DRAFT Minutes of the Foundation Programme Board
Held on the 17th of September 2013 at 2pm, in Room 8, Westport, Edinburgh, with VC links
Present:
Duncan Henderson (DH) Chair
Marlene Anderson (MA)
Kath Deans (KD) VC link Aberdeen
Fiona Drimmie (FD) VC link Dundee
David McQueen (DMcQ) VC link Forth Valley
Jill Murray (JM) VC link Aberdeen
Kim Walker (KW) VC link Aberdeen
In attendance:
Paola Solar (PS)
Apologies:
Anthea Lints (AL), Jason Long (JL), Gary Mires (GM), William Reid (WR), Andrew Russell (AR), Andrew Todd (AT)
1. Welcome
The attendees introduced themselves and were welcomed to the meeting.
2. Apologies
The apologies were read.
3. Minutes of previous meeting: 20th June 2013
The minutes of the previous meeting were approved.
Notification of AOCB
· 2014 Recruitment – KW
· Changes to exams at Dundee Medical School – FD
4. Matters Arising
4.1. ePortfolio, LEARN and delivery of core business
DH reported that the way ePortfolio is managed is about to change, as NES was seeking external partners to take on the shared management of the service. This has arisen due to the challenges of trying to run a venture that has to be flexible around its funding streams. This is difficult when working within the constraints of a public body such as a Special Health Board. It was expected that the preferred solution would be known by December.
KD expressed concern at the lack of communication about this development. KW indicated that she received updates from Steven Irvine which she would send to DH who would then distribute appropriately.
Action: KW / DH
It was reported that LEARN had now fully integrated the modules from DOTS. A new name for LEARN, to avoid confusion with LearnPro, was yet to be decided. KW noted that there were still some issues related to the completion of the module not being recorded. Any issues related to the system can be put through an ePortfolio Helpdesk request.
4.2. 2013 recruitment
DH reported that there were 45 extra Foundation year 1 posts created in Scotland for the August 2013 intake. There had been concerns in late June that there may not be enough additional posts in the UK for all of the eligible applicants, but there were a significant number of withdrawals in July. Frustratingly, it had then been necessary to reduce the number of extra posts. At Deanery level, this meant ensuring that substantive posts were filled by moving trainees from some of the extra posts. Understandably a number of trainees were less than delighted by the changes. These issues were mainly resolved by local discussion. One formal complaint was handled at Foundation school level. As one of the lessons learned, the Board agreed that next year extra posts should be labelled as such on the website, with an explanation of what may happen if they have to be removed in July.
Next year’s extra posts had been tabled and agreed at the last SMTB but they were still to be signed off by the Cabinet Secretary. There would potentially be 73 FY1s (figure provided by the Scottish Medical Schools), and 35 FY2 extra posts in Scotland. These numbers will likely change after UK discussions.
DH noted that there was no agreement across the UK yet. KW pointed out that they would need the exact number of extra posts per region so as not to repeat this year’s situation. She pointed out that she would be asked to give the latest update at the next FSD meeting that week, but she was reluctant to do so before having the UK agreement. DH will discuss with Stewart Irvine to find out the likely timescale for formal approval.
Action: DH
It was noted that the base salary funding for the extra posts comes entirely from NES. The number of extra posts will likely increase in the next couple of years. It will be helpful to have formal discussion with MDET around this issue to permit forward planning. JM and FD plan to inform Service colleagues of the funding source as they did not seem to be aware of this.
Action: JM / FD
It was also agreed that DH would send a letter to be distributed to the Service to confirm that the extra posts were only a temporary measure, and that there would probably be no funding for it beyond five years.
Action: DH
KW informed the group that there was a new private UK Medical School which will provide a UK degree. It is expected that the new UK Medical School will start to output graduates in a few years’ time. This is in addition to the existing European universities that already teach in English and take UK nationals. The number of graduates eligible to apply to UK Foundation is likely to increase. The MSC is aware of this.
It is likely that approval for extra F2 post funding will be given. As per previous Board discussion, these extra posts should be used to create opportunities for Community based training, rather than used in “acute” specialties.
The Board had previously discussed 2 Scottish medical students whose SJT scores were so low that they had been withdrawn from the allocation system. After review, the MSC had permitted them to apply for any training vacancies available in August. Both students were offered an interview. The Edinburgh University student declined an interview as they had returned home (Finland) and weren’t planning to work in the UK. The Glasgow University student was interviewed but was unsuccessful. This had been discussed with the University.
4.3. Community Post update / Additional FY2
There are currently 33 extra F1 posts but we may not require 33 F2 posts as we have been instructed to use any F2 vacancies for these individuals. This will reduce the overall costs. West Deanery had reduced their extra F1 posts by 6, South-East by 3 and North by 3 from the original 45.
DH noted that both the Collins Review and the Cook review had recommended a move to increase community posts in UK Foundation. DH noted the paper showing the recent additions in Scotland eg in FY1 Psychiatry. The Board also noted the English SHA paper and it’s roadmap for the increase in psychiatry and community posts.
The group discussed what was considered a “Community” post. It was agreed that any post that has a certain degree of community involvement (not fully hospital based), would be accepted as community post. It was noted that the SGHD as well as the Service both supported this move fully, so the extra posts would be used to enhance this provision. The SMTB is aware of and supportive of this plan.
KD noted that the UKFPO annual report would require the number of FY1 and FY2s in each specialty, for comparison purposes. DH noted that we have that level of detail available. FP Leads were encouraged to discuss novel approaches with local DMEs/Service to providing more community-based posts.
4.4. 2013 Foundation ARCP
DH reported that this had been extensively discussed at the Foundation Programme Operational Group. He thanked all involved for the hard work which led to a successful implementation of the ARCP process in Foundation this year.
4.5. Clinical Skills Training / Budgets
DH noted that some deaneries had used residual F2 study leave budget funding (after ALS courses were funded) to support access to Simulation training for F2s. He has been asked to submit a paper to MDET to support this practice and lead to a unified approach for all of the Deaneries in Scotland.
4.6. Trainee representatives
DH reported that, for various reasons, there were no trainee reps at the moment. The BMA had been contacted to provide one rep. The FPB needs one Medical School trainee from the North, one FY1 from the East and one FY2 from the Southeast - either of the last two could be Academic. Once we have the BMA rep, DH will organise the other two posts. It was noted that the trainees needed to be aware that as Scottish Board reps they would be invited to join the UK Trainee Group.
Action: DH / PS
5. FP Leads Questionnaire
5.1. Psychiatry Posts
DH noted that the Foundation Programme Leads had very helpfully provided information on their new posts. Aberdeen had created 2 new psychiatry posts and but had to withdraw 1. South-East had created 1 extra Liaison post, but had to withdraw it in July. DMQ noted that there was a FY1 liaison in Forth Valley. KD noted that there were 6 extra Psychiatry liaison posts created in the West but one had been withdrawn. FD noted that Psychiatry had significant Specialty trainee vacancies which had to be filled with LATs and LAS.
5.2. Exposed FY2
The SFB has previously undertaken some work around exposed FY2 posts. With DME and Board partners, it was ensured that no F2 doctor was working overnight without resident senior supervision eg in A&E or as Med Reg. The recent difficulties in filling ST3 posts in Emergency Medicine and Acute Medicine meant the issue had to be revisited.
East
FD noted that the FY2s doing Psychiatry placements in one hospital had clear pathways to follow and they did assess jointly with a senior nurse who was resident. The EM Depts in Ninewells and Perth had LAT / LAS cover on the Registrar rota. FD was also aware of the F2 in a remote Medicine for the Elderly Unit who was doing OOH without senior cover on site. They did not take acute admissions. KW pointed out that this was not allowed under paragraph 1.11 of the Trainee Doctor guide. Senior support had to be available on site for FY1 and FY2s. A senior nurse was sufficient but they had to have someone on site at all times. FD would discuss with the Unit.
Action: FD
North
KW noted that there was an ongoing issue with Wick’s A&E support policies.
West
DH reported that AT had given him the update from the West. The only issue had been to make sure that if an FY was doing OOH, they had to be aware of who their support was. It was also important that the support was aware of their responsibility for the trainees. A number of the EM Depts in West now had resident Consultant staffing overnight.
South-East
NHS Lothian, had taken a novel approach to the issue in August, as there had not been enough registrars for all of the EM rotas in S-E. They had chosen one site, St John’s Hospital, and had removed the registrars from overnight cover. The Consultant was now resident until 11pm. To cover 2300 – 0730, NHS Lothian had created a Clinical Development Fellow post. They had managed to recruit high quality candidates (finishing F2 or returning from abroad). These trainees received intensive training in EM and there was a report provided on a daily basis on how the Unit had performed overnight. This arrangement had worked well so far, although it was not a perfect solution. The other element of the CDF post is that they can select a parent specialty and are encouraged to become involved in Medical Education, patient safety initiatives etc. After discussion, the Foundation Board was supportive of this initiative as the Health Board had provided cover for the F2 trainees. It would be helpful to know what NHS Lothian’s long term plan is around this area. It was noted that this solution relies heavily in the high quality of the trainees recruited.
5.3. Deanery Foundation Sessions
After seeing some erroneous figures at MDET, DH had requested current information from the Deaneries. DH thanked colleagues for the updates provided and will supply this information to MDET. A query was raised around the sessional time for FPD’s. It was confirmed that it was 1PA per FPD. There were no plans to change this.
6. Shape of Training Review
WR is on the ShoT Committee and had informed that the first draft report would be issued this month, aiming for publication in October/November. There was some discussion ongoing about the possibility of moving provisional registration from the end of FY1 to the end of Medical School.
7. Foundation Programme Groups
7.1. Academic
GJ was not present but the minutes of the subgroup had been distributed for information.
7.2. Curriculum and Assessment
There were some issues about meeting dates and the last two meetings had had to be cancelled. The next one would be on the 27th of November.
7.3. Operations
KW had nothing to report.
7.4. LEARN Editorial Group
LEARN had a meeting planned for the following week. KW noted that they had a new form in place so anyone who wanted to add a module just needed to fill in this form. There had been some discussion around whether some modules were mandatory if they came from the Service. It had been agreed that nothing was mandatory unless it was important for the curriculum.
8. AOCB
8.1. The group noted that the new NES website was live from today, with links via the ScotMT website.
8.2. 2014 Recruitment
This had been covered in earlier discussion. The Cabinet Secretary’s sign off was awaited. DH would let the group know as soon as this was received. KW noted that UKFPO and HEE would be interested to know the numbers and the distribution in Scotland. It was noted that the Scottish numbers were starting to increase and the source of funding would obviously be discussed further.
8.3. Dundee Medical School
FD informed the group that the Dundee Medical School had changed their exam timing, by moving the first part of Finals. The Medical School had considered the implications for the decile ranking by undertaking a piece of work modelling the effect if they had not included year 4 in previous cohorts. This showed little change in decile position for the majority of students, with it being the samebased on 3 years compared with all 4 years data included i.e. position in year for most students is fairly consistent from year 1. With this information they were then comfortable to make the curriculum change (which was based on educational need). The Dundee EPM bundle has been altered accordingly.