Clinical Training Agency
Purchase Intentions

2009/10

Citation: Ministry of Health. 2009. Clinical Training Agency Purchase Intentions: 2009/10. Wellington: Ministry of Health.

Published in December 2009 by the
Ministry of Health
PO Box 5013, Wellington, New Zealand

ISBN 978-0-478-33962-8 (online)
HP 4976

This document is available on the Ministry of Health’s website:

Contents

Executive Summary

Introduction

Purpose

Financial information

Sector consultation

Review of 2008/09 projects

Key projects planned for 2009/10

Portfolio Overviews

Medical portfolio

General practitioner vocational training

Nursing portfolio

Māori health portfolio

Pacific peoples health portfolio

Midwifery training

Pharmacy Intern training

Clinical rehabilitation training

Appendix 1: Explanatory Notes

Contracts structure

Reporting

Appendix 2: Sector Consultation for Purchase Intentions

Appendix 3: CTA Prioritisation Decisions

References

List of Figures

Figure 1:CTA budget 2009/10

List of Tables

Table 1:Subject areas of stakeholder submissions

Table 2:Projects progressed in 2008/09

Table 3:Projects to continue or commence in 2009/10

Table 4:Non-vocational medical training places 2007–2010

Table 5:Vocational medical training places 2007–2010

Table 6:Allied/technical training places 2007–2010

Table 7:Medical portfolio budgets 2007/08–2009/10

Table 8:GPEP1 training places 2007–2010

Table 9:GPEP2 training places 2007–2010

Table 10:PGY2 rural rotation training places 2007–2010

Table 11:General practice budgets 2007/08–2009/10

Table 12:NETP training places 2007–2010

Table 13:Postgraduate nursing training units 2007–2010

Table 14:NETP outcomes 2006–2008

Table 15:Postgraduate nursing outcomes 2007–2008

Table 16:Nursing portfolio budgets2007/08–2009/10

Table 17:Māori health training units 2007–2010

Table 18:Māori support trainee numbers 2007–2010

Table 19:Māori health programme outcomes 2006–2008

Table 20:Māori health portfolio budget 2007/08–2009/10

Table 21:Pacific peoples support budget 2008/09–2009/10

Table 22:Midwifery first year of practice training places 2007–2010

Table 23:Complex care training places 2009–2010

Table 24:Midwifery budgets 2007/08–2009/10

Table 25:Pharmacy Intern training places 2007–2010

Table 26:Pharmacy intern training outcomes 2006–2008

Table 27:Pharmacy intern training budget 2007/08–2009/10

Table 28:Clinical rehabilitation training places 2007–2010

Table 29:Clinical rehabilitation training outcomes 2006–2008

Table 30:Clinical rehabilitation budget 2007/08–2009/10

Executive Summary

CTAvision:‘To facilitate development of a health and disability workforce which can meet the future requirements of health and disability services in New Zealand.’

This document summarises the purchasing and projects of the Clinical Training Agency (CTA) during 2008/09, details the anticipated purchases for 2009/10 and signals projects that the CTA will look to complete in the future. In the main the CTA purchases post-entry clinical training for doctors, nurses and midwives to the value of approximately $120 million per year.

The new CTA Board will influence the CTA’s future purchasing decisions, funding priorities and work plans. Details are still being finalised. The CTA works closely with the Workforce Development Group of District Health Boards New Zealand (DHBNZ), as well as with the CTA Nursing Advisory Group, the wider Ministry of Health and various other groups to ensure its purchasing direction is consistent with national strategies and environmental changes.

For example, a change in Government direction has led the CTA to increase funding in areas such as Surgery and Anaesthesia which will contribute to staffing the 20 new surgical theatres being planned. The CTA is also working with the Royal New Zealand College of General Practitioners to increase the number of first year General Practice trainees. There has been an increase in the number of medical graduates entering the system in 2009, and the number will increase further incrementally from 2016.

Other changes in the New Zealand health sector will impact on training. On a profession by profession basis these changes are forecasted within the Health Workforce Information Programme (HWIP). Epidemiology, demographics, technology, service models, supply side characteristics and a raft of other ever-changing factors are analysed in order for HWIP to estimate various scenarios of future need. Over the next 12 months all registrar types and a significant number of nursing roles will have robust estimates of future supply and demand requirements. The guidance provided by these estimates will have a significant influence on the direction of future funding.

The past year has seen the successful completion of the following projects:

  • Nursing Entry to Practice Expansion training programme – all District Health Boards (DHBs) now have their programmes approved by the Nursing Council
  • implementation of the new funding model for Māori health training – all DHBs now have access to Māori training funds
  • funding of five general practice training pilots in DHBs
  • new funding for rural hospital medicine places
  • new funding for postgraduate midwifery training in complex care
  • revision of surgeon training specification, revised costing and completed supply and demand estimates.

In 2009 key projects include:

  • specifying and funding intensive care medical vocational training
  • revising the physician training specification and costing
  • specifying and funding five Accident and Medical Practitioner Association training positions
  • finalising the specification and costings for rural health medicine training
  • commencing the evaluation of the five general practice pilots
  • reviewing the specifications for general practice education programmes, including the associated bursary payments
  • specifying and funding the Mammography Postgraduate Certificate
  • reviewing postgraduate nursing training funding
  • reviewing the Nursing Entry to Practice programme
  • finalising the specification for complex care and other midwifery training
  • finalising the Midwifery First Year of Practice specification
  • incorporating HWIP estimates into CTA purchasing plans.

The biggest issue regarding funding is the level of under-delivery. In some areas of high priority to the CTA, providers are unable to fill all contracted places. This issue is a key driver for CTA contracting strategies. As at 1 July 2009 the CTA was funding all places in 19 of 25 CTA-funded medical specialties (or other medical programmes) and all other CTA-funded training programmes except the General Practice Education Programme Stage 2.

Based on analysis of previous years, the CTA expects an under-provision across all portfolios of $4,000,000 for the 2009/10 financial year. This under-spend will be set aside for an innovations fund.

The Purchase Intentions consultation process yielded generally positive responses regarding CTA purchasing and identified many areas where CTA funding is desired. However, given the size of the CTA and budget constraints, not all requests are able to be met.

As part of the CTA’s ongoing quality improvement, an updated funding decision model is planned to be developed in time for funding decisions on Purchase Intentions 2010/11.

Clinical Training Agency Purchase Intentions 2009/101

Introduction

Purpose

The Clinical Training Agency Purchase Intentions 2009/10:

  • provides accountability information about the expenditure of health and disability clinical training funding
  • communicates intended activity for the upcoming financial year
  • indicates potential future funding directions and service developments.

The next section is organised into portfolio areas to reflect the purchasing activity and contract management of the Clinical Training Agency (CTA). Each area contains a budget table that covers financial years (1 July to 30 June) and a table that details funded places which align with calendar years.

The number of training places that the CTA intends to purchase, and that the provider hopes to deliver, can change for a number of reasons. A range of circumstances may cause a provider to be unable to deliver the training places contracted for with the CTA. For example, the provider may be unable to recruit the contracted number of trainees, or trainees may withdraw before completing the programme.

This document is based on the information available at the time of preparation. Delivered trainee numbers for 2009 are based on those reported up until April 2009. There may be subsequent developments that will affect actual purchasing in 2009/10 and beyond. New directives from Government, results of reviews and other events can change purchasing in ways that cannot be predicted at the time of writing.

Financial information

Budgets are reported on a financial year basis. The financial year of the Ministry of Health and, therefore, the CTA runs from 1 July to 30 June. The CTA’s objective is to manage the actual expenditure as close to budget as is reasonably possible. Unspent budget is not transferable between financial years, unless there are exceptional circumstances. There is an increase in the CTA budget from $121,500,000 in 2008/09 to $125,000,000 in 2009/10 largely due to budget increases for General Practice, Postgraduate Midwifery and Nursing Entry to Practice (NETP) Expansion. Future Funding Track (FFT), the annual adjustment for providers to manage cost pressures, was not awarded to the CTA for 2009/10, nor was the demographic adjuster. The main changes between 2008/09 and 2009/10 are the increase in Vocational medical budget and decrease in the Non-vocational medical budget. This movement was required as a significant amount of Postgraduate Year 2 (PGY2) medical funding was unspent in 2008/09 and it is anticipated that this lower level of spending will continue in the foreseeable future.

Figure 1:CTA budget 2009/10

Sector consultation

Prior to the preparation of this Purchase Intentions document, 140 sector stakeholders were sent an email invitation to contribute their views on CTA purchasing for the 2009/10 financial year. Attached to the email was the Purchase Intentions 2008/09 document with a letter outlining the points of difference between that document and the planned 2009/10 document. The stakeholder organisations contacted are listed in Appendix 2.

Twenty-three submissions came from the following 18 organisations:

  • Auckland District Health Board (DHB)
  • Australian and New Zealand College of Anaesthetists
  • Bay of Plenty DHB
  • Canterbury DHB
  • Capital Coast DHB
  • College of Nurses Aotearoa Ltd
  • Counties Manukau DHB
  • Hutt Valley DHB
  • Joint Faculty of Intensive Care Medicine
  • Lakes DHB
  • New Zealand Nurses Organisation
  • Royal New Zealand Plunket Society
  • Southland DHB
  • Tairawhiti DHB
  • Te Pou
  • the Royal College of Pathologists of Australasia
  • University of Otago
  • Waikato DHB.

Their submissions commented on the areas outlined in Table 1 below.

Table 1:Subject areas of stakeholder submissions

Workforce / Number of submissions
Nursing / 15
Medical / 10
Midwifery / 7
Māori and Pacific / 5
Allied Health / 4
Pharmacy / 1

The majority of submissions suggested that for specified programmes the CTA:

  • increase the price per trainee
  • increase the number of funded places
  • broaden the funding into related areas that are currently excluded.

No currently funded programmes were identified as low priority that could be stopped to allow funds to be reallocated. If all requests were met, it would cost tens of millions of dollars extra and the corresponding work would far outstrip the CTA’s workload capacity.

Along with the additional requests, the CTA received a good proportion of positive comments. This positive response is also shown in the calls to expand funding in training areas, as the current funding is working well. There was particular support for the postgraduate nursing and hauora Māori purchasing approaches.

Review of 2008/09 projects

Table 2 below summarises the progress of projects with CTA funding in the 2008/09 financial year.

Table 2:Projects progressed in 2008/09

Project / Progress / Summary (reported for training year)
Implement NETP expansion / Completed / Programme was funded in 2009 training year. Contracts are in place with 20 DHBs.
Implement new funding model for Māori Health training / Completed / The Hauora Māori funding model has been implemented and 20 DHBs applied for funding for 2009.
Implement outcomes of the surgery review / Completed / A new specification and costings have been developed.
Fund general practice pilots / Completed / The CTA requested proposals for DHB-led general practice pilots in late 2008. Five pilots were chosen for 20 training places and training began in early 2009.
Fund rural hospital medicine training programme / Completed / Six positions have been contracted in 2009.
Fund additional ophthalmology training / Completed / Two extra training places were located and funded.
Implement postgraduate midwifery training (complex care) / Completed / An interim specification and costings were developed for the 2009 training year. For 2009 there are 30trainees in 12 DHBs with three education providers.
Review public health medicine / Completed / A final specification and costings will be in place for the 2010 training year.
Evaluate the Midwifery First Year of Practice pilot programme / Completed / The pilot evaluation findings were generally positive.
Perform desk-audits of providers’ financial systems / In progress / CTA funds are being checked as to whether they are being used exclusively for purposes detailed in the Head and Service Agreements.
Upgrade database / In progress / The CTA database is being modified to improve efficiency, ease of use and data integrity.
Implement new prioritisation model for training purchases / In progress / The CTA is working on a new prioritisation model with which current and potential training programmes will be evaluated (see Appendix 3).
Review postgraduate nursing / In progress / Work has commenced; a revised specification and costings will be in place for the 2010 training year.

Key projects planned for 2009/10

In the 2009/10 financial year the CTA plans to undertake the projects set out in Table 3 below, either as a continuation from 2008/09 or as new projects.

Table 3:Projects to continue or commence in 2009/10

Project / Progress / Summary (reported for training year)
Implement new prioritisation model for training purchases / In progress / The CTA is currently working on a new prioritisation model with which current and potential training programmes will be evaluated(see Appendix 3).
Review postgraduate nursing / In progress / A revised specification and costings will be in place for the 2010 training year.
Specify Midwifery First Year of Practice programme / In progress / A final specification and costings will be in place for the 2010 training year.
Upgrade database. / In progress / The CTA database is being modified to improve efficiency, ease of use and data integrity.
Specify postgraduate midwifery complex care and other midwifery training / In progress / A final specification and costings will be developed.
Fund trainees for 20 new theatres / In progress / Workforces and volumes need to be agreed. The CTA has contracted for extra anaesthesia and surgery places.
Perform desk-audits of providers’ financial systems / In progress / CTA funds are being checked as to whether they are being used exclusively for purposes detailed in the Head and Service Agreements.
Specify rural health medicine / In progress / Develop a final specification and costings.
Review General Practice Education Programme Stages 1 and 2 (GPEP1 and GPEP2) training / In progress / Review training including bursary payments and scholarships.
Update specifications / Ongoing / All specifications will be scheduled for revision.
Evaluate general practice pilots / To commence / A detailed evaluation of the General Practice pilots will commence to investigate whether DHB employment is a more attractive option for potential general practitioners.
Review NETP / To commence / A revised specification and costings will be in place for the 2011 training year.
Specify and cost Accident and Medical Practitioner Association (AMPA) training / To commence / Specify and cost training.
Purchase Mammography Postgraduate Certificate / To commence / The CTA is to investigate funding Postgraduate Certificates in Mammography.
Review physician training / To commence / Re-specify and re-cost training.
Specify and fund intensive care training / To commence / Develop stand-alone specification and funding.

Portfolio Overviews

This section reports on the various portfolio areas in which the CTA is involved in purchasing activity and contract management. These areas cover: medical, general practice, nursing, Māori health, Pacific peoples health, midwifery, pharmacy internship, and clinical rehabilitation.

Medical portfolio

For the medical portfolio, the 2008/09 financial year showed evidence of shifting patterns in pre-vocational medical training. The number in training in the second postgraduate year (PGY2) has fallen from an expected 340 to approximately 170reported eligible trainees in 2009 (see Table 4). This drop follows on from a significant decrease in the previous year. Potential PGY2 trainees are locuming or leaving the country. It remains to be seen if this shift will affect the number of trainees accepted into vocational training in 2010 and beyond. At the same time, an extra 40 first-year trainees have entered the system in the PGY1 training year, but it must now be uncertain how many will enter PGY2 for 2010. In 2008 the unspent PGY2 funding was returned to the sector to fund previously unfunded medical training.

As a result of the Government initiative to provide 20 new operating theatres, the Portfolio will use some under-spend on increased vocational training associated with future staffing needs of the new theatres. In 2009, 149 unfilled PGY2 training places have been substituted to fund an additional 40 anaesthetist and 10 emergency medicine places.

For 2009/10 the portfolio will continue to focus on the Ministry of Health’s priorities and ‘shortage’ specialties. It will also continue to shift funded numbers towards those indicated by the projections of the Health Workforce Information Programme (HWIP) as they become available.

Intensive care training is now delivered separately from anaesthesia, and requires a stand-alone specification and price. The CTA has been directed by the Minister of Health to purchase AMPA training programmes. Further work on specifying and costing physician training will also be carried out.

Contracting

It has been noticeable that the medical portfolio must contract for more training places than will be filled in order to ultimately obtain a sufficient number of eligible trainees to meet budget projections. This necessity is a result of the difficulty DHBs experience in filling contracted places. The portfolio agreed to fund 3.1 percent more registrars for 2008, but training providers only managed a 0.2 percent increase in funded trainees. To minimise the financial uncertainty and loss of training funds resulting from the increasing vacancies, the portfolio intends to place some emphasis on substitution of contracted places that remain unfilled and diversion of funds to needed training places that can be occupied.