Peninsula Foundation School Committee Minutes
Tuesday 28th November 2023 14.00 – 17:00
Plumer House, Plymouth and via MS Teams
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Present:
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Apologies:
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1. Apologies
SM confirmed apologies received from those listed above.
Sarah Rawlinson has stepped down from the HoS role and Angela Cottrell has taken up the role. Sarah is now the Education Lead for the Peninsula.
AC Thanked Sarah for all her work as HoS over the past 6 years. AC also thanked Suzanne and Natalie for all their hard work during the transition period.
Thanks to all who contributed to Sarah’s leaving gift – Suzanne will send a picture around.
2. Agree meeting from May 2023 Foundation School Committee Meeting.
The foundation school are still actively seeking a representative from the medical school to attend these meetings but have not been successful yet. Keep on actions.
An increase in FPD payments has been agreed from August 2023. New TPD hours are 1 EMC for 30 posts – this is for posts and not actual doctors in training. The school has been informed that admin costs are included in the placement fee trusts receive for every DiT and as expansion happens placement fees will expand. SM to send a document with breakdown of money. The smallest increment is 0.25.
All trusts were asked what they had used the £3000 IMG money for
RCHT - Offered funding to attend IMG conference and offered additional clinical skills sessions.
TSDHT – Torbay have created a postgraduate teaching fellow post which will provide pastoral and teaching support. The post has been advertised twice but had not been filled at the time of the meeting. There is one applicant for the post and although the timing of the fellow starting has not been in line with the F1s start date the trust hope this will be an ongoing post.
UHPT – Offered a 2 day clinical skills course which had to be cancelled due to strikes. The team organising it have since been told they can no longer facilitate it due to their workload and are working hard to get another team together. There is a hope that this will be an annual event. Also, additional Sim session and prolonged orientation offered.
NDHT – Extended shadowing with accommodation was offered.. Trust is going to look at running some SIM sessions with the money they have left.RDE- Ran a bespoke IMG induction and held 2 GMC study days. All IMGs were invited to a coffee morning and a Cruise along the River Exe – This offering was for all grades of IMGs doctors. The trust are hoping to run some refresher training in January.
AC thank everyone for their impressive work across the region.
CvH suggested this would make a great presentation at ASME/AIME. The Foundation School had advertised for an IMG fellow but unfortunately the applicant could not fit the project within their work hours.
3. Trainee Rep Matters
AC welcomed new reps.
Rosanna and Alice are F2 reps from Torbay and Exeter. They have gathered some feedback from F2s and had a small response to their survey. They are not getting any feedback from trusts where they are not based and hoped it would be possible to have local reps from each trust who report into them at school level. There are local reps in each trust who either attend local foundation team meetings or are the Junior Doctors Forum reps and AC was happy for AW and RW to take this forward. Trusts to ask their reps to contact Rosanna and Alice. Severn appoint F1s and F2s for fellow roles who take on a project during their time and there is a good mix across the trusts. AC to look at implementing this in the future.
Maxcourse – Trainees have reported that they don’t know when courses get released on the system which leads to some missing out on course places. There is no automated email available on Maxcourse and this would mean sending an email to all trainees every time a course is released. AW and RW suggested that new courses were released in batches and one email was sent but this could still lead to some missing out on a place. SM to investigate other solutions.
Study leave – AC confirmed that F2s can apply for other courses/ events and not just what is on MaxCourse. School guidance is on the website (Study leave policy) including an approved course list. There are categories to apply within. Trainees are encouraged to speak to their ES/ FPD or the foundation school if they have any problems with the guidance.
4. Psychiatry update and introduction
Jason Hancock, DME in DPT joined the meeting. Currently there are 13 Foundation trainees at DPT and would be keen to be involved with expansion. Psychiatry has some unique challenges which are slightly different to other specialties. There is a recruitment crisis where it is difficult to appoint substantive consultants which means there are challenges committing to the level of supervision needed for foundation doctors. JH suggested that if supervisors could be locum consultants or higher trainees, they could take on more foundation doctors. CS has to be a consultant which is stipulated by the GMC. The named CS doesn’t have to be there all day every day but foundation doctors do need to have access to someone senior at all times. CvH suggested looking at a Prison Psych placement which is highly valued in Severn. Both foundation schools to look at setting up a joint meeting with Psychiatry representatives across the South West to discuss Foundation Psychiatry placements.
5. Foundation School Directors Update
F1 induction survey results – F1s have reported that they would appreciate their CS allocations as soon as possible and would like a buddy system in early stages of first placements. All trusts confirmed that they have shadowing opportunities but not a buddy system. TSDHT have a mentoring buddy system that is currently run by the Doctors. RW asked to share system used in Torbay with other trusts.
North Devon currently have 2 F2 IMGs who are setting up an IMG buddy project which they are writing up as a QIP. ND to feedback at next meeting on progress/success.
Absences – Any foundation doctor that has 20 days or absence needs to be looked at in more detail. Industrial action needs to be counted as absences from training. There have been developments with deals but there is potentially more IA which will increase TOOT days. All trusts to ask CS to be accurate with absences on end of placement reports.
GMC survey – overall satisfaction 2nd in country in for F1 and 11/12 for F2. AC will look at results in more detail and will feedback at next meeting.
Paeds in RCHT was recognised as a celebration area.
AC congratulated everyone on the call for all their hard work with Foundation Doctors in the trust.
6. ENHANCE Programme 3pm start
Mark Fresch, North Devon Enhance Generalism Trailblazer Clinical Lead and Helen Johnson, Deputy Dean EOE, joined the meeting to discuss understanding of enhance modules.
Enhance has been devised to prepare for the future, where whole person care can be used. There are two parts to enhance training. The first are the enhance Enable modules which cover 6 domains and are open to all foundation doctors – (Enhance website). There are 6 modules of self-directed E-Learning to complete. ES will need to complete a REAL form on the doctors e-portfolio and then a certificate will be produced by the trust education centre. The enable modules can be counted as core teaching and can be done during SDT.
The second is enhance Explore which will only be available for a certain number of doctors. These could be in the form of priority programmes where doctors complete 40% of their time in a primary care setting and 60% in secondary care to see how patients move between the two. The east of England and Yorkshire and Humber Foundation school are currently offering enhanced programmes.
AC to look at whether Peninsula could add in a Priority programme offering doctors the enhance explore programme.
The Enhanced posts available in North Devon range from F3 to ST3 grades where 20% of the clinical posts are used for individual projects. They are also looking at pre F1 cohort, with year 5 medical school students completing a 6-week block on enhanced topics and this will be for 30 students.
Helen suggested that some teaching will already fall under the enhance umbrella and can be looked at and rebranded. Helen has also put in a bid for future funding.
The Peninsula is ideal environment for enhance posts due to its population demographic, recruitment & retention challenges and costal areas. All trusts are asked to think about how we can promote the modules to Foundation Doctors. The East of England spent their enhance money on extra tasters, Educational days in a forest – forestry commission provided the course for free and the school only paid for transport, Dementia bus. Helen suggested looking at geographical surroundings and what facilities are on our doorstep. The committee felt very positive about the enhance programme and will work on ideas to try and promote it within their trusts.
7. Education Update
Sarah Rawlinson is the new Education Lead. The school has also appointed Thom Fox as an Education Fellow. Thom is an ED ST6 in Plymouth where he works in ED 60% and 40% in the education role. Thom has been asked to look at the F1 core teaching programme.
Thom has visited 4 out of 5 trusts and attending a teaching session and has surveyed the F2s about their F1 teaching. 100% of Foundation Doctors met the core learning requirement and 66% found the sessions beneficial. 17% rated teaching as poor – foundation doctors are concerned about the job role or grade of facilitators and reported a lack of clinical teaching.
Thom also had some feedback from the admin teams within the trusts who reported getting facilitators is a challenge as well as getting feedback from learners – there is a large admin burden chasing for feedback. Trusts also reported that restarting face to face after covid has had lots of challenges.
Thom would like to improve consistency between trusts and introduce some regional sessions covering 12 items on the curriculum which would be carried out as 5 x 2 monthly sessions. Trusts could choose topics or could use existing good sessions. Thom would also like to provide a region wide feedback form and ensure FPDs have access.
Thomas.fox5@nhs.net – happy to be contacted for questions.
Thom received the following feedback from committee:
- Engagement in virtual sessions is not as good as face to face and there were concerns about remote learning where facilitators are met with blank screens. AC confirmed that regional sessions would be delivered online but would be face to face at all sites> The sites where the teaching is not taking place would each have a facilitator and the F1s would all be together in their trust cameras must be on for virtual learners. The regional days are an opportunity to use the excellent sessions across the region and reduce the admin burden.
- There were some concerns that not all F1s can be free at the same time – 4trusts currently run their weekly sessions on a Tuesday lunch time.
- Trainee reps have asked not to fully remove online teaching as they are concerned that due to their workload/ days of work they would not be able to attend face to face. AC reminded the committee that teaching is protected time, but the reps confirmed that in reality this doesn’t happen.
- RCHT encourage Face to face and will only send a meeting link to individuals who have contacted them and cannot make it in person for a good reason, they do not send out the link to everyone when the teaching is set up.
- RCHT has run an F2 study day that was open to whole region where there were facilitators at each site, and this worked very well but days like this need to be organised well for it to happen.
- BW asked if Thom could find out why some trusts were rated poor and what the differences were to their offerings.
- RDE reported that they have lost at least 3 speakers who will not run an online session due to engagement. NW felt it was not unreasonable to remove people from the meeting if they do not have their camera on – NW is happy to try this and report back to the meeting.
- A document for rules of engagement for all trainees was suggested.
- Trusts felt that if the foundation doctors were not allowed to each their lunch during the sessions, they might not have many attendees at sessions. Lunch time is also a good time for educators to have breaks from clinics.
- Alice and Roseanna are education academics and would be keen to work with Thom and Sarah to improve the programme.
- SMe suggested a regional conference which had different speakers all on same day. This would cut travel time and could be run a couple times a year. So important for teaching to be face to face for trainees to meet their peers – need to think of human value as well as educational value.
8. General Practice Update
No representative available
9. Recruitment Update
August 2024 will see the last of the planned F1 expansion and the school will have 280 F1s (excluding 6 MOD) and 263 F2s (rising to 281 F2s in August 2025). For F1 2024 there has been a slight decrease in eligibility applicants with 1500 of the total 10777 applicants applying under the eligibility criteria. There has been an increase in UK grads this year from increase in medical school placements. Nationally there is a shortfall of about 500 programmes across the 4 nations. The UKFPO have been gathering data on the large number of withdrawals seen in August to better predict the drop out rate and thus cut down the number of additional programmes needed but this is very hard to calculate accurately Preference informed allocation (PIA) has been introduced for 2024 which see the removal of the Decile score and the SJT. Past data has been analysed and if everyone was allocated to first preference there would be an increase of 6% being given their 1st choice. More popular schools have traditionally been oversubscribed and have had higher scoring applicants but with the new PIA allocation all applicants have an equal chance of a place in more popular regions. Students might not be happy with their allocation using the PIA system and could choose to withdraw from the process and apply again in the following year. Some of the withdrawals the school had for August 2023 were due to applicants not being happy with their allocation and chose to try again using the PIA system.
There will be no data on any additional expansion numbers this side of Christmas. The financial position as a region is very difficult but it is likely that as a school, we will be asked for extra posts. Expansion should be asked by Dean to DME due to being in special measures.
SFP –The education and leadership and management SFP posts have been added to the Foundation Priority Programmes for August 2024 start. Due to removal of the SJT and decile scores from medical schools the school could not shortlist in a fair and robust way. For the FPP posts, for foundation doctors to be able to continue with the F2 component they will have to be on track without any concerns.
Research jobs in Plymouth and Exeter were recruited to in the traditional way. As a South West region we received 292 applicants for 20 jobs. It is believed the increased number of applications was a result of PIA where students wanted some control of where they were going. 48 candidates were interviewed and 46 were appointable.
This year the Peninsula could see a very different cohort of higher scoring applicants.
BW was a lay rep at the SFP interviews and praised team for organisation and shared the view of their being some very good applicants.
10. A.O.B
Increase in LTFT applications – the eligibility criteria have been changed to be more inclusive. Foundation Doctors are able to switch between LTFT to FT depending on their placement. Foundation is time and competency based so cannot complete early but being out of sync with the cohort adds complexity moving to specialty training which can have a significant impact on departments. Foundation Doctors need to give 16 weeks to change their hours but any FD that has an OH referral can be considered with a shorter time frame depending though, on the trust department being able to accommodate any change. Well-founded reasons requests for LTFT don’t have to be agreed if it is not possible for the trust to accommodate them. The Foundation School asked trusts to be aware of this and follow the guidance within the policy.
PSA – each trust does something different with regards to those who haven’t passed PSA with regards to prescribing.
Exeter – the trust uses Epic, a computerised prescribing programme. If FDs have failed the PSA their access to the system is removed – they can write prescriptions but will need to be countersigned.
Torbay – arrange extra training for FDs. The trust will contact the department to advise not passed PSA and may not be safe and is then left to departments to decide what to do but most need prescriptions countersigned.
Cornwall – FDs are allowed to prescribe but with extra support
Plymouth – have pharmacy colleagues who facilitate workshops which FDs find very helpful. Anyone who has failed the PSA is not allowed to prescribe. KT believes the Pharmacy is set up that any F1 prescription is double checked.
North Devon – the trust look at each FD on a case by case basis and decide what is best given their experience. FB suggested that passing the PSA should be part of the recruitment standards. FB also commented in the timing of tests and that they should not be so earlier into the year.
It was suggested that there should be no universal plan as each FD has very different abilities. Each trust needs to identify the risk and how much risk are they willing to take – need to discuss and agree their policy with their medical director.
ALS vs ILS for F1s – trusts are unable tofund ILS and ALS. ALS was brought forward to F1 for everyone but at the time of being assigned to an ALS course the trust are unaware of F1 abilities and whether they are likely to pass. The one day course only has time for teaching and not practice so the failure rates are higher. AC to meet with FB and RT to discuss this further.
Quality Panel Update – both Peninsula and Severn Foundation Schools have met with the quality team to discuss the changes to the QP process. QP will no longer require a lay rep to act as chair and this should be the FPD who has more local knowledge of departments. Lay reps can still be part of the panel to ensure fairness. Trust will need to gather as much data as possible from the EOP and GMC surveys and the QP outcome reporting tool still needs to be used. Each panel needs to have externality and it has been suggested that FPDs could go to other trusts. AC to summarise statement and send round to all trusts.
Timing of next year’s meetings – The proposed dates for 2024 were discussed and AC will revisit toalternate between Tuesdays and Wednesdays to help as many committee members attend as possible
Ange thanked everyone for all their hard work. The meeting concluded.
Actions for Review:
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Agenda Item |
FSC Member |
Action |
By When |
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2 |
TG |
TOR – School to actively seek Medical School representation of the committee. (TG) |
Ongoing |
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SM |
SM to send a document with breakdown of money placement fees |
Next meeting |
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3 |
AW & RW |
Contact each trust to identify local foundation reps |
Next meeting |
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AC |
Look at possibility of recruiting Foundation Fellows |
Ongoing |
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SM |
Investigate solutions for informing F2s of courses released on Maxcourse |
Next meeting |
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5 |
RW |
RW asked to share buddying system used in Torbay with other trusts. |
Next meeting |
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North Devon |
Trust to report on success/progress of F2 IMG Buddy QIP at next meeting |
Next Meeting |
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6 |
AC |
AC to look at whether Peninsula could add in a Priority programme offering doctors the enhance explore programme. |
Next meeting |
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10 |
AC, RT, FB |
AC to meet with FB and RT to discuss ALS vs ILS further. |
Next meeting |
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AC |
AC to summarise Quality Panel statement and send round to all trusts. |
Next meeting |
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