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Tackling the shortages: More consultants more trainees new training arrangements

8.10 As a result of the new funding for the NHS announced in the NHS Plan, and the introduction of three year allocations, NHS trusts will be able to plan for consultant expansion with confidence.

8.11 Special priority has been given to increasing the number of training places for cancer consultants. By 2006 there will be nearly 1,000 extra cancer specialists, (based on the numbers currently in training and the expected retirement rate). This will mean an increase in the numbers of cancer doctors since 1999 of nearly a third. Extra surgeons, many of whom treat cancer are on top of this number.

8.12 Other specialities which are also crucial to the treatment of cancer will also be increasing. For example, over the same period the number of urologists, (who are needed to achieve reductions in waiting times for prostate and bladder cancer treatment), will increase by an extra 123 - an increase of 32%. The number of gastroenterologists, who investigate and care for patients with gastro-intestinal cancers, will increase by 208 - an increase of over 50%. And the number of general surgeons will increase by an extra 257 - an increase of 20%.

Employing new consultants

8.13 The cancer workforce strategies to be agreed by cancer networks, including NHS trusts (see Chapter 11), should set out plans to recruit the additional staff needed to implement cancer service developments. Regional Offices and the National Cancer Director will assess the viability of network plans, taking into account the total number of consultants in each specialty that will be available nationally and the need to tackle inequalities in the distribution of cancer staff.

Training more consultants

8.14 These increases in consultant numbers by 2006 will help. But the NHS will still need more cancer doctors to meet all the future demand.

8.15 The National Cancer Director is currently working with postgraduate lead deans towards setting long-term targets for cancer specialists in this country, in discussion with the professional bodies. They will take account of the targets set in this Plan, the contribution of radiographers, nurses and other members of the cancer team and the scope for new ways of working across professions.

8.16 Based on these targets, the Government will increase the number of specialist training places year on year over at least the next three years to increase cancer consultant numbers by 2008 in those specialties where the NHS will not have enough.

Better distribution of training places

8.17 Newly trained consultants tend to remain in the area where they undertake their training. So sufficient training places and consultant posts must be made available outside London to tackle the regional inequalities in the cancer workforce.

8.18 Cancer networks and Regional Offices will need to identify where training capacity is currently inadequate because of the absence of suitably qualified consultants to undertake the training. Priority should be given to filling these consultant posts so that the training capacity is increased.

More capacity for consultant training

8.19 To increase cancer specialist numbers to meet future demands, the NHS needs to increase the number of specialist registrar posts. In the past, it has been difficult to establish additional trainee specialist posts in some specialties because NHS Trusts had to contribute 50% of the costs of basic salary for the posts even though the trainees were able to provide only limited service in the early years of their training.

8.20 The NHS Plan announced that from 2002 specialist registrar posts would be centrally funded, subject to reaching agreement with the medical Royal Colleges and other bodies on curricula and criteria for training recognition. The Department of Health is to consult urgently on this, linked to proposals for the new Medical Education Standards Board.

8.21 This new arrangement will remove the disincentives on trusts and health authorities and will ensure that the NHS can play its full role in partnership with the colleges in setting curricula and criteria for training recognition.

Histopathology

8.22 Special action is needed to increase the number of histopathology trainees. It has proved very difficult in the past to establish training posts for histopathology, despite the serious shortage of consultants, partly because of the intensive support trainees require in the early years. An additional 40 trainees are entering training this year but more action is needed.

8.23 The specialty will benefit from central funding of specialist registrar posts from 2002. A new scheme to increase the number of specialist registrars in histopathology is to be introduced. £1.3 million is being made available to fund three pilot training centres in histopathology. These will offer a three year pilot programme to deliver a new model of training to a cohort of trainees, using specially selected trainers to deliver the pathology curriculum and to develop innovative teaching methods. The centres will be up and running from 2001. As a result an extra 18 specialist registrars will be trained over the three years.

8.24 This scheme offers the potential to develop, evaluate and roll out new teaching methods and materials to other training centres, using information technology. The additional histopathology trainees will reduce the shortfall in consultant numbers and strengthen the diagnostic capacity of the NHS - critical to reducing waiting times - without increasing the burden on overstretched training centres.

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