Working in the NHS Dhiraj Uchil RCOG MTI and Sponsorship Officer Consultant Obstetrician and Gynaecologist, University Hospital Lewisham, London

Outline Creation of the NHS NHS structure- funding and regulation Working in the NHS- models of care Working in the NHS- what it means for you

Creation of the NHS NHS was created in 1948 Central principle is to provide services that are free for all at the point of delivery

What do the public think?

Perception of the NHS

Challenges

NHS funding

NHS funding

What do you need to know and why?? NHS is free at point of use, but not really “free” There are great pressures on NHS funding and demand often outstrips supply Like any other business, it needs to attract money and needs to save money Centralization of specialist services Merging units Tertiary units vs Secondary units

What does it mean for you?? Does the patient really need a follow up appointment? Are these investigations/ scans really necessary? Early discharge – eg postnatal women, ERAS/ EROS pathways Do not refer to another consultant/ specialty, even in the same hospital CS on maternal request, IVF funding Tourism healthcare

The NHS structure

Current NHS structure

Trust Foundation Trust Fancy name for “hospital”!! Describes a management Structure Foundation Trust Financial & management freedom Local community involvement Freedom to re-shape services Still accountable and regulated by the NHS

Funders Regulators

Funding of NHS services

Influencing commissioning

Funding of education in the NHS

Healthcare Regulators

Models of medical care

Paternalistic model of care Doctor knows best model Patients as passive recipients of care Rarely encountered (or tolerated) in NHS practice

Informative model Patients who do their own research with “Dr Google” and know what is wrong and what needs to be done Clinicians as mere suppliers of information without offering opinions- allow patients to decide

Shared decision making in the NHS

Models of care

Hierarchies in the system Some of you may have worked in very hierarchical systems A flattened hierarchy as is often found in the NHS may be an unusual experience Dealing with questions/ challenges “Jump calls”

Multidisciplinary teams Working in a multidisciplinary team may be a new experience for some Working with midwives throughout the woman’s journey Working with other professionals- anaesthetists, physicians, physiotherapists Learning effective communication strategies Learning together- mutidisciplinary skills and drills

Your training in the NHS

Who is responsible for your training?? Hospital Royal College Deanery

Training responsibilities Trainee Deanery Clinical Supervisor Hospital (Trust) TPD (Training Prog Director) Educational supervisor DME (Director of Med Educ) Head of School College Tutor Postgraduate Dean Medical Director

What should you aim to gain out of working in the NHS?? Technical skills Not only surgical; FBS, colposcopy, scanning, etc… Patient management skills MDT, management planning, appropriate referrals, counseling, etc… Communication skills Patients, families, colleagues, GPs, nurses & midwives, documentation, etc… Audit skills Participate, understand concept, how to plan an audit, auditable standards Organization & management skills Book early annual & study leave, swap your on calls early, organize rota

What should you aim to gain out of working in the NHS?? Presentation skills Perinatal meeting, audit meeting, etc… Teaching skills Undergraduates, SHOs, even colleagues Research skills Look for opportunities Writing skills Reviewing and writing new local guidelines

Goals for MTI trainees Transition from ST2 to ST3 level MRCOG Additional skills/ ATSMs

How to achieve your aims?? Have clear realistic goals Be enthusiastic and seek out educational opportunities Don’t have a narrow focus (eg gynae surgery). Identify the areas that your previous training may have gaps Be willing to learn….. Lots of people can teach you things, if you are willing to let them! Understand service vs training dilemma Speak to your educational supervisor and the College Tutor

Training Materials Register as a trainee with RCOG Curriculum Core training, ATSM, SST Log Book/ e-portfolio/ training matrix ST1-ST7 19 modules Assessment tools Forms for induction and appraisal

Courses to attend RoBUST PROMPT EFM- K2/ RCOG EFM package Perineal trauma repair course Communication courses Part 2 exams course

Assessment Tools Portfolio/Modular Log Book Mini-CEX Minimal clinical evaluation exercise CBDs Case base discussion OSAT Objective structured assessment of technical skills TO Team observation ARCP Annual Review of Competency Progress

Annual Assessment TO1 forms At least 10 observers Midwives Colleagues Nurses Secretaries Usually chosen by trainee but should ideally be approved by the Educational Supervisor Educational Supervisor then produces a summary (TO2)

Any Questions ?