HEE KSS Enhanced ST3 Programme 2016

Guidance (updated 25.02.16)

Overview of the Scheme

The changing role of the GP predicated by the increasing complexity of an aging populations’ health care needs, the move to care closer to home and the role of the GP beyond the immediate advocacy of the patient but as a commissioner of services has been reflected in the RCGP’s Enhanced GP Specialty Training Programme with greater emphasis being required on:

  • Enhanced generalist skills
  • Leadership skills
  • Enhanced Clinical Skills
  • Population health

This is congruent with the Shape of Training Review advocating a four- to six years (4 in GP) training programme with again greater emphasis on generalist skills

With this in mind the GP School has developed a programme: The Enhanced ST3 Programme, with the aim of offering HEE KSS GP trainees in ST3 an opportunity to expand their knowledge, skills and understanding of the GP Curriculum to a level above that afforded within the current three year training programme and linked to the aspirations of the Enhanced RCGP curriculum.

To facilitate learning in the programme trainees will have their ST3 year extended by an additional 3 months, through the provision of additional formal study days and opportunities to develop clinical interests in a personalised timetable of activities. Trainees will be required to demonstrate their leadership skills through undertaking a Quality Improvement Project and develop their skills as educators. This year the dates of the Enhanced ST3 programme will be Wed 4th May 2016 – Tue 1stNovember 2016.

To be eligible to apply for the Enhanced ST3 Programme Pilot GP trainees must meet the application criteria and provide details of their proposed personal development plan to address their identified learning outcomes in the GP Curriculum.

Application Eligibility Criteria:

  • Applicant must be in their ST3 training year on 1st January 2016
  • Applicant must have passed the AKT with a score of 70% or higher at the time of application
  • Applicant must have had an Outcome 1 at their first and second year ARCP
  • Applicant must have a well-developed reflective e-portfolio learning log
  • Applicant must demonstrate evidence of commitment to undertaking quality improvement work either through presenting their intentions, or for those who have undertaken some QIP project how they hope to develop this further.
  • Applicant must have a stated intention to undertake the CSA no later than the April 2016 diet and a reasonable expectation of success in the exam. (Eligibility to remain on the programme will be confirmed on gaining a pass in the CSA by 30th April 2016).

Application Process:

Trainees will need to provide:

  • A statement outlining their reason for wishing to apply to the Scheme
  • A statement outlining which of the clinical areas in the Enhanced GP Curriculum they wish to develop their knowledge and skills
  • Their professional / personal development plan (PDP) in relation to this curriculum area and a proposal for how the extra time will enable them to meet their learning objectives
  • Aproposal for a Quality Improvement Project they wish to undertake / develop (accepting that this may change as the programme progresses)
  • A commitment to develop their skills in delivering high quality patient care through developing skills as an educator.The application form will need to be supported by their Educational Supervisor and Programme Director
  • Applications should be submitted by no later than 9th March 2016.

Applicants will be informed of their initial success of their application by 16th March2016; however, continuation through the Enhanced ST3 programme will be confirmed subject to the eligibility criteria being fully met.

The HEE KSS Enhanced ST3 Programme Details

Medical education activities:

The future development of the whole primary care workforce is of high priority for both Health Education England and NHS England. To this end it is envisaged all GP practices will become involved in educating the workforce through a variety of sources including Community Educator Provider Networks.

To support the development of these skills the Enhanced ST3 programme will provide an opportunity to develop skills in supervision and teaching through attendance at a bespoke one day introduction to the principles underpinning medical education.

Leadership Activities:

The development of GPs as clinical leaders and commissioners of care is enshrined in the Health and Social Care Act 2012. A GP can no longer limit their role to individual patient advocacy but has to consider how to deliver high quality cost effective care across the population.

To help develop this new role GPs need to be able to reflect on the quality of care delivered and implement changes to improve patient outcomes. Quality Improvement Projects (QIP) are key drivers for this type of change. On the Enhanced ST3 programme trainees will be supported in undertaking a QIP and will follow a well-established programme based on CLIC (Clinical Leadership in Commissioning), developed within KSS in Kent over recent years.

Clinical Skills Development:

The RCGP has identified a number of clinical areas where GP trainees should consider enhancing their skills:

  • Children and young people
  • Mental Health
  • Alcohol and substance Misuse
  • Rehabilitation of patients with trauma or debilitating conditions
  • Care older adults and their carers

Trainees will have gained varying experience in the above areas during their programmes but will be asked to consider how they can develop their knowledge and skills beyond this experience looking at gaining experience in community clinics, working within the locality and across primary and secondary care to improve services for patients.

Multi-professional Working and Learning:

General Practice has a history of providing continuity of care. With the pressures on the NHS, previously described, the concept of personal continuity of care is at best challenging and largely unsustainable. Future models of care can only be delivered by a team based approach to continuity and enhanced multi-professional working. The enhanced ST3 Scheme will provide an opportunity to explore how to develop better multi-professional working for patients with chronic, complex health problems through involvement in the preceptorship programme where GPs and practice nurses learn together.

Supporting Transition to Independent Contractor Status:

Evidence supports the statement that transitions from one role to another in medicine are challenging and preparation whilst helpful cannot fully prepare one. The GP Training programme ensures fitness for practice but feedback from newly qualified GPs has shown fitness to practice and undertaking the full scope of work can be challenging. HEE KSS is piloting a model of preceptorship (as described above) which will support newly qualified GPs in HEE KSS and newly qualified practice nurses being supported through a peer learning group. Enhanced ST3s would be encouraged to join this group.

Sustainability:

The Global community faces major environmental challenges that will impact on the health of current and future generations. Sustainable approaches safeguard this future by considering the environmental impact of our choices. Medical education is central to a sustainable future for healthcare and includes important aspects such as:

  • promoting self-care and health- promotion
  • best use of medical resources
  • Medicines management
  • Developing and supporting measures to sustain basic resources

The Enhanced ST3 scheme will afford opportunities to address this important agenda and may be linked to QIP activity.

The Enhanced ST3 Scheme:

Trainees will commence the Enhanced ST3 programme on Wed 4th May 2016, whilst remaining under their usual contract until Tuesday 2nd August 2016.

They will then commence a 3 month additional period of GP training, during which they will continue to work the expected COGPED weekly timetable for a GPST3:

  • 7 clinical sessions
  • 2 sessions in a placement aimed at fulfilling the QIP project
  • 1 tutorial/educational session in practice

By starting the Enhanced ST3 programme in May, all EST3s will have successfully completed both AKT and CSA exams before they join the EST3 programme.

The Enhanced ST3 year programme includes:

  • An extra 20 days of formal study leave, some of which will be taken for:

- Attendance at a one day introduction to educational theory and clinical supervision

- Attendance at a monthly‘CLIC’ peer learning set for EST3s

  • A personalised timetable from 3.8.15 to 1.11.16

Within the Enhanced Phase ST3 trainees will work towards their PDP with the provision of the extra 20 study days which should be evenly distributed across the weekly timetable. Trainees will be expected to plan their study days in discussion with their GP Trainer and where appropriate Programme Director.

Study days would usually be undertaken on a regular basis throughout the remaining time in the programme but there may need to be flexibility sufficient for the trainee to meet their intended learning outcomes.

The CLIC programme will be managed by a very experienced course leader, and you will be supported to identify a placement in a CCG or other organisation by your own Programme Directors.

Frequently asked questions:

What if a trainee does not pass the CSA by April 2016?

To make things simpler, the EST3 programme in 2016 will not begin until May 2016. Trainees who are unsuccessful in the CSA or AKT by this stage will not be eligible to join the scheme, and will continue their standard GP training, since their primary focus has to be qualifying as a GP. Any trainee affected by this will receive personal support from the Head of the GP School at this point.

Is there any additional study leave funding available?

Trainees may apply for additional funding to support learning specifically related to their PDP based on the usual GP ST3 monthly study leave allowance for the extended period of the programme. Up to £500 additional study leave funding may be available for each EST3, on application to the Head of the GP School.

Proposed weekly timetable for Enhanced ST3s during the extended period of training, 3.8.16 to 1.11.16:

  • 6 General GP Face to Face Surgeries (at their existing ST3 year training practice) (including Visits / administration)
  • 1 Clinical Session to address RCGP Enhanced curriculum
  • 3 Study sessions which may be constituted from:
  • Personalised Sessions
  • ‘CLIC’ peer learning Set / Formal Enhanced ST3 Meetings
  • Multiprofessional meetings linked to the preceptorship programme for newly qualified GPs in KSS and practice nurses
  • Work placed Based Assessments
  • Tutorial

Enhanced ST3 trainees are required to continue to complete the required number of WPBA assessment and Out of Hours sessions pro rata through to the end of the programme (1.11.2016) in order to have a successful ARCP. Without undertaking OOH sessions, the 45% banding payable to GP trainees would not be payable, and EST3s’ status remains that of trainee in the eyes of the RCGP. These issues are non-negotiable.

When will the Enhanced ST3 trainee have their ARCP and CCT?

The GP training programme will be extended by 3 months and therefore the ARCP will take place in October 2016, prior to the completion of the training programme on 1.11.2015.

Can Less Than Full Time (LTFT) trainees apply?

The Enhanced ST3 programme is demanding and requires the ability to commit fully to undertaking the full range of expected activities. The programme can only run between May-Nov 2016. HEE KSS recognises that increasing numbers of GP trainees are undertaking their training in a LTFT capacity, for a wide variety of reasons, and wishes to make this opportunity available to all eligible candidates.

All EST3s, including those working LTFT, would need therefore to commit to being in work from May 2016-Nov 2016 (those on extended leave at that time e.g. maternity leave) would not be eligible, due to the need to attend regular learning sets, and be working on projects in the meantime

Whilst it would be anticipated that LTFT EST3 trainees would gain access to additional study leave, a personalised plan would be developed between the Head of the GP School and the EST3 to determine what was practical for them, and LTFT EST3s may not require the full three month extension to their GP training. This would be considered on an individualised basis.

If you are uncertain as to whether this scheme is for you, please contact the Head of the GP School for an informal discussion.

What if I’ve already undertaken a CLIC placement in my normal GP training? What will this add?

We’re glad you’ve asked. As an alumnus of the excellent CLIC programme, you will already appreciate the strengths of opportunity these placements provide, and probably left your placement feeling you now understand how to plan and execute a project, and how to quickly define what is achievable, meaning the second time round you can really make a difference to patient care, having learnt from your previous experiences (and dare we suggest, mistakes?). The possibilities for service improvement in the NHS are limitless, and your own potential to learn and become a better GP, and in particular a better leader, can only be enhanced by gaining more experience.

Can I develop in a specialised clinical area as part of the scheme?

Applicants need to be mindful that the Enhanced ST3 is not to develop knowledge and skills in highly specialised areas, outside the usual remit of a GP and should be guided by the RCGP curriculum.

Existing GP Specialty training affords trainees the opportunity to meet all the learning outcomes in the GP curriculum and obtain a CCT.

However there are areas within the curriculum which may be clinical, managerial or educational where Professional Development at this stage will enhance understanding of the role of the GP in that area of work or form the basis of post CCT professional study and development.

Can I undertake a further Postgraduate Academic programme as part of the Scheme?

No: The Enhanced ST3 programme will not provide sufficient time and opportunity to complete a formal Academic Degree Programme such as a Post Graduate Certificate but may afford the opportunity to undertake some exploration and experiential skills.

Highly motivated EST3 participants may be able to undertake one module of a masters level qualification, but this would need to be within the study leave allowance, and any additional funding would require investment by the trainee themselves.

How else might I develop my leadership skills or skills as an educator?

Trainees may wish to consider their future role as a team member and potential leader of a team and develop their Clinical Leadership Competencies through leadership development programmes available in the NHS.

HEEKSS will be running a targeted educator course as part of the programme.

What other opportunities are there?

Trainees may wish to explore and develop their role in population medicine and sustainability moving beyond the patient presenting and explore illness prevention, impact of social and physical factors on the health of patients, increasing access to health care and addressing health care inequality.

Finally when considering areas for development trainees are advised to think beyond their own personal wants and needs and consider how the enhanced days will benefit patient care and the health economy.

Commitment to the Scheme – e-Portfolio and attendance at CLIC presentation of work.

Submitting an application:

Interested applicants should complete the application form according to the guidance.

Trainees will need to have their application supported by their Educational Supervisor and Programme Director.

Deadline: applications should be submitted by no later than 9th March 2016. Applicants will be informed by 16th March 2016 of the outcome of their application.

Completed application forms should be to Elena Gonzalez by email to:

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Enhanced ST3 Application Criteria & Guidance (04/01/2016)