Professor Paul Baker and the North West of England Foundation School Longitudinal Integrated Foundation Training LIFT Professor Paul Baker and the North West of England Foundation School

North West of England School Trainees >1700 (F1/F2) Third most populated region in the UK Intake: 879 into 293 two-year programmes 100% community placements in GP 22.5% mental health placements 59% placement with offsite community element Aug 16: Longitudinal Integrated Foundation Training (LIFT)

North West of England School LIFT Pilot Dedicated to Prof Paul Baker Kate Burnett FPD at Salford Royal Trainee experience Leading system change

UK Foundation training 10 years old Well established Tooke/Collins/SHOT reports Broadening the Foundation Programme

UK Foundation training Education faculty Teaching Clinical Placements

UK Foundation training Feedback/Monitoring visits Foundation trainees … Busy – mostly, trainees can feel devalued Patchy/poor induction - many Little attention to curriculum – some Service displaces training – nearly all Clinic/theatre/121 time - few

Some pre-existing phenomena …. General Practitioners (GPs) as educational supervisors FY1s in general practice Integrated hospital/community placements ‘First placement’ anxiety ‘Unbanded’ tracks

Case for change Case for change: Flexner Ethical erosion Population and workforce needs

To sample a school on its clinical side, one [seeks]… continuity of service on the part of the teachers… the closeness that the student may follow the individual patients…” Abraham Flexner, 1910

UK Foundation training Longitudinal literature David Hirsh explains the benefits of a Longitudinal Integrated Clerkship https://www.youtube.com/watch?v=cKGeWSws1So

Longitudinal Integrated Foundation Training (LIFT) Summer 2015 – HENW Foundation team in place Autumn 2105 – discussions with executive November 2015 – expressions of interest LEP December 2015 – funding granted 2 year pilot August 2016 – cohort begins work

Programme Design …. Longitudinal connection with trainer Longitudinal connection with patients No loss of medical input to hospital (1 to 2 WTE - 0.9 to1.2 on wards) Attention to neglected areas

UK Foundation training Postgraduate teams Teaching Clinical Placements

More attention to neglected areas…… 121 time with trainer Theatre time OPD time Educationally unproductive tasks

Evaluation Delivery of high quality, effective, compassionate care; Holistic Person Centered Care Measureable outcomes Moral Development Rate Empathy Tolerance of Ambiguity Patient Centeredness

Evaluation Develop the right people with the right skills and the right values; Workforce transformation for future NHS needs. Measureable outcomes Impact on career choice Enhancement of collaboration and networking Work satisfaction Trainee experience

What have we learnt so far …   Trusts must produce accurate information about placements, particularly out of hours duties Primary care and hospital administrators, managers and trainers should be consulted for buy-in, planning and timetabling Choose hospital placements carefully for trainer buy-in to avoid negative briefing of trainees Every effort needs to be made to make LIFT trainees integral to the hospital part of the placement

What have we learnt so far …   Many trainees value out of hours duties and feedback will be improved if they are included Trusts must provide clear, written weekly timetables Smaller units have less flexibility and timetabling may have to be scheduled around them Multidisciplinary activities and following the patient journey are to be encouraged. If hospital on call duties mean missing GP time, this can be ‘paid back’ at another time

What have we learnt so far …   If a 3:7 GP:hospital weekly sessional split problematic an alternating 4:6 and 2:8 split is ok     Practices as close to the acute hospital site as possible, to minimise travelling HEE provides travel expenses for the use of Foundation trainees in primary care A pseudo ‘job-share’ between two LIFT trainees in parallel tracks has many advantages

Thank you