Career Post>

<Run Through TrainingAttrition Rate Start SeekingTraining Or Career Post>

<Core TrainingAttrition Start Seeking

Training Or CareerPost>

<Start Seeking HigherSpecialty Training From

Career Post>

<TIME STEP>

Data included… Historic range Source

Accepted applicants to preclinical dentistry 2007 –11 UCAS

Medical school intakes 2007–11 Higher Education Funding Council for England

Foundation programme data 2011 Foundation Programme Annual ReportMedical and GP workforce census for England 2008–11 Health and Social Care Information

CentreNational population projections 2010 Office for National Statistics

Hospital episode statistics for England 2010 –11 Health and Social Care Information Centre

Scenario data

Policy data

Development


21

Testing included: 1. Independent CfWI testing 2. Comparison with medical workforce models3. Review of the results with relevant stakeholders 4. Sensitivity analysis

Documentation and Testing

Full model documentation and independent validation and verification (V&V)

22

30000

35000

40000

45000

50000

55000

60000

65000

70000

75000

80000

2010 2020 2030 2040

FTE

Year

Supply: scenario 1 & 2

Supply after policy: scenario 1 & 2

Demand: scenario 1 & 2

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

4.0%

20 30 40 50 60 70 80

Distr

ibut

ion

Age

Now2040

-40000

-30000

-20000

-10000

0

10000

20000

30000

40000

-40000 -20000 0 20000 40000

Chan

ge in

cum

ulat

ive

disc

repa

ncy

Change in cumulative cost

Policy 1

Policy 2

Policy 3

Scenario 1

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2011 2016 2021 2026 2031 2036

Year

Percentage of workforce female

Percentage of workforce male

Analysis tools

• Create, store and edit future

scenarios

• Create, store and edit potential

policies

• Store the results of multiple

simulations

• View and analyse the results of

multiple scenarios

Policy Analysis

Analyse the scenarios, and the impact of the levers we can control (potential strategies or policies) across scenarios

Contents




planning framework

Impact…

Future supply of doctors will exceed future demand in all scenarios examined

Influenced HENSE group to recommend a 2% reduction in medical school intake from 2013, to be reviewed in 2014 and regularly at 3yr intervals. approx 120 medical students £50 Million saving per year

Many policy options tested, including rebalancing primary and secondary workforce.

Reflections on the project

Strong stakeholder buy-in to a completely new approach

System dynamics modelling ‘made sense’ Using scenarios to test policies proved highly

effective Major decisions were taken – to reduce medical

intake and not change dental intake Enabled policy makers to recognised uncertainty

of the future Approach accepted by DoH and has been/is

being used for: Pharmacy Psychiatry General practitioner Anaesthetics & Intensive care medicine

Robust workforce planning for the English medical workforce

Dr Graham Willis - Head of Research and Development Dr Andrew Woodward - Lead ModellerDr Siôn Cave - Decision Analysis Services LtdThe CfWI produces quality intelligence to inform better workforce planning that improves people’s lives

cfwi sd boston v1

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