Expanding the Foundation Programme in Psychiatry Michael Maier Head of London Specialty School of Psychiatry

Royal College of Psychiatrists Taskforce Established in response to perceived concerns about recruitment into psychiatry. Report published in November 2011 Targets set to increase F1 and F2 psychiatry posts LETBs asked to ensure the provision of 4/12 placements in psychiatry for at least 22.5% of F1s and 22.5% of F2s.

To address recruitment shortfall the psychiatry posts at F1 are more important as the posts take place before specialty choices are made half way through F2 year.

Possible barriers to this This is a large increase Only possible to achieve by taking posts from acute specialties such as surgery and medicine A challenging time to do this as NHS under pressure Other pressures such as increasing community experience and greater emphasis on integrated care

2013 situation 222 F1 posts in psychiatry in England out of a total of 6154 F1 doctor places (3.6%) To reach target 462 posts in psychiatry are needed 7220 F2 places across UK 11.7% F2s rotate through psychiatry placement. Less than the 22.5% target.

Mental Health Competencies Common mental health disorders affect one- in-six adults, and cost UK employers £25 billion each year through lost work days. One in three GP consultations has a mental health element to it, and 90% of mental health problems are treated in primary care.

1.Elicit a Clinical History 1.Perform a Mental State Examination 1.Perform Cognitive Screening Assessment 2.Perform a Risk Assessment 3.Present a Clinical Case 4.Perform Physical Examination 5.Prescribe safely in Psychiatry 6.Write a clinical letter or report

London Pilot One day a week for Foundation doctors doing a GP 4 month posting. Purposeful, supervised, work in a psychiatric setting for the duration of the 4 months. General adult settings Old age services Child & adolescent services Liaison psychiatry

Possible integrated packages Paediatrics and child & adolescent psychiatry/learning disability Care of the elderly and old age psychiatry Liaison psychiatry and A&E

Further Barriers to post conversions To deliver the core psychiatric curriculum psychiatry needs a certain number of ‘core’ posts in general adult and old age. These are the same posts that are most appealing to Foundation. Maintenance of the on call rota needs a critical mass of specialty doctors.

Recent drive to improve recruitment 2013 recruitment into core psychiatric training 95% fill nationally with 70% UKMG. Competition ratios in 2012 for CT1 psychiatry 1.4 to 2.4 across the country.

Factors affecting choice of psychiatry Perception that psychiatric treatment is not evidence based Perception that treatments don’t work Stigma of the specialty Bad mouthing by colleagues esp. in medical school Remoteness of mental health trusts from acute trusts

Possible remedies Summer schools (12) Tasters in psychiatry Student Societies Electives High quality attachments Mentoring through medical school Encourage student associate membership of the Royal College of Psychiatrists Medical School selection – are we getting the right people?

Career path of graduates from 1977 (27 years after qualifying) 57% of those who chose psychiatry 1 year after qualification ended up in the specialty 27 years later. 72.5% in year % in year 5. The % in year 1 is the highest of any hospital specialty apart from General Practice (71%)

Medical graduates early career choices and their eventual specialty destinations. Looking forward Year 1Year 3Year 5 Psychiatry74.8% Surgery Hospital Medicine GP

Of those that left psychiatry after year 1, the majority went to GP, similarly at year 3 and 5. The biggest change happens between year 1 and 3 in determining in which specialty a doctor will eventually practice. ‘Shape of Training’ may provide greater flexibility in specialty choices.

Psychiatry & General Practice higher in each year than other specialties. A&E and Hospital Medicine lower in each year than other specialties. Overall by year 1, 74% of doctors had decided their career path, by year 3, 87%, and by year 5, 92%.

Satisfaction with time available for leisure All in the NHS5.4 General Practice6.0 Hospital Practice4.9 Psychiatry6.4 Hospital Medical specialties4.5 Surgical specialties4.6 Paediatrics4.6 Accident & Emergency5.6 Obs & Gynae.4.9 Anaesthetics4.6 Radiology4.8 Pathology4.5 Medicine abroad6.7