Meeting with Health Education England and London LETB regarding decision for zero NTNs in T&O f

I was granted a meeting with Prof. Liz Hughes, Director and Dean of Education and Quality at HEE (London and SE) to discuss the reasons behind the decision to have zero NTN posts in London in 2016. In this meeting, the Postgraduate deans of London LETBs were present (Prof. Andrew Frankel, Dr. Julie Whiteman, and Dr. Sanjiv Ahluwhalia), as well as the Head of School for Surgery, Prof. Nigel Standfield.

I was given the opportunity to ask questions, and raise issues put to me via our membership. It is worth noting the process of determining the number of NTNs that was highlighted to me by those in attendance. I was told that the Training Programme Directors (TPDs) and Head of School of surgery review a complex matrix to determine a range of minimum and maximum capacity for NTNs in T&O in each LETB. This is done in late 2015. At this time, the minimum was zero and the maximum was 16 NTNs. Then, these ranges are discussed with HEE, specifically Prof Hughes, and reviewed up until the release of posts on April 8th.

It was highlighted to me that this process has many moving parts and is complicated by those achieving CCT, those taking a period of grace post-CCT, trainees on out of programme placements (going off programme or returning), and other factors. In addition, I was told that London LETB was engaged in a process with Kent Surrey Sussex (KSS) and East of England (EoE) LETBs to re-establish managed programmes, i.e. Training posts quality assured and funded by KSS and EoE, that London trainees previously occupied. These posts would now/soon be occupied by KSS and East of England trainees. The East of England “repatriation” of posts was beginning this year with 10 posts, and although not confirmed, likely to continue in 2017 with 10 further posts being repatriated, and completed in 2018 with a final 14 posts being repatriated. The KSS re-establishment had started 7 years ago and was felt to have had a positive impact on training, according to GMC surveys, JCST surveys, and focus groups with trainees.

I was told that due to these posts no longer being available to London trainees, as well as an “error in overrecruitment” by London LETBs in 2015, lead to a situation whereby there are 10-20 more London trainees than available training posts. This is the driver to have zero NTNs in London for T&O in 2016. This decision is aimed at reducing this deficit to 7 in April 2017, and 0 in October 2017. It was highlighted to me that London LETB would be funding or part-funding new local training posts in London hospitals to accommodate for this shortfall, to ensure training opportunities are not limited. It is also important to note that London LETBs may be in a similar position next year, with zero or very limited number of NTNs for October 2017.

Professor Andrew Frankel offered an apology to all trainees that have been affected by this decision, and noted that communication of this decision, as well as the factors that lead to it, should have been better. I accepted his apology and suggested that trainees would feel better about the recruitment process if they knew a range of possible NTNs per region prior to applying for ST3 national selection. He promised to discuss the practicalities of this. Clearly, it would not be possible to give confirmed figures, as this is not confirmed until after the selection process has been run.

Need advice or wish to discuss the issues in this summary? Please email president@bota.org.uk