NHS Education for Scotland
Minutes of the General Practice, Public Health and Occupational Medicine STB meeting held at 1.30 pm on Wednesday 22 April 2015 in Room 6, Westport, Edinburgh
Present: Ronald MacVicar (RMV) Chair, David Bruce (DB), Jim Chalmers (JM), Moya Kelly (MK), John Kyle (JK), Anthea Lints (AL), Ian Longair (IL), Miles Mack (MM), Neil MacRitchie (NM) deputising for Alan McDevitt and Carrie Young, Ashleigh Stewart (AS).
Videoconference: Dumfries: Jean Robson (JR).
Apologies: Nigel Calvert (NC), Frances Dorrian (FD), Alastair Leckie (ALe), Alan McDevitt (AM), Stewart Mercer (SM), Rowan Parks (RP), Paul Ryan (PR), Iain Wallace (IW). Carrie Young (CY).
In attendance: Helen McIntosh (HM).
Action1. / Welcome and apologies
The Chair welcomed all to the meeting and in particular Dr Neil MacRitchie, deputising for Alan McDevitt and Carrie Young.
Apologies were noted.
2. / Minutes of meeting held on 11 February 2015
The minutes were accepted as a correct record of the meeting and will be posted on the website.
3. / Matters arising/action points from previous meeting
3.1 / Implications of the judicial review
Significant work was ongoing to identify and create a support package for trainees at risk through a short-life working group led by Dr Alison Sneddon.
4. / STB update for MDET
No update was provided.
5. / Recruitment update
5.1 / GP
Round 1 has completed and 84 vacancies remain in Scotland (63 at the same stage last year). The Round 2 selection centre will be held on 13 May with 90 places available. UK wide there have been 1,372 applications to Round 2 however eligibility criteria has been relaxed, allowing stage 2 fails in round 1 to reapply. Tier 2s are included in Round 2. Gaps at the end of Round 2 are likely.
5.1.1 / Numbers applying for transferable competencies
Eleven trainees were eligible. The 6 month post to be dropped from the shortened programmes will be in ST2, should a balanced programme be achievable with a predictable impact on service.
In response to Scottish Government concerns about gaps, Scotland has widened out the pre GP year offered last year in England to create Career Development posts. Co-operation will be sought from Health Boards for unfilled year 1 posts to provide these opportunities. Posts will include 6 weeks experience in GP and we will target the significant number of F2s who did not apply for a training number, those that had unsuccessfully applied for community-facing core and run-through specialty training posts, and moderated trainees at Stage 3 of GPST recruitment, but not those with low scores. There was no sense of how many people would be interested in the posts which will be marketed at the end of Round 2.
The curriculum and paperwork was still being worked on and all details will be finalised by the end of May. Trainees will not be able to prescribe when in the GP component of the scheme as they will not be on the Performers List and not in a training programme. As Health Boards will employ the trainees they will responsible for supervision. Conversations were ongoing with Health Boards on release for the GP practice component and it was hoped postholders will get exposure to GP throughout the year in 6 blocks of 1 week. Location of posts was still to be agreed.
5.2 / Public Health
JC reported that all 5 Scottish posts have filled with 4 of them filled by non-medics. The recruitment process was centralised and worked well. The Faculty of Public Health was doing a long term follow up on Part A and B in exams to assess how effective the recruitment process was – at present it seemed predictive.
5.3 / Occupational Medicine
5.3.1 / UK National recruitment
No update was received.
6. / Future GP Contractual Model
Dr Neil MacRitchie presented to the STB on behalf of the SGPC, and highlighted the current status of the discussions round an evolving new contractual model. The aim was to change the emphasis of the use of GP resource given it was unlikely there would be an increase in numbers in the near future, working patterns and demographics. GPs would still have a role in undifferentiated cases but there would also be a wider team approach so that people would not always have to go via their GP to access services available in the community. The aim was for GPs and others to work at the ‘top of their licence’. The GP practice would remain the hub perhaps as part of Health and Social Care Partnerships and allocation would be needs based.
They have also considered chronic disease management. The model proposed this could be managed largely by GP Practice Nurses who could be employed by Health and Social Care Partnerships instead of the practice, while remaining under its remit and Community Nursing input where patients could be managed once diagnosed. At present patients were discharged from hospital to their GP and this could move to an Integrated Joint board for wider social care services input. It was hoped that GPs would have time to look at quality issues on a peer basis as part of their contract and it was acknowledged there could be training issues. At present there was a collegiate approach to the proposal and negotiations will take place later.
At present the SGPC was not looking at OOHs as part of the contractual discussion of the new model. DB said there was minimal experience in OOH during a GPST programme and people did not always feel ready for OOH work on completion. However he felt this had to be in place for GPs and the voluntary opting in model was not working at the moment. NM said he shared concerns about uptake and felt that if GPs felt their workload was less stretched they could chose to be involved in OOH provision.
MM said he would like to see the ability to weave different bits of work into negotiations and hoped this would be recognised. NM felt the Health and Social Care Partnerships may have the potential to allow people to work across different areas.
JR had concerns that fragmentation of care could be the result if chronic disease management was run by Practice Nurses in the Health and Social Care Partnerships rather than being run by one team. She felt it would be preferable to introduce more funding for Practice Nurses to work as part of the multidisciplinary team. NM said that in the past CHP staff were differentiated from staff in the practice and he hoped this would change so that while they might have different employers they would work as part of the same team and not in separate silos. He stressed the driver for this work was the need to provide more care and service in the community and less in acute settings and how to deliver this in a sustainable and consistent way regardless of where people lived.
7. / Use of LTFT fallow funding to support increase in training posts
RMV noted that gaps were created when a trainee went LTFT and it has been agreed that some fractions of posts could be used to support a small increase in training posts. None of the specialties represented by the STB were included in this expansion. It was felt there was a risk in increasing options and as a result less popular posts could suffer through being in a bigger pool. Twenty two new posts will be available in August 2015 created from fallow funding.
8. / Public Health Workforce
JC reported that discussion was ongoing and he will highlight points of interest to the STB as they arose. The item will continue as a standing item on the agenda. / Agenda
9. / Directorate Workstream developments
9.1 / MDET updates: February 2015 highlights
The document was circulated for information.
9.2 / Training Management and Quality
MK and RMV presented to the STB on current developments. Since 1 April 2014 there has been a single Scotland Deanery with work divided into 4 workstreams within which Training Management and Quality Management-Quality Improvement were working closely together. Each STB has been allocated a Lead/Dean Director as well as representatives from Training Management and Quality and will retain a key role. Work will be done nationally while preserving local input and separated into standard and non standard – the former will be dealt with by the Lead Dean/Director and the latter looked after locally with the Lead Dean/Director copied in for information. At present this was in a transitional phase and will be fully implemented in August 2015 although some pieces of work have been delivered already eg Inter-regional transfers. The GMC visit in 2017 was a big driver for the restructure and much data was required as evidence of single Deanery working. National programmes would see little change.
RMV highlighted Quality Management-Quality Improvement (QM-QI) developments. A single process was required to meet 3 essential aims – scrutiny – to drive improvement – to promote excellence. They were moving to a specialty grouping approach hence the STB will have a key role for both Training Management and QM-QI.
A Quality Review Panel will be established and meet once per year in August/ September as an annual forum. Data will be presented to the Panel by the Quality Improvement Manager and their team from the National Trainee Survey and other sources. There will be a Panel for each specialty grouping and the timetable of meetings will be sequenced – Foundation first – then GP – followed by Core – then HST. Panel membership will be internal only.
A Quality Management Group will also be established by specialty/groups of specialties and meet bi-monthly. This will be the operational arm for QM-QI and look at the Scottish Training Survey, QM visit reports and approval of GP training practices. This group will comprise STB Chair, Lead Dean/Director, Quality Improvement Manager and others as required and may include external representatives.
Some additional sessions APGD/ Asst Director level will be required to support this work and there will also be some changes in structure around hospital visits.
RMV acknowledged there was a risk this could become limited to an exercise in scrutiny but the aim was to ensure good practice and facilitate quality improvement. The issue would be if changes were not implemented however control of what happened was at Health Board and Practice level and it was not for NES to transfer resources from one area to another. They were also aware of the risk of not picking up concerns across specialties in a number of localities and for that reason will sequence visits. The Quality Operational Group is the forum to share concerns.
9.3 / Professional Development
ALi noted there were 15 projects within the workstream and highlighted:
· LaMP – currently working through issues with delivery.
· Fellowships – noted the 2015 GP Fellowship recruitment round was currently open and to date applications received were low.
· Recognition of Trainers (RoT) – noted issue in Public Health in that those working for Scottish Government/ISD/University did not have DMEs so had missed previous information about RoT. It was agreed NES would contact those people and confirm it will act as their DME and a letter was due to be issued. ALi will check whether this has been done. RMV will also check with ALe whether there was a similar issue for Occupational Medicine. JR reported her Health Board has written to all appraisers to highlight the need to start discussions.
· Initiatives to bring people back into workforce – returners/returners schemes. Two different programmes were being offered with some funding provided by Scottish Government. Pages on the NES website will be redesigned to act as first point of contact and the schemes will be publicised widely once finalised. JR volunteered to help with this work and ALi will include her in the communication strategy. / ALi
RMV
9.4 / Strategic Planning Directorate Support (SPDS)
DB reported this was the operational support workstream. He noted the Scottish Medical Education conference will take place on 27 and 28 April. This was a major event with 650 registered delegates.
10. / Shape of Training
DB noted an article in BMJ Careers in which Ian Finlay was quoted in on pilot work in advanced skills in community hospitals – this may be a pilot for enhanced GP Training – and the interface of primary care and health and social work. The Shape of Training group was looking at SAS doctors and the blurring of interface between primary care and acute as its main focus. All work was at a very early stage of development.
JK added that Ian Finlay proposed the creation of post CCT GPs in their first couple of years working in specific areas eg A & E and a couple of pilot sites have been proposed.
11. / Health and Social Care integration
DB noted the RCGP/NES support project on paired learning submitted its bid to Scottish Government and a decision was still awaited. A further meeting will be held on 24 April to consider the way forward.
12. / Updates
12.1
12.2
12.3
12.4
12.5 / Specialty updates
· GP
· Public Health
· Occupational Medicine
Lead Dean/Director update
Service update
Academic update
DME update
No additional updates were received.
12.6 / Trainee update
JK reported the BMA has given oral evidence to DDRB and it will be mid/end Summer before any decision was reached.
He had recently completed LaMP training and felt this should be more clinically focused. RMV noted there was an opportunity to involve Clinical Leadership Fellows in the re-design of this training. ALi will feedback JK’s comments. / ALi
12.7 / Lay representative update
IL reported he has attended 2 more approval visits – both of which were very good.
13. / AOCB
13.1 / Scottish Careers Fair
RMV noted this will take place on 12 September in Glasgow at the SECC. There will be one STB stand and he will contact STB members to seek support. / RMV
14. / Date of next meeting
The next meeting will take place at 1.30 pm on Thursday 11 June 2015 in Room 5, Westport, Edinburgh (VC available).
Actions arising from the meeting