1. Chief registrar update
Dr Orod Osanlou
ST6 Clinical Pharmacology and Therapeutics, General Internal Medicine
Chief Registrar Warrington Hospital 2016/7
Dr Michelle Cooper
ST7 Acute Medicine, General Internal Medicine
Chief Registrar Warrington Hospital 2017/8

2. Background
A key recommendation in the Future Hospital Commission report was the need to establish new, senior leadership roles whose focus was on delivering high quality, safe care
Recommended a new senior leadership role for doctors in training – the ‘chief registrar’
The Future Hospital Programme (FHP) was set up in 2014 to deliver the recommendations in the 2013 Future Hospital Commission report.
The vision of the 2013 Future Hospital Commission report was improving care for medical patients by structuring hospital services around the needs of patients.
11 principles of patient care underpin this approach.
The FHC proposed new structures for hospital medical divisions that would help achieve the vision of the future hospital. It recommended establishing the role of chief resident for trainee doctors, from which the role of chief registrar was developed and piloted (modelled on the US system).

3. Chief registrar scheme
A new senior leadership role for trainees that bridges the divide between the junior doctor workforce, senior clinical leaders and managers
Now in its second year, following a successful pilot in 2016/17 with 21 chief registrars
Target of 50 chief registrars in 2017/18 across the UK
Continued growth planned in future years
Opened up to other specialities and possibly allied healthcare professionals

4. About the role Minimum 12-month post
40-50% protected time for leadership and management
Aimed at ST5 trainees and above
RCP leadership development programme
Local mentorship & support
Speaking, networking & profile-raising opportunities

5. Chief registrar priorities
Service improvement: Using QI methodology and working with teams across boundaries
Morale: Ensuring trainees feel valued and that their voice is heard
Workforce transformation: Reorganisation of working patterns to improve conditions
Education and training: Improving education, training and induction opportunities, and mentoring trainees
Chief registrars deliver a wide range of projects locally in their trusts. Common themes include:

6. Examples of local initiatives
“Patients no longer need to stay in hospital overnight”
Facilitating junior doctor forum
Improving weekend discharge
Establishing ambulatory care and ‘acute hospital at home’ services
Redesigning pathways
Medical handover and hospital at night
Improving discharge summaries
Coaching and mentoring trainees
Renovating doctors’ mess and introducing ‘mess meetings’
“94% of junior doctors would now recommend their job to others  (compared with 10% previously)”  
Here are some examples of projects the 2016/17 cohort implemented and some of the outcomes they have achieved
The great thing is that each project is tailored individually to the needs of the local trusts
I am sure that you all recognise most of these are common themes and problems in most trusts up and down the country
“Demonstrable improvement in morale and perception of training quality”   

7. Independent evaluation findings
Health Services Management Centre, University of Birmingham
Positive impact on chief registrars and the individuals they work with
Very strong evidence of personal development
Enhanced engagement with senior clinical and managerial colleagues
Improved morale
Contributions to quality and service improvement
Effective cross-team collaboration
The Health Services Management Centre at the University of Birmingham was commissioned in 2016 to evaluate the impact of the pilot on chief registrars and their organisations. The evaluation findings include…
Copy of the evaluation full report and executive summary is available on the RCP website

8. My time as the chief Warrington Hospital February 2016-January 2017
50% clinical, 50% leadership and management
Supervisors
NHS Leadership Academy

9. Chief Registrar
Finding my feet
Who you know
How to get things done

10. Education and Training
Journal Club
Teaching for higher medical trainees
CMT teaching revamp
PACES teaching
CMT clinics
CMT training
Foundation doctors reflections and teaching
MEDIC

11. Other projects Empowering junior doctors Formalising handover
Medicines Governance lead
PTWR within 14 hours
Renovating the doctors mess
Estimated date of discharge
IT training by doctors
abdominal paracentesis day case safety
Hospital at night Ibleep improvements
Higher medical trainees maternity leave
Improving the higher medical training rota
Medically optimised patients
Foundation mentorship scheme

12. Discharge Ward Rounds
Poor weekend bed flow within directorate of medicine
Acute admissions prioritised, IP often overlooked
On calls teams too busy
Perfect for chief registrar!

13. Discharge Ward Rounds I had experience from RLBUHT and AUH
Identified barriers:
no staff dedicated to discharges
Pharmacy only open for 2 hours?
Approached chief of medicine with proposal
Wrote an SOP
Utilised capacity from myself and maternity leavers

14. Discharge Ward Rounds Started 8 week trial
Dedicated higher medical trainee for discharges
Pharmacy open from for discharges
Successful trial resulted in full implementation

15. Discharge Ward Rounds Data still being analysed Measure Days
Baseline discharges/weekend
3.5
Baseline discharge days saved/weekend
4.6
Measure
Days
Intervention discharges/weekend
9.3
Intervention discharge days saved/weekend
17.2

16. Discharge Ward Rounds
Intervention has resulted in ~ 13 more bed days saved a week
Extrapolated would result in >650 more bed days saved a year
With cost of NHS bed for a medically optimised patient estimated to cost £2731, there is a theoretical saving of ~ £150,000 per annum
- After taking into account locum costs to staff the shifts 1.

17. How I have developed? Better understanding of the system Street wise
Networking
Opportunities e.g. FHP guest editor
Teaching programme FMLM
Teaching programme NHS Leadership Academy
20+ posters/oral communications/publications

18. Next steps Continue development MSc
Further leadership projects locally
Collaborations with other chief registrars
Mentoring 2 Chief Registrars
Just because I am not a chief registrar anymore, doesn’t mean I don’t think like one…..
Once a chief registrar, you're a chief registrar forever

19. These are themes that run throughout chief registrars’ work

20. Chief Registrar Current Chief Registrar at Warrington Hospital
In post since August 2017 (approx. 1 month)
1 year post
ST7 in Acute Medicine
Approx. 50% clinical- 50% leadership and management

21. Why Did I Apply? Role promoted by TPDs
Act as an advocate for junior doctors at senior management meetings
Improve junior doctors morale
Opportunity to develop leadership skills
Quality Improvement Projects

22. Things I have already done
Presented at the local induction to introduce the role of Chief Registrar to trainees
Supported IT training sessions
Providing medical input and “real time” user advice
Encouraged communication between junior doctors
Whatsapp groups (No clinical information obviously!!)

23. Things I have already done
Negotiating CT requesting rights for CMTs on their behalf
Encouraged involvement of junior doctors in quality improvement projects
Support and guidance
Attended senior management meetings
Voiced junior doctors concerns
Promoted meetings with the medical director and assistant medical director
Historically poor attendance/little engagement

24. Current Projects at WHH
Currently involved/leading on a number of quality improvement projects including:
Introduction of “Hot clinics”
Primarily registrar led with consultant input
CMT Trainees can attend
Introduction of electronic medical take list
Selected the computer program that will work for both A&E and medical registrars
Liaising with A&E and medical registrars to ensure collaborative working on this project

25. Current Projects at WHH
More projects:
Red to Green Pilot
NHS Improvement Scheme- visual management system to assist in the identification of wasted time in a patients journey (1)
Ongoing work with Medical Handover
Structured format introduced
Redesigned the attendance sheet to include template of prompts
Reference (1)
NHS improvement Scheme-visual management system to assist in the identification of wasted time in a
patient’s journey.
A Red day is when a patient receives little or no value adding acute care.
A Green day is when a patient receives value adding acute care that progresses their progress
towards discharge.
A Green day is a day when everything planned or requested
gets done.
A Green day is a day when the patient receives care that can only be in an acute hospital bed.

26. Current Projects at WHH
Weekly registrar teaching programme
Frailty
Use of Edmonton score on admission to identify frail patients
Collaborating with Orod to ensure continuation of previous changes implemented prior to my appointment

27. Would I Recommend the Chief Registrar Role
YES
If you don’t have one in your trust- GET ONE!
Trust information, sample job description/person specification and business case available
Encourage trainees to apply
Flyers are available
If you do have one- USE US!
We can help!
Find current appointments at
Contact RCP regional managers

28. Chief registrar scheme
“The chief registrar scheme has provided me with the time and support to work on ideas to improve service provision, patient safety and intercollegiate relationships within my trust”
- Dr Alexandra Ewence, chief registrar 2016/17
Recruitment for the next cohort – 2018/19 – opens in August
Contact the chief registrar team for more information and to register interest
Recruitment for the 2018/19 cohort open now

29. Twitter: @RCPFutureHosp / #chiefregistrar
RCP chief registrar scheme
Website:
/ #chiefregistrar