Minutes of the Anaesthetics, Intensive Care and Emergency Medicine Specialty Training Board held at 10.45 am on Monday 29 April 2013 in Room 1, Floor 1, Westport, Edinburgh

Present: Eddie Wilson (EW) Chair, Philip Cachia (PC), John Keaney (JK), Stephen Lynch (SL), Mark Mitchelson (MM), William McClymont (WMcL), Alastair McDiarmid (AM), Jane McKinlay (JM), Carol McMillan (CM), Kirsty Mitchell (KM), Carol Murdoch (CM), Hugh Neill (HN), Lynn Newman (LN), Neil O’Donnell (NOD), Louie Plenderleith (LP), Christine Rea (CR), Liz Wilson (LW), Iain Young (IY).

By videoconference: Dundee – Russell Duncan (RD); Glasgow – David Stewart (DS.

Apologies: Valerie Beattie (VB), David Caesar (DC), John Colvin (JCo), Roelf Dijzhuizen (RD), Derek Gillen (DG), Paul Holder (PHo), Chris Hoy (CH), John Kinsella (JKin), Michele Laverty (ML), Anthea Lints (AL), Alan Orr (AO), Rowan Parks (RP), David Semple (DS), Fiona Small (FS).

In attendance: Helen McIntosh (HM).

1. / Welcome and apologies
The Chair welcomed Dr John Keaney, returning to the STB as the College of Emergency Medicine representative; he welcomed Dr Alastair McDiarmid, replacing Dr John Read as Regional Adviser/Deanery representative NOS (Anaesthesia) to his first meeting and Dr Jane McKinlay, Emergency Medicine trainee representative to her first meeting of the board.
The Chair recorded the thanks of the board for Dr Read’s long service as a member. Dr Read will continue to represent Scotland in the UK recruitment process and step aside after the current round is completed.
Apologies were noted.
2. / Minutes of meeting held on 11 March 2013
The following amendments were noted:
Page 3, item 4, ICM
·  second sentence to read ‘…longer term solution.’
·  final sentence tor read ‘…almost zero attrition in joint training programmes…’
With these amendments the minutes were accepted as correct record of the meeting and will be posted on the website.
3. / Matters arising
3.1 / CT2 Anaesthesia/ST3 recruitment
The situation regarding a small number of trainees who were unable to apply to ST3 due to exam timing was discussed at the most recent MDET meeting. MDET agreed there was no specific requirement in the Gold Guide to extend training and it was likely LAT posts will be available however those affected will be viewed sympathetically on a case by case basis by PG Deans.
PC noted similar issues have affected Psychiatry and CMT. He felt a UK-wide solution was required for Colleges to amend exam timings or to return to issuing conditional programme offers. EW stressed this was not just a Scottish issue and while the College acknowledged the problem it had no solution. He will ensure this was discussed at the next Scottish College Board meeting in June and will report back to the STB beyond that.
Action:
·  EW to report on Scottish College discussion at a future STB meeting.
3.2 / Emergency Medicine College representation: update
As noted in item 1.
4. / Dual CCT Programmes. Clarification on CCT or CESR route should trainee leave one programme
This was an important issue and will be kept on the agenda. PC said at present individuals were not eligible for CCT unless a UK wide exception was made; he cautioned against raising false expectations.
Action:
·  Agenda item for next STB meeting.
5. / Workforce Planning
5.1 / STB input to trainee numbers and workforce planning for 2014 and beyond
As part of the annual process Professor Padfield has arranged to meet each of the specialties. EW stressed it was important to feed into all workforce discussion and noted Professor Padfield will leave post soon.
5.2 / Anaesthesia
EW has sent a summary paper to Professor Padfield for information and discussion. The paper stated there should be no further cuts in trainee numbers as there were insufficient trainees in Core Anaesthesia and consultant delivered care was increasing. Consultant information held by ISD was acknowledged as inaccurate as it did not refIect consultant expansion of approx 3% related to service demand however it was working to improve the information it held.
Anaesthesia donated posts to ICM recruitment this year but this cannot be regarded as long-term strategy and the lack of funding for ICM training meant other potential partner specialties were not engaged.
5.3 / Emergency Medicine
JK felt workforce planning did not take account of attrition. The attrition rate in Scotland for Emergency Medicine was 50% with a similar picture in the rest of the UK. As a result there were 17 ST4 vacancies in WoS and only 6 applicants so there would be a high level of gaps leading to patient safety issues. Consultants will have to do night shifts which will be very expensive. He felt the unplanned expansion of Emergency Medicine consultants was undertaken with no reference to the number of trainees being produced and would like to see a vision of what the service would look like in 2/3/5 years time. JK and EW both reported their specialties were reaching the stage where they did not have people available to fill consultant posts. EW noted Professor Padfield has taken account of workforce information supplied by Anaesthesia but agreed there did not seem to be an overall vision.
RD added that while attrition has been at its worst they have been unable to recruit to HST hence no CCTs were due in EoS until 2017.
In summary, EW said the STB should continue to feed into workforce planning by all available routes. He noted the frustration caused when the Reshaping Board supported a strategy for the recycling of unfillable EM ST posts to increase Core numbers which was subsequently not supported by Regional Workforce.
5.4 / Intensive Care Medicine
ICM representatives noted concerns around the specialty becoming less attractive due to work/lifestyle balance. There will be required significant consultant expansion by 2016/17 with concerns expressed that insufficient trainee numbers had been recruited to feed this expansion. Anaesthesia has been supportive but there was no independent funding for ICM training in Scotland which is in contrast to the rest of the UK. There is a significant risk that trainees will be lost from Scotland and this will also impact on Academic training.
EW will feedback all the points made today into his discussion with Professor Padfield.
Action:
·  EW to feedback all comments/points made today into his discussion with Professor Padfield.
6. / Recruitment update
6.1 / 2013 Recruitment
NES will conduct a formal review in May of the one year pilot of national recruitment for which it will seek co-ordinated STB responses. JK noted his dissatisfaction with the ACCS recruitment process held in London which he felt had been chaotic and raised a specific concern around one of the interview questions used within the process. MM said his experience of the national UK process was more positive and that it was slicker and consistently applied, however he queried whether a more people based process would be more effective.
Anaesthesia
·  CT1 offers were complete and all vacancies filled with some ranked candidates remaining (30+); this was frustrating as they would have liked to expand core training.
·  Anaesthesia ST3 interviews were held last week; of the 45 candidates for 60 posts, 5 were not appointable and so they will not fill. Offers will be issued in May with the deadline for acceptance set at 28 May and clearing interviews will be held in June.
Intensive Care Medicine
·  Twelve candidates were interviewed last week for 10 badged posts. As one candidate was deemed unappointable 11 were ranked for 10 posts (2 people applied for Anaesthesia elsewhere in UK). Offers will be issued this week via SMT. Two non badged posts were available and a post will be offered to the one applicant. LW noted the recruitment process for non badged posts required candidates to have prior approval of time OOP plus funding so this did impact on the number of applications. The process of recruitment itself went well and they were ably supported by FS and her team; EW will write to FS to thank her for her input.
·  LW noted a Faculty representative attended the recruitment process and reported no concerns.
Emergency Medicine
·  ACCS EM advertised and filled all 26 posts via UK process.
·  EM ST4 advertised 25 posts but will not fill in all regions, especially WoS. UK wide there were 166 applicants for 240/250 vacancies; 152 candidates were interviewed and of those 27 were waiting for exam results.
·  JK said the recruitment process itself had been acceptable however Scottish consultants had been assured they would interview only Scottish candidates and this did not happen. Offers were delayed for exam results and will be issued on 13 May and the full picture will be known at the end of May.
·  There was no opportunity to input to questions used in the UK national process.
Action:
·  EW to write thanking FS and her team for their input to the ICM recruitment process.
6.2 / LAT appointments and clearing processes
EW has already informed UK recruitment that Scotland will recruit locally for Anaesthesia LAT appointments. Posts will be advertised in May and interviews held in June.
The clearing process for Anaesthesia ST3 will take place week beginning 17 June in Birmingham. ML had confirmed Scotland was not obliged to put any or all posts into the process. EW felt they should not put all posts into the process as it was likely they would get a poor return and there will be no first choice Scottish applicants. He asked for the views of Anaesthesia representatives as to whether Scotland should participate. LP felt they should; LN noted the College newsletter said there was an excess number of 60/65 candidates UK-wide and although not all would be appointable she felt it was worth participating. ‘Near misses’ will be put into clearing but not in first choice area. It was agreed EW will check the situation regarding preferencing and LN will send him the College newsletter. Anaesthesia representatives will then agree by email whether to participate.
Actions:
·  EW to check the situation regarding preferencing.
·  LN to send the College newsletter to EW.
·  Anaesthesia representatives to agree by email on participation in clearing.
7. / Quality Assurance of Training
The GMC trainee survey was currently open. HN noted patient safety concerns raised via the survey were sent to Deanery, DMEs and Medical Directors; it was agreed it would be useful for the STB to receive this information and he will take this forward.
8. / Academic Issues
No report was received.
9. / College reports
·  Anaesthesia
No report was received.
·  Emergency Medicine
JK noted the College was still discussing exit points.
10. / Trainee reports
JMcK noted the WoS trainee has issued a survey on happiness in the workplace which it hoped to circulate nationally. She will bring back the survey results to the STB at a future meeting.
She also felt access to study leave was difficult and there was no drive to release trainees for courses to aid career development which all had a demoralising effect on trainees.
Action:
·  JMcK to bring survey results to STB at a future meeting.
11. / Number of STB Meetings
The board agreed to meet as arranged on 29 May; to cancel the meeting arranged for 27 June; to meet as arranged on 28 August. Work on agreeing numbers for next year will be co-ordinated by email.
EW will then review frequency of meetings for 2014.
Action:
·  EW to review frequency of meetings for 2014.
12. / Liaison Dean Report
PC highlighted:
·  HEE was now ‘live’.
·  MDRS: HEE was proceeding with this. A single bid was received and accepted in principle and the aspiration was for a single electronic process by August 2014. Scottish Government’s position was ‘arms length’ and it remained interested/engaged but not committed. Half of all Scottish specialties were involved in UK recruitment but Scotland will either fully commit or not at all.
·  Additional UK Foundation places have been announced meaning there will be sufficient places for all UK graduates – Scotland will provide around 45 additional places. An option appraisal on Foundation training was being conducted to address the year on year over supply of graduates. Nine options were being considered by the UK Scrutiny Group the most favoured of which was the abolition of Foundation with one year added to core training.
·  Enhanced GP training: the curriculum for 2 years hospital/2 years primary care has gone through the approval process and while the educational case was agreed GMC will not give its final approval until training was confirmed as supportable and deliverable.
·  IDTs: the national UK process was now live and applications open and Deaneries have been asked to identify any available posts. The referring Deanery will not make a judgement but confirm details eg there were no complaints against a trainee. A single panel hosted in one of the London LETBEs with external representatives will consider applications against a stricter set of criteria. The new process was likely to make it more difficult to get an IDT.
·  Francis Report: Scottish Government will not produce a formal response but was encouraging Scotland to take cognisance feed findings into the 20/20 vision work. The Government has also asked Health Improvement Scotland to undertake a review of adverse incident reporting. The NES Board has considered the Francis Report and has asked MDET to make a response. Each STB will be asked for its views and feedback from a workshop on the Report at the Conference on 30 April will be collated and feed into the response. PC will circulate the 2 discussion papers produced for the Conference workshop. It was agreed to discuss the Francis Report as an agenda item at the May STB meeting.
Action:
·  PC to circulate discussion papers for Conference workshop on Francis Report.
·  Agenda item for May STB meeting: Francis Report.
13. / Revalidation for doctors in training
The ARCP season was beginning and all will be required to complete a self-declaration online on SOAR for an Outcome 1. This SOAR system was currently being finalised for registration and trainees will be sent logins and passwords and information sent to Educational Supervisors. Until the system was up and running paper self-declarations were acceptable. England was also revalidating via ARCP but collecting different data from Scotland in the form of certificates; if they were not produced individuals will not get an Outcome 1. Educational Supervisors will tick off receipt of documentation required for receipt by the ARCP Chair.
14. / AOB
No other business was raised.
15. / Date of next meeting
The next meeting will take place at 10.45 am on Wednesday 29 May 2013 in Meeting Room 6, Floor 1, Westport, Edinburgh (videoconference available).

Actions arising from the meeting