We are committed to a robust, transparent and evidenced-based approach to decommissioning postgraduate training posts, working in collaboration with our stakeholders.  

Introduction

This section sets out the process the Deanery follows for decommissioning PGMDE training posts.

Regulatory

The Deanery decommissioning process is informed by guidance from the Centre for Workforce Intelligence (CfWI) Report 2011and NHS London workforce planning.

Specifically, London Deanery will seek to decommission posts where:

• There are significant concerns about the quality or safety of patient care
• The post is persistently failing to deliver curricula, regulatory or contractual requirements
• Service reconfiguration results in a post being no longer able to deliver essential elements of the curriculum
• There is a need to reduce the number of posts in a speciality across London because of  national or local (London) workforce planning predictions
• There is a need to use London’s educational resources to maximum benefit for trainees and for patients e.g. to improve consultant : trainee ratio.
  

Process

Guiding principles to underpin the process of decommissioning training posts were developed by HoSs and agreed with the LCMDE Management Group in November 2010. These have been developed further to reflect the maturation of the commissioning system and evolving responsibilities. They are:

• Decommissioning of training posts or removal of trainees will always be undertaken safely, with consideration to the quality and safety of patient care and service and with appropriate notice where possible. It is acknowledged that there may be times when the evidence is deemed serious enough to remove posts/trainees with immediate effect.
• Training posts may be decommissioned for a variety of reasons (see 2.2 above). In all circumstances, the Commissioner will work in partnership with the LEP and LP (for a commissioned specialty) to ensure a safe transition and to ensure that communication  with all parties – including trainees who may be affected by changes – is open and transparent.
• The professional judgment of the HoS (or equivalent) and the specialty lead of the relevant LP will be sought to shape decommissioning recommendations to the LCMDE Management Group. This will ensure that any decision taken is evidence based, drawn from specialist knowledge and locally supported.
• As far as possible, a standard set of quality criteria will be used as the basis for decommissioning decisions. In some circumstances e.g. craft specialties, additional specialty-specific criteria may be required.
• The HoS and the LP will advise the Commissioner if they consider that there are systemic issues across a LEP necessitating an examination of the quality of training posts in other specialties.
• The suspension of training posts or removal of trainees will be a managed process involving both the medical director and director of medical education of the affected trust.
• Through the Strategic Partnership Board, LETB design leads will be actively involved in the decommissioning process for 2012 .
• Through the LETB Transitional Boards and LETC, LETBs will be actively involved in framing the principles, criteria and processes to be established from 2013.

Where decommissioning is occurring because there is a need to reduce the number of posts in a speciality across London due to national or local (London) workforce planning predictions, or there is a need to use London’s educational resources to maximum benefit for trainees and for patients, training ‘quality’ will be used as the basis for decommissioning decisions.

The criteria to be adopted for 2012 – 2013 are represented below:

1. Persistently identified areas of concern as identified via the GMC training survey. In particular those LEPs that had received red triangles over two consecutive years, with a failure to demonstrate an improvement
2. Evidence taken from visits undertaken and feedback from trainees
3. Analysis of local Trust survey results if available and validated by LP
4. Posts that  have had a historic difficulty in being filled.

It is expected that specialities with fewer than 40 trainees will be protected from decommissions, unless there is evidence that  posts have been historically difficult to fill. 

Data/Evaluation

Decisions are based on the criteria outlined above.