1. Professor Paul Baker and the North West of England Foundation School
Longitudinal Integrated Foundation Training
LIFT
Professor Paul Baker and the North West of England Foundation School

2. North West of England School
Trainees >1700 (F1/F2)
Third most populated region in the UK
Intake: 879 into 293 two-year programmes
100% community placements in GP
22.5% mental health placements
59% placement with offsite community element
Aug 16: Longitudinal Integrated Foundation Training (LIFT)

3. North West of England School
LIFT Pilot
Dedicated to Prof Paul Baker
Kate Burnett
FPD at Salford Royal
Trainee experience
Leading system change

4. UK Foundation training
10 years old
Well established
Tooke/Collins/SHOT reports
Broadening the Foundation Programme

5. UK Foundation training
Education faculty
Teaching
Clinical Placements

6. UK Foundation training
Feedback/Monitoring visits
Foundation trainees …
Busy – mostly, trainees can feel devalued
Patchy/poor induction - many
Little attention to curriculum – some
Service displaces training – nearly all
Clinic/theatre/121 time - few

7. Some pre-existing phenomena ….
General Practitioners (GPs) as educational supervisors
FY1s in general practice
Integrated hospital/community placements
‘First placement’ anxiety
‘Unbanded’ tracks

8. Case for change Case for change: Flexner Ethical erosion
Population and workforce needs

9. To sample a school on its clinical side, one [seeks]…
continuity of service on the part of the teachers…
the closeness that the student may follow the individual patients…”
Abraham Flexner, 1910

10. UK Foundation training
Longitudinal literature
David Hirsh explains the benefits of a Longitudinal Integrated Clerkship

11. Longitudinal Integrated Foundation Training (LIFT)
Summer 2015 – HENW Foundation team in place
Autumn 2105 – discussions with executive
November 2015 – expressions of interest LEP
December 2015 – funding granted 2 year pilot
August 2016 – cohort begins work

12. Programme Design …. Longitudinal connection with trainer
Longitudinal connection with patients
No loss of medical input to hospital (1 to 2 WTE to1.2 on wards)
Attention to neglected areas

13. UK Foundation training
Postgraduate teams
Teaching
Clinical Placements

15. More attention to neglected areas……
121 time with trainer
Theatre time
OPD time
Educationally unproductive tasks

16. Evaluation
Delivery of high quality, effective, compassionate care; Holistic Person Centered Care
Measureable outcomes
Moral Development Rate
Empathy
Tolerance of Ambiguity
Patient Centeredness

17. Evaluation
Develop the right people with the right skills and the right values; Workforce transformation for future NHS needs.
Measureable outcomes
Impact on career choice
Enhancement of collaboration and networking
Work satisfaction
Trainee experience

19. What have we learnt so far …
Trusts must produce accurate information about placements, particularly out of hours duties
Primary care and hospital administrators, managers and trainers should be consulted for buy-in, planning and timetabling
Choose hospital placements carefully for trainer buy-in to avoid negative briefing of trainees
Every effort needs to be made to make LIFT trainees integral to the hospital part of the placement

20. What have we learnt so far …
Many trainees value out of hours duties and feedback will be improved if they are included
Trusts must provide clear, written weekly timetables
Smaller units have less flexibility and timetabling may have to be scheduled around them
Multidisciplinary activities and following the patient journey are to be encouraged.
If hospital on call duties mean missing GP time, this can be ‘paid back’ at another time

21. What have we learnt so far …
If a 3:7 GP:hospital weekly sessional split problematic an alternating 4:6 and 2:8 split is ok
   
Practices as close to the acute hospital site as possible, to minimise travelling
HEE provides travel expenses for the use of Foundation trainees in primary care
A pseudo ‘job-share’ between two LIFT trainees in parallel tracks has many advantages

22. Thank you