FPB 12.10

Foundation Programme Board meeting

Date :Tuesday 20 March 2012

Time :2:00pm

Venue : McLean room, The Lister, Edinburgh

MINUTES

Item / Action
Welcome and Apologies
Present
  • Dr Duncan Henderson (DH) – Chair, Foundation Lead for South East Scotland (TheLister)
  • Dr David Bruce (DB) - Foundation Programme Lead – East (East)
  • Mrs Kath Deans (KD) - FoundationSchool Manager (VC-North)
  • Dr Mairi Finlay (MF) – FY2 / Academic trainee representative (VC-North)
  • Dr David McQueen (DMcQ)– DME representative (TheLister)
  • Prof Gillian Needham (GN) –Liaison Dean - North (VC-North)
  • Dr Andrew Todd (AT) – Foundation Programme Lead – West (Monklands)
Apologies
  • Prof Allan Cumming (AC)- Scottish Deans Medical Education Group representative
  • Dr Greg Jones (GJ) – Chair of Academic Sub Group
  • Dr Jason Long (JL) - BMA Consultant
  • Prof Gary Mires Scottish Deans Medical Education Group representative
  • Dr Rob O’Donnell (RO) - BMA Scotland trainee / FY1 representative
  • Prof Paul Padfield (PP) – Scottish Government
  • Miss Leila Platt (LP) – Scottish Medical School Committee medical student representative
  • Mrs Mandy Snell (MSn) – Lay representative
  • Dr Andrew Russell (AR)– SAMD representative
  • Dr Kim Walker (KAW) - ScottishFoundationSchool Director, Foundation Lead – North Deanery
In attendance: Eliza Raeburn (ER) (TheLister)
Prof Allan Cumming has retired from his current role at EdinburghUniversity and from his position as Chair of the Scottish Deans Group. Prof Gary Mires will commence as Chair of the Scottish Deans Group from June 2012 and will be the incoming Scottish Deans Medical Education Group representative on the FPB. Both Prof Cumming and Prof Mires had submitted their apologies for the 20 March 2012 FPB meeting.
On behalf of the FPB, DH formally acknowledged the role Prof Cumming had played as a liaison between Undergraduate and postgraduate training. DH thanked Prof Cumming for the excellent contribution he had made as a member of the FPB and wished him well in his new role.
Minutes of meeting held 13 December 2011
The minutes of the meeting held Tuesday 13 December 2011 were accepted.
Matters Arising
3.1. / LTFT
Noted.
KD indicated an updated “Training as a Less Than Full Time Trainee (LTFT) in Scotland” document has been amended and comments incorporated. An updated version will be circulated across Deaneries. “Flexible Trainee” has been returned to “LTFT” and it has been agreed LTFT will be retained as the defined term for Less Than Full Time trainees.
Agreed:
Formal guidance will be extremely helpful and will ensure consistency across Scotland. The FPB agreed to accept and adopt the LTFT document as Foundation Programme policy.
DH thanked KAW and AT for leading the creation and definition of an LTFT document for the FP.
Action:
  • All FP leads to take forward LTFT document as agreed FP policy in their respective Deaneries.
/ All, FP Leads
3.2. / Shadowing week payment (DH)
Sir Bruce Keogh (Medical Director – National Health Service, England) has written to all FY1 doctors confirming that they will be paid for four days of Shadowing Week. The funding source has not yet been agreed in England.
This issue has been discussed by Scottish Government Health Department (SGHD), Health Boards and NES. Despite some initial resistance, there seems to be outline agreement that four days of shadowing should be funded in Scotland. Dr Stewart Irvine, incoming Director of Medicine, is currently working with the SGHD to establish which budget is used to fund this initiative.
It was noted Wales, and some English Deaneries, already funded 4 – 7 days of Shadowing Week. Northern Ireland is currently discussing the issue, but is likely to fund four days.
Action:
  • All Deaneries to proceed forward with the understanding that payment will be made to FY1 for four days of Shadowing.
FP leads will be alerted, as a matter of urgency, if the requirement for four days of Shadowing is not approved and implemented.
The FPB noted that as one day of Shadowing is already paid for, Health Boards will only actually need to source additional funding for three days. DH will cascade the official announcement when available. / All
3.3. / Exposed FY2 / GMC Emergency Department Survey (DH)
The Scottish FPB was ahead of the UK in preparing the report on Exposed FY2 posts in Scotland. The recent GMC survey of UK Emergency Depts mirrors some of the previously gathered information. All were asked to update on current Exposed FY2 status:
East (DB): Issues still unresolved and pending consideration by NHS Tayside. Resolution is being sought.
West (AT): The Dean is engaged in further discussions relating to re-classification of Dumfries and Galloway as Remote and Rural. Collation of evidence is underway. The Exposed FY2 data will be integrated into the West’s report to the GMC on Emergency Departments.
North (GN): Report on Emergency Dept has been drafted for GMC; Dr Irvine will discuss findings with the SGHD prior to release to GMC. Dr Irvine and GN have re-circulated their initial report with the Directors of Medical Education (DMEs) for input and feedback.
South East Report has been submitted. No change from previous report.
Action:
  • All to copy FPB representatives/Foundation leads on their Deanery submissions for the GMC Emergency Department Survey to ensure collective input and consistency.
DH clarified that there are two separate reports under discussion – the Exposed FY2 report for Scotland and the GMC Emergency Department Survey of individual Deaneries. The Exposed FY2 report had allowed Deaneries to compile a full report of current Exposed FY2 posts and identify rotas with a risk of exposure. The information previously collated for the Exposed FY2 report would link into the required information for the GMC Emergency Department Survey.
AT noted there had been little scope to provide additional explanation of rota setup on the GMC Emergency Department Survey; GN explained the covering letter from the GMC had indicated if ongoing concerns were to be highlighted there was an option to contact the GMC separately. / All
3.4. / Foundation Post Governance: Sign Off (DH)
There have been ongoing discussions at Foundation Programme Operations Group (FPOG) regarding Sign Off, including what constitutes Sign Off and how Sign Off should be processed. The ScottishFoundationSchool is now looking at potentially applying a Foundation Annual Review of Competence Progression (ARCP) process. This would not be as labour intensive as the Specialty Training ARCP but would be both complementary and preparatory for trainees entering the Specialty Training process.
Action:
  • All to advise DH and KAW of current Deanery Sign Off processes in Foundation to identify commonalities and good practice.
A Foundation ARCP would ensure a consistent practice and provide an effective Governance mechanism. Further discussions will be held at the 27 March 2012 FPOG meeting. / All
3.5. / Professionalism and Excellence – update (DH)
FPB continues to support and encourage Professionalism and Excellence in the Foundation programme. Dr John Colvin, Lead in Professionalism and Excellence, has requested DH and the FPB provide feedback on what achievements are rewarded over and above the standard trainee programme.
West (AT): Audrey McPetrie has identified two good examples in the West Deanery. FY1 doctors had been involved in improving guidelines for blood tests. This had benefited the quality of the Foundation programme, reduced costs and set good practice guidelines. An Academic FY1 had been engaged in the drafting of a Surgical Induction booklet for the Surgical Unit. Practice for Prescribing had also been improved in consultation with Foundation doctors.
East (DB): NHS Tayside is piloting a Prescribing check and correct procedure to identify errors, issues and problems.
North (KD): Ann Cadzow is engaged in a review of the mock interview process. Feedback has been sought from trainees not successfully appointed to jobs. There is also a review of appointments at a Director level, which should still be highlighted as an initiative of excellence. Suzanne Nabavian is investigating potential avenues demonstrating excellence. North Deanery trainees received the highest score for Obstetrics & Gynaecology in the UK and the third highest UK score for Surgery.
GN indicated the new Foundation Curriculum will be discussed further at the NES Quality Improvement Forum and demonstrates the Foundation Programme’s commitment to innovation and creative projects.
MF had been involved in an undergraduate and senior trainee review.
Action:
  • All to send their examples of Professionalism and Excellence to DH who will forward to Dr John Colvin for promotion and circulation across Scotland.
  • DH will confirm with Dr John Colvin if report will be presented to senior representatives, i.e. SGHD and Chief Medical Officer.
/ All
DH
3.6. / 2012 Recruitment (DH)
Round 1 of 2012 Recruitment has been completed and the UKFPO have confirmed there are only 75 student doctors in the UK without posts. Those currently not placed will be allocated a post in the Round 2 2012 recruitment batch. The FPB can expect all UK medical graduates to be allocated a place in the first round of batch allocation i.e. all applicants will be offered an FY1 post.
This will likely change in 2013. 2012 saw an increase of UK graduates and it is anticipated UK graduates will further increase in 2013. DH has requested accurate numbers of graduates from all of the Scottish Medical Schools. It is currently expected there will be an excess of 100 students graduating over the number of Scottish posts. There are usually around 40 graduates that don’t take up post the following August, leaving an excess of 60. The Foundation Programme can expect there to be increasing difficulties over the next three years, as the number of graduates increase each year, with no change in the total number of UK Foundation posts. The issue is being discussed at a DoH, Devolved Nations, BMA level.
Action:
  • DH will update the FPB on any developments in plans to address the excess numbers of UK graduates.
/ DH
3.7. / Psychiatry Foundation posts and tasters (DH)
Dr Susan Miller, Chair of the Specialty Training Board in Mental Health, has previously met with FPB representatives to discuss increased Foundation posts in Psychiatry. Scotland currently has 23% of Foundation doctors undertaking a post in Psychiatry. This is higher than the percentage in England. The recent UK recommendations are to have 7.5% of FY1 posts and 7.5% of FY2 posts in Psychiatry. Previously, each Deanery had undertaken to review both the absolute number and distribution (FY1 / FY2) of Foundation Psychiatry posts in their Region. All were asked to provide updates on current status in their Deanery:
North:(GN)
A recent meeting with the Royal Psychiatrists College had highlighted there are real issues at the supply end of Psychiatrists to NHS Service, as well as ongoing concerns relating to intake and recruitment. The RoyalPsychiatristsCollege recognises the need to lift the profile of Psychiatry and promote the specialty. It was noted that there are a number of specialties with similar concerns and all should be supportive of efforts to increase representation. The FPB queried if final figures on the total number of Psychiatry posts against FY1 posts were available in the North. GN indicated, to her knowledge, there had been no efforts in the North Deanery to increase Psychiatry posts in FY1, or the proportion of Psychiatry posts.
Action:
  • GN to follow up figures on proportion of Psychiatry FY1 posts in the North Deanery and current status.
West: (AT)
Dr Tom Brown, a member of the Mental Health Specialty Training Board, is retiring from clinical practice and will be taking up a post at the Royal College of Psychiatrists. AT will need to further explore options for Foundation and Psychiatry with Dr Brown’s successor.
It must be acknowledged that the underlying difficulty with allocating new Psychiatry posts in Foundation is that these posts are not new, additional posts, but redistributed Foundation posts. This will mean a potential decrease in Foundation posts elsewhere. There may be leeway to modify rotations (as has been done to include HDU in Foundation).
AT had considered the possibility that some rather less popular and poorly performing Surgical posts could be “re-badged” as Psychiatry, but this would be dependent upon response to Deanery visits etc. AT highlighted his concern that Psychiatry was not alone in having a shortage of Foundation posts and potentially a related dearth of application to higher training posts. Specialties such as Medical microbiology and O&G already fall into this category. He was concerned that Foundation should not be forced into loss of its generic nature for potential specialty career related issues.
DH agreed other specialties have similar issues. The West Deanery has 17% of Foundation posts in Psychiatry. However, the recommendation to increase Psychiatry posts in Foundation has come as a UK wide directive and needs to be investigated by all Deaneries.
East(DB)
The East had been happy with their current arrangements, but had undertaken a review of the Foundation posts allocated to Psychiatry. 9 of 93 FY2 posts are in Psychiatry and the Deanery is investigating moving 4 of these to FY1.
South East (DH)
There are already 3 posts in FY1 in South East in Liaison Psychiatry. There may be scope to review some of the FY2 posts at St John’sHospital with a possible switch to FY1.
Agreed:
FPB is actively trying to assist the proposal to provide additional posts and a switch of FY2 to FY1 posts in Psychiatry. It will be a challenge to implement significant change.
Action:
  • DH and KAW will meet with Dr Susan Miller and discuss local progress.
It was noted that Wales does not currently offer FY1 posts in Psychiatry as there are no suitable training posts.
Tasters
KD advised the UKFPO Annual report will list all tasters by specialty. This will establish how many Psychiatry tasters are currently in Scotland. GN queried how Foundation should best demonstrate support for Psychiatry tasters. DH noted there had not been a previous policy on promoting a specific taster and that generally tasters are a trainee driven area. KD agreed that trainees are allocated to programme according to where their interest lies, i.e. a trainee looking for a Psychiatry role would be placed in Psychiatry for their initial post.
Action:
  • KD will forward UKFPO Taster information for circulation amongst FPB and Foundation leads.
/ GN
DH, KAW
KD
Business Case for Additional FY2 GP posts (DH)
The Collins report has recommended greater exposure of FY2 doctors to Community based posts. DH and KAW will be preparing a Business Case for additional FY2 GP posts in Scotland, with input from AT and DB. This will summarise current status and make recommendations for the future.
It was noted that exposure to FY2 GP posts is as low as 20% for some Deaneries.
All were asked to consider how to move posts in Secondary Care to Primary Care.
South East (DH):
A review of availability of practices to take FY2 trainees had shown that there is training capacity available, with keen trainers. It was noted that current FY2 GP doctors undertake out-of-hours work in local hospitals. This preserves pay banding for the doctors and augments OOH cover for hospital rotas. The arrangements are fairly rigid in that only one stint of night shifts is permitted and always in the same week for each block of Foundation training, eg always week 7, so that the Practice can plan around this.
There may be some scope to look at some of the few FY2 posts with a poor educational rating.
In his role as Foundation Programme Director, DMcQ had observed that some FY1s who aspired to a career in GP, did not apply for GP FY2 posts because they felt that hospital training in FY2 was more valuable at that stage, and they would gain community experience as a GPST.
West (AT):
No issues with proposal in principle, but there will be Service issues to consider if Foundation trainees are moved to GP. The review would need to address the potential impact upon on call and out of hours. A link could be explored between GP and Acute posts.
East (DB)
The proposal to increase both GP and Psychiatry posts in Foundation is good, especially as much of Psychiatry is based in the Community, however, the proposal does not address Service impact. This is the key issue. In terms of Service, moving existing Foundation posts into GP and Psychiatry is currently unachievable. This must be acknowledged in the business case.
North (KD/GN)
Trainees currently have cross cover with hospitals, with a week of nights and two weekends. Trainees indicate their preference for posts and the Deanery seeks input from trainees to ensure trainees can elect certain sections. GN indicated the North intends to aim for an increase in FY2 posts such that 50% of all FY2’s undertake a GP post. The North is currently negotiating arrangements with Service and will seek the support of DMEs, regional groups and DB to ensure successful implementation.
Agreed:
Service impact will be a significant challenge in consideration of the proposal to introduce new FY2 GP posts.
Action:
  • DH and KAW to prepare initial report on proposal to increase GP posts in FY2, in consultation with FPB members.
/ DH, KAW
New Curriculum (DH)
The new Curriculum has been formally launched. There is a three page document summarising the changes in the 2012 Curriculum. DH will circulate when finalised.
AT highlighted there will be increased responsibility for the Clinical Supervisor, plus the local groups who report to the Clinical Supervisor. Time needs to be allocated for people to contribute. This will be discussed further at FPOG.
The new Curriculum will be the major focus for the Scottish Foundation Day on 31 May 2012.
The other significant change all should be alerted to is the change from Work Place Based Assessment to Supervised Learning Event.
Induction for Doctors New to UK Practice (KD/GN)
KD advised the North Deanery has been working on an Induction programme for Shadowing week.
GN advised the Induction for Doctors New to UK Practice is a national initiative which had been cascaded via COPMed. GN had volunteered to draft a response on behalf of Scotland, with assistance from Fiona Anderson (Training and Education Development Manager - East Deanery).
Action:
  • AT will check information on UK refugee applications and forward to GN.
  • All to aggregate responses to GN for inclusion in the report on Induction for Doctors New to UK Practice as required.
  • GN will forward report to DH once consultation process with Fiona Anderson is complete.
/ AT