March 2014 Better Training Better Care Evidence linking high quality training to improved patient safety NACT Annual Conference January 2015 Patrick Mitchell Director of National Programmes

Programme history In 2009, Medical Education England (MEE) led two reviews into the quality of postgraduate medical education and training which led to Sir John Temple’s report: Time for Training and Professor John Collins’ report: Foundation for Excellence MEE was requested by the then SofS to implement the 66 recommendations through the £3m Better Training Better Care (BTBC) programme

Our workstreams 1.Local implementation and pilots 2.Role of the trainee 3.Role of trainers 4.Workforce planning 5.Improving careers guidance and availability 6.Integrated technology enhanced learning 7.Broadening the Foundation Programme 8.Regulatory approach to supporting Better Training Better Care 9.Funding and education quality metrics

Better Training Better Care Aims to improve the quality of training and learning for the benefit of patient care Professor Sir John Temple: Time for Training ‘Making every moment count’ ‘Appropriate supervision’ and/or ‘Consultant present service’ ‘Service delivery must explicitly support training’ Professor John Collins: Foundation for Excellence Appropriate supervision for trainees Concerns that trainees are working beyond their level of competence Redistribution of posts and community experience Programme formally closed March 2014

Where are we now? Completed independent evaluation of the 16 BTBC pilots – led by Matrix Knowledge Completed national evaluation of workstreams two to nine – led by HEE / Academy of Medical Royal Colleges Planning the national spread and adoption phase of the BTBC pilots through key partners including: Faculty of Medical Leadership and Management Academy of Medical Royal Colleges General Medical Council NHS Improving Quality NHS Employers NHS Litigation Authority

The BTBC pilots The objective 16 projects piloted across different settings and disciplines Aim to improve training and education Aim to improve patient care Evidence of sustainability and adoptability Demonstrate value for money Pilot themes Hand over / care transition Out of hours 24/7 Communication Front door (A&E/acute medicine) Patient and rota scheduling Multidisciplinary working Pilots support national issues 7 day care Integrated care Urgent and emergency care Francis and Berwick Human Factors Patient safety

What makes a project successful? Leadership Trust Board support Governance Communications Academic and lay representation Wider engagement and buy in from trainees and trainers, MDT IT Dedicated project management

Trainees as change agents Trainees demonstrated outstanding leadership skills championing their pilot projects during implementation and outside of the pilot environment. Mid Cheshire – Handover Trainees moved to other trusts and requested the pilot initiative to be implemented in their new roles. Mid Cheshire – Handover Trainees moved to other trusts and requested the pilot initiative to be implemented in their new roles. East Kent – EM rota Trainees displayed strong leadership and enthusiasm for the pilots and trainers reported strong leadership of FP doctors and registrars in handovers. East Kent – EM rota Trainees displayed strong leadership and enthusiasm for the pilots and trainers reported strong leadership of FP doctors and registrars in handovers. Leeds and York – Decision making in psychiatry Trainees championed the system and took on a strong leadership role from the outset. Leeds and York – Decision making in psychiatry Trainees championed the system and took on a strong leadership role from the outset. Trainees felt better supervision and support allowing them further development Clear leadership in the handover process was clear in 100% of meetings 100% trainees higher confidence, 83% felt benefitted by the change

Improving workplace based assessments (WBAs) The pilot projects presented innovative ways to significantly improve WBAs and productivity by improving training and creating opportunities for WBAs to be conducted without impacting on commitments to clinical care. North Bristol – Video feedback for consultations Improved trainee consultation styles and increased the number of WBAs in an outpatient area. North Bristol – Video feedback for consultations Improved trainee consultation styles and increased the number of WBAs in an outpatient area. Pennine – EPIC Reward system increased WBAs During ‘double-credit weeks’, five-fold increase in the completion of WBAs. Pennine – EPIC Reward system increased WBAs During ‘double-credit weeks’, five-fold increase in the completion of WBAs. East Kent – EM rotas Increase in opportunities to complete WBAs while on ward duty and on shift by means of hot and cold rota systems 25% more WBAs completed than previous year 85% of feedback sessions helped trainee identify a personal area for improvement 4% increase in ward WBAs and 27% in shift WBAs completed

Integration of training in care Trainees became more integrated in the delivery of care and in the wider multi- disciplinary team. This has had a positive effect on patient care and improved communications and multi-disciplinary team working. King’s – RAT+ Increased consultancy support, improved patient time to treat and presented opportunities for nurses to develop. King’s – RAT+ Increased consultancy support, improved patient time to treat and presented opportunities for nurses to develop. Mid Cheshire – Handover Greater consultant input at handover meetings, with registrars taking on leadership roles in their absence. Mid Cheshire – Handover Greater consultant input at handover meetings, with registrars taking on leadership roles in their absence. Dudley – Prescribing Better working relations and understanding between pharmacist and trainees, with improved knowledge by trainees in prescribing and in national guidelines. Dudley – Prescribing Better working relations and understanding between pharmacist and trainees, with improved knowledge by trainees in prescribing and in national guidelines. 82.6% improvement in ‘out of hours’ tasks handed over and increase in staff satisfaction Significant improvements in time to treatment and time to referral Improved relationships in pharmacy department

Impacting on culture, efficiency and effectiveness Leeds and York – Decision-making in psychiatry Rota change allowed more trainees to come on day duty and have greater exposure to training and support, this improved productivity, communications and MDT working Leeds and York – Decision-making in psychiatry Rota change allowed more trainees to come on day duty and have greater exposure to training and support, this improved productivity, communications and MDT working Mid Cheshire – Handover Greater degree of efficiency in performing handovers, better quality information recorded and an increase in the number of tasks completed. Mid Cheshire – Handover Greater degree of efficiency in performing handovers, better quality information recorded and an increase in the number of tasks completed. South Manchester – Surgery Reconfiguring theatre lists exposed trainees to concentrated training in specific areas, trainees developed better skills and gained confidence in performing simple procedures across specialities South Manchester – Surgery Reconfiguring theatre lists exposed trainees to concentrated training in specific areas, trainees developed better skills and gained confidence in performing simple procedures across specialities Several of the pilots have had a positive impact on culture, efficiency and effectiveness in the implementation of their pilots. 82.6% improvement in ‘out of hours’ handover and 10% increase ‘out of hours’ discharge Increases of 37.7% weekday, 29.1% weekend and 22.1% night shift activity 12.7% increase in supervised operative training

Integrated Technology Enhanced Learning (TEL) Share and spread of good practice and innovation across higher and postgraduate education Underpinned by the DH TEL framework. E-learning Simulation M-learning Development of a hub to provide a national picture of where TEL is happening and provided Access to examples and TEL resources that are delivering major benefits in health education and training

Broadening the Foundation Programme Three main components: -Curriculum Development -Improving Selection into the Foundation Programme -Harmonisation and Improved Delivery Redistribution of posts Broadening the Foundation Programme report – Foundation doctors to undertake a placement in the community -Same educational supervisor -100% do a community based placement by Trainees do not undertake same specialty twice

Next steps? BTBC delivery will focus on: National spread and adoption of the BTBC learning through a multi agency collaborative Supporting trainee led ‘Inspire Improvement’ Developing Technology Enhanced Learning and TEL hub Implementing “Broadening the Foundation Programme” Role and value of the trainer (including Badge of Honour) EDQUIN Development

Questions Patrick Mitchell Director of National Programmes