developing robust workforce policies for the english health and social care system using system...
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Business Systems Laboratory 3rd International SymposiumADVANCES IN BUSINESS MANAGEMENT. TOWARDS SYSTEMIC APPROACH
Developing robust workforce policies for the English health and social care
system using system dynamics
Perugia, Italy - January 21-23, 2015
Dr Siôn CaveDecision Analysis Services Ltd, England
Jack LawrenceModeller, CfWI, England
Dr Graham WillisHead of R&D, CfWI, England
Daniele Gioe’Modeller, CfWI, England
Business Systems Laboratory 3rd International SymposiumADVANCES IN BUSINESS MANAGEMENT. TOWARDS SYSTEMIC APPROACH
Agenda
Background
Robust workforce planning
Past, present and future of SD modelling
Reflections on SD for policy analysis
1
2
3
4
The English health and social care system is large and complex
CfWI (2014). Horizon 2035: Health and care workforce futures - Progress update
What size and type of workforce do we need?
Do we trust this?
Full
tim
e e
qu
ival
en
ts
YearNow 2040
?
Supply
Demand
Robust workforce planning
Understand the system
Explore the future
Simulate the possibilities
Make robust decisions
Focal question
Transparent and participatory
Applying the Robust Workforce Planning Framework
Horizon scanning
Scenario generation
Workforce modelling
Policy analysis
Robust and published development approach
Workforce Modelling
Horizon Scanning Scenario Generation Policy Analysis
Model scoping
Model construction
Model documentation
Model testing
First application for policy analysis
Medical and dental school intake project
To ensure an adequate and affordable supply of good quality trained doctors and dentists
To advise on future total intakes to undergraduate medical and dental training in England
Timeline for the medical and dental school intake project
Horizon scanning
Scenario generation
Workforce modelling
Policy analysis
Aug 2011 Feb 2012 Oct 2012
January 2013
High level supply structure
Stakeholders
• DH’s Workforce Data and Analysis Team• Health and Social Care Information Centre• BMA• GMC and specific deaneries• UCAS• NHS Pensions• Medical project reference group• + National road shows….
GP
Medical school Foundation 1
Career post
Foundation 2 Core training
Run-through training
GP training
Higher specialty training Trained hospital doctors
33,800
34,000
34,200
10 15 20 25 30 35 406,000
6,500
10 15 20 25 30 35 40
5,500
6,000
6,500
10 15 20 25 30 35 40
7,000
8,000
10 15 20 25 30 35 40
7,300
7,500
10 15 20 25 30 35 40
6000
6500
7000
10 15 20 25 30 35 4012200
12300
10 15 20 25 30 35 40
0
50000
10 15 20 25 30 35 40
0
100000
10 15 20 25 30 35 40
0
50000
10 15 20 25 30 35 40
2011 = 34,069* 2011 = 6,081 2011 = 6,341
2011 = 7,765 2011 = 35,803
2011 = 7,346
2011 = 6,524 2011 = 12,252 2011 = 39,088
2011 = 19,687
* Based on the sum of inflows – course drop
outs accounted for at the end of the course
Implementation in System Dynamics software
13
Medical SchoolEnglandStart Medical
School English
Start MedicalSchool From OOC
Medical SchoolAttrition
CompleteMedical School
Medical SchoolComplete Attrition
Leave System
FoundationYear 1
Start F1
Resit F1
FoundationYear 2
Start F2
Resit F2
Foundation 1Attrition
Foundation 2Attrition
Finish F1 Finish F2
Start F1 FromOES
Start F2 FromOES
SeekingTraining orCareer Post
Core TrainingHigher
SpecialtyTraining
Run ThroughTraining
GP Training
Career PostWithout CESR
GP
HospitalConsultant
Start GP TrainingFrom English
System
Start Core TrainingFrom English Medical
System
Start Run ThroughTraining From English
System
Complete CoreTraining
Start HigherSpecialty
Training fromEnglish Medical
System
Complete HigherSpecialty Training
Complete GPTraining
HospitalConsultant toGP Training
Start HospitalConsultant to GP
Conversion Training
Complete HospitalConsultant to GP
Conversion Training
Seeking GPPosition Start GP Position
Following Training
SeekingHospital
ConsultantPosition
Complete RunThrough Training
Start HospitalConsultant PositionFollowing Training
Start GP TrainingFrom OES
Start Core TrainingFrom OES
Start Run ThroughTraining From OES
Start HigherSpecialty Training
From OES
Start GP PositionFrom OES
Start HospitalConsultant Position
From OES
Start CareerPost
Career PostWith CESRCareer Post
Gains CESR
Career Post With CESRBecome Hospital
Consultants
Start Seeking Trainingor Career Post After
Career Post
Start SeekingGP Position
Complete GPTraining Leave
System
Complete HigherSpecialty Training
Leave System
Start Seeking HospitalConsultant Position after
Run Through Training
Complete RunThrough Training
Leave System
Complete CoreTraining Leave
System
Complete ConsultantTraining Core Start
Seeking Career Post
GP Training AttritionLeave Medical System
GP Run Through TrainingAttrition Rate Start Seeking
Training Or Career Post
Run Through TrainingAttrition Rate Leave
SystemRun Through Training
Attrition Rate Start SeekingTraining Or Career Post
Higher SpecialtyTraining Attrition Rate
Leave System
Higher Specialty TrainingAttrition Start Seeking
Training Or Career PostCore Training
Attrition Rate LeaveSystem
Core Training AttritionStart Seeking Training
Or Career Post
Career Post AttritionRate Leave System
Career Post WithCESR Leave System
Start Career PostWith CESR From
OES
Start CareerPost From OES
GP AttritionLeave System
Hospital ConsultantAttrition Leave System
Complete F2 StartSeeking Training or
Career Post
Pass F2 LeaveSystem
Percentage of Medical
School Intake That Will Drop
Out
<100 Percent>
Percentage of the Students
that start F1 that will Drop
Out
<100 Percent>
Percentage Students Fail
Foundation 1 and Resit<100 Percent>
Initial Foundation 1
<100 Percent>
Percentage Students Fail
Foundation 2 and Resit
<100 Percent>
Initial Foundation 2
Pass F2
Percentage Student Pass
F2 And Leave System
<100 Percent>
GP Attrition Rate
<100 Percent>
Initial GP
Initial Hospital Consultants
in GP training
Hospital Consultant Attrition
Rate
Initial Hospital Consultant
<100 Percent>
Percentage Career Post
Gain CESR Per Year
Initial Career Post
<100 Percent>
GP Training Attrition Rate
Leave Medical System
<100 Percent>
GP Training Attrition Rate
Seeking Training or Career
Post
<100 Percent>
Percentage Complete GP
Training And Leave System<100 Percent>
Time to find GP Position
Run Through Training
Attrition Rate Leave Medical
System
<100 Percent>
Run Through Training
Attrition Rate Seeking
Training or Career Post
<100 Percent>
Start SeekingHospital ConsultantPosition after Higher
Specialty Training
Percentage Complete Run
Through Training And Leave
System
<100 Percent>
Percentage Complete
Higher Specialty Training
And Leave System
<100 Percent>Time to find Hospital
Consultant position
Initial Seeking Hospital
Consultant Position
Initial Seeking GP Position
Core Training Attrition Rate
Leave Medical System
<100 Percent>
Core Training Attrition Rate
Seeking Training or Career
Post
<100 Percent>
<100 Percent>
Percentage Complete Core
Training And Leave System
<100 Percent>
Higher Specialty Training
Attrition Rate Leave Medical
System
Higher Specialty Training
Attrition Rate Seeking
Training or Career Post
<100 Percent>
Initial Seeking Training or
Career Post
Initial Career Post With
CESRAverage Time to find Career
Post
<100 Percent>
<100 Percent>
<100 Percent>
Annual Medical School
Intake From England
FLAG Start
Accademic Year
<Time>
<TIME STEP>
Accademic Year
Start Date
Time Spent In Medical
School By DelayLength
Annual Medical School
Intake From Outside Of
Country
<TIME STEP>
<100 Percent>
1 Year
<100 Percent>
Complete F2
Including Attrition
Percentage of the Students
that start F2 that will Drop
Out
<100 Percent>
<100 Percent>
<Percentage Students Fail
Foundation 1 and Resit>
<Percentage Students Fail
Foundation 2 and Resit>
<100 Percent>
GP Training Length
Including Delay Percentage
Start GPTraining
Start and Continue GPTraining By Remaining
Delay
<100 Percent>
<FLAG Start
Accademic Year>
Complete GP
Training
Accademic Year
<TIME STEP>
<TIME STEP>
<TIME STEP>
<FLAG Start
Accademic Year>
Complete GP Trainingand Progress To Next
Year
Start RunThrough Training
Start and Continue RunThrough Training By
Remaining Delay Run Through Training Length
Including Delay Percentage
<TIME STEP>
<FLAG Start
Accademic Year>
<TIME STEP>
Complete Run
Through Training
Accademic Year
<TIME STEP>
Complete Run ThroughTraining and Progress To
Next Year
<100 Percent>
Start CoreTraining
Start and ContinueCore Training ByRemaining Delay
<TIME STEP>
<FLAG Start
Accademic Year>
<TIME STEP>
Complete Core Training
Accademic Year
<TIME STEP>
Complete CoreTraining and Progress
To Next Year
<100 Percent>
Start HigherSpecialty Training
Start and Continue HigherSpecialty Training By
Remaining Delay
Higher Specialty Training
Length Including Delay
Percentage
<100 Percent>
<FLAG Start
Accademic Year>
<TIME STEP>
<FLAG Start
Accademic Year>
<TIME STEP>
Complete Higher
Specialty Training
Accademic Year
<1 Year>
Complete HigherSpecialty Training andProgress To Next Year
<100 Percent>
Foundation Year 2
TOTAL
Seeking Training or
Career Post TOTAL
GP Training TOTAL
Run Through Training
TOTAL
Core Training TOTAL
Higher Specialty
Training TOTAL
Career Post Without
CESR TOTALCareer Post With
CESR TOTAL
Seeking Hospital
Consultant Position
TOTAL
Hospital Consultant
TOTAL
Hospital Consultant to
GP Training TOTAL
Seeking GP
Position TOTAL
GP TOTAL
<TIME STEP>
<FLAG Start
Accademic Year>
<100 Percent>
GP Training New
Entrants
<FLAG Start
Accademic Year>
<TIME STEP>
Foundation TOTAL
Training Run
Through New
Entrants
<TIME STEP>
<FLAG Start
Accademic Year>
Higher Specialty Training
New Entrants
<TIME STEP>
<FLAG Start
Accademic Year>
<TIME STEP>
<FLAG Start
Accademic Year>
Number of CCT
Consultant Per Year
<TIME STEP>
<FLAG Start
Accademic Year>
Number Completing
Core Training
<TIME STEP>
<FLAG Start
Accademic Year>
Start Consultant
Training Core TOTAL<TIME
STEP> <FLAG Start
Accademic Year>
Pass F2 TOTAL
<TIME STEP>
<FLAG Start
Accademic Year>
Number of Completing
Consultant Training
HS
<TIME STEP>
<FLAG Start
Accademic Year>
<100 Percent>
<Time>
<INITIAL TIME>
<Time>
<INITIAL TIME>
<INITIAL TIME>
<Time>
<INITIAL TIME>
<Time>
<INITIAL TIME>
<Time>
<INITIAL TIME>
<Time><INITIAL TIME>
<Time>
<100 Percent>
<100 Percent>
<INITIAL TIME> <Time>
<INITIAL TIME>
<Time> <INITIAL TIME>
<Time>
<100 Percent>
<INITIAL TIME>
<Time>
<INITIAL TIME>
<Time>
<INITIAL TIME><Time>
<INITIAL TIME>
<Time><TIME STEP>
<INITIAL TIME>
<Time>
<TIME STEP>
<Time>
<INITIAL TIME>
<Time>
Annual F1 Intake From
Outside Of English System
<TIME STEP><FLAG Start
Accademic Year>
Annual F2 Intake From
Outside Of English System
<FLAG Start
Accademic Year> <TIME STEP>
Annual GP Training Intake
From Outside Of English
System
<TIME STEP>
<INITIAL TIME>
<Time>
Annual Run Through Intake
From Outside Of English
System
<INITIAL TIME>
<TIME STEP>
<FLAG Start
Accademic Year>
Annual Core Training Intake
From Outside Of English
System <INITIAL TIME>
<Time> <TIME STEP>
Annual Higher Specialty
Training Intake From
Outside Of English System
<INITIAL TIME><Time>
<TIME STEP>
Annual Career Post Without
CESR Intake From Outside
Of English SystemAnnual Career Post With
CESR Intake From Outside
Of English System
Annual Hospital Consultant
Intake From Outside Of
English System
Annual GP Intake From
Outside Of English System
<FLAG Start
Accademic Year>
<TIME STEP>
<TIME STEP>
<TIME STEP>
GP TOTAL By Gender
Start Consultant or GP
Training From Career
Post
Start Higher SpecialtyTraining From Career
Post
<TIME STEP>
Time to Complete
Consultant to GP
Conversion Training
Annual Hospital Consultant
Start GP Conversion
Training
<TIME STEP>
<INITIAL TIME>
CompleteConsultant Core
Training AvailableFor Higher
Specialty Training
<TIME STEP>
Start Consultant or GPTraining Core Career Post
TOTAL
<FLAG Start
Accademic Year>
GP Training TOTAL
By Gender
Career Post Without
CESR TOTAL By Gender
Run Through Training
TOTAL By Gender
Core Training TOTAL
By Gender
<Initial Medical School
By Completion Year>
<Start Core Training
From F2>
<Start Core Training
From Career Post>
<Start GP Training From
F2>
<Start GP Training
From Career Post>
<Start Run Through
Training From F2>
<Start Run Through
Training From Career
Post>
<Initial GP Training By
Delay Length>
<FLAG Start
Accademic Year>
<Initial Run ThroughTraining By Delay
Length>
<FLAG Start
Accademic Year>
<Initial Run ThroughTraining By Delay
Length>
<Initial Higher
Specialty Training
By Delay Length>
<Initial Higher Specialty
Training By Delay
Length>
<Initial Core Training
By Delay Length>
Core Training Length
Including Delay Percentage
<Initial Core Training By
Delay Length>
Start GP PositionRejoiners
Annual GP Rejoiners
Start HospitalConsultant Position
Rejoiner
Annual Hospital Consultant
Rejoiners
Start Career PostWith CESR Rejoiner
Annual Career Post With
CESR Rejoin
Start CareerPost Rejoiners
Annual Career Post Without
CESR Rejoin
<FLAG Start
Accademic Year>
InputString
TimeLine
<TIME STEP>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine> <InputString
TimeLine>
<InputString
TimeLine><InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine> <InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine> <InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine><InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine><InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
<InputString
TimeLine>
Start Consultant C RT or
GP Training RT From
Career Post TOTAL
<TIME STEP>
Start Career Post
TOTAL
<100 Percent>
Annual Career Post With
CESR Become Hospital
Consultants
<InputString
TimeLine>
<TIME STEP>
SeekingTraining orCareer Post
Core Trained
Seeking Training orCareer Post Completed
Core Training TOTAL
Career PostCompleted
Core Training
Career PostCompleted Core
Training Gains CESR
Career Post CompletedCore Training Attrition
Rate Leave System
Start Career PostCompleted Core
Training From OES
<100 Percent>
Initial Career Post
Completed Core Training
<100 Percent>
Annual Career PostCompleted Core TrainingIntake From Outside Of
English System
<FLAG Start
Accademic Year>
Career Post Completed
Core Training TOTAL
By Gender
Start Career PostCompleted Core
Training Rejoiners
Annual Career Post
Completed Core Training
Rejoin
<InputString
TimeLine>
<InputString
TimeLine>
Start Career PostCompleted Core
Training
<Average Time to find
Career Post>
<Percentage Career Post
Gain CESR Per Year>
<100 Percent>
Initial Seeking Training or
Career Post Completed
Core Training <InputString
TimeLine>
<Number Start HigherSpecialty Training FromCareer Post Completed
Core Training>
Start Seeking HigherSpecialty Training From
Career Post
<TIME STEP>
<Number Start Higher Specialty
Training From Career Post
Completed Core Training>
Foundation Year 2
TOTAL By Gender
<Start GP Training
From Career Post>
<Start Run Through
Training From Career
Post>
<Start Core Training
From Career Post>
Foundation Year 2
TOTAL Gender Ratio
Start F2 TOTAL
<TIME STEP>
<FLAG Start
Accademic Year>
Start F1 TOTAL
<TIME STEP>
GP Training Gender
Ratio
Career Post Completed
Core Training TOTAL
<Time>
Initial Seeking Training Or
Career Post Age Profile
<100 Percent>
Annual GP Training Intake
From Outside Of English
System Age Profile
<100 Percent>
Initial Seeking GP Position
Age Profile
<100 Percent>
Initial GP Age Profile
<100 Percent>
Annual GP Intake From
Outside Of English System
Age Profile
<100 Percent>
Start GP Position Rejoiners
Age Profile
<100 Percent>
Initial Hospital Consultant to
GP Training Age Profile
<100 Percent>
Initial Hospital Consultant
Age Profile
<100 Percent>Annual Hospital Consultant
Intake From Outside Of
English System Age Profile
<100 Percent>
Annual Hospital Consultant
Rejoiners Age Profile
<100 Percent>
Seeking Hospital Consultant
Position Age Profile
<100 Percent>
Annual Career Post With
CESR Rejoin Age Profile
<100 Percent>
Annual Career Post WithCESR Intake From Outside
Of English System AgeProfile
<100 Percent>
Initial Career Post With
CESR Age Profile
<100 Percent>
Annual Career PostCompleted Core TrainingIntake From Outside Of
English System Age Profile
<100 Percent>
Annual Career Post
Completed Core Training
Rejoin Age Profile
<100 Percent>
Initial Career Post
Completed Core Training
Age Profile<100 Percent>
Initial Seeking Training or
Career Post Completed
Core Training Age Profile
<100 Percent>
Annual Career Post WithoutCESR Intake From Outside
Of English System AgeProfile
<100 Percent>
Annual Career Post Without
CESR Rejoin Age Profile
<100 Percent>
Initial Career Post Without
CESR Age Profile
<100 Percent>
Annual Core Training Intake
From Outside Of English
System Profile
<100 Percent>
<100 Percent>
Annual Higher SpecialtyTraining Intake From
Outside Of English SystemAge Profile
<100 Percent>
<100 Percent>
Annual Run Through Intake
From Outside Of English
System Age Profile
<100 Percent>
<100 Percent>
Career Post With
CESR Age Ratio
Career Post Without
CESR Age Profile
<100 Percent>
Career PostCompleted Core
Training Age Profile
<100 Percent>
Number Complete Core
Start Seeking Career
Post
<TIME STEP>
<FLAG Start
Accademic Year>
<Career PostCompleted Core
Training Age Profile>
<TIME STEP>
<TIME STEP>
<100 Percent>
AgingS TCP
Aging
GP T
AgingGP T
AR LS
AgingGP TAR
SToCP
GP Training TOTAL
By Age
Aging
S GP Aging
GP
<TIME STEP>
GP TOTAL By COO
Aging
RT T
Aging RT T AR STorCP
AgingRT TAR
SToCP
AgingHCtoGP T
Start Hospital Consultantto GP Conversion Training
TOTAL
Complete Hospital
Consultant to GP
Conversion Training
TOTAL
<100 Percent>
Aging
HCAging
S HC
Aging
CP
AgingCPw
CESR
AgingCPwCT
AgingSCPoT wCT
Aging
CT T
AgingCT ARSTorCP
AgingCT AR
LS
Aging
HS T
AgingHS T
AR LS
Aging HS T AR SCPoT
<InputString
TimeLine>
Career Post Without
CESR Age Profile By
Age Band
Career Post Attrition Rate
<Career Post Attrition Rate>
<Career Post Attrition Rate>
<InputString
TimeLine>
Core Training TOTAL
By AgeCore Training
RATIO Age
GP TOTAL By AgeGP RATIO By Age
<100 Percent>
<Start Seeking Higher
Specialty Training
From Career Post>
<Seeking Training or Career Post>
Career Post Without
CESR TOTAL By COO
GP Training NewEntrants From English
System
<TIME STEP>
<FLAG Start
Accademic Year>
Training Run ThroughNew Entrants From
English System
<TIME STEP>
Start Core From English
System TOTAL
<TIME STEP>
<FLAG Start
Accademic Year>
<FLAG Start
Accademic Year>
<Percentage Start
Higher Specialty
Training>
<FLAG Start
Accademic Year>
Hospital Consultant
TOTAL By COO
Hospital Consultant
TOTAL By Gender
<Percentage Complete Run
Through Training And Leave
System>
<Percentage of the
Students that start F1 that
will Drop Out>
<Start and Continue GP
Training By Remaining
Delay>
<Career Post With
CESR>
<Career Post With
CESR Age Ratio>
<Percentage Start
Higher Specialty
Training>
F1 CompleteAttrition Leave
System
<100 Percent>
Pass F1
<100 Percent>
<Percentage Complete
F1 And Leave System
Including F2 Limits>
<Percentage Complete
Medical School And Leave
System Including F1 Limits>
<INITIAL TIME>
<Time>
<INITIAL TIME>
<Time>
Start Consultant CT From
Career Post TOTAL
Start Consultant RT From
Career Post TOTAL
Start Consultant GP Training
RT From Career Post TOTAL
<FLAG Start
Accademic Year>
<Time>
Annual Medical School Intake
From England Age Profile
Annual Medical School
Intake From Outside Of
Country Age Profile
<InputString
TimeLine>
Initial Foundation 1 Age
Profile
<InputString
TimeLine>
Annual F2 Intake From
Outside Of English
System Age Profile
<InputString
TimeLine>
Annual F1 Intake From
Outside Of English
System Age Profile
<InputString
TimeLine>
Initial Foundation 2 Age
Profile
<InputString
TimeLine>
<100 Percent>
<100 Percent> <100 Percent>
<100 Percent>
Aging
F2
Aging
F1
Aging
MS
Start MedicalSchool
<FLAG Start
Accademic Year>
Complete Study Yearand Progress To Next
Year
Start AndContinue Medical
School
<TIME STEP>
Foundation Year 2
TOTAL By Age
Finish F2 TOTAL
<TIME STEP>
Sum Finish F2 Age
MS F
Sum Finish F2 Age
Workforce
<Flag Aging Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger><Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<Flag Aging
Trigger>
<100 Percent>
<TIME STEP>
<Time>
<INITIAL TIME>
<GP Attrition Rate IncScn and Pol and Max
Age Adj>
GP Attrition Rate
TOTAL
<100 Percent>
<TIME STEP>
<1 Year>
<Hospital Consultant
Attrition Rate Inc Scn and
Pol and Max Age Adj>
<1 Year>
<Career Post Attrition
Rate Inc Scn and Pol and
Max Age Adj>
<Start Seeking Training or
Career Post After Career
Post>
<TIME STEP>
<1 Year>
<Career Post Attrition
Rate Inc Scn and Pol and
Max Age Adj>
<Career Post With CESR
Become Hospital
Consultants>
<TIME STEP>
<1 Year>
<Career Post Attrition Rate
Inc Scn and Pol and Max
Age Adj>
<1 Year>
Pass F2 And Stay
In System TOTAL
<TIME STEP>
Career Post With CESR
Become Hospital
Consultant TOTAL
<TIME STEP>
<FLAG Start
Accademic Year>
Foundation Year 2TOTAL By Gender
and COO
GP Training TOTAL
By Gender and COO
GP TOTAL By Gender
and COO
Run Through TrainingTOTAL By Gender and
COO
Core Training TOTAL
By Gender and COO
Higher SpecialtyTraining TOTAL ByGender and COO
Hospital ConsultantTOTAL By Gender and
COO
Career Post Without
CESR TOTAL By Gender
and COO Career Post WithCESR TOTAL ByGender and COO
Career Post Completed
Core Training TOTAL By
Gender and COO
Hospital Consultant to GPTraining TOTAL ByGender and COO
<Start GP Training To
Meet Desired Places>
<Time>
<TIME STEP>
<Start Run Through
Training To Meet Desired
Places>
<Start Core Training To
Meet Desired Places>
<Start Higher Specialty
Training To Meet Desired
Places>
HospitalConsultant
Attrition RateTOTAL
<100 Percent>
Hospital ConsultantTOTAL Percentage
Increase
<100 Percent>
<TIME STEP>
Number Completing
Run Through
Training
<TIME STEP>
<FLAG Start
Accademic Year>
Number Completing
GP Training Core By
Gender
<TIME STEP>
<FLAG Start
Accademic Year>
<FLAG Start
Accademic Year>
<Percentage of the
Students that start F2 that
will Drop Out>
<Initial Hospital Consultant>
<Time>
GP Total By 10 Yr
Age Bands
Hospital Consultant
TOTAL By Age
Hospital ConsultantTotal By 10 Yr Age
Bands
Number Completing
GP Training Core By
Age
<TIME STEP>
Number Completing GP
Training Core By Age
By 10 Yr Age Bands
<Start Seeking Hospital
Consultant Position after
Higher Specialty Training>
<Start Seeking Hospital
Consultant Position after Run
Through Training>
<Start Hospital
Consultant to GP
Conversion Training>
If this structure isimplemented may want toconsider using a different
delay type
<Initial GP Training By
Delay Length>
<Initial Run ThroughTraining By Delay
Length>
<Initial CoreTraining By Delay
Length>
<Initial Higher Specialty
Training By Delay
Length>
Hospital ConsultantAttrition Rate Fixed
for 12 Months
<100 Percent>
Flag
Attrition
Trigger
Fixed Attrition
Rate Start Date<Time>
<TIME STEP>
<INITIAL TIME>
GP Attrition Rate Fixed
for 12 Months
<Flag
Attrition
Trigger>
<100 Percent> <TIME STEP>
<1 Year>
Career Post WithCESR Attrition RateFixed for 12 Months
<Flag
Attrition
Trigger>
<100 Percent>Career Post Without
CESR Attrition Rate
Fixed for 12 Months
<Flag
Attrition
Trigger><100 Percent>
Career Post Completed
Core Training Attrition
Rate Fixed for 12 Months
<Flag
Attrition
Trigger>
<100 Percent>
GP Training
Attrition Delayed by
1TS
<TIME STEP>
Run Through Training
Attrition Delayed by
1TS
<TIME STEP>
Core Training
Attrition Delayed by
1TS
<TIME STEP>
Higher Specialty
Training Attrition
Delayed by 1TS
<TIME STEP>
Start HospitalConsultant PositionFollowing Training
TOTAL by Age
<TIME STEP>
<FLAG Start
Accademic Year>
<1 Year>
<1 Year>
<1 Year>
<1 Year>
<Percentage TrainingEntrants From English
System Start GPTraining>
Complete F1
TOTAL
<TIME STEP>
<FLAG Start
Accademic Year>
Number Completing GP
Training Core
<TIME STEP>
Start GP Training
From F2 TOTAL
<FLAG Start
Accademic Year>Start GP TrainingFrom Career Post
TOTAL
Start Run ThroughTraining From F2
TOTAL
<FLAG Start
Accademic Year>
Start Run ThroughTraining From Career
Post TOTAL
Start Core
Training From F2
TOTAL
<FLAG Start
Accademic Year>
Start Core Training
From Career Post
TOTAL
Number Start HST from
Career Post
<FLAG Start
Accademic Year>
Start HST from
English System
TOTAL
<FLAG Start
Accademic Year>
<TIME STEP>
<TIME STEP>
<Higher Specialty Training
Attrition Start Seeking
Training Or Career Post>
<Complete Consultant
Training Core Start Seeking
Career Post>
<TIME STEP>
<GP Run Through TrainingAttrition Rate Start Seeking
Training Or Career Post>
<Run Through TrainingAttrition Rate Start Seeking
Training Or Career Post>
<Core TrainingAttrition Start Seeking
Training Or CareerPost>
<Start Seeking Higher
Specialty Training From
Career Post>
<TIME STEP>
• 15 separate influence diagrams
• 997 distinct variables• Initialised with 903,525
data items• Segmented by age and
gender
Model takes approximately 10 seconds to simulate.
Impact
The SD approach enabled rapid quantitative policy analysis.
Future supply of doctors projected to exceed future demand in all scenarios examined.
Influenced HENSE group to recommend a 2% reduction in medical school intake from 2013, to be reviewed in 2014 and regularly at 3yr intervals. This is approximately 120 medical students.
Many policy options tested, including rebalancing primary and secondary workforce.
Where system dynamics has been used so far…
Jan 2012 Jan 2013 Jan 2014
Medical and dental school intake
Pharmacy workforce
Speech and language therapy workforce
obstetricians and gynaecologists
Trauma and orthopaedic surgeons
Social care workforces
Anaesthetist workforce
Dental care professionals workforce
Dental workforce
Psychiatrist workforce
General practitioners
Jan 2015
Horizon 2035
A new challenge: Horizon 2035 – A system level analysis
What skills and competences do we have?
What might we need in future?
Framework + system = insights
NumbersSkillsCosts
Supply Demand
People and skills?
Workforce groups?
Training?
Education?
Money?
Future challenges?
Skills gap and
overlaps?
Idea skill mix?
Reflections…
Systemic
Future-oriented
Flexible
Transparent
Inclusive
Comprehensive
Understandable
System dynamics and Systems Thinking methods are being used to inform UK health and social care policy
More information on CfWI’s work is available online…
www.cfwi.org.uk/publications/a-strategic-
review-of-the-future-pharmacist-workforce
www.cfwi.org.uk/publications/a-strategic-
review-of-the-future-dentistry-workforce-
informing-dental-student-intakes
www.cfwi.org.uk/publications/gp-in-depth-
review-preliminary-findings
www.cfwi.org.uk/publications/a-strategic-
review-of-the-future-healthcare-workforce-
informing-medical-and-dental-student-
intakes-1
Workforce studies
Method based
Contact details
Dr Graham WillisHead of Research and DevelopmentCfWI, England
@
+44(0)7812 340 405
www.cfwi.org.uk | www.horizonscanning.org.uk
Dr Siôn CaveDecision Analysis Service Ltd, England
+44(0)7825 758 139
Questions welcomed…
Business Systems Laboratory 3rd International SymposiumADVANCES IN BUSINESS MANAGEMENT. TOWARDS SYSTEMIC APPROACH
Developing robust workforce policies for the English health and social care
system using system dynamics
Perugia, Italy - January 21-23, 2015
Dr Siôn CaveDecision Analysis Services Ltd, England
Jack LawrenceModeller, CfWI, England
Dr Graham WillisHead of R&D, CfWI, England
Daniele Gioe’Modeller, CfWI, England