London medical education boss quits amid plans to break up deanery

BMJ 2012; 345 doi: (Published 13 November 2012) Cite this as: BMJ 2012;345:e7685
  1. Helen Jaques
  1. 1BMJ Careers

The director of medical and dental education commissioning at London Deanery is to step down in April next year amid plans to split the deanery into three.

Fiona Moss, who is responsible for commissioning, managing, and quality controlling training of around 12 500 doctors in foundation, core, and higher specialty training programmes in the capital, has announced that she will leave the deanery when the government’s changes to medical education and the medical workforce come into place in April 2013.

At this point London Deanery will divide into three local education and training boards (LETBs): South London; North West London; and North Central and East London. Each will have its own director of education quality and postgraduate dean.

Moss would not comment on her reasons for leaving but said that she hoped the new structure would be effective. “LETBs are well placed to make strong connections between service and training and thus to use education and training to improve the quality of care for today’s and tomorrow’s patients,” she said.

“My hope is that the new structure, by being anchored at a local level, can work even more effectively to deliver education and training that will better prepare London’s trainees of today for exciting and changing futures in tomorrow’s NHS.”

Health Education England, the new national leadership organisation for NHS education and training, has this week confirmed that England will be covered by 13 employer led LETBs, which will take on full responsibility for commissioning postgraduate medical education and training from the 13 postgraduate deaneries.

All LETBs are currently operating in shadow form, with delegated authority from clusters of the existing strategic health authorities, and will take on the £4.9bn (€6.1bn; $7.8bn) budget for multiprofessional education and training next April after authorisation by Health Education England.

Most deaneries in England will transfer directly to their respective LETB. For example, Northern Deanery will become part of North East LETB, North Western Deanery and Mersey Deanery will both become part of North West Deanery, and Severn Deanery and South West Peninsula Deanery will join South West LETB.

London was initially going to be covered by one single LETB but instead will split into three to accommodate the city’s three big academic health centres, King’s Health Partners, North West London Academic Health Science Partnership (which will encompass Imperial College Healthcare NHS Trust); and UCL Partners.

The three new LETBs in London will initially share some deanery services and related functions, such as recruitment and professional development, in an integrated shared service that will be based at the University of London. The specialty schools will encompass the whole of London during the transition period up to April 2014, after which the LETBs will be free to commission training individually.

The plan to split up London Deanery has caused concern that expertise might be diluted across the city and functions replicated at the three new organisations.

Andrew Long is head of London Specialty School of Paediatrics, which is responsible for national recruitment to paediatrics specialty training in England and for the training of 1000 paediatric trainees in London. He said that he had been working with the training programme directors in each of the three LETBs in the city to ensure that paediatric training continues on a London-wide basis for as long as possible but that “the future is more uncertain after 2014.”

He said, “The very worst possibility as far as I’m concerned is that we’ll end up with three discrete training programmes and a ‘virtual school’ that works across these.

“I’m not hugely scared about [the split], but what I don’t want it to do is break up the excellence that we’ve got through using the opportunities in three significant parts of London, each of which has different mixes of international expertise, and deny trainee opportunities from working in all parts of London.”

Oliver Warren, surgical registrar in the North West Thames region and head of London Deanery’s Prepare to Lead programme, said that costs and complexity are likely to increase as the result of education and training in the city requiring three sets of backroom staff.

“If the speciality schools are to continue across London, it is not yet clear to me what the point of having the three different LETBs is. I see potential dilution of skills and experience and replication of process increasing costs,” he said. “Trainees are not currently aware of this big change, and I can’t help but think some of that had been a purposeful decision to do much of this out of the direct sight of trainees. I’ve seen little evidence of engagement with the very individuals these LETBs are meant to serve.”

He added, “I don’t know how we’re going to make sure that the real richness of training that is available within the whole of London is still available to trainees when people are fragmented into these three different LETBs. It would seem to me that there is going to be a potential loss of institutional intelligence from existing deaneries by the creation of three new bodies instead of one deanery.”


Cite this as: BMJ 2012;345:e7685