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

We need to understand the uncertaintyFu

ll ti

me

eq

uiv

ale

nts

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

System dynamics modelling

Demand side

OutputsSupply

side

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

Considering the workforce system as a whole

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

Graham.Willis@cfwi.org.uk

www.cfwi.org.uk | www.horizonscanning.org.uk

Dr Siôn CaveDecision Analysis Service Ltd, England

+44(0)7825 758 139

SionCave@DAS-Ltd.co.uk

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