Deaneries: what do they do?
BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e3846 (Published 12 June 2012) Cite this as: BMJ 2012;344:e3846
- Davinder P S Sandhu, postgraduate dean and head of education, Severn Deanery, Bristol
- davinder.sandhu{at}southwest.nhs.uk
Abstract
What are they, and what are their functions, asks Davinder Sandhu
A series of Department of Health consultations on education and training—including Liberating the NHS: Developing the Healthcare Workforce from Design to Delivery, the NHS Future Forum’s consultation, and the Education Outcomes Framework—inform the Health and Social Care Act 2012 and make reference to deaneries and in particular to deanery functions.1234 The language in these documents almost suggests that the functions of deaneries are those of an antiquated workforce model, with little reference to employers and easily slotted into a variety of education models. Instead they advocate a new model in which local education and training boards, made up largely of employing organisations, oversee medical education and training and a new organisation, Health Education England, provides national leadership.
The difficulty is that not only does the wider workforce misunderstand what a deanery does and what it delivers, so do trainees, educational supervisors, and clinical supervisors—the very group that in its core function the deanery serves. It is important for the health department, the universities, NHS employers, and trainees to understand the functions of deaneries, especially because in England local education and training boards will take over medical education and training when strategic health authorities close in April 2013.
What are deaneries?
The deanery is a virtual organisation whose primary role is to facilitate and support educational governance. Deaneries have a regional footprint that encompasses several cities and hospitals as well as medical schools and universities, because medical education is delivered through a variety of education providers.
Medical and dental training is experiential and learnt directly through delivering care for patients and through simulation. Deaneries are firmly embedded within the employers and are not remote bodies at arm’s length. Many chief executives believe that deaneries are remote, and education is not on their radar because their time is taken up with other pressing issues such as finance, health targets, and care of patients. For consultants and trainees the deanery is perceived to be an organisation you go to if you have a problem, such as with performance or health issues, with study leave, or with an appeal against a negative outcome of an annual review of competence progression (ARCP).
Postgraduate medical training consists of a two year foundation training programme and a series of specialty specific complex programmes from three to 10 years, delivered in programmes in different trusts as well as in primary care. Currently there are about 54 000 trainees in 65 specialties and 36 subspecialties. The funding of postgraduate medical and dental education is through the medical and dental education levy, which is part of the £4.9bn multiprofessional education and training budget.
A number of key deanery functions are detailed below.
Quality assurance
Deaneries undertake quality management of education processes and programmes on behalf of the General Medical Council (GMC). They also supervise the GMC’s national training surveys and ensure that all posts have GMC approval and all trainees are in approved posts while out of programme.
The quality management process is crucial as today’s training reflects patient safety for the next 15 years. In addition, deaneries contribute to the joint appraisals of the directors of medical education and of training programme directors, foundation programme directors, and heads of school. All these senior officers of the deanery are consultants based in the employing trusts, as indeed are the thousands of education supervisors and clinical supervisors.
Recruitment and training
Deanery recruitment teams work closely with colleges and faculties to recruit junior doctors to specialties locally, and some also lead on national recruitment. For employers, fill rates can have a direct effect on rotas, European working time regulations, and patient care.
The returns on recruitment numbers, applicant ratios, and fill rates are collated nationally to support workforce planning and career advice.
In their educational governance role, deaneries—through the offices of the training programme directors, specialist trainee committees, educational supervisors, and clinical supervisors—act as facilitators of their major function, which is to make sure that the specialty training programmes are delivered to the standards set by the royal colleges. The role of the lead dean on specialist advisory committees is key in ensuring new curriculum developments are deliverable, on advising about disinvestment of posts, and on the allocation of new national training numbers in collaboration with the Centre for Workforce Intelligence. Therefore unlike other professions, medical workforce planning is determined nationally and not locally.
In overseeing the delivery of training deaneries must ensure that:
Patients are protected
The curriculum of each specialty is delivered (a particular challenge in general practitioner training, with a dispersed model of large number of practices)
There is professional and generic skills training for trainees in areas such as leadership, management, team working, ethics, communication, and teaching skills
Workplace based assessments are supervised and recorded
Trainees who need targeted or additional training are supported within the programme
Remedial and poor performance issues of the individual and the organisation are resolved
Career advice and personal development are incorporated
Credentialing of foundation, core, and higher specialist training is recorded
Interdeanery transfers and study leave are facilitated
Simulation facilities and a sustainability culture to reduce the NHS’s carbon footprint are developed
The postgraduate dean (PGD) has an important role as the honest broker with appeals about ARCP outcomes and requests for interdeanery transfers, and
Deaneries are well placed to handle risk as they have very few employment tribunals.
The structure of postgraduate schools in England allows good practice to be shared and enhances the quality of the programmes. For instance, to appreciate the complexity of the larger schools, medicine currently has 29 specialties, surgery has 10, pathology has eight, psychiatry has six main specialties, and paediatrics has 17 subspecialties. Dentistry has a multiprofessional approach and trains hygienists, therapists, technicians, nurses, and dentists in 13 specialties.
Deaneries have an important link with medical schools in delivering the foundation programme, which is managed by the director of the foundation school through the trust’s foundation programme directors.
Revalidation of trainees
The PGD is the responsible officer for revalidation of trainees. As trainees are a mobile workforce with several employers, revalidation will be conducted through a robust ARCP process. The management of serious untoward incidents involving trainees and affecting patient safety is an important part of the deanery’s role of educational governance.
Faculty development
A further deanery function is identification, training, and development of the educational faculty, a key GMC requirement that is currently under review.5 The areas of development include equality and diversity, teaching skills, appraisal, and assessment.
Clinical academic training
Deaneries liaise with the National Institute of Health Research, universities, and specialties to bid for academic programmes such as academic clinical fellowships and clinical lectureships. Furthermore, PGDs have a role in promoting the development of medical education as an academic discipline by developing promising trainees and faculty through partnerships with higher education institutions.
Workforce
Postgraduate deans in England manage and contract for medical education through the learning development agreement between the strategic health authority and local education providers. They advise on local medical workforce planning and disinvestment and investment in posts. In this critical area it is important that there is external oversight. Therefore it is essential that if the PGD is not the director of education and quality on the local education and training board then (as recommended by the Department of Health) the PGD, as the senior responsible officer for medical education, should have an advisory function to the local education and training board and also be accountable to the director of education and quality of Health Education England for professional education leadership.1
Primary care
There are specific roles held by the directors of general practice in deaneries, such as:
Supporting the primary care workforce through the retainer and induction programmes
Providing induction into NHS general practice for European Union and non-European Union general practitioners
Supporting practitioners with performance difficulties who are referred by trusts, the GMC, and the National Clinical Assessment Service
Quality assuring and supporting the provision of high quality continuous professional development for general practitioners and practice staff
Facilitating the placement of undergraduate nursing students in approved training environments, and
Working with the strategic health authority and other regional and national bodies to develop educational strategies to support specific initiatives—such as the diagnosis and management of dementia.
National roles
Postgraduate deans in the United Kingdom have strategic roles in the Conference of Postgraduate Medical Deans of the UK (COPMeD) as advisers and representatives on national bodies such as the royal colleges and the Department of Health.
The government emphasises that it would like employers to be more involved with developing and delivering medical education. The paradox is that all the above educational roles are carried out by staff who are part of frontline services in the acute, mental health, and primary care trusts. In fact a recent letter from the NHS medical director, the four chief medical officers, and the chair of the General Medical Council specifically requested the release of consultants to fulfil this important role.6
Management costs of deaneries are currently under scrutiny. PGDs are the natural advocates to protect the medical and dental education levy within the multiprofessional education and training budget, which are direct costs to the health service. The hidden and indirect costs are the huge time invested by consultants, managers, and education committees in trusts to support recruitment, develop curriculums, conduct assessments, perform ARCPs, give careers advice, deal with performance issues, and supervise trainees, so that our patients are not only protected but also receive the best possible care. It is important that in any reorganisation of education and training structures, such goodwill and hidden costs are not forgotten.
Footnotes
Competing interests: None declared.