NHS Education for Scotland s2

NHS Education for Scotland

Minutes of the Obstetrics & Gynaecology and Paediatrics Specialty Training Board, held on 8 of December 2014, at 1.30pm, in Rooms 3 and 4, Westport, Edinburgh

Present: Clare McKenzie (CM) Chair, Claire Alexander (CA), Peter MacDonald (PM), Rowan Parks (RP)

Videoconference: Alastair McLellan (AM), Richard Ferguson (RF)

Apologies: Laura Armstrong (LA), Andrew Ecclestone (AE), Alison Graham (AG), Hilary MacPherson (HM).

In attendance: David Arnot (DA), Paola Solar (PS)

1.  Welcome and Apologies

The group introduced themselves and the apologies were noted.

2.  Minutes of meeting held on 15 September 2014

The minutes of the previous meeting were approved as a correct record.

3.  Matters Arising

3.1.  LTFT Scotland process

A large cohort of OG and Paediatric trainees go into LTFT, but the cost savings are re-distributed with other specialties, so the OGP STB felt their specialties were disadvantaged. A new policy has been approved by MDET, which will standardise the approval and review process throughout the four regions.

A shadow period will take place next year, to make sure that the new process is robust and at the same time to identify the funding that will be available for recycling. The process will consist also of annual reviews of those in LTFT to ensure consistency across the regions. It is anticipated that the funding recycled will be available for 2016 recruitment and the Chair will continue to raise this issue with MDET on behalf of the specialities.

3.2.  RAG report for GP Training

Both Subgroups had been asked to look at the GP RAG report due to the low performance of O&G in the NTS. This followed a discussion at the last STB where there was a question as to how O&G were performing in comparison to other acute hospital specialities. The spreadsheet highlighted that with the exception of emergency medicine in some units, all acute specialties with high volume work were not performing well.

The O&G Subgroup had noted that some units were under-reported. They had discussed the areas perceived as poor by GP trainees, and had tried to share the reasons for green flags. The Subgroup had acknowledged that there was a tension between what was required by the GP curriculum and what the posts entails in O&G, which in most cases is driven by service needs. There is also a lot of dissatisfaction amongst GP trainees from having to work on wards, which does not take account of their skills.

It was not clear whether the red flags for regional teaching were for departmental teaching or for the mandatory GP training. This should be teased out better in the next survey.

Another point noted was that the majority of O&G TPDs felt that overseeing the training of GPs was not part of their role. They also felt that the GP TPDs were not very involved in their training. In one region the GP TPD is invited to the STC meetings. It is proposed that other regions will consider this in the future.

It was also highlighted that the NES remuneration of TPDs is assessed on headcount of O&G trainees and that GP trainees are not counted.

The issue of the TPDs responsibilities has also been identified in Surgery. All trainees need to have appropriate in-site supervision, so the role of the ES, CS and TPD is crucial. It was felt that the specialty TPD should be able to oversee rotations for GP trainees, as changes to ST training can affect the other grades within a department. It was felt that the job description of the TPD should be checked.

The Paediatrics Subgroup had also discussed the RAG report in the morning meeting. They felt that the TPDs are aware of the curriculum for their specialty but not necessarily of the GPs curriculum. There is a tendency for big centres to bring up less green flags. Induction and Handover were areas of good practice in general. There had been discussion about improved induction.

The STB agreed that to ensure high quality educational environment there should be one lead for GP trainees per department. CM will review the job description for TPD and follow this up with RP and AM.

Action: CM

3.3.  LAT in Scotland Deanery

MDET has agreed that the West of Scotland LAT policy will be rolled out to the whole Scotland, with some wording modifications. The regions should aim for the same recruitment process as for NTNs, with at least one station similar to the national process. CM will send the draft policy to CA and PM.

Action: CM

The Chair highlighted that HEE has plans to reduce the number of LATs next year, and possibly remove LATs completely for 2016. This could have implications for Scotland – no change to the current LAT policy is planned at present.

3.4.  Scottish Medical Training Careers Fair feedback

CA noted that the College had planned their own event which was shelved in light of the NES initiative.

Both O&G and Paediatrics had found the Fair very successful. It will be difficult to find out whether it has any impact for at least 5 years.

AM noted that there have been two wash-up meetings. They had agreed that it had been a very successful event and were working on the lessons learned. MDET had committed to repeat the Fair for another 4 years and to gather as much data as possible. Next year the venue will be different but it will take place again in the West of Scotland.

3.5.  STB Membership

CM is keen to ensure the Subgroups are robust, and make the STB a Core group. The proposal to change the membership was discussed.

It was questioned whether to include the Paediatric Cardiology rep in the STB, as it is a separate specialty training programme (similar to the rationale for representation from CSRH). CM will liaise with Ben Smith to see if he would like to be part of the STB or if PM can represent paediatric cardiology.

Action: CM

RP indicated that in the future, as part of the move to the single deanery, there will be one MEL rep and someone from the Quality Management and Training Management workstreams in the STB.

The lack of engagement of DMEs and MDs was noted. MDET is taking this issue to SAMD.

The meetings are also lacking Academic representation. It was agreed that it would be more effective if the Academic reps could come to the Subgroups once a year, when specific Academic issues would be discussed.

4.  Transitional Board update

This Board has only met once. Clinical Radiology, Interventional Radiology, Clinical Oncology and ICM had had a modest increase in numbers. There is another meeting set for January but there is no agenda yet.

4.1.  CSRH Numbers update

The Chair had fed back the comments from the last STB to Ailsa Gebbie in relation to the fact that the STB had not supported the application for further numbers of trainees and that more detail would be required for any further discussion.

5.  Update from MDET

This had been covered above.

6.  Report from CSRH

There was no rep from CSRH.

7.  Report from Obs & Gynaecology Subgroup

7.1.  Recruitment Numbers/ plans

The recruitment process is well organised and in place. It seems that there are slightly less applications than last year. The interviews will be done in one day only but the number of panels has been increased.

7.2.  Modelling O&G numbers

CA will speak with DA about it after the meeting.

7.3.  Issues raised by Subgroup (ATSM Urogynaecology)

·  Kate Patrick is the new Simulation rep in the O&G Subgroup. Ultrasound simulation would be an excellent resource for O&G and there is appetite to have a shared facility across Scotland, but this would be very expensive (more than £900K). Since there is no requirement for ultrasound simulation in the curriculum it is unlikely that there will be funding available for this.

·  The Subgroup needed clarity around IRT in the new Scotland Deanery. The policy has already been signed off, so CM will send it to CA.

Action: CM

·  ATSM Urogynaecology is not an issue anymore – the trainees have been able to complete the surgical competences.

·  There was some anxiety about the quality of trainees for ST3 recruitment, although currently no Scottish region is recruiting at that level. The Subgroup will compare ARCP outcomes for trainees entering at ST1 and at ST3 level since 2007. CA will prepare a paper and will bring it to this STB in due course.

Action: CA

·  There will be no LAT national recruitment this year.

8.  Report from Paediatric Subgroup

8.1.  Recruitment numbers / plans

The recruitment process is set up. There have been 64 applications for ST1 and 17 for ST2, which is similar to last year’s numbers.

20 vacancies have been identified for ST3 and ST4 recruitment in London. There are also a few LATs.

It is expected that all posts will be filled.

8.2.  Grid Training posts – 24.10.14 meeting

The Paediatrics Subspecialty training can be divided into two groups in Scotland: dedicated training for subspecialty (Grid Training); and special interests training. Grid training is co-ordinated by RCPCH for the UK. The numbers who leave Scotland and the numbers who come to Scotland tend to be in balance.

Smaller programmes have to ring-fence salaries for grid training, but larger ones, such as the West of Scotland do not need to. Smaller programmes do not have the clinical workload so by default trainees tend to gravitate towards the West, which causes access imbalance. There is also tension between delivering subspecialist training and the delivery of good generalist training. It is recognised that due to a number of factors there is inequity within Scotland. By co-ordinating the training of grid posts across Scotland within the Single Deanery, it is hoped that these can be addressed.

At the event organised by PM on the 24 of October the subspecialty leads gave their data about their future subspecialty workforce requirements. The outcome was that about 30 posts per year committed to Paediatric subspecialties are needed in Scotland. It is proposed that a pool of 30 salaries per year is gathered from the regions to support grid training and allow a more co-ordinated approach.

The Board agreed that the principle of ring fencing funding may be possible, however a full proposal required to be developed. It was felt that the Transition Group would also be very interested in this initiative.

PM will prepare a paper for the STB agenda of 26 May 2015.

Action: PM

8.3.  Issues raised by Subgroup

·  The trainee rep had reported that the Academy of Medical Royal Colleges had mentioned a date of August 2017 for implementation of Shape of Training. The Board confirmed that there is no date yet.

·  PM highlighted a very successful Yorkhill trainer education event that had been held for paediatric trainers to aid with the requirements for Recognition of Trainers. There were plans for further events.

9.  Report from Liaison Dean

9.1.  Quality Management

There is an initiative to move from four different regional quality management systems to one process, improving consistency across Scotland. The STBs will be asked to take on roles to actively contribute to the delivery of QM. Further details will be shared when the details of the process are clarified.

9.2.  Hospital Training

MDET is looking at a new form of alignment with STBs. A MEL will be allocated to each STB, as well as a member of the Training Management team.

10. Report from Liaison Medical Director

AG had submitted her apologies.

11. AOB

11.1  AMTF

The Scottish Government had started an initiative for Advanced Training Fellowships. The Health Boards had been requested to present their bids to fund overseas AMTF. There had been a number of submissions. NES and the STBs may be asked to assess the educational value of these posts. It is not clear yet what role will NES have with the supervision of these Fellowships.

12. Next meeting date

Monday, 23 February 2015, 1.30pm, Room 3, Westport, Edinburgh.

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OGP STB 08.12.14 Minutes