Minutes of the Foundation School Committee at Plumer House, Plymouth, Tuesday 11th December 2018, 8.30 or 10.00 – 13.00.
Sarah Rawlinson (Health Education England), Trudi Geach (HEE), Suzanne Maddock (HEE), Natalie Band (HEE), Angela Cottrell (RDE), Alex Parr (F2 Rep), Jan Morgan (TSDFT), Jamie Dunn (TSDFT), Mandy Turner (TSDFT), Nina Bossa (RDE), William Gewanter (F2 rep), Caroline Rawlings (NDHT), Himanshu Sharma (UPHT), Kerry Dungay (UPHT), Bill Wylie (Lay rep), Katja Adie (RCHT), Tom Smith-Walker (RCHT), Alok Bahl (F1 rep), Matthew Arnaouti (F1 rep), Giles Richards (Head of School of Psychiatry), Andrew Kelly (Medical School Representative Plymouth), Steven Burr (Medical School Representative Plymouth).
1. Trainee Support
Discussion was held on trainees in all trusts who are requiring additional support. This part of the meeting involved the Foundation School representatives, Lay rep and FPDs only.
Tom Lewis (NDHT), Elizabeth Ginn (SDHT), Nicki Saulsbury (Medical School Representative Exeter), Neil Walker (RDE)
3. Meeting notes from May Foundation School Committee Meeting were agreed.
Matters arising from the previous meeting were discussed:
Train the trainer courses
I: SR reported that she is still in discussions with NS for proposed dates.
A: SR will continue to chase.
I: TG & SR to report on regional teaching under item 5 on the Agenda.
I: All trusts were reminded that the Foundation School requires a Job Description for each placement. TG reported that she had received Job Descriptions from 3 out of the 5 trusts. A template was sent to all trusts at the beginning of the year.
A: All trusts to ensure that Job Descriptions are forwarded to TG for at least all F1 placements by the FS Welcome Event 18th March 2019. SR stated that there should be a job description for all F1 and F2 jobs.
I: AP said that he was asking the trainees in the actual rotation to write the Job Descriptions for UPHT as it gave a better reflection on what the job entails.
I: A copy of the new Study Leave Policy agreed at September’s meeting together with a flow chart for the process, has now been sent out to all trusts and all trainees. JM queried whether changes had been made following a recent DEG meeting however SR clarified that The Foundation School Policy was as agreed by the FSC meeting in September. The Study Leave policy was a Regional Policy at the moment but it is being discussed Nationally. SR has been asked by HEE to compile a list of courses which she has provisionally provided but will add to as and when thus providing a more accurate list.
KD said there had been issues with some trainees calling courses by different names when applying for study leave to get it through the sign off process. Only when the invoices arrive is it being noticed. SR said that this was a probity issue for the trainees in question and also whoever is signing off the approval for study leave must check they are happy with what they are approving.
PSA Information Pack for trainees who are new to the UK
I: SR and AB have met and they are in the process of producing an Information Pack. AB stated he had contacted a Pharmacist in Torbay who would be willing to hold a training session in January.
A: SR and AB to continue working towards producing a guide and explore the possibility of setting up a teaching session.
Community Posts – travel time and expenses
A: SR still to liaise with all trusts to see how claiming back travel time would affect the community posts with a view to producing new guidelines from August 2019.
Self-assessment of learning – PDP
I: Although TG reported she had sent this new form and guidance out to all trainees the trainee reps present requested it be resent to ensure all trainees are aware.
A: TG to resend guidance and a copy of the form available on HORUS.
The meeting minutes were formally agreed upon.
Giles Richards was invited to give his Psychiatry update at this point as he needed to leave the meeting early. Therefore, the Agenda was altered to accommodate him.
I: GR asked the meeting if there had been any news on the proposed expansion of the Psychiatry in Foundation Programme as he had not heard anything further. SR felt that this would now be on hold until the outcome of the current national Foundation Programme Review is known.
I: SR raised an issue with the lack of supervisors in Derriford.
A: GR advised he will investigate this further.
I: AC advised GR that the Eating Disorder posts at RD&E have been moved to Liaison Psych due to the lack of in post supervision of trainees.
I: KA advised that RCHT F1 trainees had reported feeling isolated in their community Psych posts particularly those in their first rotations. RCHT now bring these trainees into MAU 1 day per week to experience some Acute medicine and this has been received positively by the trainees. The trainee reps present agreed that in all trusts this was an issue for F1s in any community posts.
A: SR requested that all F1 FPDs investigate what happens with F1s in community posts to integrate them in their trusts around exposure to Acute Medicine, training on trust computer systems and the social aspect. FPDS to let SR know what plan they put in place to address the issue be it bringing trainees into the trust, shadowing or other solutions.
I: TG advised the F1 2019 Academic interviews will be held on Friday 21st December in Exeter. Panel members had now been found. 32 applicants will be interviewed to fill 8 posts on offer.
6. Regional Teaching
I: SR stated that the feedback from trainees on the availability and quality of teaching across the trusts has prompted a need to review the current system. The Severn Deanery provide a regional teaching programme. SR asked the FSC to consider moving the Peninsula to a regional teaching programme for F2s only as F1s benefit from local teaching.
SR asked the meeting to consider the following proposal:
A Regional Teaching programme be implemented wef August 2019 to meet the new mandatory requirement of 60 hours per year teaching offering Core Skills days and other days
F2 to attend 2 mandatory Core Skills days which could include topics such as, Human Factors, Resilience & Health, Core Skills days with stations etc.
The other days to be offered to include topics such as nonclinical, Ethics & Law, Management & Leadership, Clinical themed days e.g. Paeds, O & G, GP, Psychiatry.
The total of 60hours to be broken down into face to face teaching, E-learning and departmental teaching in a split agreed by the FSC. SR gave the example of: Min 70 % Face to Face which would equate to 7 days per year.
Max 20% E-Learning which would equate to 12 hours per year.
Max 10% Departmental Teaching which would equate to 6 hours per year.
FSC decide what to be offered as core days and these will be run centrally with an electronic booking system (system currently used by Severn).
Each trust to offer a minimum of 10 non-core days to be opened to all F2s with a maximum number of attendees to avoid staffing issues.
Study leave to attend all teaching must be applied for by trainees and agreed by trusts in line with the new study leave policy.
Funding for Core days would be met centrally through the study leave budget and trust costs would be reimbursed via the monthly return by clicking the 2nd TAB. However, funding for trainee’s travel costs would need to be agreed.
SR felt some of the advantages of adopting this new system would be, protected bleep free teaching time for trainees, improved consistency of teaching for all and all would be able to benefit from the good teachers available across the patch. The negatives would be increased traveling for trainees, the commitment from trusts required to provide 10 training days.
The meeting reacted positively to this proposal and a general discussion ensued. The use of Skype was discussed as a solution to some Geographical issues. AP said that as well as Severn, Northern Ireland has also adopted a regional teaching model and we could also ask them for ideas.
I: SR asked the meeting for suggestions for what teaching trainees would like and a list of suggestions was drawn up by SR. GR stated that the School of Psychiatry would be very keen to offer a day and SR has had supportive feedback from the GP school as well.
SR sought feedback from the trainee reps as to their opinion on her suggested breakdown. It was clarified that ALS and SIM training was separate to this proposal. It was agreed that there should be a maximum of 30 attendees per session. Further discussions on the logistics of adopting this proposal were held.
I: In principle the FSC agreed to adopt SR’s proposals although SR agreed further details would need to be agreed.
A: SR to go out to each trust to request details of teaching that each trust can provide the Foundation School would aim to implement the programme w.e.f. August 2019 and therefore details from individual trusts will be needed by April 2019.
7. Medical School Update (New Agenda Item)
I: AK advised that they were currently undertaking a review of the programme. Their major undertaking at present was the imminent increase in admission numbers to 160 students per year. The curriculum was again under review. They are currently working with the GMC regarding new outcomes for students. Plymouth University students are now undertaking placements in Taunton Hospital as well as Truro.
I: KA raised the issue of the completion of TOI forms when students transfer from Medical School to Foundation training. The was a general feeling that more information needed to be disclosed to support trainees when they start Foundation if appropriate.
A: SR asked that the medical schools considered having a process to oversee information provided by the student before it is signed off by the Medical Schools.
8. Trainee representative matters
I: WG had been asked by Tom Lewis TPD North Devon to ask the meeting how trainees who need support are being dealt with. He felt that trainees were leaving Medical Schools with deficiencies. He asked that consideration be given to supporting these trainees via the PDU as there is not the capacity at trust level. SR stated that she had discussed this matter with North Devon and the Dean. There are a growing number of trainees in difficulty and growing recognition across the board that more needs to be done but there has also already been a number of initiatives such as ‘return to work champions’ in each trust. SR asked the trainee reps what they thought could help. They suggested that it would help if the various avenues of support such as ES, PDU, Occupational Health, Careers service were publicised more and SR stated there was more work that needed to be done with Educational Supervisors so there is an awareness of how to refer trainees on to appropriate support.
I: KA advised that a ‘Buddy’ system in RCHT pairs F1s with an F2 and that this has had some positive results.
A: SR stated that in principle the ‘Buddy’ System should be rolled out Peninsula wide.
I: MA said the was no encouragement in Plymouth for trainees to become involved in teaching and yet it is now a significant part of Core Surgical Specialty Training Application requirements. SR stated this is the kind of issue that should be raised at Quality Panels. HS confirmed that this matter had indeed been discussed at the recent Quality Panel in UPHT.
A: SR requested HS use the Quality Panel data to approach the relevant departments.
A: MA to email AK at Plymouth Medical School who will provide a name of someone to contact for F1s to get involved with teaching Medical Students.
Trainees are feeling there has been an influx of PAs that are taking over the learning opportunities in trusts for clinical skills, e.g. suturing. An example given was that a PA had been designated as Lumber Puncture competent where the Dr is not because the PA had taken all the lumber puncture opportunities. SR requested that trainees raise these issues with their CS and if needs be this would then need to be escalated to TPD level with very specific examples. This is an issue for trusts to address with Foundation School support if needed – there should be someone responsible for PAs in each trust. SR said that PAs are an essential part of the workforce development plans.
I: AP provided an update from recent FDAB meeting. Findings from a recent Exception Reporting Survey were discussed at FDAB. They received more than 650 responses. Over 150 said they were working overtime daily and 335 were working overtime weekly. Over 300 responders said that they never Exception Reported and 230 stated that they were actively discouraged by their CS to report. In response SR said that there is an awareness of Trainee issues with Exception Reporting at deanery and national level.
I: Evening Inductions were discussed as a solution if starting on a night shift.
I: It is felt that extra Induction is needed for overseas trainees.
I: There is talk of Apps being made available to assist trainees.
I: Some hospitals have 2am meetings to help with the loneliness of hospitals at night – trainees felt this was a good idea.
I: The trainee reps welcomed the earlier discussion around the proposed regional training programme which they felt addressed most of their issues. A suggestion was made that at the end of each teaching session, 5 mins were spent by the teacher on their area of expertise.
I: F1 teaching - a request was made that F1 teaching be scheduled for later in the day so they do not have to return to the ward afterwards.
A:SR once again reiterated that if trainees are not being released for training they must Exception Report. If a CS will not sign it off, then the trainee should request the CS puts in writing their reasons for not signing off and then trainees should escalate this to the Foundation School.
9. Career Destination Survey
I: NB presented her attached report on the data from this year’s Career Destination Survey. 2018 is the first year that this survey was completed online and the first year the FS used the National Survey. This has resulted in the loss of some of the data we had access to in previous years due to the survey content.
19% of trainees secured a specialty training post which is down 18% from the previous year. Of those trainees applying for a ST post 23% were not successful. There has been an increase of 11% of trainees taking a UK service post indicating that trainees were taking time to choose which specialty they want to apply too. Of those choosing to go straight into specialty training the biggest number are choosing GP.
SR stated that National figures had not yet been released. The Foundation School Review that is taking place is looking at the need to be flexible in the transition from F2 to ST. A F3 year has been discussed or extending the F2 to 2 years. The meeting was asked if there was concern nationally with the fall in numbers going straight into ST, but the was consensus that overall they are not struggling to fill ST vacancies.
10. Update from National Foundation School Directors
I: SR advised there was nothing to report.
Welcome Event 2019
I: TG confirmed that date for the FS Welcome Event is MONDAY 18th MARCH 2019. An email has been sent to all trusts with various actions on it. In view of the space available trusts are asked to bring a MAX of 5 trust staff to include existing trainees.
A: All trusts to respond to email re Welcome Event.
I:TG has sent a copy of the 2019 - 2020 2 year programmes to all centre managers and TPDs.
A: Any amendments to programmes must be sent by trusts to the FS ASAP so that oriel can be updated.
I: Recently held Quality Panels were discussed. SR advised that all Quality Panel reports are in the public domain and published on the Deanery Website so i trusts can refer to them for guidance on completion. If no feedback has been received for a post, then trusts can go out to trainees retrospectively for feedback but the recommended practice would be for the trainees on the Quality Panel to go out to the trainees in the relevant posts and request anonymous feedback prior to the panel being held. BW informed the meeting that the Quality Team are currently reviewing the whole process for next year. SR also advised that the new NETS (National Training and Education Survey) may affect the Quality Panels in future. The NETS is due to close on 14th December with data shared sometime in the new year. The feeling is that this will replace the End of Placement survey if it is fit for purpose.
I: AP felt there was too short of a time frame from receipt of the data to the time of the Quality Panels to analyse the data.
A: FS to look at closing surveys earlier to produce data earlier.
Dynamic Induction Package
I: CR expressed a concern that trusts have been informed that the Dynamic online Induction licence was not being renewed and that they have yet to hear what is going to replace it. They currently give all their new F1s a day off in lieu to complete their online induction in July prior to starting F1. This system has allowed trusts to sign off some competencies for three years meaning they are covered if they move trusts within the Peninsula without the need to re-sit. Managers in the meeting were concerned that if any replacement system did not have this functionality it will have a time impact.
A: TG to refer to Neil Squires to check what is replacing Dynamic and when.
The meeting concluded.
12. Next meetings
5th March 2019 RILD Building Exeter (start time to be confirmed).
21st May 2019 Plumer House Plymouth (start time to be confirmed).
25th September RILD Building Exeter (start time to be confirmed).
10th December Plumer House Plymouth (start time to be confirmed).