South Thames Foundation Schoolwww.stfs.org.uk Expanding the foundation programme in psychiatry Jan Welch Director South Thames Foundation School

Previous STFS work Concerns –Unpopular posts –Isolation –Supervision ‘I was the only doctor there, and on my first night on call the police were blue-lighting in psychotic patients...’ ‘I hadn’t been trained in restraint.. they were short of nurses and one patient tried to throw a television at me and then strangle herself. I was trying to pull off the ligature and was terrified that I was going to make things worse... ‘ ‘a lack of induction into basic issues in psychiatry – prescribing, emergencies, MHA’

South Thames Foundation Schoolwww.stfs.org.uk But... Increasing population need –1 in 4 of population will suffer with mental health problem –35% of GP consultations for mental health issues – EM attendances for self-harm –suicide 3 rd leading cause of death ages 10-24

South Thames Foundation Schoolwww.stfs.org.uk STFS Review of Foundation training posts in psychiatry Focus group and recommendations  links with acute hospital  breadth of experience  other staff awareness of roles and responsibilities  specific induction eg clinical support, Mental Health Act, risk assessment  supervision

South Thames Foundation Schoolwww.stfs.org.uk Psychiatry Task Force 2011 Aim –To address concerns about recruitment and progression Targets –at least 7.5% of F1 posts should be in psychiatry for the August 2013 intake / around 22.5% of F1 doctors should rotate through a placement in psychiatry –at least 7.5% of F2 posts should be in psychiatry by August 2014 / around 22.5% of F2 doctors should rotate through a placement in psychiatry

South Thames Foundation Schoolwww.stfs.org.uk Capacity FDs are not CTs –need induction / supervision / generic teaching etc –Need to understand the purpose of the FD in the psychiatry placement Structure of posts –liaison posts popular as on acute site –ensure time on acute site especially in F1 –innovative eg 1 day a week in GP placement Type of experience –1 vs multiple specialties

South Thames Foundation Schoolwww.stfs.org.uk Supervision “Foundation doctors must always have direct access to a senior colleague who can advise them in any clinical situation. Foundation doctors must never be left in a situation where their only help is outside the hospital or the place where they work.” GMC 2011 On call At night F2 in a CT rota

South Thames Foundation Schoolwww.stfs.org.uk Supervision F2 on a CT rota On call for several sites At night often only doctor Home visits

South Thames Foundation Schoolwww.stfs.org.uk Funding implications For mental health trusts –for new posts with 2014 tariff –shortfall of £2913 per F1 and £4866 per F2 post For acute trusts –backfill of eg removing surgical FD posts –eg physician’s assistant £23732 (median) –F1/F2 locum costs £35-40 p/h plus agency fee (£67200 pa) –risk of destabilisation

South Thames Foundation Schoolwww.stfs.org.uk Isolation Driving Safety Communications –e mail –bleeps etc Induction / specific psychiatry training Teaching Practical issues

South Thames Foundation Schoolwww.stfs.org.uk Psychiatry in foundation - more work required How best to develop programmes which: –ensure that all foundation doctors receive appropriate training in mental health –expand experience and competences –are safe and integrated –work in parallel with other initiatives to support recruitment and retention –and not (necessarily)...