Approach to implementation of ‘Broadening the Foundation Programme’ Dr Nicola Walters FY1 Training Program Director St George’s Healthcare NHS Trust

Broadening the Foundation Program Report published by Health Education England in February 2014 Recommendation 1 - Educational supervisors should be assigned to foundation doctors for at least one year Recommendation 2 - Foundation doctors should not rotate through a placement in the same specialty more than once, unless this is required to enable them to meet outcomes in the Curriculum Recommendation 3 – Foundation doctors should undertake a community-based placement or an integrated placement – 80% from August 2015 and 100% from August 2017

Previous targets 22.5% of F1 doctors and 22.5% of F2 doctors in should complete a placement in psychiatry 55% of F2 doctors should complete a placement in the community or primary care 5% of doctors in an academic placement 10% of F2 doctors in ‘shortage’ specialties

What did we need to achieve at St George’s Hospital? 42 FY1 doctors and 39 FY2 doctors Increased numbers of community posts Reduced numbers of surgical posts Meeting psychiatry targets at FY2 level Allowed us to review whole program, set up processes for formal feedback at the end of each post and for ES / CS

Identification of new posts Community scoping exercise Queen Mary’s Hospital, part of St George’s NHS Healthcare Trust (community services) Possibilities in the 3rd sector Eventually, more opportunities than needed Needed to establish whether posts were appropriate for FY1 or FY2 doctors

Important steps Site visits to meet team Meet Educational Supervisors / managers Review of job plans to quality assure posts Discussed training if there was already a trainee in post Offer teams further contact with TPD / Foundation faculty if required

Review of surgical posts Maintaining transparency in this process Multiple resources used: GMC survey 2014 HESL annual feedback 2013-14 Surgical focused visit report November 2013 SGH Foundation feedback July 2014 Educational and Clinical Supervisor feedback 2012-14 Foundation faculty minutes and inappropriate duties record 2012-14

Next steps Paper presented to Executive Management Board of Trust All specialties that were affected were contacted 3 surgical FY1 posts / 1 medical FY2 post removed 2 established FY2 posts moved to FY1 1 FY1 psychiatry post → FY2 Community posts created in hospice, GU medicine, dermatology and ‘Management of the elderly with complex conditions in the community’

Provision for lost posts MDT co-ordinator for surgical post Physician Associates (already established at SGH) Final plans for surgical post not completely clear as yet Medical post being replaced by core medical trainee for next year

Challenges Variation in post numbers that needed to be changed Complexity of reconfiguring rotations for more than 80 doctors to ensure balance Dealing with expectations of supervisors when posts changing to FY1 Responsibility of ensuring that decommissioned posts have plans in place to replace doctors

Special thanks to Dr Sarah Hammond, Consultant Anaesthetist seconded to the NHS Leadership Academy