1. Working in the NHS Dhiraj Uchil RCOG MTI and Sponsorship Officer
Consultant Obstetrician and Gynaecologist,
University Hospital Lewisham, London

2. Outline Creation of the NHS NHS structure- funding and regulation
Working in the NHS- models of care
Working in the NHS- what it means for you

3. Creation of the NHS NHS was created in 1948
Central principle is to provide services that are free for all at the point of delivery

4. What do the public think?

5. Perception of the NHS

6. Challenges

11. NHS funding

13. NHS funding

14. What do you need to know and why??
NHS is free at point of use, but not really “free”
There are great pressures on NHS funding and demand often outstrips supply
Like any other business, it needs to attract money and needs to save money
Centralization of specialist services
Merging units
Tertiary units vs Secondary units

15. What does it mean for you??
Does the patient really need a follow up appointment?
Are these investigations/ scans really necessary?
Early discharge – eg postnatal women, ERAS/ EROS pathways
Do not refer to another consultant/ specialty, even in the same hospital
CS on maternal request, IVF funding
Tourism healthcare

16. The NHS structure

17. Current NHS structure

18. Trust Foundation Trust Fancy name for “hospital”!!
Describes a management Structure
Foundation Trust
Financial & management freedom
Local community involvement
Freedom to re-shape services
Still accountable and regulated by the NHS

19. Funders
Regulators

20. Funding of NHS services

21. Influencing commissioning

22. Funding of education in the NHS

23. Healthcare Regulators

24. Models of medical care

25. Paternalistic model of care
Doctor knows best model
Patients as passive recipients of care
Rarely encountered (or tolerated) in NHS practice

26. Informative model
Patients who do their own research with “Dr Google” and know what is wrong and what needs to be done
Clinicians as mere suppliers of information without offering opinions- allow patients to decide

27. Shared decision making in the NHS

28. Models of care

29. Hierarchies in the system
Some of you may have worked in very hierarchical systems
A flattened hierarchy as is often found in the NHS may be an unusual experience
Dealing with questions/ challenges
“Jump calls”

30. Multidisciplinary teams
Working in a multidisciplinary team may be a new experience for some
Working with midwives throughout the woman’s journey
Working with other professionals- anaesthetists, physicians, physiotherapists
Learning effective communication strategies
Learning together- mutidisciplinary skills and drills

31. Your training in the NHS

32. Who is responsible for your training??
Hospital
Royal College
Deanery

33. Training responsibilities
Trainee
Deanery
Clinical Supervisor
Hospital (Trust)
TPD
(Training Prog Director)
Educational supervisor
DME
(Director of Med Educ)
Head of School
College Tutor
Postgraduate Dean
Medical Director

34. What should you aim to gain out of working in the NHS??
Technical skills
Not only surgical; FBS, colposcopy, scanning, etc…
Patient management skills
MDT, management planning, appropriate referrals, counseling, etc…
Communication skills
Patients, families, colleagues, GPs, nurses & midwives, documentation, etc…
Audit skills
Participate, understand concept, how to plan an audit, auditable standards
Organization & management skills
Book early annual & study leave, swap your on calls early, organize rota

35. What should you aim to gain out of working in the NHS??
Presentation skills
Perinatal meeting, audit meeting, etc…
Teaching skills
Undergraduates, SHOs, even colleagues
Research skills
Look for opportunities
Writing skills
Reviewing and writing new local guidelines

36. Goals for MTI trainees Transition from ST2 to ST3 level MRCOG
Additional skills/ ATSMs

37. How to achieve your aims??
Have clear realistic goals
Be enthusiastic and seek out educational opportunities
Don’t have a narrow focus (eg gynae surgery). Identify the areas that your previous training may have gaps
Be willing to learn….. Lots of people can teach you things, if you are willing to let them!
Understand service vs training dilemma
Speak to your educational supervisor and the College Tutor

38. Training Materials Register as a trainee with RCOG Curriculum
Core training, ATSM, SST
Log Book/ e-portfolio/ training matrix
ST1-ST7
19 modules
Assessment tools
Forms for induction and appraisal

39. Courses to attend RoBUST PROMPT EFM- K2/ RCOG EFM package
Perineal trauma repair course
Communication courses
Part 2 exams course

40. Assessment Tools Portfolio/Modular Log Book
Mini-CEX Minimal clinical evaluation exercise
CBDs Case base discussion
OSAT Objective structured assessment of technical skills
TO Team observation
ARCP Annual Review of Competency Progress

41. Annual Assessment TO1 forms
At least 10 observers
Midwives
Colleagues
Nurses
Secretaries
Usually chosen by trainee but should ideally be approved by the Educational Supervisor
Educational Supervisor then produces a summary (TO2)

43. Any Questions ?