West of Scotland Regional Trainers Day 2013

“Just when we thought we had a handle on it….!”

Looking ahead!

“To improve is to change; to be perfect is to change often.” Winston Churchill “Any change, even a change for the better, is always accompanied by drawbacks and discomfort.” Arnold Bennett

Changes within NES  John McKay Assistant Director for Quality Improvement and Performance Management  David Cunningham Assistant Director for Continuous Professional Development

NES Vision Project  Professional Development  Training Management  Business Support  Quality  Multi-Professional leadership and external engagement Throughout Scotland all Deaneries should be doing the same things the same way.

2014 Single Scottish Deanery 5 Regional offices  Glasgow  Edinburgh  Dundee  Aberdeen  Inverness

 Scottish Wide ES and Training Practice Accreditation and re- accreditation standards and process  National Strategy for CPD “NES should be the first port of call for all Doctors in Scotland meeting CPD needs”

2CQ Reconfiguration

Recruitment  Stage 2 Cut off score increasing % % %  Candidates Demonstrated Round % %

StART Alliance:  Scotland’s Strategy for Attracting and Retaining Trainees  After round 2 - still 25 vacancies in Scotland  Scotland: Home of Medical Excellence  NES + stakeholder groups  Improve recruitment and retention in specialty training  Revamped advertising, use of social medial  Newly commissioned work on what ‘attracts’ trainees  Trainee Ambassadors: Word of mouth is strongest influence

Recruitment  Alternative Foundation Competency Certification more robust  ALS certification before commencing in training  NES will become Tier 2 Visa sponsor for whole programme from February 2014

RCGP  E-portfolio!

Curriculum update Oct 13: Prescribing Safety –  Based on GMC commissioned survey  More focus on knowledge of therapeutics and demonstration of skills for safe/appropriate prescribing and medication reviews  Improved skills in management of polypharmacy Mental Health –  Co-morbidity of physical conditions in metal health  Assessment and safety planning for suicidal patients  Promote hope and demonstrate compassion

Exam Changes: AKT  Wide selection of questions  Every AKT drug calculations  Free text to replace choosing from lists  Content shaped towards prescribing safety CSA  At least 2 cases with major prescribing component  New tests of prescribing behaviour  Child actors cases from Nov 13  may include paediatric prescribing  Handwritten scripts WPBA: COT/CBD/SEA/Audit/Learning Log

Future Assessment Changes  GMC mandated there should not be assessment for assessments sake  All assessments should have meaningful formative feedback  DOPS to be replaced by Integrated Clinical Skills August 2014  Structured Learning Event (SLE) format in development for August 2015  Will allow wider use of material for assessment e.g prescribing, SEA/audit discussions in addition to existing WPBA  Focused CBD pilot due for reporting

How to pass the CSA?

A year of Reports!

Francis Report  Report into failing standards of care in Mid Staffordshire  290 recommendations  20 refer directly to medical education

Impact of Medical Education:  GMC set standards for educational environments/approved practice settings  Prioritisation of Patient Safety within Quality Assurance Training Visits  Routine quality visits to training environments  Trainees actively encouraged to provide feedback on standards of patient safety and quality of care (GMC survey and trainee post assessment questionnaires)  More information sharing between service providers and Deaneries  Any visit identifying patient safety concerns to be shared with PCOs  Clinical Leadership Training for all trainees (LaMP)

GMC Recognition and Trainer Approval:  Traditionally in place for GP Trainers  From will be extended to cover secondary care named ES/CS’s and undergraduate teachers  Based on standards already set out in ‘The Trainee Doctor’ and ‘Tomorrow's Doctors’

Academy of Medical Educators: 7 Framework areas used to set standards –  Ensure safe and effective patient care through training  Establish and maintain and environment for learning  Teaching and facilitating learning  Enhancing learning through assessment  Supporting and monitoring educational progress  Guiding personal and professional development  Continuing professional development as an educator Adapted for GP by RCGP

New Self Submission Documentation for ES and Training Practice approval/re-approval  Scotland wide document  Referenced to standards set in RCGP version of AoME Framework areas  More detailed document for each ES  Approval for individual ES’s and the Practice as an educational environment  Re-focusing of questions and visits to meet set standards  GP Training in West of Scotland is already well placed to comply will all requirements

Shape of Training Report

Why change?  Needs of patients are changing fast  Increasing multiple-morbidity  Super-specialisation can be a hindrance in some instances to good patient care

Consensus opinion:  More generalists able to work across specialties  Better preparation for working in multi-professional teams  Greater career flexibility  Training needs to be tailored to meet changing patient need  Training should be based on what kind of doctors are needed

 More doctors capable of providing general care across a range of different settings  Doctors will progress to credentialing in specialist areas (including GP).  More opportunities for doctors to change roles  Local workforce and patient need should drive opportunity  Full registration should move to the point of Graduation with measures in place to demonstrate Graduates are fit for purpose

So what may it look like?  Two year Foundation Programme to remain initially  Doctors will enter ‘themed’ broad based specialty training e.g. ‘Community’ might include GP, Psychiatry, Paediatrics, COTE  Will last between 4 and 6 years  Transferable competencies between specialties  Exit point will be a CST (Certificate of Specialty Training)  Further career enhancement via ‘credentialing’  Delivery Board to be established

All Doctors to develop generic skills in:  Patient safety  Communication with patients and colleagues  Teamwork, Management and Leadership  Evaluation and application of research

19 Recommendations:  8. Appropriate organisations, including employers must introduce longer placements for doctors in training to work in teams and with supervisors including putting in place apprenticeship based arrangements.  9. Training should be limited to places that provide high quality training and supervision, and that are approved and quality assured by the GMC.

So where does this leave EGPT?  Educational case for UK 4 year GP Training widely accepted  RCGP still pressurising for 2 years in GP  Cost neutrality imposed  Re-focusing of some existing posts towards ‘community’ slant

On a very positive note:  May CSA 3 rd best pass rate in UK for 1 st attempt takers  2013 GMC Survey West of Scotland Deanery rated 3 rd top of 20 UK Deaneries for overall satisfaction for GP Training  1 st among large Deaneries in UK