Broadening the Foundation
Programme Workshop
October 2014
Jan Welch
Director, South Thames
Foundation School
South Thames Foundation School
www.stfs.org.uk
Aims for the morning
•
•
•
•
•
•
Update understanding of Broadening
Review of definitions
New ‘rules’
Local actions
Share good practice
How can we help?
South Thames Foundation School
www.stfs.org.uk
South Thames Foundation School
www.stfs.org.uk
Questions from last workshop
What is community?
– (where named clinical supervisor
must be based)
– site?
• but sites may be shared
– employment
• but some acute and community trusts
have merged
– the ‘ambulance test?
South Thames Foundation School
www.stfs.org.uk
What is surgery?
South Thames Foundation School
www.stfs.org.uk
The ‘Spirit of Collins’
South Thames Foundation School
www.stfs.org.uk
South Thames Foundation School
www.stfs.org.uk
Categorisation of specialties (1)
Specialty
Specialty type
Community?
Academic
Depends on content
Depends on content
Acute (Internal) Medicine
Medical
No
Allergy
Other
No
Anaesthetics
Other
No
Audio vestibular medicine
Other
Cardiology (Cardiovascular Disease)
Cardio-thoracic Surgery
(Thoracic Surgery)
Chemical Pathology
Medical
Possibly depending on site,
activities and supervisor
No
Surgery
No
Other
No
Child and Adolescent
Psychiatry
Psychiatry
Yes if site and/or supervisor
in community
South Thames Foundation School
www.stfs.org.uk
Categorisation of specialties (2)
Community Sexual and
Reproductive Health
Other
Yes provided site and/or
supervisor in community
Dermatology
Other
Potentially if site and/or
supervisor in community
Emergency Medicine
Other
Yes for posts in urgent care
with community supervisor
Endocrinology and
Diabetes Mellitus
Other
Potentially if site and/or
supervisor in community
Forensic Psychiatry
Psychiatry
Yes if site and/or supervisor
in community
Forensic Psychotherapy
Psychiatry
Yes if site and/or supervisor
in community
Gastro-enterology
Medical
General (Internal) Medicine Medical
No
No
General Practice
Yes
South Thames Foundation School
Other
www.stfs.org.uk
Categorisation of specialties (3)
General Psychiatry
Psychiatry
Yes if site and/or supervisor
in community
General Surgery
Genitourinary Medicine
(Venereology/Sexual
Health)
Surgery
Other
No
Yes provided site and/or
supervisor in community but
not if ward-based HIV role
Geriatric Medicine
Medical
Potentially if site and/or
supervisor in community
Haematology
Hand Surgery
Infectious diseases
Other
Surgery
Medical
No
No
Only if site and/or supervisor
in community
Medical ophthalmology
South Thames Foundation School
Potentially if site and/or
supervisor in community
www.stfs.org.uk
Categorisation of specialties (4)
Medical Psychotherapy
Psychiatry
Yes if site and/or supervisor in
community
Neurology
Neurosurgery (Neurological
Surgery)
Medical
Surgery
No
No
Obstetrics and Gynaecology
Other
Occupational medicine
Other
Only if site/supervisor in
community
Potentially if site and/or
supervisor in community
Old Age Psychiatry
Psychiatry
Yes provided site and/or
supervisor in community
Ophthalmology
Other
Oral and Maxillo-facial
Surgery
Oral surgery
Surgery
Potentially if site and/or
supervisor in community
Potentially if site and/or
supervisor in community
Potentially if site and/or
supervisor in community
South Thames Foundation School
Surgery
www.stfs.org.uk
Categorisation of specialties (5)
Otolaryngology
Other (as largely
clinics/examinations)
Potentially if site and/or
supervisor in community
Paediatric Surgery
Surgery unless part of paediatric
team, then other
No
Paediatrics
Other
Potentially if site and/or
supervisor in community
Palliative Medicine
Other
Potentially if site and/or
supervisor in community
Plastic Surgery
Surgery
Potentially if site and/or
supervisor in community
Psychiatry of Learning Disability Psychiatry
Yes provided site and/or
supervisor in community
Public Health Medicine
Other
Rehabilitation Medicine
Other
Yes NB SUPERVISOR DOES NOT
NEED TO BE MEDICAL
Potentially if site and/or
supervisor in community
South Thames Foundation School
www.stfs.org.uk
Categorisation of specialties (6)
Renal Medicine (Nephrology)
Medical
Potentially if site and/or
supervisor in community
Respiratory Medicine
Medical
Potentially if site and/or
supervisor in community
Rheumatology
Other
Potentially if site and/or
supervisor in community
Sport and Exercise Medicine
Other
Potentially if site and/or
supervisor in community
Stroke Medicine
Medical
Potentially if site and/or
supervisor in community
Trauma and Orthopaedic
Surgery
Surgery unless orthogeriatric model
Possible if part of MSK team with
community supervisor
Tropical Medicine
Medical
Urology
Surgery unless supervised by
physician
Only if site/supervisor in
community
Only if site/supervisor in
community
www.stfs.org.uk
South Thames Foundation School
Principles for posts, programmes and linkages
•
•
•
•
Clarity about targets
Review of all 1700 1 year programmes
Clear expectations about content
Linkages – managed by STFS but some more ‘2 years in
one place’ programmes
South Thames Foundation School
www.stfs.org.uk
Targets . . . .
Specialty
F1
F2
Acute
MEDICAL
General (Internal) Medicine
Geriatric Medicine
Intensive Care Medicine
Community
F1 Total
Grand Total
Acute
Community
20
20
9
9
29
12
6
2
12
6
2
7
7
OTHER
2
16
Emergency Medicine
General Practice
Obstetrics and Gynaecology
Paediatrics
7
4
2
0
General Psychiatry
General Surgery
Trauma and Orthopaedic Surgery
Urology
GRAND TOTAL
Targets
Surgical post reduction
22.5% F1 doctors in psychiatry
22.5% F2 doctors in psychiatry
55% F2 doctors in primary care
80% community placement
100% community placement
South Thames Foundation School
7
9
PSYCHIATRY
SURGERY
F2 Total
2
19
6
4
20
22
9
7
4
2
9
7
2
4
1
1
2
2
2
1
2
2
10
10
3
3
13
9
9
1
2
1
2
10
2
1
66
1
30
1
30
0
By when
Shortfall
(August)
29
6
36
Over
supply
2
2015
2015
2015
2015
2017
2
1
Target met
3
5
www.stfs.org.uk
Programme composition (1)
2x4/12 surgery
Trauma and
Orthopaedics
Geriatric Medicine
Surgery
Options for reconfiguration
• Reduction of over-supply, eg conversion to
psychiatry/community
• Sharing out surgical posts more equally
• Reviewing supervision and designation eg orthogeriatric
posts
South Thames Foundation School
www.stfs.org.uk
Programme composition (2)
Repeated sub-specialty
General Internal Medicine
Trauma and Orthopaedics
General Internal Medicine
• Designation of posts limited by national requirements
• Generally possible to reconfigure by sharing out
specialties more evenly
South Thames Foundation School
www.stfs.org.uk
Programme composition (3)
More than 1 community placement
General Practice
Psychiatry
Emergency Medicine
• May be excellent but some provide insufficient acute
experience
• Also need to distribute placements as widely as possible
• Additional community experience (community facing
placement) valuable
South Thames Foundation School
www.stfs.org.uk
‘Rules’ for 1 year programmes
 No more than 4 months of surgery or 8 months of
medicine in one year
 No medical sub-specialty or other specialty to be repeated
within one year
 No more than 1 x 4 month community placement in 1 year
 Programmes should consist of 3 x 4month posts unless
exceptional reasons and programme demonstrated to be
educationally sound – if so complete derogation form for
STFS approval
South Thames Foundation School
www.stfs.org.uk
Linkages
• Managed by STFS
• STFS responsible for balancing composition between 2
years – as long as ‘building blocks’ there
• Currently incoming F1 doctors are provided with their
incoming programme and F2 linked trust, but rank
programmes later
• Management of linkages may need to be reviewed – but
reconfigurations make this problematic
South Thames Foundation School
www.stfs.org.uk
Proposed ‘rules’ for 2 year programmes
• No more than 1 community placement in 2 years
• No more than 2 surgical placements in 2 years
• No more than 3 medical placements in 2 years
• No medical or surgical sub-specialty or other specialty
should be repeated over the 2 years
South Thames Foundation School
www.stfs.org.uk
Guidance – general principles
• FDs based in an acute trust for a year, and continue to be
employed by this trust while on 4/12 placement in
community psychiatry
• Travel must be considered (driving licence not in national
person specification)
South Thames Foundation School
www.stfs.org.uk
Designated clinician
• Facilitates management of community / psychiatry
placements
• Has time in their job plan
• Organises placements and teaching
• Has access to some administrative support
South Thames Foundation School
www.stfs.org.uk
Employment
• FD should hold contract with acute trust (‘lead employer’)
• Acute trust takes responsibility for leave arrangements but
close liaison essential
• FD should have honorary contract with
community/psychiatry provider
• Medical indemnity arrangements must be clearly stated
(STFS strongly recommends that FDs join MDU/MPS)
South Thames Foundation School
www.stfs.org.uk
Other necessary provision for training
placements
• Access to e-portfolio during working day
• Robust departmental induction, in addition to that provided by the employing
trust and at a different time, so that the FD can attend both
• FDs must be able to attend weekly teaching at their host acute trust. At
least one hour a week of departmental teaching in the community
placement should also be provided
• Time to complete SLEs and staff to supervise
• Engagement with employing acute trust foundation faculty group/FD
monitoring processes
• Involvement in ARCP process
• Administrative support
South Thames Foundation School
www.stfs.org.uk
Supervision
• ‘Foundation doctors must always have
direct access to an appropriate senior
colleague for advice in any clinical
situation. They must never be left in a
situation where their only help is outside
the hospital or the place where they
work’ (GMC The Trainee Doctor 2011)
• The senior colleague may be a nondoctor, if both competent to supervise
the relevant activities being supervised
and fully appraised of this responsibility
South Thames Foundation School
www.stfs.org.uk
Any questions?
South Thames Foundation School
www.stfs.org.uk
Workshop
• What work still needs to be done locally to meet the BTFP
targets ?
NB numbers may need to be adjusted across patch
• What are the barriers to doing this?
• What are your plans to backfill for FDs?
• What else would be helpful from STFS/HEKSS/HESL?
South Thames Foundation School
www.stfs.org.uk