Bolton Trainers 24.9.19 Nick Walton

Discussion areas 2016 Junior Doctor Contract Update OOH, Out of Hours and Urgent Unscheduled and Emergency Care New GP Curriculum and ePortfolio HEENW Lead Educator role Trainer contribution to Foundation teaching Programme

2016 Junior Doctor Contract Update 2% Annual pay uplifts for next 4 years Transitional pay protection £1,000 a year extra for all LTFT trainees Study leave and mandatory training Personalised work scheduling meetings and off-site educational supervisors Supernumerary status of GP trainees Additional mileage/expenses for GP trainee home visits

Supernumerary status of GP trainees Doctors in general practice (GP trainees) working in supernumerary training settings are additional, not intrinsic, to the workforce. Doctors in these settings contribute to service provision, however the effective running of the service should not be dependent on their attendance and they will not be used as a substitute for a locum. https://www.bma.org.uk/collective-voice/influence/key-negotiations/terms-and-conditions/junior-doctor-contract-negotiations/agreed-new-contract-deal-for-junior-doctors-in-england

Out of Hours and Urgent Unscheduled and Emergency Care Started August 2019 Change from OOH to urgent & unscheduled care Move from counting hours to Trainee demonstrating capabilities(No minimum required hours) This includes delivering safe patient care, demonstrating effective communication skills, maintaining continuity for patients and colleagues, co-ordinating across services and enabling patient self efficacy.

All trainees will need to add sufficient evidence of engagement with and performance of Urgent and Unscheduled care so that there is sufficient evidence for CS and ES to make a judgement of progression in this area during training and a judgement concerning competence in this area at the end of ST3

Development of capabilities may be gained “in hours” and in varying secondary / community / urgent care Will need significant opportunities to develop these capabilities in Out of Hours Services / primary care based urgent /unscheduled care provider organisations. GP trainees will need to gain experience in GP / primary care settings in order to develop the requisite capabilities to work across the OOH /urgent / unscheduled spectrum of care

May include Post/placement Experience Hospital A and E Paediatrics - particularly experience gained in Emergency Assessment Units Medicine including Medical Assessment Units Psychiatry GP “In Hours” Urgent and Unscheduled Services in GP practices including undertaking “Duty Doctor” sessions GP Extended Hours where the service being provided includes provision of urgent appointments and is not limited to only encompass “routine” follow up of long term conditions Urgent Care / Treatment Centres Primary Care services delivered within a secondary / community care provider

Documentation of evidence includes Clinical encounters in the learning log Feedback forms OOH summary log sheet

Level of Supervision required Change from the established Traffic light system Observational Direct Supervision Near Supervision Remote Supervision

Observational Enable GP Specialty trainees to KNOW about services Typically ST1 / ST2 Induction programmes Trainees do not assume any responsibility for the management of patients

Direct Supervision These sessions enable the GP trainee to begin developing their capabilities through the delivery of clinical service and thus KNOW HOW to deliver care Typically ST1 / ST2 Must be undertaken prior to a GP trainee delivering patient care in any out of hours / unscheduled or urgent care organisation The trainee does not take final clinical responsibility for any patient: this rests with the clinical supervisor

Near Supervision These sessions enable the GP trainee to continue to learn experientially through supported delivery of clinical service to patients.Trainees will be enabled to SHOW HOW / DOES they deliver such care. May commence in ST1/ST2 and typically will occur during the ST3 year The GP trainee consults independently but with timely access to a nominated clinical supervisor who can directly assess the patient in person

Remote Supervision Trainees may be offered opportunities to experience working with remote supervision whilst still in training as preparation for independent practice, but it is not a requirement prior to CCT. The trainee will demonstrate working at the DOES Will take place after a trainee has undertaken at least 6 months (FTE) of a GP training placement and the trainee has gained appropriate experience of working under near supervision at ST3 The GP trainee consults independently but can access help and advice promptly from a nominated clinical supervisor via telephone or other appropriate interface

Clinical Supervision GP trainees undertaking direct, near and remote sessions should have an identified individual who will, (for the duration of that session) have the lead responsibility for ensuring the safety of both the trainee and patients and who has been appropriately trained: the clinical supervisor.

Developing Capabilities – Summary Trainees must be able to demonstrate that they have met the intended learning outcomes relating to urgent / care by CCT. However: There is no specific urgent / unscheduled / OOH experience / activities in relation to observational sessions which are mandatory for trainees to undertake. There are no specific types of near and remote supervision sessions that are mandatory for trainees to undertake and without which “capability” could not be deemed to have been achieved. There is no specific requirement to have undertaken remote supervision sessions prior to CCT

Mapping Urgent and Unscheduled Care to the RCGP Curriculum capabilities Not yet finalised Area of Capability linked to ‘competencies’ with intended learning outcomes

Area of Capability – 1. Knowing yourself and relating to others Core capability Specific capability Learning outcomes relevant to urgent care Fitness to Practise   Communication and Consultation Manage the factors that influence your performance Establish an effective partnership with patients Comply with professional demands whilst showing awareness of personal needs and preserving your resilience and health Anticipate and manage factors that influence you day to day performance including your ability to perform under pressure. Flexibly and efficiently achieve consultation tasks in the context of limited time or challenging circumstances, using a range of communication skills tailored to each patient’s needs in the clinical context.

The New GP Curriculum The GMC requires that all specialty curricula are aligned to the nine domains of the Generic Capabilities Framework

The Core Curriculum - five ‘Areas of Capability’

Within the areas of capability, are the specific core capabilities that will be familiar from previous versions of the curriculum

Topic guides .

WPBA and ePortfolio The new curriculum will be represented by new learning log entries linkage in the ePortfolio from September 2019. Clinical experience groups replace curriculum headings in the new version of the ePortfolio 8 Clinical Experience groups are as follows - 1. Infants, children and young people under the age of 19 2. People with mental health needs (including addictions) 3. People with long-term conditions and disability 4. Frail and/or elderly people (including multiple morbidity and care of the dying) 5. Gender health (Women’s, Men’s and LGBTQ health) 6.People requiring urgent and unscheduled care 7. People with health disadvantages and vulnerabilities (for example veterans, mental capacity difficulties, safeguarding issues, and those with communication difficulties) 8. Health promotion and people with non-acute and/or non-chronic health problems

New methods of WPBA assessment will be introduced in August 2020 Care Assessment Tool Leadership activity Quality Improvement project Prescribing assessment (live now)

Evidence of progression The requirements that must be met at the end of ST2 and ST3 stages of training are now made explicit by including progression point descriptors under each area of capability linkage to Generic Professional Capabilities and relevant MRCGP assessments word pi ctures for ‘end of ST2 - needs further development’, ‘end of ST3 – competent’, and ‘end of ST3 – excellent’.

HEENW Lead Educator Role The GP School recognises that lead educators are increasingly involved supporting educational delivery and monitoring. We would like to formalise this role and provide support and development as part of this process. The GP school has developed a Lead Educator Network with three distinct pathways for progression. These pathways could determine progressive development along each individual one or an integration of any of the three to progress towards AD competences.

The Role includes New trainer interview panels Trainer reaccreditation panels Learning environment accreditation in addition to the patch role. 4th stand alone theme-ARCP Panel member/chair The time is funded at the standard rate of £500 per day or £275 per half day.

Training ½ Day of supported small group work 1 visit where you will be an observer to an AD completing the visit 1 visit where an AD will observe you completing the visit An independent visit from which you will submit your recommendations to an AD for feedback Likely 3 months ‘lead educator’ training meetings QA by patch AD

Commitment A minimum of 5 visits within 12 months and there will be the potential to continue to support the school and the developing learning hubs at 2 sessions per week as a career opportunity

GP Trainer contribution to Foundation Programme 2 strands to this GP Trainers teaching on Foundation Programme Develop support network for Foundation Clinical Supervisors