QUALITY MANAGEMENT GROUP

Minutes of Meeting

Friday 31st August 2012 2:00 – 4:00 pm

Level 8 Postgraduate Office Meeting Room

Ninewells Hospital & Medical School

Present: / Chair - Dr C McKenzie (CMc)
Mrs Rosie Baillie (RB), Dr John Davidson (JD), Ms Fiona Erickson (FE), Dr F Drimmie (FD), Dr Justine Nanson (JN), Mrs Fiona Anderson (FA), Mr S Haddow (SH),
Dr Matt Lambert (ML) – trainee rep
Lay Representative –Ms Liz Stanford (LS),
By VC –Mrs Mary Malarkey (MM), Medical Education Services Administrator, Forth Valley
In attendance: MrsC Cunningham (CC)
ACTION
1. / Apologies and Introductions
Apologies were received from Dr Gordon McLeay (GMc), Prof Morwenna Wood (PMW), Ms Christine Rea (CR), Dr David McQueen (DMc), Mrs Sally Bradley (SB), Ms Karen Murray (KM), Mr Martyn Ward (MW), Dr William McClymont (WMc), Dr D Bruce (DB)
2. / Minutes of Previous Meeting
The minutes of the previous meeting were agreed and accepted as a true record of the meeting.
3. / Action from Previous Meeting (Paper 2)
4.2.1 Highland FY Vacancies
KM to provide an update for Highland on staffing. SH gave feedback on HR sub-group meeting where travel & subsistence had been discussed for people who rotate from Dundee to Highland. CMc will alert this issue to DMT. This could impact on T & C’s for EoS rotations in Surgery. FA suggested this information could be included on JDF website when finalised.
4.2.3TTMG - TPD Meetings
Still in progress. FE forwards summaries to RB when these happen.
4.2.3Information on Trainers and Courses from FV & Highland
Information has now been received from MM, but still await data from KM.
4.2.29T & O Review
JD reported that this review has been subsumed into a bigger piece of work which is reviewing provision of all out of hours surgery across NHS Tayside. The Associate Medical Director has produced a paper which is being taken to EMT. CMc will discuss with PC on his return from A/L to ask for access to view if there are any educational effects.
4.6 Sharing ofMinutes from DME Meetings
JD agreed that this could be done.
4.2 (22) Feedback from FPDs to QM Team
CMc reported on this. Discussion will take place at next Foundation Committee Meeting with FPDs on developing a better structure/process for feeding back their discussions with their portfolios of specialties. / CMc
KM
CMc
4 / GMC – Annual Deanery Report 2011 (Paper 3)
Action point 1 – Vacancies and Rota Gaps. The Reshaping Medical Workforce document is out for consultation. CMc reported there is to be a specialty by specialty decision on whether the glide path continues, or not. This will be included in DR update to GMC.
SH reported that all Foundation vacancies had been filled, but there were then two subsequent resignations. However, NHST may plug into Dumfries & Galloway recruitment process. SH also reported that information on two recent doctors in difficulty had not been shared with NHST in sufficient time. FD agreed there were specific issues that should have been addressed sooner. The process will be reviewed to ensure that information is shared timeously and subsequent discussion will take place with FD/SH.
SH also reported that HR in NHST will now have a resource who can monitor trainees who are not engaging with their employers/deanery. A more formal approach may now be taken to record and document information on these trainees.
MM reported that they were not aware of any issues regarding vacancies in FV. CMc asked if MM could remind DMcQ about the Paediatrics staffing levels as the GMC survey had further red flags.
Action point 2 – Reporting of Adverse Incidents. There is a new question in Deanery Report for the GMC. Deanery has to inform GMC of all incidents involving trainees which had been reported to the Dean.
Action point 3 – Collection of Trainer Data. RB reported that all QIMs have discussed this ongoing and national issue. No robust process is in place in any of the regions for collecting data on trainers. Zircadian system bought by NHST appears detailed. NHS Lothian have enquired about this system and CMc has passed SH details to them to liaise with him. The deanery will supply a list of the educational roles to prepopulate Zircadian. The general issue of data collection has been escalated to Stewart Irvine, as it will be even more prominent with the introduction of GMC Approval and Recognition of Trainers in 2013.
Action point 4 – TTMG. CMc asked FE if LearnPro figures were available yet. FE confirmed they were not available as yet. Ongoing.
Action point 19 – Foundation Emergency Medicine. SH reported that three new consultants have now been recruited which should ensure that the FY lone working issue in PRI is resolved. CMc will feedback to PC that the resource is now available and further information on this will come from the Clinical Director for Emergency Medicine.
Action point 22 – Foundation Curriculum. New curriculum is now available. FA reported that the FPD’s have been contacting the department leads to cascade new curriculum and assessment information to the Ed Sups. Deanery had sent an email previously but only to Educational Supervisors. This was the process that had been agreed at TTMG.
MM reported on the process that had been adopted by FV. All Educational and Clinical supervisors had been contacted with information on new curriculum and new assessments.
The group discussed the best way to get the information disseminated to the Clinical and Education supervisors. FA advised that the deanery does not keep a list of clinical Sups. SH advised that, if requested, he could send out an email communication to all consultants. CMc asked FA to consider, on behalf of Foundation, whether SH’s offer to email the consultant bodies should be taken up
Action: Request an update from Foundation Committee on how they plan to cascade information. Report back at next meeting.
Action point 24 – Paediatrics in Forth Valley. GMC survey has red flags in Paediatrics FV. TPD report awaited before making decision regarding the need for a visit. CMc will talk with PC. It was agreed that it would be useful to have information on staffing levels from the Trust side and what their plans are.
Action point 25 – Plastic Surgery. Visit to Glasgow planned at end of September. Further information has been received from St John’s which will be reviewed. / FD/SH
MM
CMc
FA
CMc
5. / GMC Survey 2012
Final Response Rate - RB reported that the response rate was 91.2% this year. 10% higher than last year. In terms of UK response rate we are still near bottom of the list. Of the 9% who had not responded in the EoS, quite a high number were Foundation trainees. NoS has quite a high rate of FY return, also GP in Tayside, where trainees are informed that a response is required for progress.
Discussion took place on the best way to approach this problem in future and directly target the foundation trainees in 2013. The Deanery & NHST will work together to produce a joint statement to trainees next year on expectations. CC will note this for future as a reminder.
RAG Report / Summary Report (Papers 4 & 5) – RB talked to these papers. Foundation Emergency Medicine is a positive performer in comparison to 2011 results. Speciality Training produced good results for Clinical Radiology, Dermatology, Diabetes and Endocrinology. There were commendable improvements in induction across the board.
Areas of concern were highlighted which tended to marry up with issues already on the radar: MFE in RVH which will be visited in two weeks time. Psychiatry has quite a few concerns across a number of sites - RB is consolidating detail on this and a focus group is planned with trainees. Paeds at FV still has a number of issues and TPD report is awaited. Plastic Surgery results show slight improvements, but still a number of issues. Actions still being put in place since February visits.
GMC have introduced pink flags this year (equivalent to NES-applied amber flags of previous years). Undermining pink flags are an issue across the board. NES has produced a report on this highlighting that some of the flags are statistical anomalies.
SH reported that the Dignity at Work policy is being re-launched by NHST. Senior HR advisers should put this issue on the agenda to ensure medical staff attend meetings and have copies of the policy.
CMc also reported there were a number of red flags on regional teaching at Foundation level. FA commented that the block-release teaching programme is under review at national level. The format of the teaching programme was changed but not the content. She commented that we need to ensure we have a meaningful teaching programme for FY trainees. RB commented that these red flags were not very reliable as the wording of the questions on teaching was ambiguous. FA will look at the content of the teaching package and feedback CMc will write formally to DB to let him know of this action.
RB stated that the December 2012 PAQ questions on teaching will be revised and include appropriate definitions of what teaching is being asked about to ensure more reliable feedback from trainees.
TTMG
JD reported that funding had now been approved for significant increase in resources which will be used to appoint additional ADME, dedicated to Surgical, Medicine, Support Services, Mental Health Services, GP. Job descriptions and adverts will be out shortly.
JD reported that the Associate Medical Director for Medicine and JD had made an unannounced visit to RVH, which uncovered some discrepancies in the quality of the information being fed back. The triggered visit is very welcome. A monitoring exercise to assess admissions will be undertaken through HR in the week commencing Monday 10th. CMc reported that numerous concerns had been raised by trainees in MFE including workload.
JD also reported that the AMD for Medicine was also dealing with the patient safety issues highlighted by the GMC survey and the red flags. DN & JD had met with the new AMD in Mental Health and had a very positive meeting. He is aware of red flags.
JD also reported that despite repeated attempts to engage with senior management, there are still major ongoing concerns about Surgery. JD asked, following the QM visit, what was the plan for Surgery going forward. JN reported that from a Foundation point of view, she was hugely concerned about Surgery in Ninewells. General Surgery had been visited and a number of recommendations made with particular focus on Foundation Surgery. RB was struggling to get responses from the department, however following CMc’s email to the surgeons, they were now engaging and a meeting was being planned. CMc will report back to next FPD meeting.
MM reported that Surgery in FV had improved. New surgeons keen on Educational Supervision and teaching.
Patient Safety Issues (Paper 6)
JD has agreed with AMDs that they will respond to patient safety comments by 7 September. JD will forward responses to RB when received. JD asked it to be formally documented that he had written and emailed the AMD with responsibility for surgery on many occasions, with no response whatsoever.
UG/PG Comparison. RB & SB had met to discuss and compare survey results. In general the red flags do not match up, apart from usual concerns around IT access. More negative results on both sides in Surgery. UG results fairly good on the whole. The survey questions and indicators used are not the same, therefore it is difficult to do a direct and meaningful comparison.
CMc highlighted that the business proposal developed for NHST may be useful to other Health Boards. SH offered to share the paper with MM. FE to email this. / CMc/SH
CC
FA
CMc
CMc
CMc
JD
FE
6 / Deanery
6.1 / Completed Visits
ENT in Aberdeen Royal. Visit report approved by DQMG by email, actions are currently being followed up.
6.2 / Outstanding Visit Actions (Paper 7)
-Plastic Surgery in St Johns were due to give us back evidence by today. Documention and update has now been received (not in time to update this paper). Glasgow being revisited later in the month. Aberdeen’s survey results had improved.
-Plastic Surgery (National Programme) actions. Response from TPD was not forthcoming until CMc emailed. TPD has responded but doesn’t address all the issues. CMc will follow this up.
-General Surgery. Some replies received, but inadequate to address the issues fully. CMc will take forward and talk with DB as A/Dean for Foundation. CMc will feedback at next meeting.
-Outstanding actions will be updated for next meeting. / CMc
CMc
RB
6.3 / Future Visits in 2012.
GeneraMFE, RVH, 18 September
MFE, NW, 24 September
Acute Internal Medicine, NW, 25 September
Plastic Surgery, GRI, 28 September
Endocrinology & Diabetes, NW, 31 October
Cardiology, NW, October (date tbc)
Gastro, NW (date tbc)
Foundation Medicine, PRI (date tbc)
6.4 / TPD & LEP Reports
These reports went out end of July with three-week turnaround. TPD report size much reduced this year. 23 returned out of 38 so far. Some TPD’s on A/L. 10 with no response, so RB will chase these up.
LEP report being finalised by JD.
The Deanery report needs to be forwarded to GMC in October, therefore all TPD & LEP reports required before then.
Report from FV goes to the West and copied to CMc. MM will check with DMc re. completion of FV LEP report. / RB
MM
6.5 / Trauma & Orthopaedics Focus Group (Paper 8)
Two focus groups had been held and were considered to be a good way to get feedback from trainees; both had been very constructive. The meetings highlighted some specific educational issues, therefore APG Dean for Surgery will meet with the TPD and Clinical Director to take forward. There is a problem with clinic overbooking. SH was asked to add the service related issues to the TTMG agenda.
6.6 / Psychiatry Focus Groups (Trainees & TPDs)
Already discussed
6.7 / Clinical Skills Centre
FD reported on this. A trust representative had attended the Clinical Skills Steering Group meeting. One of the items discussed was whether the Clinical Skills Centre could be used more by NHS Tayside for induction purposes. SH replied that the whole induction programme for trainees would be looked at very differently for next year, probably a week-long induction programme which will be practical shadowing experience plus face-to-face teaching. This will be mandatory and trainees will be paid for this. NHST will run the programme. It was not thought that the CSC could be used in this respect.
TTMG
7. / Incident Reporting: FY1 QI Project (Additional Papers a-c)
Progress Improvement paper – The group agreed that this was a good paper.
Critical Reflections on an Incident (Good & Bad) – These showed examples of what was done in this programme, however no information was provided on how the Trust responded to these.
8. / Electronic Room Booking System
FE reported that NHST are implementing a new electronic booking system, which goes live in December. Further information was later provided from SB. Gillingham room in PRI not included on this and can’t be managed until system goes live. SB asked if Gillingham could still be managed through the Deanery. FA mentioned that the structure within the Deanery will change in November, where teams will be refined. FA will talk to SB about this. RB will email SB on how these rooms are booked. / FA
RB
For Information
9. / STC Minutes (Paper 9)
CMc reported that QM information sheet for completion at STCs had been proposed through EDSTAC. The TPD’s declined this in favour of a standard format for STC agenda. CMc has now drafted this and will be discussed at DMT. CMc asked for feedback.
FD suggested including in the TPD day pack for information, if DMT approved.
FD asked about trainee reps on ST committees. RB had previously emailed TPDs asking basic information about their STCs – how often were these held, who attended, were there trainee and deanery reps present? There is variation including the frequency of meetings. CMc has recommended that every four months is appropriate.
FA wondered how much do trainees feel included/excluded from STCs and do the trainees who do attend cascade the information to colleagues. ML thought it varied between specialties. There is no standard as to what a trainee rep actually does. FA thought the JDF would be a useful platform to gather information from trainees. ML will take to the next meeting for group comment.
ML also reported that JDF information was now included in the induction pack. / ML
10. / TTMG Minutes (Paper 10)
Already discussed
11. / AOB
-MM reported there were major concerns with LearnPro data . Data within the system reports there are 501 foundation doctors in FV! MM is sorting through the system however more resource is needed. There will be a business case presented by DM to take on extra resource.
-MM also reported that the Medical Director in FV has set up a focus group for his trainees from Foundation to ST level, first meeting was this week. Trainees were invited by email, and response was excellent. Lunch was provided. This will be held every three months. Notes/minutes from this meeting will be sent to DQMG for information by MM. FE will take this back to TTMG for discussion. MM/FE will liaise.
-FA asked about an issue raised in the last minutes re. FY1 recruitment to Psychiatry. The likely number will be two posts at FY1 level, not four as previously thought.
-ML advised the group that numbers and working patterns in MFE seem wrong as there is no SpR in the evenings. ML will cascade back to trainees re. QM visit. / MM
FE
ML
16. / Date of Next Meeting
30th November 2012 2 – 4 pm

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