CMC Chair Dr Derek Sherwood
Council of Medical Colleges in NZ
 Represent 15 NZ Medical Colleges or their NZ
Branches and more than 14,000 Doctors
 A collective voice for the Colleges
 Vocational Training
 Continuing Professional Development/Education
 Promoting Professionalism
 Advocacy re Protecting and Promoting Public Health
 Conduit for information flow to and from HWNZ
Medical Training in NZ
 Undergraduate
 Med Schools/Universities
 Pre vocational
 MCNZ/DHBs
 Vocational
 MCNZ/Colleges
History of Vocational Training in
New Zealand
 Colleges began being formed from Specialist societies
from the 1920 onwards modelled on British Colleges
 Some were bi-national from the onset eg RACS
 Some became bi-national as education and
qualification requirements became more onerous
 A register of specialists only after the 1968 Act
 Many still trained in the UK until the 1970s.
Vocational Training recent years
 New Colleges as new specialities have developed
 New “craft groups” within Colleges as sub specialisation
has increased
 Increasing requirements of Colleges from AMC and
MCNZ


College accreditation standards
MOUs between MCNZ and Colleges
 Still a high reliance on overseas trained vocationally
registered doctors
 Note no planning/funding for the increased grads
How is Vocational training
funded at present
 HWNZ has contracts for the provision of postgraduate
training with DHBs and other Health Provider Orgs
 Money allocated for about 2/3 trainees to recompense
the cost of training and any “service slow down”.
 The amount per trainee is different for each speciality
based on a historic formula
 In General Practice the contract is now with the
RNZCGP
Current Funding
 $102 million; vocational trainees, prevocational
trainees and allied
 $62 million Vocational Training
 $18.5 million Pre Vocational Training
 $21.6 million RNZCGP
 1730 Vocational Trainees 1146 are funded
Other workforces training
funded by HWNZ
 Nursing
 Dental
 Allied
 Mental Health
 Disability support
 Midwifery
 Some funding of unregulated or Kaiawhina workforce
What are the problems from a
College perspective?
 The money allocated does not correlate with actual
costs
 The funding goes directly to DHBs so is an income
stream not directly linked to training
 The number of training positions is only very loosely
based on future needs
 There has been no additional funding to meet the
training needs of the increased number of medical
graduates
What are the problems from a
HWNZ perspective
 A variable correlation between investment and HWNZ
priorities
 A bias toward post graduate medical training
 Bias toward training in hospital settings
 Limited community based health work force with
educational capacity
 There is a subsidy of the trainee workforce needed to
meet service needs rather than “targeted” investment
 There is a disconnect between NZ Health Strategy and
DHB annual plans
Other challenges in health that
might be addressed through
changes to vocational training
 There are shortages in some specialities
 There are some small subspecialities that have
vulnerable workforces
 There are problems with geographic maldistribution
 There are inequalities in healthcare delivery
HWNZ
 Established in 2009
 To Achieve Governments Health Targets by providing a
capable and well distributed supply of health
professionals
 Chair Prof Des Gorman
What have they done 1
 Initially resisted developing a Health Workforce plan
but rather promoted the development of a flexible
workforce.
 Review of Specialities promoting new models of care
 Review of regulations to remove barriers to role
substitution
What have they done 2
 In 2014/15 worked with Colleges to determine
criticality and vulnerability of specialities
 Funding to be allocated on


Vulnerability ranking
 Age distribution of SMOs
 Dependence on general registrants
 Dependence on IMGs
Contribution to government priorities
What have they done 3
 Now have access to MCNZ APC application workforce
data which has allowed them to develop
 Health of The Health Workforce Report
 Health Workforce Calculator
 Have worked with Colleges to provide better career
information to Students and RMOs
 But they wanted to develop a new funding model to
have more influence on training despite constrained
budget
Funding and implementation
Principles Agreed
 The right workforce for the communities needs
 Address geographic mal distribution
 Diversity in workforce to reflect community
 Increased primary care workforce
 Aligned with the Health Strategy
 Engagement with Stakeholders
 Current trainees supported until end of training
 Transition over 3-5 years
What Colleges would like
 All stakeholders need to be engaged
DHBs, Colleges, MOH, RDA
NZMA, NZMSA, ASMS and Med Schools
 DHBs need to be accountable for use of training
funding and to collaborate regionally and nationally
 HWNZ to engage with Colleges to get best intelligence
re workforce needs and consult on ideal trainee
numbers
 HWNZ to be transparent and collaborative
 To continue to accredit training positions or sites
 A commitment to adequately funding training
positions
Initial proposals
 Status quo but some reduction on subsidy to create a
fund that could be targeted at areas of training need
 Subsidy attached to trainee rather than position
 Reduced subsidy and surplus “invested in the pipeline”
 Or a mixture of the above
 These were all only considered for medical training
The Models of Care problem
Role Delegation/substitution
New Roles
New treatments
Use of Technology
An Investment Model the solution?
2016 The Grand Unified Theory
 A pure Return on Investment approach
 The entire health workforce considered
 Incorporates Models of Care
 Great in theory but how would it work?
 Practically a “Pharmac” type approach preferred
What are the potential benefits
of the ROI approach
 Opens up the possibility of a redesign of services with
community involvement and input from all
stakeholders
 Better match of workers to service needs
 Better geographical coverage of services
 Services more aligned with Health Strategy
What are the potential risks of
the ROI approach
 Paralysis due to the complexity
 New orphan health workforces
 Qualifications that are not recognised overseas
 Loss of critical mass of specialists to provide acute care
in provincial centres
 Services and training based on costs not quality
To summarise
 The present system of funding has delivered high
quality vocationally trained doctors but
 There has been on overall under supply
 They are geographically mal distributed
 There has been a lack of diversity
 They may not be ideal for future models of care
 There are shortages in some specialities
 Vocational Training takes time and considerable
investment and any change needs to take into account
the impact on present trainees and SMOs
The HWNZ ROI Model offers;
 A complete approach to service models of care and the
work forces required but;
 One of the drivers is clearly cost saving
 There are considerable risks
 It will be a complex and potentially costly process
The Colleges would favour
 Adequate funding of the current model and new ways
of funding some specialities
 Better engagement to inform decisions re trainee
numbers
 Investigating areas of shortage and mal distribution to
find solutions which might include;



New models of Care
Incentivising training and SMO retention
Better career information for students and RMOs
Questions?