Press Release

Minister for Health publishes final report of Strategic Review of Medical Training and Career Structure Working Group

The Minister for Health, Dr James Reilly TD, today (7 July 2014) launched the final report of the Strategic Review Working Group chaired by Professor Brian MacCraith (President, DCU)

This final report focuses on issues relating to strategic medical workforce planning and career planning and mentoring supports for trainee doctors and makes recommendations. It also addresses specific issues in relation to the specialties of public health medicine, general practice and the community-based aspects of psychiatry.

Welcoming the report, the Minister noted the Group’s work regarding strategic medical workforce planning. “For too long, we have struggled with forward planning of medical specialist posts in the public health system,” he said, “I would like to thank the Working Group for highlighting the historical deficiencies in our medical workforce planning and the steps that are now being taken to address them, notably HSE-MET’s Medical Workforce Planning Project”.

Commending Prof. MacCraith and the members of the Working Group for including an update in the final report on progress in advancing the Group’s previous recommendations, the Minister emphasised the importance of ensuring that all the Group’s recommendations are implemented in order to build a sustainable medical workforce for the future. “Prof. MacCraith and the Working Group have helpfully set out a number of recommendations about how we should move forward, in order to ensure that the recommendations are embedded in the day-to-day business practice of the health system. My Department and the HSE will now work together to put the necessary arrangements in place in order to drive and oversee implementation of all the recommendations of the Strategic Review and assess their impact into the future”.

Concluding, Minister Reilly expressed his sincere appreciation to Prof. MacCraith and the members of the Working Group for their time, expertise and commitment throughout the Review process. The Minister also thanked all those who engaged with the Working Group during the process and, in particular, the trainee doctors with whom the Group had met.


Notes for Editors

The Minister established the Working Group in 2013. It was tasked with examining and making high-level recommendations relating to training and career pathways for doctors with a view to:

  • Improving graduate retention in the public health system;
  • Planning for future service needs;
  • Realising maximum benefit from investment in medical education and training.

Click here for the terms of reference.

In all, the Group has submitted three reports: December 2013, April 2014 and June 2014. In total, across these reports, the Group has made 25 recommendations (see below for all recommendations) and prepared three high-level implementation plans, which address a range of challenges and issues relating to the recruitment and retention of doctors in the Irish public health system. In its final report, the Group also recommends the following in relation to implementation of Review recommendations:

  • As a matter of priority, the Department of Health and HSE should jointly agree and put in place appropriate multi-stakeholder arrangements to oversee continued implementation of the recommendations of the Review;
  • NCHD and Consultant retention rates in the public health system should be reported on a quarterly basis through the Health Service Performance Assurance Report;
  • Six monthly implementation reports should be submitted to the Minister for Health, and subsequently published.

Membership of the Working Group:

  • Prof. Brian MacCraith, President, DCU (Chair);
  • Ms Oonagh Buckley, Assistant Secretary, Department of Public Expenditure and Reform;
  • Dr Áine Carroll, Director of Clinical Programmes, HSE;
  • Dr Philip Crowley, Director, Quality and Patient Safety, HSE,
  • Mr Eunan Friel, Secretary, Forum of Irish Postgraduate Medical Training Bodies;
  • Dr Colm Henry, National Lead, Clinical Director Programme, HSE;
  • Dr Tony Holohan, Chief Medical Officer, Department of Health;
  • Mr Leo Kearns, National Lead for Transformation and Change, System Reform Group, HSE;
  • Prof. Eilis McGovern, National Programme Director for Medical Education, Medical Education and Training Unit, HSE;
  • Mr Barry O’Brien, National Director, Human Resources, HSE;
  • Dr Siobhan O’Halloran, Chief Nursing Officer, Department of Health;
  • Ms Caroline Spillane, Chief Executive Officer, Medical Council;
  • Ms Frances Spillane, Assistant Secretary, Department of Health;
  • Dr Barry White, Consultant Haematologist, St James’s Hospital.

Summary of Recommendations

Recommendations (December Report)

1 With regard to the quality of the training experience, and pending implementation of the hospital reconfiguration programme, the Working Group suggests that interim measures be identified by the HSE, employers and the training bodies with a view to protecting training time for both trainees and trainers.
2 In relation to non-core task allocation, the Working Group recommends that a national implementation plan should be put in place by the HSE to progress this matter. Examples of good practice exist at various clinical sites nationally and the plan should take account of these. The Working Group also notes the on-going process under the Haddington Road Agreement in this regard
3 With regard to duration of training, the Working Group recommends that specialties that have not already done so should urgently review their programmes in line with international norms. Due regard should be taken of patient safety and competence to practise independently at the end of training.
4 The Working Group considers that greater predictability at the outset of training schemes regarding locations of rotation would be beneficial for trainees and their families. The Group recommends that HSE-Medical Education and Training (HSE-MET) and the Forum of Irish Postgraduate Medical Training Bodies continue to work together to progress this on a specialty-by-specialty basis, so that all newly-appointed trainees are informed in advance of their placements/locations for the first two years of a training scheme. This should result in multi-year training agreements between the training body and trainee.
5 In view of the feedback from stakeholders and the emerging evidence from the Medical Council’s Workforce Intelligence Report, the Working Group considers that more flexible and differentiated approaches and options during training that take account of family, research or other constraints should be explored by HSE-MET and the Forum of Irish Postgraduate Medical Training Bodies. In this regard, the Working Group suggests that HSE-MET and the Forum of Postgraduate Irish Medical Training Bodies explore the implementation of a couple matching/family-friendly initiative for the July 2014 intake.
6 In relation to training supports, the Working Group considers that a more differentiated model that takes account of the needs of and costs associated with various specialties and stages of training would be beneficial. It recommends, in this regard, that HSE-MET review the funding mechanism for additional training requirements (such as examinations and courses) with a view to addressing disparities affecting certain trainees/specialties.
7 With regard to the paperwork burden associated with rotations, the Working Group recommends that the HSE and employers should jointly explore how processes can be streamlined. Addressing this issue would improve the quality of the employment experience for trainees, as rotations tend to be 6-monthly or annual.
8 With regard to improving communication, the Working Group recommends that measures to improve communication should be rolled out on a consistent basis by the HSE and hospital managements. The Working Group considers that the NCHD Lead initiative to be implemented during 2014 is an important step in this regard.
9 With a view to supporting career planning, the Working Group notes the importance of improving the feedback loop between HSE-MET and the training bodies and, in this regard, the Group welcomes HSE-MET’s plans to develop and implement a careers and training website for graduates, to be introduced on a pilot basis in early 2014.


Recommendations (April Report)

1 The Working Group recommends that the relevant parties commence, as a matter of urgency, a focused, timetabled IR engagement of short duration to address the barrier caused by the variation in rates of remuneration between new entrant Consultants and their established peers that have emerged since 2012. It further recommends that the relevant parties explore options, within existing contractual arrangements, to advance a more differentiated Consultant career structure as outlined in Section 5.3 (i.e. clinical service provision, clinical leadership and management, clinical research, academic, quality improvement and other roles).
2 With regard to developing opportunities for flexibility within the Consultant’s work commitment, the Working Group recommends the development and introduction of a system of accountable personal development/work planning for all Consultants, aligned with professional competence schemes, as appropriate. This system should build on the existing Clinical Directorate Service Plan process and take into account similar processes in other jurisdictions. In relation to quality improvement, the Working Group notes that there is a comprehensive programme of work in the health service to train people in quality improvement skills and it would be desirable for provision to be made in work plans for those who will lead in this field.
3 With regard to family-friendly flexible working, the Working Group recommends that more individually-tailored time commitments should be made available, and facilitated where possible, for both new and existing Consultant posts. With regard to all new Consultant posts, the Working Group recommends that recruitment notices should indicate that a flexible working facility is possible.
4 In relation to improving supports for newly appointed Consultants, the Working Group recommends that the personal development/work planning process for Consultants outlined in Recommendation 2 above, should include an outline of the resources required to achieve the service and personal objectives set out in the plan. These should be agreed at time of appointment and should be reviewed annually by the Consultant and Clinical Director/Employer in the context of changing objectives and the resources available to the Consultant team. In addition, in tandem with the development of work plans, the Working Group recommends that all newly appointed Consultants should be offered the opportunity to avail of an appropriately individualised induction programme upon appointment.
5 The Working Group recommends that the reconfiguration of hospital services should be used as an opportunity to address the barrier of the unattractiveness of the working environment in some Level 2 and Level 3 hospitals. In this regard, the Working Group recommends that Hospital Group strategic plans should include proposals for rationalisation of services with unscheduled care rosters. The Strategic Advisory Group (SAG) on the Implementation of Hospital Groups should define this as one of the criteria for the development and evaluation of these plans.
6 With regard to improving clarity around availability of Consultant posts by specialty and location, the Working Group recommends more centralised and coordinated workforce planning and better matching of new posts to service requirements and existing trainee capacity. The Group acknowledges the on-going work in HSE-MET to develop a model of medical workforce planning, which will be of significant assistance in this regard and will support appropriate, competitive succession planning. While recognising the value of international experience, the Working Group recommends the continued development of post-CSCST fellowship capacity in Ireland in order to retain specialist medical expertise in the public health system in advance of appointment to Consultant posts.

Recommendations (June Report)

Strategic Medical Workforce Planning
1 In the context of the current and future needs of the health system and Action 46 of Future Health (DoH, 2012), the Working Group recommends that an appropriate workforce planning structure is established at national level led by the Department of Health, in collaboration with other Government Departments and national agencies, to support inter alia strategic medical workforce planning on a cross-sectoral basis. This structure should link with any structures established by HSE-MET in the context of the MWP model being developed by the MWP Project.
2 As the availability of appropriate and accurate data is an essential tool for high-quality workforce planning, and in the context of the NCHD/Consultant databases developed by HSE-MET, the Working Group recommends that additional resource – including technical/specialist support – is provided for the HSE-MET medical workforce planning function in order to support its strategic objectives.
3 With regard to the current multi-step Consultant appointment process, the Working Group recommends that it should be re-designed and modernised as a matter of priority. A systems and service-wide approach to posts – both new and replacement – should be incorporated, that better balances local autonomy and national coordination – in line with the Hospital Group structures.
4 The Working Group recognises that, currently, there are in the region of 900 doctors in service posts in the acute hospital sector and c. 260 public and community health doctors, and notes that career structures and pathways for these doctors are limited. The Group recommends that processes are put in place by the HSE, as a matter of priority, to consider how best to address this issue, having due regard to the following:

  • The needs and requirements of the public health system, including service reconfiguration and integrated models of care;
  • Patient safety and quality of the patient experience;
  • Registration, qualifications and training, clinical governance, CPD and supervisory arrangements.
Public Health Medicine
5 In the context of Action 46 of Future Health (DoH, 2012), Healthy Ireland (DoH, 2013) and emerging service developments, as well as national and regional demand for public health expertise, the Working Group recommends that a working group is established to examine matters including the following and make recommendations as appropriate:

  • The current and future role of the public health specialist in Ireland, including the appropriate skill mix in relation to public health functions;
  • The attractiveness of public health medicine as a career option;
  • The curriculum and content of the specialist training scheme, and associated administrative arrangements relating to the rotation of trainees around the system;
  • Any requirement for post-CSCST sub-specialisation;
  • The replacement rates required to fill existing public health specialist posts in order to ensure the viability of the specialist training scheme and any expansion that may be required to plan for future service developments;
  • Measures to enhance the awareness of public health medicine as a career option at undergraduate level and during the Intern year.
General Practice
6 In the context of trainee feedback regarding current barriers to the establishment of practices on completion of specialist training and preferences for patterns of work in the future, the Working Group recommends that the appropriate parties further investigate these issues. This could usefully involve exploration of the following:

  • Introduction of GMS contracts that allow for flexible working;
  • Measures to encourage newly qualified GPs to remain in Ireland at the end of training.
7 In the context of the Framework Agreement concerning the GMS/GP contract, and in line with the Programme for Government, the Working Group recommends that the GMS contract should reflect the needs of the patients, including inter alia the need to provide structured chronic disease management in primary care.
8 The Working Group notes HSE Mental Health Division’s plans to address foundational issues within mental health services (HSE, 2014: 48) and recommends that this work should include appropriate consideration of the working environment and physical safety aspects.
Career Planning and Mentoring Supports
9 In the context of HSE-MET’s MWP project and the establishment of career planning supports, including the Medical Council and HSE careers websites, the Working Group recommends that outputs/projections from the MWP planning model are fed back through these and other media in order to provide greater clarity for medical students and trainees on opportunities for doctors in the health system on completion of specialist training.
10 The Working Group notes the work already commenced in relation to the development of mentoring supports and systems across all training programmes. The Group recommends that this work should continue and be expedited as part of the work programme of the multi-stakeholder retention steering group that that was established to address the recommendations of the December report. This work should also take cognisance of the HRB Review.