Minutes of the Foundation School Committee at the Raleigh Building, Plymouth Science Park, Plymouth

Thursday 14th December, 10.00am – 1pm.
Hiu Lam (Health Education England), Trudi Geach (HEE), Suzanne Maddock (HEE), Richard Sloman (HEE), Natalie Band (HEE) Sarah Rawlinson (PHT), Steve Tran (F2 rep), Steve Boumphrey(PHT), Angela Cottrell (RDE), Charlotte King (SDHT),  Tom Stovin (F2 rep), Alex Parr (F1 Rep), Giles Richards (Head of School of Psychiatry), Kirsty Ellmers (SDHT), David Richardson (NDHT), Elizabeth Ginn (SDHT), Tom Smith-Walker (RCHT)
1. Apologies: Hisham Khalil (PCMD), Trudy Eddy (RCHT), Linda Willimott (PHT),  Tamsin Sleep (SDHT), Angela French (Lay Rep), Nicki Saulsbury (Medical School Representative Exeter), Katja Adie (RCHT), Tom Lewis (NDHT), Nina Bossa (RDE), Paul Thomas (Head of Peninsula School of Primary Care)
2. Welcome to the new Head of the Peninsula Foundation School.
I: After introductions round the table HL welcomed Sarah Rawlinson as the new Head of Peninsula Foundation School.  SR advised her official start date was yet to be confirmed but will possibly be 1st February 2018.  HL thanked the committee for their support during his time as Interim Head of School.
3. Meeting notes from Thursday 28th September 2017 were agreed.
I: Matters arising from the previous meeting were discussed:
I: North Devon Induction Packs for Trainees.
These have received positive feedback and the FSC have asked for them to be uploaded onto the PGME Website.  TG informed the meeting that the document may be too large to upload and that the Website was currently under review but she would check whether this was possible.
A: TG will see if it is possible the work schedules can be uploaded
I: Study Leave
HL reported he had investigated the new contract to see if there was anything specific about the amount of hours study leave F1s must receive.  The BMA has confirmed there is nothing specific in the new contract.  HL has also checked the Foundation School Reference Guide and again there is no specific reference to how many hours they are supposed to receive.  The committee therefore agreed that a minimum of 75 hours and a maximum of 120 hours be allocated to include all generic teaching.  AP reported that at the Foundation Advisory Meeting recently there was a feeling nationally that F1s felt it was more useful to do taster weeks in F1 than in F2.
I: Missed Teaching
HL requested at the previous meeting that all Trusts should establish what is done in their own trusts about missed teaching. Each trust reported they had found that there was very little Exception Reporting happening in regards to missed teaching.  HL stated across the footprint, DMEs reported that most exception reports are related to hours and not educational concerns and felt that unless trainees exception report specific instances it would be very hard to take the matter forward. 
A: It was agreed that if Trainees raise an exception report for missed teaching they can have the time back.  It was felt this would encourage trainees to report instances so that they can be followed up.
I: Local Training.
During the previous FSC Meeting it had been established that Georgia Jones had been in discussion with Plymouth University about developing a course on teaching and leadership but it was felt that again the costs would be prohibitive.  NS had felt that this was something that Exeter University could provide the trainers for if we could provide the venues at little or no cost.  As NS was not present it was agreed to carry this forward to the next FSC Meeting in March when hopefully NS would be able to report on the costs involved.
A: NS to provide the costs of providing half day teaching courses and look into the feasibility of providing them and update the committee at the next meeting.
The Trainee Reps present confirmed they had sent a survey to all F1s and F2s and although they had not had many responses the general feeling was that trainees would really welcome more local course provision in view of the cost and time savings.  Elsewhere nationally trainees are able to do half days of PGCert without having to commit to the fully PGCert.
A: ST to find out where this was offered and report any best practice at the next FSC meeting.
I: Short Notice Night Shift Cover. 
I: No further specific examples of FS trainees being moved at the last minute however AP knew of Med Reg being told on13/12 at midday that she was now needed to cover night shift. 
I: Quality Panels
TG confirmed that she had sent out a role description for Trainee Representatives on the Quality Panels.
SM advised that she was unable to track down the video referred to at the last meeting and felt that it had not been finalised due to some inaccuracies on the video surrounding the process. 
I: F2s in GP Travel Time
TG advised that she had followed this up with Medical Staffing in the various trusts and it appears that the way this is dealt with varies widely.  TG felt that if this is taken further there will need to be consistency across the Peninsula.  This will mean that the GP trainer contract will need to be rewritten.  NB advised that during GP Practice visits each practice is asked to provide a timetable for F2s which specifies travel time and is therefore include in their contracted working hours.  TG advised Medical Staffing state that there is NO provision in the new contract for travel time.  A general discussion ensued and the following was agreed.
A: Due to only 2 queries being received in the last few years no action to be taken at the present time to change the way individual trusts or practices deal with travel time to GP practices. FS will continue to monitor any specific queries from F2 trainees if they feel they are being dealt with unfairly.
A: All trusts to ensure that when allocating F2s to individual GP practices they take into account where the trainee lives in relation to the practice and whether they have access to a car.
I: National Induction Survey – Medical Schools
Following concerns raised at the previous meetings about trainee’s being unprepared for real life when commencing FS training TG confirmed that she had contacted Clare van Hamel.  She has assured TG that Medical Schools do receive the feedback from this survey.
Trusts confirmed that they will be encouraging F1s to complete a night shift during their shadowing week if they have no previous experience.
SDHT confirmed they are in the process of redesigning their F1 induction following feedback from the previous FSC Meeting.
F2s in GP visits
AC raised feedback she has received from GP practices about whether these visits can be amalgamated with visits made by other stakeholders.  TG confirmed that we are trying to bring this in using a spreadsheet system that the various teams have access too.  Resources and the lack of someone taking overall control were making things difficult at the moment but it is definitely something that the FS were working towards.  At present for example Severn FS are no longer doing separate visits they are all being undertaken by the GP School.
I: Less than full time trainees
TG confirmed the Less than full time trainee issue had been sorted with Katja Adie.
4. Psychiatry.
I: During the last meeting TG informed the committee that nationally it is being proposed that 75% of Foundation Trainees will be required to undertake some sort of 4 month Psychiatry post.  GR stated he had not heard anything about this proposal.  HL confirmed that this was a national recommendation but that details were not yet forthcoming on funding, service impact/effect on acute trusts.  The North West is involved in a pilot exercise and some feedback is expected soon.  Clare van Hamel has feedback that suggests that trainees who have completed a Psych placement are not persuaded to ultimately pursue a career in Psychiatry.  
GR conceded that recruitment into Psychiatry is poor nationally but he felt that this initiative is not just about recruitment but about improving the generic skills of all doctors in mental health related issues by giving them experience in the Psychiatry field rather than just cases that present themselves in ED departments.
I: GR advised HEE are widening access to training by opening the recruitment process particularly in eastern Europe by offering an ‘F3 year’ to cover FS requirements consisting of two,  6 month placements one in GP and one in Psychiatry. 15 out of 30 applicants have been recruited to start in February 2018; however the start date may be delayed due to issues with GMC registration.  1 trainee has been recruited to start in Plymouth.   HEE are opening this process out to 200 posts in January 2018.  GR advised that the North East have been involved in a pilot of this scheme for a number of years.  
I: HL informed the FSC that the UKFPO will be sending out a survey shortly to all Foundation Schools to ascertain what these possible posts to meet the new 75% requirement figure would look like and to rate their educational value.  Historically there has been a problem with existing Psych posts not being geared up to Foundation trainees.  Feedback suggesting that they felt that they were there to provide medical cover only and were not made to feel part of the Psych team receiving little or no Psych teaching.  GR stated he was not aware of any specific issues now with Foundation trainees.  HL discussed one particular post in Torbay that was causing concerns that he and the trust were in the process of looking into following feedback during the recent Quality Panel.  RDE also confirmed that their recent Quality Panel also raised some issues which were being looked into.  SR confirmed that they had had problems last year with some PHT Psych posts but the issues were addressed and now the feedback at their recent Quality Panel was positive and the trainees valued these posts.  HL asked SR and SB for best practice and SR said that they had made 1-1 contact with Psychiatry and fed back the trainees comments directly.  The Psych team then took these concerns on board and addressed them.  GR felt that a number of substantive appointments made in Plymouth by Livewell has helped the situation. 
I: The FSC felt that the new F3 recruits would be very vulnerable having never worked in the NHS and that they would need a lot of supervision.  Georgia Jones had previously raised concerns that there were not enough ES and CS to increase capacity in Psych posts.  GR stated that this was at the time largely down to the lack of substantive consultants.  He said that the situation in Cornwall and Plymouth was now resolved with nearly all substantive posts filled.  DPT and North Devon still had some issues.  GR stated that although there was a need to ensure the educational value in Psychiatry of these posts their patients did also need medical care and by the very nature of their conditions if they did not receive medical care in Psychiatry they would not access it elsewhere in the NHS.
5. Trainee Representative Matters
I:  The Trainee reps present had sent out a survey to all Foundation trainees prior to the meeting.
I: Teaching Standards
Trainees feel that the standard of teaching varies in quality and they would like teaching to be on clinical matters and more case based teaching rather than non-clinical matters. For example a session given by police on conflict resolution which lasted over 3 hours was felt by trainees not to be as useful as clinical teaching.  F2 teaching in Plymouth had been highlighted as good, so HL asked Plymouth to share best practice.  SR was unable to give specifics from memory but SR and SB advised that around 18 months ago the trust streamlined and condensed teaching.
A: HL requested that each trust request specific feedback from their trainees on the quality of teaching in their location and provide feedback to the next FSC.
I: The trainee reps suggested that a regional curriculum be drawn up to standardise teaching content across the Peninsula.  The FSC felt that this would be impractical due to the variation in specialties across the Peninsula.
I: Educational Leadership Half Day Course
Trainees would welcome the provision of this course locally.
I: Support
One trainee raised the issue that they had felt isolated following the death of a patient and wanted advice as to what support was available.  HL felt that in the first instance the trainee should approach their ES or CS and accesses the professional support where appropriate. 
6. Quality Panels and Current Post Surveys
I: TG advised that North Devon was the only Quality Panel yet to run, which will be conducted on 16th January 2018.
I: TG presented the Foundation School’s Oriel upload spreadsheet to the meeting highlighting the descriptor on each individual 2 year programme. TG stressed to the meeting that it was essential that we ensure that the description given against each programme is an accurate representation of what the actual individual posts will be.  TG confirmed that the programmes are always uploaded with the caveat that they are subject to change but to avoid as many trainee issues as possible we need to check them thoroughly and badge posts accurately.
A: All trusts to check the information on their programmes sent via email recently by TG and confirm any changes by deadline of 5th January 2018 as specified on the email.
I: TG also stated that we need up to date job descriptions this year.  The trusts present felt that their HR departments would have these.
A: TG to contact each trusts HR for up to date job descriptions.  These will then be uploaded onto the website for students to refer to whilst ranking their programmes.
7. Resilience Training
I: AC from RDE has had 25% of trainees referred to occupational health.  This includes trainees who had positive flags on their TOI from Medical School.  This is resulting in significant problems with a large number of trainees who require a lot of support.  AC wanted to know if there was any form of resilience training available to trainees.  She was aware that Peninsula Medical Students receive some whilst at Medical School but this was not the case for trainees from other areas.  HL informed the committee that following the recent restructure, the PSU was changing to the Professional Development Unit..   They were looking to deliver a number of resilience courses but the first priority would be to train the trainer as there were over 4000 trainees covered by Peninsula and Severn offices.  Whilst this programme is rolled out trusts should continue to signpost trainees requiring support to the appropriate channels.
I:  The subject of TOIs was discussed.  There is a general feeling that the information passed on from Medical Schools about possible support issues was inadequate.  If more information was forthcoming prior to trainees starting then it would be easier to allocate more supportive ES.  ST pointed out that some trainees did not want to disclose this information as they wanted a clean slate when starting their FS training.
A: TG to contact the Medical School FSC representatives to discuss the quality of information provided on TOIs.
8. Welcome Event
I: Following feedback from previous years TG said that the time spent with current trainees in each trust was the thing they most valued.  TG proposed therefore that the trusts reduced the length of their presentations to provide more time for Q & As in each trust.  Also they need to have job descriptions and details of pay etc. in a hand out format.
A: Each trust to start to plan their presentations for next year’s Welcome Event and ask for volunteer trainees to attend.  Each trust to ensure that there is as much time as possible for the delegates to talk to existing trainees.  Each trust to prepare hand outs on job descriptions, pay etc.
I: TG advised to print a brochure similar to previous year’s it was going to cost in excess of £400.00, whereas to produce a colour photocopy version it would only cost £38.00.  The FSC agreed to produce with a photocopied version.
A:  All trusts that haven’t already done so to email any amendments to existing content to SM by original deadline.  SM to produce a brochure in house.
I: TG raised the subject of organising a social event after the Welcome Event.  This is usually organised by trainees from the trust hosting the Welcome Event but it has been hard to gage interest and volunteers in the past.  After a general discussion it was felt that refreshments provided by the trust after the event to facilitate a further Q & A would be the best option.
A: AC to speak with RDE Foundation Team/Mess to see if this is possible.
I:  TG referred the meeting to the update which was sent the previous day to all trusts and FS trainees.  The ARCP functionality has not yet been released but this is due in the early part of 2018.  A discussion around what Audits are completed on HORUS at trust level and at Foundation School level took place.
A: All trusts are to confirm what audits they are undertaking and what audits they would like  the FS to carry out and report back to SM/TG.
I: AP informed the meeting that he had been able to transfer parts of his portfolio from NES to HORUS through a specific website.
10. Terms of Reference.
I: HL discussed the Terms of Reference of the FSC which have to be reviewed every two years. The next review is due in 2018.  The meeting agreed to defer this item until SR starts in her role in 2018.
A: Terms of Reference to be reviewed by the FSC in 2018.
11. Update from the National Foundation School Directors (Nov2017)
I: HL reported that he was unable to attend November’s meeting but had received the minutes.  The Medical Licensing Assessment for UK and International trainees should be implemented by 2020.   The outcome of MLA will not be ranked but trainees will receive either a pass or fail rating.  According to the current pass rates from medical Schools, GMC is anticipating around a 2% failure rate.
AP reported the trainee reps had had a debate at the recent Foundation Advisory Meeting around various issues about the MLA including how it would fit in with Medical School finals/F1 and who would fund it, in view of Brexit there was also a feeling that it was not now needed as it was originally being brought in to test European trainees skills but Europeans may now need to undertake the PLAB test.
I: TG again stressed that 2 clinicians were still needed to take part in the F1 National standalone recruitment round taking place in Birmingham on 18th and 19th April 2018.  It will take place at the Aston Villa FC.  TG needs to know ASAP as accommodation will need to be arranged as it will not be possible to travel up and back in one day due to the early starts.
A: Volunteers to notify TG if they are able to attend ASAP.
LTFT & Absence from training.
I: The UKFPO has specified that trainees at 60% will need 20 months to complete their training year.  They also issued a reminder that the 20 day absence ruling does not mean an automatic extension to training is required.  It is designed to trigger a review of training.
12. AOB
I: TG advised that last year we had 25 trainees apply to SWAP their F2 rotations.  Of these the FS was able to accommodate 14 trainees.  This year’s SWAPs process is currently open and all F1s have received details on how to apply.  TG stressed that if a trainee has completed a surgery or medicine rotation in their F1 programme they cannot repeat a surgical or medicine post unless some element of it is community facing.  TG asked the meeting to decide how posts are deemed community facing.  The UKFPO guidance only states trainees must attend “regular” clinics it does not specify how many clinics per 4 month post was required as a minimum.  PHT stated that they aim for 6 clinics in the 4 month post. TG stressed that if trusts could not guarantee the community facing element of a post we would be unable to include the post in the SWAPs process for a trainee who had already done surgery or medicine in F1.  TG asked the FSC to also decide how we monitor compliance as this is a National UKFPO requirement w.e.f August 2017.
A: It was agreed that all trainees in community facing medicine or surgical posts agree with their CS on their PDP at their initial meeting how many clinics they will attend in that 4 month period aiming for a minimum of 6.  It was generally agreed however that a trainee could not be penalised for not attending clinic if they have not been released to do so because of ward pressures.  In this instance they should log why they are not able to attend and this will need to be reviewed.
Rota Monitoring
I: HL advised that wef Autumn 2017 all trainees should be advised 6 weeks in advance of their rota and compliance to this is now being monitored by NHSI
I: HL advised that following CSR, the PSU will now become the Personal Development Unit (PDU).  HEE may allocate funding following bids from all HEE offices to implement a Supported return to training ( SuppoRTT) programme for trainees who have been TOFP, off sick etc.  This may mean a return to work champion in each LEP with a two Hubs (Peninsula and Severn) within Post Graduate Medical Education to coordinate and work with the champions in facilitating a smooth return to training.  This may involve such things as simulation training and resilience, leadership, management and coaching training.  News on funding allocation is expected in January 2018.
The meeting concluded.