Psychiatry in the Foundation Programme

Interim Report

  1. Following recommendations from the Psychiatry Taskforce, Medical Professional Board (England) agreed that the proportion of psychiatry posts in the Foundation Programme should be increased to 7.5% in each year.
  2. The Service Level Agreement between the Department of Health (England) and Strategic Health Authorities (SHAs) issued in April 2012 stated:

“SHAs should indicate what plans they are putting in place to provide at least:

  • 22.5% of F1 doctors with a four month F1 placement in psychiatry from August 2013;
  • 22.5% of F2 doctors with a four month placement in psychiatry from August 2014.”
  1. This interim report provides evidence of progress against the F1 requirements in England and invites discussion about how best to support further increases in the proportion of high quality psychiatry posts in both F1 and F2 across the UK.

Background

  1. The Foundation Programme, introduced in 2005, has two core objectives:
  2. To enable medical graduates to consolidate, develop and demonstrate their generic clinical skills in the workplace as they prepare for specialty or GP training; and
  3. To help medical graduates make informed decisions about their careers.
  4. Although the Foundation Programme Curriculum champions the importance of assessing and managing patients with common mental illnesses, deaneries/foundation schools have struggled to deliver workplace opportunities. Many schools have been reliant on class-room based sessions. Assessments relating to patients with mental illness have been under-represented in foundation doctors’ e-portfolios.
  5. Professor John Collins in his report, Foundations for Excellence, challenged all deaneries/foundation schools to ensure that every foundation doctor rotated through at least a four month placement in a community setting (e.g. general practice, psychiatry, community paediatrics). In addition to ensuring that foundation doctors gain a broader understanding of the range of healthcare settings where care is delivered, Professor Collins also advocated this shift to broaden the pool of supervisors.
  6. Some deaneries/foundation schools have expressed concerns about the quality of psychiatry placements and in particular supervision out of hours. While deaneries/foundation schools have had to take urgent action to address these concerns, analysis of the 2012 GMC trainee survey suggests that psychiatry and general practice are the least likely specialties to be associated with negative indicator scores.

Progress against F1 requirements (Appendix 1)

  1. Preliminary data extracted from the Foundation Programme Application System (FPAS) suggests that the proportion of F1 doctors rotating through a four month placement in Psychiatry in England will more than double from August 2013. This is probably an underestimate of the increase, as the 2011/12 comparative figures include missing data and posts where psychiatry is not the primary focus (e.g. day release).
  2. Data is not yet available forthe anticipated number of F2 posts in psychiatry in 2014 as these are not consistently reported on the application system. Half of the foundation schools allocate appointees to F2 rotations during the F1 year. Further information should be available in early 2014.
  3. Across the UK, 9.3% of F1 doctors will rotate through a F1 placement in psychiatry from August 2013. Oxford, Yorkshire and East Midlands are the only deaneries to meet the recommendations.

Next steps

  1. The College has just appointed a lead for foundation to identify and share good practice.
  2. Help is need from the Divisions and Heads of School of Psychiatry to work with postgraduate deaneries and mental health trusts to ensure that psychiatry F1 and F2 posts are of a high quality. In particular, we need to focus our attention on those deaneries which fall particularly short of the 22.5% agreed requirement for F1 in England.

Professor Stuart Carney

Associate Dean for Education Policy and Strategy