Minutes of the Meeting of the Mental Health Specialty Training Board Held at 10.30 Am

Minutes of the meeting of the Mental Health Specialty Training Board held at 10.30 am on Friday 14 June 2013 in Room 5, Floor 1, Westport, Edinburgh

Present: Susan Miller (SM) Chair, Margaret Bremner (MB), Sandra Duke (SD), Stephen Lawrie (SL) part meeting, Kathy Leighton (KL), Robin McGilp (RMcG), Siobhan Murphy (SMu), Norman Nuttall (NN), John Russell (JR) part meeting.

By videoconference: Aberdeen (Forest Grove House) - Dik Athawes (RA), Gillian Needham (GN); Aberdeen (Royal Cornhill Hospital) - Sally Winning (SW); Inverness – Ronald MacVicar (RMacV).

Apologies: Geraldine Bienkowski (GB), Roger Blake (RB), David Brown (DB), Tom Brown (TB), Ashley Catto (AC), John Channon (JCh), Stella Clark (SC), Alastair Cook (AC), John Crichton (JC), Euan Euston (EE), Linda Findlay (LF), Tracey Hicks (TH), Paul Hudson (PH), Johan Leuvennink (JL), Michelle McGlen (MMcG), Seamus McNulty (SMcN), Rowan Parks (RP), Rhiannon Pugh (RP), Karen Shearer (KS), Laura Sutherland (LS), John Taylor (JT), Judy Thomson (JT), Adele Warrilow (AW).

In attendance: Qudrat Ullah (QU) observing, Helen McIntosh (HM).

1. / Apologies and welcome
SM welcomed all to the meeting and in particular Dr Qudrat Ullah who was observing to gain management experience. Apologies were noted.
2. / Minutes of the meeting held on 3 May 2013
The following amendment was noted:
Item 4.3, Page 4, Challenges, second bullet point, second sentence to read ‘Psychotherapy Faculty must consider that there were significantly fewer UK training posts than previously.’
With this amendment the minutes were accepted as a correct record of the meeting and will be posted on the website.
3. / Matters arising
3.1 / Knowledge Network Subscriptions Advisory Panel: academic nominee
SM confirmed David Christmas has accepted the role.
3.2 / NES response to Scottish Government Engagement Paper on the Prevention of Suicide and Self-Harm
The response lined to that from the College and has been submitted.
4. / Recruitment
4.1
4.2 / Recruitment team update
UK national recruitment 2013
·  Survey responses
·  Fill rates
·  Core numbers
·  Eportfolio presentation – feedback to National Recruitment Office
·  Numbers for clearing and candidate information
All CT1 posts filled; there were significant gaps in ST4 as only 21 of 63 posts filled. Psychiatry was not the only specialty in Scotland experiencing difficulty in filling posts eg CMT/Emergency Medicine. HM will circulate the Scottish and English fill rate information to the STB; to note England did not include posts it had not expected to fill in the recruitment round. A request has been made to join the College’s Autumn recruitment.
HEE has stated it would like regions to assume responsibility from Colleges for recruitment. This would be acceptable as the North West Deanery was the suggested Psychiatry lead however HEE had not been aware the College also ran Scotland’s recruitment process. SM will discuss this further with Stewart Irvine. GN noted discussion with Professor Jacky Hayden and the Medical Director of HEE at the recent COPMED conference who acknowledged HEE was floating many different ideas but not all were likely to be put into practice. Additionally although core fill this year has been very good Professor Hayden did not favour expanding numbers. However it was felt Scotland could make a good case for increasing its core numbers, survey evidence suggested a significant drop off in progression to ST4 and it has never recruited to the numbers suggested by manpower planning.
With one or two exceptions, most specialties were happy to continue UK national recruitment, including Psychiatry, and this has been SRDB’s recommendation to SMTB.
Seven deaneries in England piloted recruitment to the broad based framework however only 2 candidates in the UK had chosen this as first preference and only 50% of posts filled. It was felt likely broad based training was likely to become the norm following the Shape of Training Report.
JR noted a CT2 trainee in Lothian has been accepted to the Psystar programme and will seek information from Professor Reid regarding deferring entry to ST4.
SM confirmed Psychiatry in Scotland will participate in clearing.
Actions:
·  HM to circulate information on Scottish and English fill rates to STB members.
·  JR to seek information from Professor Reid regarding deferral for research.
5. / Workforce
5.1
5.2 / Meeting to discuss reshaping for 2014
First thoughts on numbers 2014 and beyond
SM and AC met Professor Padfield as arranged and a meeting for the workforce group and STB chairs has been arranged for 9 July at which MB will deputise for SM. SM asked STB members to provide MB with up-to-date retirement figures for each of the Psychiatry specialties for that meeting. Not all responses have been received as yet - DA will consult a colleague for Old Age Psychiatry retirement figures; SMur has emailed Psychotherapy colleagues and KL will supply CAMHS information. RMcG noted College returns now requested MHO status and this could make these returns more reliable.
SW represented the BMA on the Reshaping Board and reported it will meet immediately after the pre-meeting 9 July. As discussion at the pre-meeting will influence the later meeting it was essential to make all relevant information available to the group.
SM will liaise with AC prior to the meeting on 9 July.
Actions:
·  DA to provide OAP retirement information; SMur to provide Psychotherapy information; KL to supply CAMHS information.
·  SM to liaise with AC prior to 9 July meeting.
6. / Scottish Learning Disabilities posts – review
No ST4 posts filled this year and as a number of posts have been lost over the last few years’ consideration was being given to establishing a national training programme. RMcG, JR, SM and FH have discussed this by email and agreed to establish a working group, including trainee representation which will consider pros and cons, hosting and TPD arrangements. JR will arrange a meeting date and invite a trainee representative. It was agreed HM will circulate SMur’s Psychotherapy presentation to assist discussion.
Actions:
·  JR to arrange a meeting date for the working group by email and invite a trainee representative.
·  HM to circulate Psychotherapy presentation from previous STB.
7. / Quality Review – Tayside Pilot
SM will ask RB whether the item should carry forward to a future meeting.
Action:
·  SM to ask RB if item will carry forward.
8. / ARCP sub group update
SES was half way through ARCPs. The process was almost paperless although they still reviewed paper reports. There were 13 panellists including 3 externals and 50 trainees reviewed with a high proportion of Outcome 5s. Mini PATs were the main issue which was very disappointing as they have made considerable effort to increase the number of workplace based assessments. They will interview all trainees who had not undertaken sufficient workplace based assessments. One trainee who had not self-declared on SOAR has been given an Outcome 5. SD said there were few Outcome 5s in EoS. Overall SOAR has worked well. However, the biggest issue has been the slow speed of the eportfolio system and although all 50 ARCPs were completed in one morning this had been irritating. JR reported the issue to the College and asked for it to be cascaded to the Chair of the ESTC. It appeared the College server was the problem and the College has apologised and hoped access to the website and eportfolio will improve after the installation of a new server in October. Meantime all trainees/trainers were encouraged to report any issues to the College. It was felt that if the system worked well the process would be good although some refinement was still required. SM reported the College had discussed whether to launch the new website in August for new trainees or to delay until it was fully functioning. JR agreed to produce information on the process for the STB.
Externality was provided differently in each of the Deaneries eg WoS provided Scottish externality.
RMcG noted last year’s report on the process confirmed the ARCP process was being fairly and well applied.
Action:
·  JR to produce information on ARCP process for STB members.
9. / Foundation
SM reported a number of FY1 posts in Psychiatry have been confirmed of which 5 were in WoS. The most recent Heads of Schools meeting had discussed Foundation posts and one member of the group stressed the importance to educate all trainees in core competences and not just as a recruitment exercise. GN said COPMED sought robust recruitment to core training and she felt this was a positive message. SM stressed the need to ensure experience for Foundation trainees was of a high standard.
9.1 / EoS & N information
Noted: 3 conversions from FY2 to FY1 in EoS; 2 new FY1 posts in NoS.
10. / START Alliance
The circulated paper was presented to MDET and reported the workshop held at the PGMET conference. There was increasing recognition of the issues of recruitment and retention resulting in the establishment of the START Alliance between NES, Colleges, Health Boards, Medical Schools and others. The initiative was not just to market Scotland but to understand the factors influencing decisions on where to train. The Alliance was currently concentrating on gathering data and commissioning new research. Alastair McLellan, Anne Dickson, Rowan Parks and RM were leading the work for NES.
There has always been competition between specialties and areas within Scotland however they were now competing against one another in a smaller pool. The aim of the Alliance was to create and retain a bigger pool of applicants to Scotland and it will target the 2014 recruitment round. There appeared to be 2 chief factors – junior trainees at Foundation level were influenced by where they came from and testimonials from friends and peers. This could provide an opportunity to use trainees as champions and advocates for training and living in Scotland.
SM participated in the START Alliance workshop at the conference and subsequently sent the group information relating to Scottish Psychiatry trainees. She and AC have also notified the group they wish to be actively involved in its work.
The item will remain on the agenda as a standing item.
Action:
·  Standing agenda item.
11. / GMC Educational Environments
This was discussed at the most recent MDET meeting. There was much discussion at UK level regarding consistent Quality Management visits and the GMC was seeking to set standards which may result in more College involvement/role in visits. Comments on the document to be sent to SM.
Action:
·  All to send comments on the document to SM.
12. / SAPE requirements for Higher Trainees
The expectation was that the curriculum required some Psychotherapy for all HSTs in Psychiatry training in the broadest context. There were slightly different descriptors depending on the specialty and evaluation and guidelines for ARCPs using workplace based assessments. The College was clear this must be done not ‘would be good practice’. An issue in SES regarding availability to Psychotherapy experience was noted. SM will send her audit tool and presentation to the STB and JR will speak to the English ARCP external next week for information on the situation in England.
RMcG said a minimum of 6 good quality Reflective Practice Notes were required. JR confirmed he was cascading this information which will also feed into the revalidation process and map to ILO life-long learning but not in all curricula. Much work has been done on by College on ILO 19 reflective practice and the North West Deanery was also developing a pilot on how to assess quality. ILO 19 will go to the GMC for approval via Psychotherapy and possibly also via General Adult. It was likely this will soon form part of the curriculum.
Actions:
·  SM to circulate audit tool and presentation to STB.
·  JR to seek information on situation in England from English external ARCP panellist.
13. / Heads of School meetings
Issues discussed at the most recent meeting:
·  Exit exam at the end of ST6 – to comprise an exam in addition to the present exam and a reflective log which will not be knowledge based. College solicitors were considering whether to apply this prospectively or for all trainees currently in programme. GMC approval will have to be given however this was likely as it was the chief driver for exit exams. The GMC had made exit exams a requirement several years ago although it has taken some specialties a long time to develop these. It was not clear whether this would add anything to the current exam however it was clear the public supported exit exams. The cost to trainees was high and generated much anxiety which was not the original intention and pass rates varied. GP’s knowledge based test had 4 components and individuals could not work in UK unless they have passed it, other than as a trainee, and there was a significant failure rate. However GP felt this was an important element in ensuring CCT holders met the required level. JCST also required exit exams and allowed 6 maximum attempts although there was not a significant failure rate. Some Colleges set a lower maximum number of attempts.
·  English issues – reduction in consultant numbers/posts not being filled/disempowerment of consultants, supervisor standards and experience and competency base.
·  Study leave – the level of leave was being re-stated.