South Thames Foundation Schoolwww.stfs.org.uk Broadening the Foundation Programme Workshop October 2014 Jan Welch Director, South Thames Foundation School

South Thames Foundation Schoolwww.stfs.org.uk Aims for the morning Update understanding of Broadening Review of definitions New ‘rules’ Local actions Share good practice How can we help?

South Thames Foundation Schoolwww.stfs.org.uk

South Thames Foundation Schoolwww.stfs.org.uk Questions from last workshop What is community? –(where named clinical supervisor must be based) –site? but sites may be shared –employment but some acute and community trusts have merged –the ‘ambulance test? Must a clinical supervisor be a doctor? (yes but special dispensation for public health)

South Thames Foundation Schoolwww.stfs.org.uk What is surgery?

South Thames Foundation Schoolwww.stfs.org.uk The ‘Spirit of Collins’

South Thames Foundation Schoolwww.stfs.org.uk

South Thames Foundation Schoolwww.stfs.org.uk Categorisation of specialties (1) SpecialtySpecialty typeCommunity? AcademicDepends on content Acute (Internal) MedicineMedicalNo AllergyOtherNo AnaestheticsOtherNo Audio vestibular medicineOther Possibly depending on site, activities and supervisor Cardiology (Cardio- vascular Disease) MedicalNo Cardio-thoracic Surgery (Thoracic Surgery) SurgeryNo Chemical PathologyOtherNo Child and Adolescent Psychiatry PsychiatryYes if site and/or supervisor in community

South Thames Foundation Schoolwww.stfs.org.uk Categorisation of specialties (2) Community Sexual and Reproductive Health Other Yes provided site and/or supervisor in community DermatologyOther Potentially if site and/or supervisor in community Emergency MedicineOther Yes for posts in urgent care with community supervisor Endocrinology and Diabetes Mellitus Other Potentially if site and/or supervisor in community Forensic PsychiatryPsychiatry Yes if site and/or supervisor in community Forensic PsychotherapyPsychiatry Yes if site and/or supervisor in community Gastro-enterologyMedicalNo General (Internal) MedicineMedicalNo General PracticeOtherYes

South Thames Foundation Schoolwww.stfs.org.uk Categorisation of specialties (3) General PsychiatryPsychiatry Yes if site and/or supervisor in community General SurgerySurgeryNo Genitourinary Medicine (Venereology/Sexual Health) Other Yes provided site and/or supervisor in community but not if ward-based HIV role Geriatric MedicineMedical Potentially if site and/or supervisor in community HaematologyOtherNo Hand SurgerySurgeryNo Infectious diseasesMedical Only if site and/or supervisor in community Medical ophthalmologyPotentially if site and/or supervisor in community

South Thames Foundation Schoolwww.stfs.org.uk Categorisation of specialties (4) Medical PsychotherapyPsychiatry Yes if site and/or supervisor in community NeurologyMedicalNo Neurosurgery (Neurological Surgery) SurgeryNo Obstetrics and GynaecologyOther Only if site/supervisor in community Occupational medicineOther Potentially if site and/or supervisor in community Old Age PsychiatryPsychiatry Yes provided site and/or supervisor in community OphthalmologyOther Potentially if site and/or supervisor in community Oral and Maxillo-facial Surgery Surgery Potentially if site and/or supervisor in community Oral surgerySurgeryPotentially if site and/or supervisor in community

South Thames Foundation Schoolwww.stfs.org.uk Categorisation of specialties (5) Otolaryngology Other (as largely clinics/examinations) Potentially if site and/or supervisor in community Paediatric Surgery Surgery unless part of paediatric team, then other No PaediatricsOther Potentially if site and/or supervisor in community Palliative MedicineOther Potentially if site and/or supervisor in community Plastic SurgerySurgery Potentially if site and/or supervisor in community Psychiatry of Learning DisabilityPsychiatry Yes provided site and/or supervisor in community Public Health MedicineOther Yes NB SUPERVISOR DOES NOT NEED TO BE MEDICAL Rehabilitation MedicineOtherPotentially if site and/or supervisor in community

South Thames Foundation Schoolwww.stfs.org.uk Categorisation of specialties (6) Renal Medicine (Nephrology)Medical Potentially if site and/or supervisor in community Respiratory MedicineMedical Potentially if site and/or supervisor in community RheumatologyOther Potentially if site and/or supervisor in community Sport and Exercise MedicineOther Potentially if site and/or supervisor in community Stroke MedicineMedical Potentially if site and/or supervisor in community Trauma and Orthopaedic Surgery Surgery unless orthogeriatric model Possible if part of MSK team with community supervisor Tropical MedicineMedical Only if site/supervisor in community UrologySurgery unless supervised by physician Only if site/supervisor in community

South Thames Foundation Schoolwww.stfs.org.uk Principles for posts, programmes and linkages Clarity about targets Review of all year programmes Clear expectations about content Linkages – managed by STFS but some more ‘2 years in one place’ programmes

South Thames Foundation Schoolwww.stfs.org.uk Targets....

South Thames Foundation Schoolwww.stfs.org.uk Programme composition (1) 2x4/12 surgery Options for reconfiguration Reduction of over-supply, eg conversion to psychiatry/community Sharing out surgical posts more equally Reviewing supervision and designation eg orthogeriatric posts Trauma and Orthopaedics Geriatric MedicineSurgery

South Thames Foundation Schoolwww.stfs.org.uk Programme composition (2) Repeated sub-specialty Designation of posts limited by national requirements Generally possible to reconfigure by sharing out specialties more evenly General Internal MedicineTrauma and OrthopaedicsGeneral Internal Medicine

South Thames Foundation Schoolwww.stfs.org.uk Programme composition (3) More than 1 community placement May be excellent but some provide insufficient acute experience Also need to distribute placements as widely as possible Additional community experience (community facing placement) valuable General PracticePsychiatryEmergency Medicine

South Thames Foundation Schoolwww.stfs.org.uk ‘Rules’ for 1 year programmes  No more than 4 months of surgery or 8 months of medicine in one year  No medical sub-specialty or other specialty to be repeated within one year  No more than 1 x 4 month community placement in 1 year  Programmes should consist of 3 x 4month posts unless exceptional reasons and programme demonstrated to be educationally sound – if so complete derogation form for STFS approval

South Thames Foundation Schoolwww.stfs.org.uk Linkages Managed by STFS STFS responsible for balancing composition between 2 years – as long as ‘building blocks’ there Currently incoming F1 doctors are provided with their incoming programme and F2 linked trust, but rank programmes later Management of linkages may need to be reviewed – but reconfigurations make this problematic

South Thames Foundation Schoolwww.stfs.org.uk Proposed ‘rules’ for 2 year programmes No more than 1 community placement in 2 years No more than 2 surgical placements in 2 years No more than 3 medical placements in 2 years No medical or surgical sub-specialty or other specialty should be repeated over the 2 years

South Thames Foundation Schoolwww.stfs.org.uk Guidance – general principles FDs based in an acute trust for a year, and continue to be employed by this trust while on 4/12 placement in community psychiatry Travel must be considered (driving licence not in national person specification)

South Thames Foundation Schoolwww.stfs.org.uk Designated clinician Facilitates management of community / psychiatry placements Has time in their job plan Organises placements and teaching Has access to some administrative support

South Thames Foundation Schoolwww.stfs.org.uk Employment FD should hold contract with acute trust (‘lead employer’) Acute trust takes responsibility for leave arrangements but close liaison essential FD should have honorary contract with community/psychiatry provider Medical indemnity arrangements must be clearly stated (STFS strongly recommends that FDs join MDU/MPS)

South Thames Foundation Schoolwww.stfs.org.uk Other necessary provision for training placements Access to e-portfolio during working day Robust departmental induction, in addition to that provided by the employing trust and at a different time, so that the FD can attend both FDs must be able to attend weekly teaching at their host acute trust. At least one hour a week of departmental teaching in the community placement should also be provided Time to complete SLEs and staff to supervise Engagement with employing acute trust foundation faculty group/FD monitoring processes Involvement in ARCP process Administrative support

South Thames Foundation Schoolwww.stfs.org.uk Supervision ‘Foundation doctors must always have direct access to an appropriate senior colleague for advice in any clinical situation. They must never be left in a situation where their only help is outside the hospital or the place where they work’ (GMC The Trainee Doctor 2011) The senior colleague may be a non- doctor, if both competent to supervise the relevant activities being supervised and fully appraised of this responsibility

South Thames Foundation Schoolwww.stfs.org.uk Any questions?

South Thames Foundation Schoolwww.stfs.org.uk Workshop What work still needs to be done locally to meet the BTFP targets ? NB numbers may need to be adjusted across patch What are the barriers to doing this? What are your plans to backfill for FDs? What else would be helpful from STFS/HEKSS/HESL?