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RCPI President criticises level of funding for specialist training

By Catherine Reilly - 11th Jun 2023

speicalist training

The RCPI President has strongly criticised the level of funding for specialist training in the context of increasing trainee numbers.

Prof Mary Horgan made her comments at a conference on the future of medical training organised by the Forum of Irish Postgraduate Medical Training Bodies on 31 May.

She was responding to a presentation on recruitment and retention of the future medical workforce by Prof Brian Kinirons, Medical Director of HSE National Doctors Training and Planning (NDTP). Prof Kinirons had outlined the need to increase training numbers in the context of consultant workforce requirements.

Prof Mary Hogan

Speaking during a questions and answers session, Prof Horgan queried the funding situation arising from NDTP’s requests for extra training places. She remarked that more funding was required “to do training properly”, rather than “a trickle”.

“Increased funding is a reflection of the value our health service puts into training,” she commented.

Prof Kinirons said he would challenge the word “trickle” and insisted there was “a recognition” that “appropriate” funding was required to increase places.

 “I also recognise the fact that education has become much more complex…,” added Prof Kinirons, who noted that postgraduate bodies and the HSE have made significant investments in simulation, for example.

“I think there is a recognition that the SLA funding is a dynamic piece, but again, we work with a budget as well, it isn’t an open-ended budget…,” he said. “The key message for me is that we will be coming to you looking at growth, that is really the key piece, and we recognise the funding has to come with that growth.”

During his presentation, Prof Kinirons said: “Our ambition in NDTP is to have a sustainable workforce that does not rely on international medical graduates for service delivery.”

The Department of Health and HSE have agreed to a target of 6,000 consultant posts by 2030 to bring Ireland in line with comparator countries, as recommended by the Department-appointed NCHD taskforce. Currently, there are around 4,200 consultant posts. Under the targets agreed by the Department, trainee numbers would increase from around 5,000 to 5,800, which would involve conversion of non-training NCHD posts. While emphasising that training numbers needed to grow, Prof Kinirons acknowledged the consultant target was not achievable by 2030 through the Irish training pipeline.

During his presentation Prof Kinirons described retention as a key issue, but also challenged “a narrative” that Ireland was “haemorrhaging” doctors. He presented research undertaken by the NDTP, which showed 68 per cent of doctors who achieved their certificate of satisfactory completion of specialist training (CSCST) in 2016 were working in Irish healthcare (7 per cent in the private sector). However, 32 per cent were working abroad – predominantly in the UK – and there was a wide range of attrition depending on specialty.

Prof Kinirons said Ireland had “world-class” training programmes that should be valued.

“We need to do what we do, do it better, and train more. I think we need to target retention specifically at the post-CSCST group,” added the NDTP Medical Director, who described 32 per cent as “an unacceptable attrition rate”.

Asked by the Medical Independent (MI) about the funding situation, Prof Kinirons said: “I think the challenges we have are we are trying to do more complex work with more trainees, with a budget that isn’t fixed and does grow.… There isn’t an open-ended budget on this, but as numbers have increased, funding to support that has increased every single year.”

In regard to consultant numbers, he said the “huge investment in the consultant stock in a country which is traditionally under-resourced in terms of consultant numbers” was welcome. “And it is about having rotas that are sustainable, having a work/life balance for the consultants of the future.… The challenge is how we get there and we will get there, but I think 2030 [to meet the target number] is very, very tight.”

Asked if the new consultant contract would help, Prof Kinirons said his sense among the clinical community was that it was not considered a disincentive to returning to Ireland.

However, recruitment and retention involved wider aspects including infrastructure and the appropriate supports to do the job, he added.

Meanwhile, the conference also heard an update on implementation of the Forum’s Strategic Framework for Postgraduate Medical Training in Ireland 2021-2030.

The conference heard that a formal governance structure to monitor progress of the strategy implementation has been agreed. A number of projects have been prioritised for delivery this year, including a common memorandum of agreement between postgraduate training bodies, the NDTP and clinical sites.

The Forum has called for strategic investment in postgraduate training. The HSE informed MI it cannot release details of SLA funding due to commercial sensitivity.

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