1. Approach to implementation of ‘Broadening the Foundation Programme’
Dr Nicola Walters
FY1 Training Program Director
St George’s Healthcare NHS Trust

2. Broadening the Foundation Program
Report published by Health Education England in February 2014
Recommendation 1 - Educational supervisors should be assigned to foundation doctors for at least one year
Recommendation 2 - Foundation doctors should not rotate through a placement in the same specialty more than once, unless this is required to enable them to meet outcomes in the Curriculum
Recommendation 3 – Foundation doctors should undertake a community-based placement or an integrated placement – 80% from August 2015 and 100% from August 2017

3. Previous targets
22.5% of F1 doctors and 22.5% of F2 doctors in should complete a placement in psychiatry
55% of F2 doctors should complete a placement in the community or primary care
5% of doctors in an academic placement
10% of F2 doctors in ‘shortage’ specialties

4. What did we need to achieve at St George’s Hospital?
42 FY1 doctors and 39 FY2 doctors
Increased numbers of community posts
Reduced numbers of surgical posts
Meeting psychiatry targets at FY2 level
Allowed us to review whole program, set up processes for formal feedback at the end of each post and for ES / CS

5. Identification of new posts
Community scoping exercise
Queen Mary’s Hospital, part of St George’s NHS Healthcare Trust (community services)
Possibilities in the 3rd sector
Eventually, more opportunities than needed
Needed to establish whether posts were appropriate for FY1 or FY2 doctors

6. Important steps Site visits to meet team
Meet Educational Supervisors / managers
Review of job plans to quality assure posts
Discussed training if there was already a trainee in post
Offer teams further contact with TPD / Foundation faculty if required

7. Review of surgical posts
Maintaining transparency in this process
Multiple resources used:
GMC survey 2014
HESL annual feedback
Surgical focused visit report November 2013
SGH Foundation feedback July 2014
Educational and Clinical Supervisor feedback
Foundation faculty minutes and inappropriate duties record

8. Next steps Paper presented to Executive Management Board of Trust
All specialties that were affected were contacted
3 surgical FY1 posts / 1 medical FY2 post removed
2 established FY2 posts moved to FY1
1 FY1 psychiatry post → FY2
Community posts created in hospice, GU medicine, dermatology and ‘Management of the elderly with complex conditions in the community’

9. Provision for lost posts
MDT co-ordinator for surgical post
Physician Associates (already established at SGH)
Final plans for surgical post not completely clear as yet
Medical post being replaced by core medical trainee for next year

10. Challenges Variation in post numbers that needed to be changed
Complexity of reconfiguring rotations for more than 80 doctors to ensure balance
Dealing with expectations of supervisors when posts changing to FY1
Responsibility of ensuring that decommissioned posts have plans in place to replace doctors

11. Special thanks to Dr Sarah Hammond, Consultant Anaesthetist seconded to the NHS Leadership Academy