Guidance on the Quality Management of GP Specialty Training in the HEKSS

KSS GP Specialty School

Guidance on the Quality Management of GP Specialty Training in the HEKSS

This guidance is intended for GP Specialty Programme Directors, GP Trainers, Medical Education Managers, GP Faculty Administrators and GP Training Practice Managers, but will be also helpful for GPStRs, to inform them about the context and procedures of the GP Faculty visiting process and will inform those acting as visitors and those being visited.

Visits are an important part of the HEKSS Quality Management (QM) process. They help to assure that LEPs providing Postgraduate Medical Education and Training meet the requirements of the General Medical Council (GMC) Standards as set out in The Trainee Doctor:

The objectives of the visit are to:

• Ensure that the GMC standards for the delivery of postgraduate medical education are met
• To investigate any matters of concern against the GMC standards
• To provide assurance to the GMC of the quality of training
• To identify common issues and notable practice across specialties
• To improve the quality of education and training by sharing information and disseminating innovation

LEP Visits

GP training is carried out in environments such as hospital and GP Training Practices, which are referred to as Local Education Providers (LEP). It is the responsibility of LEPs, and their GP Faculties (local units of the GP School) to ensure a process of quality control is in place.

As part of its quality management, the HEKSS GP School will seek to gain information about the delivery of GP Education and training from a number of sources including a rolling series of visits to each Trust and GP Local Faculty Group. The visit process is looking not just at the educational experience of GP trainee doctors in hospital posts and in GP surgeries but how the local faculties support the process and in turn are supported.

Visits are planned or may be triggered by specific concerns such as:

• GMC Trainee Survey feedback
• A serious trainee complaint
• Concerns identified through the Local Faculty Minutes
• Evidence from other sources raising serious questions about service problems that could affect trainees

Where an exception visit is considered this will be reviewed with the GP Dean and Dean Director. Where there is seriousconcern the Dean Director will inform the Quality Management Group (QMG)at the next meeting of the group. If the problem is chronic or deemed less pressing after review, the matter will be discussed at QMSG before a decision to undertake an exception visit is made.

IMPORTANT NOTE FOR TRAINEES

This process is focused on reviewing educational support, educational processes and curriculum delivery and is NOT about their performance or progress in GP training.

The GP Specialty Visit Process

There is a rolling programme of visits which typically visits each GP LEP every 2-3 years. This is supported by an annual review of GP Specialty programmes.

Annual Review

An annual review to be undertaken at the GP Dean Team Meeting in February in preparation for the annual decision making process for KSS wide LEP visits. Information used to inform this process will typically include:

• LFG minutes
• Reflection on on-line Trainee Survey Feedback
• Reflection on GMC Survey Results
• MRCGP examination results report (CSA, AKT and WPBA)
• ARCP results of all GP trainees in LFG
• Record of attendance of PDs at PD conferences / workshops
• Record of GP Trainer attendance at GP Trainer Days / Workshops
• Number of GP trainees defined as being in difficulty

Routine Visit to each GP LEP

Routine visits will typically occur every 2-3 years. Large Training Programmes with more than one centre (East Kent, Brighton and Mid-Sussex, East Sussex, Maidstone and Tunbridge Wells) will typically rotate the visit location.

Visits to the GP LEP will usually be timed to link with the regular HEKSS Quality Management visits to Trust based LEPs for the appropriate area but on occasions these processes may be separate.

Where general practice specialty training is being visited in association with other specialties the visit process will take place over two days:

• Day 1 Visit to review GP trainees in GP placements (GP LEP visit)

• Day 2 Visit to review the training of GP trainees in the specialties highlighted for visiting by the HEKSS wide LEP visit programme (Trust LEP visit)

These datesmay be consecutive days or separated by up to two weeks.

Where there is a visit to a Trust LEP to specialties which do not have GP trainees (e.g. Radiology or Anesthetics) the GP Department will not, on that occasion, be part of the visiting team.

Day 1 Visit to GP trainees in GP placements

Pre-visit Arrangements

The co-ordination for Day 1 will be organised through the GP Department and queries concerning these arrangements will be answered by the relevant GP Patch Manager.

The local GP Programme Directors, working with the MEM or GP Faculty Administrator, will need to inform the local GP Trainer Group, and the group of GP trainees in GP placements of the dates and times of the meetings for the discussion groups.

GP trainees who should be available to attend include:

• GP ST3 trainees
• GP ST1 and ST2 trainees including those in Integrated Training Posts

There is a requirement for a minimum of 50% of GPSTRs and GP Trainers to attend the Visit.

One GP Training Practice will, via local negotiation, need to be identified as a representative of the LEP for visiting by the team of visitors.

Day 1 Pre-Visit Documentation “The Bundle” and Preparation

The visitors will obtain information from a number of sources including pre-prepared data relevant to the GP LEP. This “bundle” will be made available four weeks before the visit. The bundle will typically include:

• LFG minutes from last three GP LFG meetings
• Latest available GMC Trainee Survey results (including those in GP and from trainees in acute specialties in the Trust)
• Collated feedback from on-line GP trainee surveys
• LFG handbook (electronic copy)
• Copy of last visit report
• Trainer attendance at Patch Trainer Days (to Lead Visitor)

Programme Directors do not need to specifically prepare anything further for the visit but may wish to prepare information relating to for example the content of the GP education programmes and evaluations of the VTS.

Ahead of the visit, members of the visiting team are required to:

• Review the LEP Visit training package
• Have read the GMC Trainee Doctor (2011)
• Have undertaken Equality and Diversity Training
• Return the KSS Visitor Guidance Declaration

Visitors should complete their pre-visit Template (PD, Practice Manager and Trainee) and discuss any areas/issues of concern, notable practice or issues requiring clarification/further investigation at the visit with the Lead Visitor. Visitors should consider the issues under the GMC Domains:

• Domain 1: Patient safety
• Domain 2: Quality Assurance, Review and Evaluation
• Domain 3: Equality Diversity and Opportunity
• Domain 4: Recruitment, selection and appointment
• Domain 5: Delivery of curriculum including assessments
• Domain 6: Support and development of trainees, trainers and local faculty
• Domain 7: Management of Education and training
• Domain 8: Educational resources and capacity
• Domain 9: Outcomes

Day 1 – The Visiting Team

The visiting team will typically consist of:

• Patch Associate GP Dean from a different patch (Lead Visitor)
• GP Training Practice Manager from a different patch
• A GP Programme Director from a different patch (to provide an external input)
• A GPStR (preferably one who is in, or who has experienced training in a Practice placement)

Other visitors may include the GP Head of School and lay visitors.

Day 1 – The Visit Timetable

Visit to the local GP Faculty which will involve visiting a local practice selected to represent the Faculty. This will be followed by meetings with the ST3 GP trainees and any ST1 and ST2 GP trainees currently in General Practice. The visiting team will also meet with local Trainers, Practice Managers and GP Programme Directors. Where possible this meeting will be held at the same GP Practice although it can be moved to an alternative practice location if necessary.

The timetable will be finalised in discussion with the GP Practice Manager, GP Visits Co-ordinator and the GP Lead Visitor. The GP Patch Manager will confirm the final arrangements.

The suggested timings of the day are given below outlining the visit programme.

Duration / Session
30 minutes / GP Visiting team meet for briefing
1.5 hours / Practice Visit including discussion with practice members in groups, visiting team
de-brief and verbal feedback to Trainer and practice team
Up to 1 hour / Travel/Lunch if required (depending if staying in first location or need to travel)
45 minutes / Meet group of GP trainees (ST3’s and include ST1 and ST2 doctors in GP
placements, including Integrated Training Posts)
15 minutes / Tea break
45 minutes / Meet group local GP Trainers and Practice Managers
45 minutes / Meet GP Programme Directors
30 minutes / Visiting Team Review visit Feedback to PDs and to start to write report
6 hours / Total Visit time

Gathering Evidence

The Practice Visit

The visiting team will meet with as wide a range as possible of GPs, other healthcare professionals / members of the primary health care team, the Practice Manager, administrative and reception staff and trainees based in the practice being visited.

The lead visitor should run a briefing session at the start of the visit to raise any particular issues that may have been indicated from the documentation or from the discussions to determine the timetable for the visit and assign interviewing roles.

Discussion and questions will relate to the GMC Domains and specimen questions can be found in the LEP Visit Guide proformas.

Should the trainee(s) in the practice wish to raise significant patient safety or other concerns these should be shared with the lead Visitor and a one to one discussion be offered.

The visit to the GP practice is NOT related to the accreditation / re-accreditation of trainers: the practice being an example of training experienced in the GP LEP. Trainer accreditation / re-accreditation is a separate process in the GP School managed through the Trainer Selection Committee and GP Specialty School Board.

Meeting the GP Trainees

The visit focus is on the GP component of GP specialty training. Where trainees wish to share experiences related to the hospital component of their training the Lead Visitor will forward such information to the relevant Programme Directors, Patch Associate GP Dean separately from the LEP reporting process.

Trainees should be offered an opportunity to meet a member of the visiting team one to one should this be required.

Meeting the Educational Supervisors (GP Trainers)

The trainers will be met as a group. The purpose of the meeting is to discuss the trainers’ experience of training related issues. Support for trainer development is an important area to explore during this meeting. Visitors may explore issues raised during the trainee session but this meeting should not include direct feedback.

Meeting the GP Programme Directors

The visitors will meet the group of GP Programme Directors separately from GP trainers. Visitors may explore issues raised during the previous meetings.

Feedback

At the end of the visit to the GP practice verbal feedback will be given to the GP Trainer and Practice Manager. The feedback will highlight areas of notable practice and may contain areas where improvements could be made. The feedback will be incorporated into the collective feedback which will form the basis of the LEP report.

At the end of Day 1 brief headline feedback will be given to the Programme Directors. Programme Directors should be advised that the final report may contain other areas of notable practice and areas for improvement in addition to those highlighted on the day.

Any areas requiring immediate action where patient / trainee safety is compromised will require urgent attention on the day of the visit. Where patient / trainee safety concerns are identified these MUST be shared with the GP Head of School / GP Dean and Patch Associate GP Dean. Concerns will be shared with the Dean Director by the GP head of School / GP Dean.

Any feedback / concern trainees have expressed about other specialties the trainees have encountered in their training may be shared at this time.

The feedback from Day 1 of the visit will be incorporated into the final visit report to the LEP including reports from other specialties visited.

Day 2 - Visit to Acute Trust LEPs

This is the day in which the other Specialty Schools have the opportunity to meet with their trainees and their Supervisors in hospital posts. In each case a number of specialties will be reviewed in detail (including higher level training specialties)

If the specialties being visited include those used in the GP Specialty programme for that LEP the GP trainees (ST1/ST2 working in those specific specialties at the time of the visit) will be interviewed to give their feedback on the post.

If the specialties being visited include those used in the GP Specialty programme for that LEP the visiting team will include a GP visitor usually the lead visitor from the Day 1 visit to the GP Faculty.

Where a visit to an Acute Trust does not coincide with a GP Faculty visit and the specialties are not those used by GP training the GP School will not be involved in this visit.

Psychiatric Trusts have separate visits as a result of their different geographical locations and they will include a GP visitor, as this specialty hosts a significant number of GP trainees.

The organisation of the 2nd day will be carried out by the HEKSS Quality Management Groupwho will liaise with the Trust via the Medical Education Manager, and ensure that the necessary documentation is shared with the GP visitor. There is detailed guidance on this process.

Meeting the Trainees -Day 2

Arrangements for meeting groups of trainees will be managed by the HEKSS Quality Management Group. GP Trainees may be interviewed along with trainees from foundation and core / specialty trainees in a single specialty group or GP trainees from a number of specialties being visited may be interviewed together.

Where a GP trainee wishes to share experiences related to other hospital posts not being visited the interviewing visitors will direct the trainees to the GP Visitor and offer an opportunity to have a one to one should this be required.

Meeting the Educational / Clinical Supervisors / Programme Directors – Day 2

GP Trainers and Programme Directors will have been visited on Day 1 for GP and will not be required to attend again. The meetings will be related to supervisors in the secondary care specialties being visited.

Feedback Session – Day 2

At the end of the visit, brief headline feedback will be given. Feedback will be given by the whole team of visitors to the visited specialties and will relate to the overall provision of educational support at the LEP, highlighting good practice, as well as areas for improvement in the mandatory and developmental criteria in the GMC domains.

At least one of the local team of Programme Directors will need be available to hear the feedback from the visitors at the end of the visit, and ideally, if possible, the Patch Associate GP Dean responsible for that area.

Any issues that may arise during a visit concerning GP training posts in hospital specialties that are not being formally assessed (i.e. are not any of the specialties being visited) will not be raised in the formal feedback session, but will be fed back directly to the Patch Associate GP Dean for that GP Training Programme in order to validate and resolve locally if necessary, and will not form part of the final report.

Report Writing

The management of the reporting process is detailed in the Specialty Visits Operational Guidance and Visiting Procedure Guidance.

For Day 1 visits to the GP faculty the GP Lead Visitor will compile a draft visit report using the Visit Report template.

The draft report should include the areas of notable practice and concerns shared in verbal feedback but may have additional items raised.

All mandatory requirements and recommendations should be referenced to the findings in Section 2 of the visit template

The Lead GP Visitor must ensure that all the Day 1 visitors contribute to the report to the GP Faculty and circulate the draft report for comment. This should be returned to the Lead Visitor within 5 working days of the visit.

The Day 1 visit report should be shared with the appropriate Patch Associate GP Dean for the GP Faculty being visited for a factual accuracy check. Any comments from the PAD will be discussed with the Lead Visitor (and other visitors as necessary) and, if deemed appropriate by the Lead Visitor will be incorporated into the visit report.

The GP visitor will contribute to the writing of the Day 2 report.Issues relating to specialty posts used for GP Training will be reported on only if those specialties form part of those visited on the second day.