1. HEE Foundation Programme Review
Joint Foundation Faculty Sharing Best Practice Event - 8th March 2019

2. Medical Education Reform
Enhancing Supervision
Locally Employed Doctors: SAS/Trust Grade
ACP/ Multi-professional Team Working
ARCP Review Implementation
Individualised Training Pathways
Enhancing Junior Doctors’ Working Lives
Training Structure and Delivery
Undergraduate Medical E&T: School Expansion & Quality
Foundation Programme Review
Geographic distribution
TOPOL, Technology & Innovation
Population Health Management Fellowships

3. Facing the Facts, Shaping the Future;
‘The NHS Foundation Programme is a world-leading medical education offer that supports newly-qualified doctors, developing generalist clinical skills and informing their future career choices. HEE has worked with UK partners to develop the programme since 2013, supporting service need by increasing the number of doctors completing a GP, Community or Psychiatry post…
‘HEE with partners, will review the Foundation Programme in England during 2018 to assess how it can best support the development of the doctors of tomorrow.’
Facing the Facts, Shaping the Future;
A draft health and care workforce strategy for England to 2027

4. Why now? Current issues 1500 additional medical school places
Facing the Facts, Shaping the Future – NHS workforce strategy and the NHS long-term plan
8 years on from Collins Review (evaluation of Foundation Programme, 2010)
Trainee morale – flexibility, supervision, need for better transition to postgraduate
Improving care for patients - geographic and specialty issues
Moving healthcare to prevention, population health and community based care
Maintaining standard regardless of point of full registration
@NHS_HealthEdEng

5. Working Groups PURPOSE SUPPORTING AND VALUING EDUCATIONAL SUPERVISION
Foundation Programme Review
WORKFORCE ISSUES
TIME TO CHOOSE
Learner and Trainer Engagement
Policy and Four Nation Alignment

6. Progress to Date
Five working groups created into themes to deliver the Review’s aims – chaired by PGDs/FSDs with wide cross-system stakeholder membership
Established key ‘problems’ we were trying to solve
Developing options for potential solutions (some tested in Oct)
Some ideas for potential pilots emerging
Policy and Four Nation Alignment working group exploring how the recommendations emerging from the groups work across all nations
Overarching literature review, research and data to inform the review
Identifying best practise examples – but more welcomed!
Stakeholder events held in March shaped the aims and objectives of the Review and in November reviewed early thinking. A third event was also held in January where we tested our early recommendations
Engagement events held doctors in training and educators in October and January
Testing/refining recommendations with working groups, prior to publication of report – assumed April but alignment to LTP Workforce plan is crucial

7. What we have heard from trainees…
There should be more acceptance of taking time out and allowing flexibility
Foundation Trainees should be able to access their ES much more frequently, value supervision from registrars, MDT and named senior workplace supervisor are crucial
Technology could be used more effectively e.g. e-portfolio and supervision
Many consultants provide unofficial support to trainees and are interested in the trainees some with proactive contact
Short placements that are difficult can put someone off choosing a speciality
4 month rotations were generally favoured over 6 month rotations but this differed between FY1 and FY2 years
First rotations in the community (GP/psychiatry) can be isolating from peers, and therefore transition to a hospital rotation can be particularly difficult
Hybrid posts idea welcomed – QI/Digital/Chief Foundation Doctor
Concerns re burden of assessment and guidance on competencies
Widespread support for more flexibility in deciding and changing specialty without detriment
Widespread support for development of step out-step in and other flexible options
Not enough career advice, similar to medical schools, HEE and local deaneries could organise career fayres

8. Emerging Themes Pluripotency essential
FDs are important for service delivery but that the 'service' they provide needs to fit with their skills/training
Differentiation between purpose of F1 and F2
Increasing flexibility and autonomy for trainees - we need to be flexible, especially in F2, in what the trainee does in their working day just as we might be with other employees especially if it is part of their training
Increased flexibility in delivery of Foundation
Linking of hard to recruit to geographies with increased medical school intake
Range of options to support difficult to recruit specialties

9. Emerging Themes
Raising awareness of special circumstances to support and value trainees
Enhance career support offered at medical school and to Foundation trainees
Specialty recruitment may be too early for many trainees
Taster sessions are valuable, but availability and structure requires further consideration
Enhance Education, Clinical and Workplace supervision
Consistent quality of supervision for F1 & F2
Widening the pool of those able to provide supervision

10. Early Recommendations

11. Distribution of posts, recruitment and selection
Equitable distribution of posts to supports population health needs
Review special circumstances
Smaller units of application
Priority Programmes
Geographic preferencing
Review academic FP
Monitor E&D data

12. Purpose and Structure Generic (Pleuripotency)
FY1 – transition to workforce
F2 – development of independence/decision-making skills
Time for self development (‘CPD’)
1 hour/week for FY1 (or 4 hours/month)
3 hours/week for FY2
Pilot innovative FY2 programmes
More flexible training (e.g. LIFT)
Community posts should be in FY2
Support measures in Trusts (recognise inexperience)

13. Supervision NACT JDs for ES/CS
Dedicated Foundation ES who understand the ‘breadth of medicine’
Trainers should be held to account
Recruit ES from a range of (medical) backgrounds
Senior trainees in mentorship roles
Time in job plans – ES 10 meetings/year
ePortfolio to support the ‘purpose and structure of the FP’

14. Supervision (2) Workplace supervision at all times
OOH handover, supervision, fair division of labour
CS to have time on job plan
PSG compulsory

15. Teaching and Careers Support
Annual review of programmes
Simulation x 3 /year
Study leave to achieve FP curriculum requirements
Careers:
Centralised basic resource
Local coordinator/champion
Access to eportfolio/alumnus programme for those taking time out after FY2

16. College of Foundation

17. Next Steps…
Develop possible pilots to test proposals depending on the outcomes of the review
Last round of working groups end of March
Final Foundation Assurance Board in April
Publication of a report along with findings and recommendations for all 4 nations, collectively and individually.
An implementation plan for England

18. THANK YOU anthony.choules@nhs.net