Broadening the Foundation
Programme Workshop
Jan Welch
Director, South Thames
Foundation School
South Thames Foundation School
www.stfs.org.uk
Aims for the morning
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Current understanding of Broadening
Local actions
Sharing good practice
How can we help?
South Thames Foundation School
www.stfs.org.uk
South Thames Foundation School
www.stfs.org.uk
South Thames Foundation School
www.stfs.org.uk
South Thames Foundation School
www.stfs.org.uk
Previous targets
• Stated that, ‘by 2014, LETBs should have
demonstrated credible progression
towards existing targets for placements in
general practice and psychiatry, in both F1
and F2’.
• 22.5% of F1 doctors in psychiatry
• 22.5% of F2 doctors in psychiatry
• 55% of F2 doctors in the community or
primary care
• 5% of doctors in an academic placement
• 10% of F2 doctors in shortage specialties
South Thames Foundation School
www.stfs.org.uk
South Thames Foundation School
www.stfs.org.uk
South Thames Foundation School
www.stfs.org.uk
Implications for STFS
• Increase in community posts
• Developments of integrated community placements
• Increases in psychiatry posts (some are community based,
so contribute to both targets)
• Medical posts including community-facing experience
• Reductions in surgical foundation doctor (FD) posts
South Thames Foundation School
www.stfs.org.uk
What is a community placement?
• A four month placement with a named clinical supervisor
• Primarily based in a community setting, such as general
practice, community paediatrics, palliative care or
community psychiatry
• Defining ‘community’ is challenging
• The named clinical supervisor must be based in the
community.
South Thames Foundation School
www.stfs.org.uk
What is an integrated placement?
• A four month placement with a named clinical supervisor
where the foundation doctor is primarily based in a
community setting.
• The named clinical supervisor must be based in the
community.
South Thames Foundation School
www.stfs.org.uk
What is a clinical supervisor?
• A registered and licensed medical practitioner,
responsible for overseeing a foundation doctor’s
clinical work and providing oral and written
feedback during a training placement
• Clinical supervisors must have adequate training,
support and resource to undertake their training
role, including adequate time in their job-plan
• Cover for absences important
South Thames Foundation School
www.stfs.org.uk
What is a community facing placement?
• A four month placement in which the foundation doctor is
primarily based within an acute setting
• The placement should include opportunities to develop
holistic skills including long-term conditions and the
increasing role of community care
South Thames Foundation School
www.stfs.org.uk
Timing of community placements
• Typically community placements take
place during the F2 year
• F1 doctors are consolidating acute
skills and can be at risk of isolation if
distantly community based, especially
for their first placement
• F1 posts based in the community
should include opportunities to attend
host acute trust for teaching and
maintenance of acute clinical skills
South Thames Foundation School
www.stfs.org.uk
Where can new
community placements be developed?
• GP excellent but capacity limited
• Psychiatry expansion underway – most posts have
‘community supervisors’
• Existing community eg sexual health, palliative care
• New services eg musculo-skeletal
• Trusts with strong community links in good position to
develop innovative community based placements (can
include some time in acute trusts, eg in on call rotas)
South Thames Foundation School
www.stfs.org.uk
What activities can FDs carry out in
community placements?
Sections of Foundation Doctor Curriculum
2012/14
1
2
4
7
8
10
Professionalism (p17-19)
Relationship and communication with patients
(p20-22)
Ethical and legal issues (p25-26)
Good clinical Care (p30-37)
Recognition and management of the acutely
ill patient (p40-41)
Patients with long-term conditions (p44-47)
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 and safety
• Foundation doctors must never be left without
appropriate clinical supervision
• good safety of foundation doctors in
community placements also crucial
• eg many new doctors cannot drive, and so
should not be expected to cover several
different sites at night, along country roads,
by bicycle
• Local guidance on safety is on
http://www.stfs.org.uk/sites/stfs/files/Safety%2
0of%20foundation%20doctors%20Final%20%20February%202014.pdf
South Thames Foundation School
www.stfs.org.uk
Covering the workload
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Significant numbers of surgical post reductions
Posts will move away from acute trusts
Workload will need to be provided differently
Crucial both for patient safety and avoiding impact on
other trainees
• Other staff will need to be recruited and trained
• Solutions will depend on whether:
– fewer doctors to be supported in some activities
– doctors to be replaced entirely
South Thames Foundation School
www.stfs.org.uk
Fewer FDs – roles providing support
• Many common FD activities are unnecessary for their
training, eg
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routine phlebotomy
finding medical records
portering samples, forms and patients
organising meetings
filing
• Others are more valuable but can be carried out by others eg
IV cannulation
• Arranging scans etc and reviewing results require clinical
input but workload reduced by effective EPR systems
South Thames Foundation School
www.stfs.org.uk
Support roles
(Skills for Health role directory)
• Role level 1 (£14,294 – £15,013 pa: Band 1
AfC scale ex HCA)
• Support worker role based care
• Support worker, phlebotomy
• Role level 2 (£14,294 – £17,425 pa: Band 2
AfC scale ex HCA)
• Phlebotomist
• Role level 3 (£16,271 – £19,268 pa: Band 3
AfC scale ex HCA)
• Integrated support worker
South Thames Foundation School
www.stfs.org.uk
Clinical activities of foundation doctors
Important activities contributing to service work
include:
• history taking, examination and differential diagnosis
• management of acute and chronically ill patients and
diagnostic testing
• prescribing
• clinical skills eg taking arterial blood gases,
proctoscopy etc.
• assessment of elective admissions
• communication skills and counselling including
breaking bad news
• co-ordinating treatment and investigations
• discharge planning
• writing discharge letters and other communications
South Thames Foundation School
www.stfs.org.uk
Roles to replace foundation doctors
Many of these activities can be carried out by other types
of staff but:
may require significant additional training for role, eg
prescribing and practical procedures
• Role level 7 (£30,764 – £40,558 pa: Band 7 AfC scale ex
HCA)
• Advanced practitioner
• Role level 8 (£39,239 – 47,088 pa: Band 8a AfC scale ex
HCA)
• Consultant nurse practitioner
• Cross cutting role (£30,764 – £47,008 pa: Band 7/8a AfC
scale ex HCA)
• Physician associate
South Thames Foundation School
www.stfs.org.uk
Physician associates
• Dependent health professionals who are trained in the
medical model to obtain medical histories, conduct
examinations, request and interpret tests and diagnose
and treat injuries
• 2 year postgraduate diploma - more training places being
commissioned locally
• Do not yet prescribe
• Not yet a regulated profession
South Thames Foundation School
www.stfs.org.uk
South Thames Foundation School
www.stfs.org.uk
Any questions?
South Thames Foundation School
www.stfs.org.uk