Health Education England working across the South West Peninsula Postgraduate Medical Education
Minutes of the Foundation School Committee at RILD RDE Barrack Road Exeter, Wednesday 4th March 2020,
9:00 or 10.00 – 13.00.
Sarah Rawlinson (Health Education England), Trudi Geach (HEE), Natalie Band (HEE), Suzanne Maddock (HEE), Angela Cottrell (RDE), Neil Walker (RDE), Nina Bosa (RDE), Jamie Dunn (TSDFT), Philip Reilly (TSDFT), Fionn Bellis (NDHT), Caroline Rawlings (NDHT) Daranee Boon (UPHT), Kate Talmage (UPHT), Trudy Eddy (RCHT), Kathryn Eccleston (RCHT via skype), Tom Smith-Walker (RCHT via skype), Andrei Brunchi (F1 rep), Jan Morgan (TSDFT), , Bill Wylie (Lay Rep), Nick Toms (Medical School Representative Plymouth), Simon Bonell (Head of School of Psychiatry), Sharon Hooper (HEE Quality)
Discussion was held on trainees in all trusts who are requiring additional support. This part of the meeting involved the Foundation School representatives FPDs and Lay Rep only. The following general non confidential points were agreed:
Tim Hookway (UPHT), Alok Balal (F2 Trainee Rep), Marie Jasim (F1 Trainee Rep), Kerry Dungay (UHPT).
2. Meeting notes from December’s Foundation School Committee Meeting were agreed.
Before discussions began SR welcomed to the meeting new members to the committee and general introductions were made around the table.
Matters arising from the previous meeting were discussed:
Medical School Update
I: NT introduced himself as the rep from Plymouth Medical School. He briefly confirmed the work being done with the new STEP online forms. This work is involving their Health Conduct Review Group and Student Support Officers. Student will complete and submit the form and the Medical School will review and add concerns evidenced then this will then be forwarded to the relevant Deanery.
Trainees teaching medical students
I: NW reported that F2s teaching F1s is working well with very positive feedback. RDE will therefore be implementing the same system for the forthcoming year.
A: NW to send TG details and TG will forward it on to all other trusts to implement as a best practice.
I: SR investigated whether an additional form needs completing for entries recorded on the mandatory log. It was decided that the existing HORUS process was enough.
A: Every trust was reminded to make a list of Core teaching in their trust to be used at ARCP.
I: SR once again clarified that the MINIMUM requirement in hours for teaching was 60 hours total. Of these hours the MINIMUM number of CORE hours is 30. SR reported that there are still trainees behind where they should be which need tackling now or there will be issues at ARCP.
I: SR reported that she had not received any emails commenting on the proposed Doctor’s Charter and had therefore assumed there were no points for her to pass on to the foundation review board.
Foundation Priority Programmes
I: NDHT are still proceeding to apply for 2 FPP starting August 2021. FB stated that they that they were going to trial them starting August 2020 at trust level. RDE are in preliminary talks with SR about FPPs but it is doubtful that they will make the application deadline of the end of March 2020. SR reported that she had not had any other expressions of interest from other trusts. PR said following his appointment SDHT were keen to come up with a proposal which will now have to be for August 2022. SR in still in talks with Plymouth University to put something together based in Plymouth.
I: SR informed the meeting that 47% of the Peninsula FS cohort last year consisted of trainees who had scored in the bottom centile of scores. Lower scoring applicants are increasingly being linked to trainees in difficulty. SR is therefore keen that we invest in FPP to attract higher scoring applicants to the Peninsula that would not normally consider applying to the Peninsula.
I: NB reported she is in the process at analysing data we hold from all local Medical students over the last 7 years. 7 years ago, 70% of Foundation school trainees were from the Peninsula Medical School. Last year this had dropped to 23%. A discussion centred around what could have caused the change. Reasons suggested that due to financial pressures trainees were moving back home to live with family, lack of cultural diversity, lack of connectivity to the rest of the UK (poor travel connections).
A: NB will produce a report on the data and distribute to the trusts.
I: SR stated that senior management within the Deanery were aware of the issue and discussions and plans were ensuing about promoting the Peninsula and its performance in the GMC survey where the Peninsula have been in the top 3 for trainee overall satisfaction consistently over the last 5 years.
A: NT agreed to push the positive messages within the Peninsula Medical School to encourage students to remain in the Peninsula for their training.
ATSP Teaching Programme
A: Action to be carried over to next meeting MJ not present.
I: SR informed the meeting that she has some money to appoint a TPD to oversee the educational teaching programme in the Peninsula. It will only be for 0.5 PA but if there is anyone in the trusts who is interested please ask them to contact SR. Details have yet to be discussed and formalised.
PSG – Placement Supervision Groups
A: SR still to establish whether PAs can form part of the PSG.
Foundation Psychiatry Priority Programmes
I: SR stated that of the 3 FPPP offered the ones in Exeter and Plymouth have been filled. The one in Truro was not filled and TG confirmed that this programme will now be converted back to a normal FP and will be filled in the standard allocation round in March. Nationally of the 40 programmes 33 have been appointed to. SR asked whether SB could give any insight as to where the Royal College were regarding the appointment of supervisors to these posts.
I: SB confirmed that they had had no input to these programmes or the appointment of supervisors at school level. He felt that they will be higher scoring applicants with an interest in Psychiatry with access to enhanced mentorship on a possible weekly basis. They will also be granted access to the Psychiatry International Congress, but he was unsure how these trainees will be given the extra time to access these additional opportunities.
I: SR said that a College Rep is attending the next FSD meeting and she is hoping to obtain further information then. She felt that these trainees will have an Educational Supervisor as normal with the additional support from a Psychiatry supervisor.
A: TG and SR will meet with the 2 trainees who have successfully been appointed to the FPPP to ensure they are aware that they will not be eligible to apply to the SWAPS process and that they will have to use their study leave for the extra Psychiatry opportunities. They are concerned the trainees may not be aware of what is expected of them.
This will also need agreement/negotiation with the appointed Psychiatry supervisors. All trusts felt that finding ES in Psychiatry was already a local issue.
I: SB stated that there were ongoing recruitment issues in the Peninsula, however recent recruitment to RCHT had positive outcomes.
I: SB requested that as he would need to leave the meeting before the FS Term of Reference were agreed that Psychiatry DME’s be considered as Psychiatry representatives instead of/as well as himself as Head of School. SR was keen to ensure that there remains some Psychiatry representation on the FSC.
3. Regional Teaching
I: NB reported that after considerable chasing there was now only 1 trainee who had not booked on the required number of Regional Teaching days. There was also another issue with one trainee who has booked 3 courses for their final placement which also in GP and will therefore miss a lot of time in this placement.
I: NB also disclosed that a Public Health course due to be run early in March has had to be postponed. NB is in contact with the trust and they are working on a contingency. The worst-case scenario at this point is that the course will be run as a ½ day course meaning that some trainees may need to make up 3 hours of Regional Teaching.
I: A general discussion ensued around the fact that some trainees have booked onto two, two-day courses, meaning that although they had met the hourly requirement, they had not participated in 4 different courses. It was agreed that the training was still valid and therefore acceptable. SR stated that with the trainer for Human factors back from Maternity Leave, next year attendance at a Human Factors course will be compulsory, so trainees will not be able to do the same next year.
I: It was agreed that there needs to be an increase in capacity for Regional Teaching.
A: SR asked the trusts to plan to provide 1 additional Regional Teaching Course each.
I: North Devon are looking to increase theirs from 4 to 6 days. Funding using the Study Leave budget was then discussed and the latest communication from HEE. SR stated it implied that Regional teaching would still be funded. The suggestion of sponsorship was discussed. SR stated that the HEE are officially against sponsorship, but she was aware that some specialties use it.
A: A proposal from Torbay was discussed and SR advised them to put together a proposal and she would refer the matter to Neil Squires at the Deanery.
I: SR stressed that Regional Teaching programme was provided in response to feedback from trainees and aims to provide high quality, relevant and enjoyable teaching.
I: JM asked whether if a trainee had not met the minimum requirement of 24 hours Regional Teaching, would this mean they would not meet all their competencies at ARCP?
After a general discussion the committee agreed that broadly speaking then this would result in an adverse outcome at ARCP.
I: NB reminded those present that if a trainee turns up to a course that they have not booked onto and they can attend - they can be added onto the course on MAXCOURSE retrospectively.
A: All present to remind any course administrators/trainers in their trusts that this can be done to ensure no trainee is incorrectly penalised for a lack of the required hours.
I: FB asked whether there was a need to check what trainees had logged as Regional Teaching is actually Regional Teaching. SR suggested that all trainees with other concerns have their teaching checked as this can add to the overall picture of the trainee but agreed that there must be a element of trust involved and that it was not practical to check all trainees.
I: JD proposed that a post ARCP Regional Teaching day be put together for all trainees given an outcome 5 because they have not met the Regional Teaching requirements. It was felt this was a good idea.
A: JD to put together a proposal for SR and agree a date.
A: NB/SM to review questions on Regional Teaching for the end of year feedback surveys so that meaningful feedback on the teaching can be obtained.
A: WEF next year to help prevent some trainees booking too many Regional Teaching courses and blocking others all trusts must ensure that courses do not go live until 8 weeks before they are due to happen.
I: NW stated the feedback that they have had from Exeter trainees was very positive and he felt that all the effort that had been put into Regional Teaching was worth it.
A: NB to compile report on the MAXCOURSE feedback received.
4. GMC 20 day absence
Reservists time off
I: SR reported she has recently had an increase in requests to plan the use of the 20 days absence that is the maximum number of days allowed in each Foundation training year before a review is triggered. SR emphasised that these 20 days must ONLY be used for statutory leave such as:
Jury Service (trainees must try to defer any calls for Jury Service in the first instance)
Self-isolation (in current situation with COVID 19)
Planned hospital admission for an operation
If a trainee exceeds the 20 days absence a review should involve SR as FSD. Some discretion as to whether an extension to training is allowed. SR would take into account whether or not the absence was spread out over the year or in one rotation. Anything over 30 days would result in an extension to training. If trainees are required to self-isolate or be off sick due to the COVID 19 virus in general then this will be classed as statutory sick leave and therefore will count towards the 20 day allowance, however we may have to consider on a case by case basis.
I: in response to reports of trainees taking annual leave to cover planned operations, SR stated that she was not comfortable in encouraging this and this practice should not be condoned.
I: SR stated that in principle HEE and all trusts support military reservists to do the training they need to do as part of their reservist commitments. It was however important to distinguish between what is an employment issue and what is a training issue.
If the trust agrees to the trainee taking unpaid leave to attend reservist commitments, then HEE will also support but it must be made clear that there will be an implication to their training and would likely result in an extension to training. The trust would have to pay for the extension required.
It was stressed that Foundation training is unique in that it is both competency and time based. SR stated she had checked with all her FSD colleagues and all guidelines available and there was no precedent. She has also taken advice from reservist colleagues. Trainees are told by the military that they must attend but SR has been advised that in reality this is not the case. Trainees should contact their commanding officer to explain they cannot be released from training for the length of their Foundation training.
Trainees cannot use part of the 20 day statutory leave allowance. They can of course use annual leave to attend.
A: In order to provide a clear and consistent approach across the Peninsula SR will write a formal policy on Reservist Foundation Trainees which will be added to the Deanery website.
I: In some circumstances it may be appropriate to approve study leave to attend a military course.
5. Trainee/Portfolio documentation
I: SR stated in strong terms that documentation is very important when concerns are raised about a trainee. Evidence must be logged via a PSG/other meeting form etc. It is very difficult for her as FSD when she is advised that there is a problem with a trainee when their portfolio looks fine with nothing evidenced.
I:Recently audits undertaken by the FS have shown that forms such as Initial Meeting and End of Placement reports are not being completed on trainees portfolios. Any reports still in draft will disappear from HORUS 6 months after they have been keyed. Supervisors only have access to their trainee 3 months past the end of placement.
A: All trusts need to educate their supervisors to ensure they know what needs to be done and when.
A: Trusts to target repeat offending supervisors as a great deal of stress is caused to trainees when they cannot get their forms signed off in time.
I: SR suggested that providing a discussion has taken place with the trainee beforehand; emails concerning trainees can be copied and pasted into a significant meeting form, general meeting form or action plan to evidence actions/support agreed. The trainee will be able to see any comments made. In the event of an appeal by the trainee robust evidence is needed to uphold ARCP adverse outcomes. Care must be taken when documenting anything about a trainee in view of potential freedom of information requests.
A: SM to resend HORUS guidance for supervisors to trusts for them to send to all supervisors
A: SM amend all teaching guidance to reflect the reduction permissible hours for E-learning to 10 hours to move this in line with HORUS limits.
6. ARCPS (agenda order swapped)
I: SR announced that HEE has introduced a standardised policy on ARCPS across all schools.
A: SR to send a copy of the new policy to all trusts.
I:SR stated that broadly speaking the FS was already complying with the new policy. This policy was conceived in an effort to make the process less intimidating for trainees. Headline points are:
ARCP process to be used as a feedback tool.
Limit the size of the panel to a maximum number of 4.
The ARCP is when the panel meet and decide outcomes.
Unless an adverse outcome is expected trainees must be given the choice of whether or not they wish to attend a face to face post ARCP discussion.
A: The suggested wording for all invites is: “you are invited to a post ARCP discussion”. Trusts must ensure that trainees are not told they have to attend unless they are being given an adverse outcome.
A: The committee agreed that at this point no change would be brought into the existing FS process. All F1s would be invited for a face to face post ARCP discussion, all trainees in difficulty and a percentage of F2s. In addition, all those with an unexpected and adverse outcome would be seen face to face.
7. Study Leave (Agenda order swapped)
I: New guidance was sent out to all MEM’s this week by the Deanery. SR has asked for further clarification on some points. The FS already has clear guidance as to who signs off study leave and at what level. HEE have confirmed anything signed off and approved before April will be honoured. There is increasing pressure to allow only a maximum of one aspirational course per year per trainee. This is already the case in most of the rest of the country.
A: F1s doing ALS and/or tasters need to borrow study leave from their F2 budget. It is essential therefore that F1s also complete the study leave record form and upload it to their F1 portfolio.
A: NB to resend the study leave record form to trusts.
8. Regional Teaching
Courses for 2020/21
I: This item had previously been discussed under item 3 of the Agenda.
9. Medical School Update
Supporting Trainees Entering Practice (STEP)
I: This item had already been discussed under matters arising from the previous meeting, however NT confirmed that Plymouth medical school was putting in place a robust system to aid transition to F1 and will inform the FSC when appropriate.
I: NT confirmed that this was happening but they like the FS were finding it hard. This is due to the change in GP specialty training from 18 months hospital based placements followed by 18 month GP placements, to 1 year in hospital and 2 years in GP. SR expressed a wish to try and co-ordinate between the Universities, FS and GP school. SR asked if NT had heard when the next PSWG meeting would be taking place? NT had not heard.
A: SR to enquire about the date of the next PSWG meeting.
I: The expected increase in Foundation School places was briefly discussed. 1500 new places are expected but NT confirmed that they also had heard nothing as to which Foundation Schools these places would be allocated to. SR confirmed that they are not automatically going to where the new Medical School places were originally allocated, however she is hopeful that the Peninsula meets more than one of the expected criteria for allocation.
10. Trainee Rep Matters
I: AB said he has been asked to raise the issue of commute time to community placements. At present those F2s in GP placements can claim the difference in time between their normal commute to the acute trust base and the time to commute to their GP placement. However, those in a medical community placement do not. Trainees feel that those working in a medical placement are working 20% more hours and commuting on top. The situation has come to lite as at present Sidmouth Hospital have an F2 in GP and an F2 in community care of the elderly both based in the same building, 1 being compensated and the other not.
I: In response SR stated that the GP agreement was an inherited historic agreement. Although trainees are in GP they are employed by the base trusts and GPs receive a nominal payment. The practices do not pay their wages. Also, in a GP practice the trainees’ hours can easily be more flexible. Appointments can be made around their hours. In a community hospital setting rotas are fixed and cannot be moved around in the same way as in GP.
I: RCHT advised they were currently also looking at this issue as there is a disparity between the hours worked in GP and other placements.
I: NW advised he was already aware of the Sidmouth situation and is trying to find a solution.
A: Community placements at Sidmouth, Bodmin and Penzance will be examined by the relevant trusts in relation to travel time.
A: SR will seek advice from the Deanery.
A: The committee agreed in the interim as a short-term measure, trainees will be permitted to Exception Report if they are in a community placement and are traveling excessively. NW will contact the Sidmouth Trainee to advise them and thank them for bringing this issue to the Committee’s attention.
11. Welcome Event
I: NB reminded the trusts that the deadline for the receipt of their presentations was 4/3/20.
So far one had been received.
A: Trusts to send a copy of their presentations to NB/SM ASAP.
She advised there would be no parking but there will be drop off point to off load equipment. The format will be largely the same as in previous years.
A: Trusts were reminded of the earlier 10.30am start time.
12. FSC Terms of Reference Review
I: The FSC terms of reference were reviewed, discussed, amended and voted upon. Please see the amended Terms of Reference attached.
A: As a result of review F2 Trainee Rep position to be offered out to all F2 trainees.
A: TG to remind GP school that they need to send a representative to the FSC.
13. Any other Business
I: SR advised there was now a national committee that will meet to decide if Inter Foundation School Transfer requests will be granted. SR is required to sign off all requests before they are submitted to the committee.
A: Clarification is being sort as to how many face to face meetings the Educational Supervisors should undertake per trainee.
I: Clarification was sort re the date of the next FSC meeting. It was confirmed that the meeting has now moved to Tuesday 12th May at Plumer House Plymouth.
Tuesday 12th May 2020 Plumer House Plymouth (start time TBC)
Wednesday 23rd September RILD CS Room 1 Exeter (start time TBC)