EDUCATION CONTRACT: QUESTIONS AND ANSWERS

  1. Why is the Education Contract Being Introduced?

Wales has its own set of unique challenges arising from:

  • recruitment and retention
  • high rates of Less Than Full Time working
  • the impact of changes to immigration legislation
  • a large number of training locations.

The majority of drivers for change are generic to all specialties and have already been detailed within published Reconfiguration Discussion Documents[1]. In order to ensure we Wales can recruit and retain high quality trainees there is a need to improve the quality of training on offer to trainees by investing in the educational environment. Specifically we need to protect teaching time, provide opportunities to attend outpatient clinics and provide theatre time. This will lead to a culture across NHS Wales which supports learning, education and training as recommended in the Heath Education Investment Review[2].

Before now, junior doctors in the UK have not been guaranteed teaching time. Wales is leading the UK in this area, by embedding guaranteed teaching time into the junior doctor’s working week contract. The aim is that this will improve patient outcomes and junior doctor morale. Junior doctors in Wales will be the first in the UK to get ring-fenced time for learning written into their contracts.

  1. Is this related to the change to 1:11 rotas?

A foundation stone that the Wales Deanery used in order to improve sustainability within rotas was to build upon the recommendations within the Temple report2 and to set a standard of a one in eleven rota requirement for trainees which would allow sufficient time for trainees to achieve their required learning objectives during the working day. The 1:11 rota will allow sufficient time for trainees to attend clinics, elective lists, formal training sessions and any other requirements within the relevant curricula.

The Wales Deanery recognises that for certain specialties and localities it may not always be possible to achieve the 1:11 standard, and as a result has introduced the concept of the Education Contract. It should be noted that in some specialties, in order to ensure trainees can meet the requirements of the finally agreed Education Contract, they will need to be on rotas of 1:11 or higher.

  1. How will the Education Contract Work?

The Education Contract forms an agreement between the Trainee, the Local Education Provider (LEP) (Health Board or Trust) and the Wales Deanery. , Welsh Government and Health Board.

The Education Contract is made up of 2 elements a Generic Contract and specialty specific criteria and metrics. The generic element of the contract is applicable to all trainees irrespective of specialty and grade. It is mapped against a number of key documents including the GMC Education Standards[3] which were introduced in January 2016 and the most recent version of the Gold Guide[4]. The agreed criteria and metrics for the specialty specific criteria are sourced from the specialty curricula mapped to a particular year of training and include aspects such as attendance at specified numbers of outpatient clinics, dedicated emergency or elective theatre sessions and mandatory teaching attendance requirements.

The contract details a commitment from the LEPs to ensure trainees have access to the required number of outpatient clinics, theatre sessions, teaching sessions, ward rounds and other educational opportunities to meet training needs.

The Education Contract is an iterative document which will evolve over time following feedback from the trainees and LEPs.

It is also a vehicle to ensure any changes to curriculum and standards as a result of patient safety concerns, service innovations and education strategies are implemented.

  1. What is the time scale for implementation?
  • By August 2016 trainees in the following specialties will be working to an Education Contract: Paediatrics, Obstetrics & Gynaecology, Core Surgical Training, Higher General Surgery and Trauma and Orthopaedics.
  • By August 2017 trainees in the remaining following specialties will be working to an Education Contract.
  1. How will the Education Contract be implemented?
  • A total of nine Education Contracts will be introduced from August 2016.
  • 4.1Two Obstetrics & Gynaecology contracts will be implemented from 3rd August 2016 one for trainees in ST1/2 posts working on a Tier 1 rota and the second for trainees in ST3+ posts working on a Tier 2 rota in Wales.
  • 4.3An Education Contract for trainees working on the Core Surgical Training Programme (CT1 and CT2 trainees) will be introduced from 3rd August 2016 along with separate contracts for trainees working in Higher General Surgery (ST3+) and Higher Trauma and Orthopaedics (ST3+) training programmes.
  • 4.4 In September 2016 four Education Contracts will be implemented for trainees on the Paediatrics training programme. Two General Paediatrics contracts will be introduced one for trainees working at ST1-3 level on Tier 1 rotas and one for trainees working at ST4+ level on Tier 2 rotas. Two contracts for Neonatal training placements will also be introduced again one for trainees working at ST1-3 level on Tier 1 rotas and one for trainees working at ST4+ level on Tier 2 rotas.
  1. Are Health Boards ready for this change?

In December 2014 the introduction of Education Contracts were first raised with Health Boards across Wales. In June 2015 the Deanery met with the Health Boards to outline detailed proposals for their introduction. Most recently a workshop involving stakeholders from the Health Boards was held in December 2015 to discuss the detail of the contract and implementation issues. At the conference there was general agreement that the Education Contract provides Wales with an excellent opportunity to deliver and promote high quality training and that the majority of the content was reasonable. Following the workshop the contracts were revised and a number of other issues considered such as: variability in access to education resources at different sites, mechanisms (including data collection processes) for monitoring access to training opportunities, communication and quality assurance.

The development of the Education Contract has been overseen by the Wales Deanery Reconfiguration Programme Board, a multi-stakeholder group which approved the final versions of the Education Contracts.

  1. How will the effectiveness of the new Education Contract be monitored?

As agreed with stakeholders at the engagement event on the 7th December 2015 the Wales Deanery in conjunction with the Specialty Schools, will monitor compliance against the Education Contract using existing mechanisms.

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  • The annual review of competence progression (ARCP) process for trainees will also support the identification of areas where contract requirements are not being met.
  • End of Placement Evaluation Forms (EPEFs) currently in place across most specialties are being revised to deliver a consistent mechanism for monitoring the Education Contract.
  • The Wales Deanery has developed a real time monitoring solution (known as ECAS) to enable trainees to record attendance at the specialty specific educational events. To ensure a full triangulation of data the LEPs will also be required to report on progress at regular intervals.
  • The Wales Deanery envisages that the Education Contract will sit alongside the annual commissioning process between the Deanery and the LEPs. Where evidence has shown that LEPs are not complying with the requirements of the Education Contract the Deanery Quality Management process will be triggered to work with the LEP to improve standards and delivery.
  1. Is this the same contract causing strikes in England?

Junior doctors in England are currently negotiating a new employment contract which relates to pay, terms and conditions of employment.

This is completely different to an education contract. However, as the NHS in Wales is devolved, junior doctors in Wales will not be obliged to sign up to this new work agreement.

  1. Further Information

For further information, please contact: 02920 687445 or email

Briefing Paper: Education Contract, page 1

[1] Paediatrics Training in Wales, The current programme, the challenges and proposed future model. A Discussion Document. May 2012, Obstetrics & Gynaecology Training in Wales, The current programme, the challenges and proposed future model. A Discussion Document. August 2012, Anaesthetics Training in Wales, The current programme, the challenges and proposed future model. A Discussion Document. November 2013, Medicine Training in Wales, The current programme, the challenges and proposed future model. A Discussion Document. December 2013.

[2] Health Professional Education Investment Review. 14th April 2015. Welsh Government.

[3] General Medical Council – ‘Promoting excellence: standards for medical education and training’ (July 2015)

[4] COPMeD – ‘ A Reference Guide for Postgraduate Specialty Training in the UK’ (The Gold Guide) Sixth Edition (February 2016)