Welcome - PowerPoint PPT Presentation

Loading...

PPT – Welcome PowerPoint presentation | free to view - id: 20a9fb-ZjA2N



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Welcome

Description:

... appropriate for their demonstrated level ... Alternative meanings of 'Residency' ... Doctors names, Grade & Rotation dates. Bleep and phone numbers. Emails ... – PowerPoint PPT presentation

Number of Views:143
Avg rating:3.0/5.0
Slides: 180
Provided by: brianpa8
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Welcome


1
(No Transcript)
2
Welcome IntroductionDebbie KendallProject
DirectorJD Advisory Team
3
(No Transcript)
4
Professor Jacky HaydenPostgraduate DeanNW
Deanery
5
Welcome
  • Professor Jacky Hayden

6
Working and training in a 48 hour week
  • For safe patient care trainees need
  • Working patterns with time to hand over patient
    care in the presence of a senior clinician
  • Graded supervision throughout the 24 hours
  • Time to reflect, think and discuss

7
Working and training in a 48 hour week
  • For effective learning trainees need
  • Clear post descriptions matched to the curriculum
  • Work experience that will deliver the agreed
    competencies
  • Graded supervision
  • Time to reflect, think and discuss

8
Working and training in a 48 hour week
  • To meet the goals of the curriculum without
    prolonging training trainees need
  • Minimal time spent on empty tasks
  • Sufficient clinical and leadership opportunities
  • Effective use of their time with their clinical
    supervisor
  • Effective educational supervision with clear goal
    setting

9
Working and training in a 48 hour week
  • Graded Supervision
  • Fellows junior doctors are assigned
    incrementally increasing responsibility and
    independence during their training, appropriate
    for their demonstrated level of competency and
    professional development (as assessed by the
    supervising physicians)
  • (University of Minnesota)

10
Working and training in a 48 hour week
  • It is every ones job to ensure that we have safe
    care for patients today and safe care for
    patients in the future

11
International RecruitmentMr Pramod Luthra,
Associate Dean Dr Chris Till, Head of School,
Anaesthesia
12
MTI and Anaesthesia in the North West
  • Chris Till
  • Head of School
  • North Western Deanery

13
Where are we now?
  • Multiple vacancies on ST3 rotation

14
Why do we have vacancies?
  • MTAS/MMC
  • Run through trainees not completing ST2 in time
  • Once a year August recruitment
  • SpRs get their CCT throughout the year
  • No need for period of grace
  • No suitable candidates to fill LAT posts
  • Limited number of ST3 training opportunities

15
How can we fill these training posts?
  • LAS
  • LAT
  • More rounds of ST recruitment
  • Let the trusts fill them locally
  • Let trainees do locums (48 hour compliance)
  • Tier 2 recruitment
  • Tier 5 MTI recruitment

16
The Differing View
  • Gaps in the rota are service problems
  • Gaps in rotas affect training opportunities
  • Gaps should be sorted out locally
  • Gaps should be coordinated centrally

17
NW School Plan
  • MTI route (2 year specified training)
  • Coordinated school recruitment
  • Split into 3 sub-regional sectors with rotations
    in each sector
  • HR/employment issues led by one host trust in
    each sector
  • Recruitment company facilitated

18
What is needed?
  • Clinical Director engagement
  • College Tutor engagement
  • Deanery support
  • RCoA support
  • No detriment to local trainees
  • MTI trainees treated as trainees and not rota
    fodder
  • Guaranteed return after 2 years

19
Achievable?
  • Trust support
  • School support
  • Deanery support
  • ?RCoA support
  • ?Time frame
  • ?Cost
  • ?Method of recruitment

20
Moving On 8 October 2008
Pramod Luthra Associate Postgraduate Dean North
Western Deanery
21
Vacant posts
  • Unfilled training posts within a training
    programme
  • Vacant non training posts

22
UKBA Points based Tier system for leave to
stay, work and or train in UK
  • Tier 1
  • Tier 2
  • Tier 3
  • Tier 4
  • Tier 5

23
Tier 1
  • Tier 1- is points based (29 Feb 2008)
    Do not require a job offer
  • Restricted- employment but not for training
  • Unrestricted

24
Tier 2
  • Require the Resident labour market test
  • If employing UK graduate (non UK or EEA resident)
    do NOT need RLM
  • If already in training before 28 Feb 2008 and
    have job can employ without RLM
  • New spouse visa cannot work in training job
  • Sponsor employing Trust

25
Tier 3
  • Tier 3 for temporary workers, not for doctors.
    Suspended indefinitely

26
Tier 4
  • Tier 4 UK Med school graduate doing
    Foundation training- student visa
  • Covered by FPO letter
  • Does not require Deanery input
  • (flexible training being looked at- re duration
    of stay)

27
Tier 5
  • Covers Doctors on MTI scheme
  • Sponsored by NHS Professionals
  • Require Trust, College/specialty and Deanery
    involvement

28
Medical Training InitiativeNHSP-055
  • Support for the Application of a UKBA Certificate
    of Sponsorship under the Tier 5 Government
    Authorised Exchange
  • Document is to support application to be made by
    the Employer to the National Sponsor to allow the
    following doctor from Overseas to undergo
    training in the UK for a period of no longer than
    24 months under the above Scheme

29
  • Name of post International Training Fellowship
  • at ST3 (ST4 Paeds Psychiatry) or above
  • For a maximum period of 2 years
  • Will not lead to award of CCT

30
  • Part 1 - to be completed by the Employer and
    Supervising Consultant
  • Part 2 - to be completed by the Deanery
  • Part 3 - to be completed by NHS Professionals.

31
Deanery section requires
  • Evidence of Funding
  • overseas scholarship - letter from the overseas
    body awarding the scholarship
  • NHS Salary letter from Trust offering contract
  • This must confirm funding will be appropriate to
    level of post appointed to

32
Professional Educational
  • From Royal College/specialty letter or email.
  • Letter confirming provision of education and
    training from TPD and DME
  • Copy of educational contract work plan- matched
    to
  • Will be offered formative summative appraisal

33
GMC
  • Evidence of GMC registration approval (email
    Inviting the migrant to attend an identity check
    is sufficient).
  • GMC registration (PLAB).

34
Effect on training programme
  • Confirmation letter from TPD and DME post will
    not diminish the training opportunities available
    to the
  • specialty programme trainees
  • other trainees in Trust

35
Working time New Deal compliance
  • Copy of provisional timetable demonstrating
    compliance with New Deal

36
MTI scheme application
  • The application and/or supporting letter from the
    Trust along with the above should be posted to
    the Deanery or emailed,( if there are pdf copies
    of the documents), to -
  • Emma James, Education Manager,
    e.james_at_nwpgmd.nhs.uk and
  • Pramod Luthra, Associate Postgraduate Dean,
    p.luthra_at_nwpgmd.nhs.uk.

37
The Resident Consultant ModelMr Matt
BluckChildrens Young personsNetwork
38
Resident Consultants? Matthew Bluck 8th October
2009
39
  • What does it mean?
  • Consultants who spend their on-call duties
    resident in the hospital
  • Unfortunate title
  • Alternative meanings of Residency
  • Consultants undertaking a role which is perhaps
    not aligned with the traditional ideas of what a
    consultant should do

40
  • A New Idea?
  • No!
  • Happening all over the country
  • Small or geographically isolated units
  • Illustration of commitment to deliver care
  • Formalised agreement and appropriate remuneration
    may be new, as may the introduction across a city
  • Royal Free

41
  • Why do we need Doctors?
  • Medicine is developing and moving forward
  • Nursing and Professions Allied to Medicine are
    moving forward
  • But they are fundamentally different

42
  • What about New Ways of Working?
  • What / where is the value?
  • Trained doctor vs untrained doctors vs nurses vs
    AHPs
  • Trained doctor untrained doctors nurses
    AHPs
  • Qualified multidisciplinary team
  • This IS a new way of working

43
  • What about Current Consultants?
  • High value in non-resident tier
  • Consultant networks
  • Governance
  • Clearly defined

44
  • What Prompted the Idea?
  • EWTD?
  • New Deal?
  • Quality International practice
  • Clinical incidents in August and September
  • Support in hospitals overnight
  • 24 hour specialties Obstetrics / NICU / PICU

45
  • What About my Family?
  • Expert if possible the Expert
  • Expert fully trained fully qualified doctor
  • Expert fully trained fully qualified nurse
  • Expert fully trained fully qualified AHP

46
  • What have we been doing?
  • Cells of 11
  • Unfilled posts
  • EWTD compliance
  • Reconfiguration

47
  • What are we doing?
  • Making it Better
  • Provide care at home, or care closer to home,
    wherever safe and appropriate to do so
  • Safer services by concentrating specialist staff
    and expertise in fewer, bigger units
  • Standardised neonatal service with improved
    staffing levels. Regional neonatal intensive care
    services

48
  • What is the configuration?
  • Community Paediatric Nursing Teams
  • 8 In-patient Paediatric Units
  • 8 Obstetric Units
  • Co-located Midwifery Led Units
  • ? Standalone Midwifery Led Units
  • 3 Level 3 Neonatal Units
  • 8 Level 2 Neonatal Units

49
  • What are the outcomes?
  • What started as a Safety issue
  • Became a compliance issue
  • Returned to a safety issue
  • Weeks of nights
  • 56 / 72 hour working weeks
  • gt72 hour working weeks
  • EWTD compliance is now a by-product of this model

50
  • Conclusion
  • EWTD is actually about safety
  • NHS North West, The North Western Deanery and the
    Children Young People and Families Network
    spotted this
  • Clinical Leads supported the changes
  • Well the majority

51
  • The Challenge Ahead
  • Acceptance of the model
  • The detail
  • Fixed vs unfixed night duties etc
  • Working with other grades on the resident tier
  • Managing other grades on the resident tier
  • Job planning
  • Career progression

52
  • The Challenge Ahead
  • The changing workforce profile

53
Any Questions? For further Information please
contact Matthew Bluck Principal Consultant,
Teamwork Management Services mbluck_at_teamwork-ms.c
o.uk or Halcyon Edwards Associate Director,
Greater Manchester Children, Young People and
Families Network halcyon.edwards_at_Northwest.nhs.uk

54
North West RosteringDr Jenny Harrop Deputy
Project Director, JD Advisory TeamwithDr Jon
Bright Anna Finbow
55
North West Rostering
  • A solution for complex rota management within
    working time regulations

56
A Collaborative Approach
57
Identifying the need!
  • Recognising the team within a rota
  • Working with EWTD New Deal
  • On call vs. daytime staffing requirements
  • Auditable rostering with a comms facility
  • Management of Annual Study leave
  • Real time consequences of those actions
  • Anticipate and alert future issues

58
Rota Work Flow
Rota Design
Population
Monitoring
My Ward My Team My Shifts My Swaps
Management
59
Management??
  • Doctors names, Grade Rotation dates
  • Bleep and phone numbers
  • Emails
  • On call lists for switchboard/acute areas
  • Leave approvals
  • Swaps
  • Locum availability

60
Live Demo
  • Administration pages
  • Ward, team, doctor views
  • Individualised rota per doctor
  • Proformas for swaps

61
Hot Cold RotasDr John CoakleyHomerton
University Hospital
62
Hot and cold rotas
  • Dr JH Coakley MD FRCPMedical Director and
    Intensive Care ConsultantHomerton University
    Hospital NHS FTHomerton RowLondon E9
    6SRjohn.coakley_at_homerton.nhs.uk

63
(No Transcript)
64
Homerton University Hospital
  • 550 beds (300 acute medical) in Hackney
  • Emergency care predominates (106,000 AE, 160,000
    OPD, 35,000 IP, 5,000 births)
  • Medical take 25 40 patients
  • Surgical take 8 10 patients
  • Orthopaedic and urology take small numbers

65
Night staff August 2003
5pm
10pm
12mid
8am
11pm
Medical PRHO Medical PRHO Medical SHO Medical
SHO Medical SpR Surgical PRHO Surgical
PRHO Surgical SHO Surgical SpR Orthopaedic
SpR ITU SpR Anaesthetic SHO Clinical Site Manager
66
Night staff October 2003
5pm
10pm
12mid
8am
11pm
Medical PRHO Medical PRHO Medical SHO Medical
SHO Medical SpR Surgical PRHO Surgical
SHO Surgical SpR Orthopaedic SpR ITU
SpR Anaesthetic SHO Clin Site Manager Clin Site
Manager
Oncall from home
Oncall from home
handover
67
Reality check - EWTD 2009
  • Continuity of care by individual juniors is dead
  • We therefore have to introduce continuity by
    system and/or team
  • We have to get as many people away at night as
    possible
  • We cannot afford to lose continuity of training
    either

68
Total football..
Put simply, it means all 10 outfield players in a
team are comfortable in any position. So if a
defender wants to go on a mazy run towards goal,
a midfielder will fill in for him at the back -
and stay there. It may sound crazy, but it was a
style of play that made Holland the greatest side
of the 1970s.
69
Whats the vision for emergency care?
  • 98 in 4 hours basic minimum acceptable
    standard
  • Emergency care delivered across boundaries by
    specialists who are interested and committed
  • Set up cold team and hot team for training
    and service delivery
  • Over time (say five years) integration of acute,
    emergency and critical care medicine to provide a
    seamless service
  • Improve training while complying with EWTD 2009
  • Extend consultants normal working day -

70
Taking Care 24/7 how we ran it
  • Project Board meetings every 2 weeks
  • Medical Director
  • Operations Director
  • Clinical Director of Medicine
  • Director of PGME
  • Associate director of HR
  • Junior doctor representative
  • Senior nursing representative
  • Project manager
  • Representative of NWP

71
Taking Care 24/7 - obstacles
  • Dislike of change
  • Risk aversion
  • MMC
  • EWTD
  • Custom and practice
  • the college says.
  • the dean says.
  • my boss says.
  • Im not covered to.

72
Taking Care 24/7 - enablers
  • Dislike of change
  • Risk aversion
  • MMC
  • EWTD
  • Custom and practice
  • the college says.
  • the dean says.
  • my boss says.
  • Im not covered to.

73
Taking Care 24/7 - enablers
  • Communication
  • Medical Council, Directorate Boards, Clinical
    Board, Postgraduate meetings.
  • Reference Groups for medical and nursing staff
  • Discussion documents e-mailed
  • E-mail discussion encouraged
  • Homerton Life CEOs Brief etc
  • Lots of corridor and canteen conversations
  • People can still hear the wrong message

74
Acute Care Unit
  • 56 beds
  • Planning based on 48 hour LOS
  • Receives all acute admissions in surgery,
    orthopaedics, urology and medicine
  • Junior staffing proportionate to emergency
    activity
  • Busy!

75
Acute Care Team (ACT)
  • Consultant led 24/7 team with no commitments
    other than acute care
  • Extended normal working hours for acute care
    (including consultants) and improved handovers
  • Consider which clinicians are best able to
    deliver the required competencies
  • Integrate delivery of acute care across
    specialties
  • Develop sustainable acute rotas

76
Acute Care Team
  • Consultants (12P, 6S, 5TO, 3U)
  • 6 Medical ST 3 or SpRs (AM or EM)
  • 8 Medical ST 1 or 2, FY2 (ACCS or AM)
  • 3 Surgical ST 2 to 6
  • 1 Orthopaedic ST 2 to 6 (0800 - 2200 only)
  • 1 ICM ST 1 to 6 (0800 1600 only)
  • 6 Foundation Trainees FY1
  • CCO
  • CSM

77
Handovers
  • 0800 very brief
  • 1030 to discuss PTWR issues ACT
  • 1600 brief, to hand over jobs etc from cold to
    hot team
  • 2100 for night

78
Weekday and night ACT
79
Weekend ACT
80
Example most FY2 - ST2
  • 16 weeks per year acute work
  • Full shift for acute work
  • Protected training time in cold specialty for
    rest of year no nights no weekends

81
Example most ST3
  • 12 weeks per year acute work
  • Full shift for acute work
  • Protected training time in cold specialty for
    rest of year no nights no weekends

82
What is the impact on training?
  • For a typical junior doctor the time available
    for the delivery of daytime service rose from 52
    of the year to 60 of the year, and the shifts
    devoted to acute care fell from 78 to 60 per
    year. This allows more time to be spent in
    daytime training learning the skills required to
    deliver elective work.
  • The costs saved on junior doctors rotas amounted
    to about 0.25m recurrent .

83
What worked well?
  • Doctors hours
  • Relationships between physicians, surgeons,
    critical care and outreach have improved
  • Night handover is very good
  • Patients seen by a consultant very quickly
  • Emergency / elective split works well for cold
    team juniors
  • The change in surgical and orthopaedic rotas
    works well for the ED.

84
(No Transcript)
85
(No Transcript)
86
(No Transcript)
87
(No Transcript)
88
and what didnt
  • Stable Medical Leadership daily change of
    consultant (s)
  • Junior Doctor Rotas
  • too complex
  • dont facilitate continuity of care particularly
    for longer stay patients

89
Hard to change, easy to stay the same, but
  • Don't be so gloomy. After all it's not that
    awful. Like the fella says, in Italy for 30 years
    under the Borgias they had warfare, terror,
    murder, and bloodshed, but they produced
    Michelangelo, Leonardo da Vinci, and the
    Renaissance. In Switzerland they had brotherly
    love - they had 500 years of democracy and peace,
    and what did that produce? The cuckoo clock. So
    long Holly.
  • Orson Wells (Third Man)

90
Care 24/7 Dr Diana Hamilton-FairleyGuys St
Thomas Hospital
91
EWTD A challenging opportunity to improve
careDiana Hamilton Fairley Deputy Medical
Director GSTT
92
  • Aim

How change to achieve EWTD is an opportunity
to Improve the quality of care for all
patients Improve patient safety through robust
systems based on prioritisation and
competency Maximise training opportunities To
illustrate the changes we have made Compliance
in Cardiac surgery Taking Care 24/7
Team Generic surgical rota
93
GSTFT
  • Foundation Trust 2004
  • Kings Health Partners GSTT, KCL, KCH, SLaM 2009
  • Two of the oldest teaching hospitals in London
  • 1150 beds
  • Guys Hospital mainly elective and tertiary
  • St Thomas Hospital Acute and elective
  • Evelina Childrens Hospital Acute, secondary and
    tertiary services 120 beds
  • 750,000 patient contacts per year
  • Annual Budget 680m
  • 9000 staff
  • Academic Partners London South Bank University
    University of Greenwich
  • 2500 Clinical Trainee Placements per year

94
  • The aim is that patients are cared for day and
    night by
  • The right person with
  • The right skills at
  • The right time
  • PATIENT SAFETY

95
Changes in Cardiac Surgery
  • No SHO grades in training/challenge of EWTD
  • New workforce model
  • SHOs replaced by
  • Surgical Care Practitioners
  • Nurse Case Manager
  • Pharmacist
  • 1 registrar ward-based each week
  • The Good - 5 weeks concentrated training
  • The not so good - No firm structure

Change is possible without more Drs!
Dissent is OK Keep talking
Dont give up
96
Taking Care 24/7
  • Improve quality of care for the Acutely ill
    patient
  • Separate Emergency from Elective pathway
  • And
  • Achieve EWTD
  • Minimise inappropriate duties for all professions
  • Optimise supervision and support of junior staff
  • Maximise training opportunities
  • Keep costs down (saving of 4.1m recurrent per
    annum)

97
Taking Care 24/7 team
  • Multi-professional team
  • Senior Nurse Practitioners (SNP)
  • Doctors
  • Physiotherapists
  • Clinical Assistant Practitioners / Physicians
    Assistants
  • Diagnostics
  • Co-ordinated to respond to the patients needs
  • Competency based

98
East South Wing SNP 2 Cardiology ST1-2
Cardiothoracic ST3-5
H_at_N St. Thomas Hospital (800)The acute site
Evelina Childrens PNP Paed ST3-5 Paed ST1-2
Paed AE ST1-2
North Wing SNP 3 FY1/ PA Periop 2 Anaesthetic
ST3-5 ICU 1 ST3-5, 2 Yr 1-2 Obstetrics 2 ST 3-7,
Yr 1-2, 1 anaesthetist ST3-5 Neonates 1 ST 3-5,
Yr 1-2
Acute Team Covers all areas SNP 1 (Beds) Medicine
ST3-5 ST1-2 Surgery ST3-5 ST1-2 Ortho /
Plastics ST1-2
99
H_at_N at Guys Hospital (330)The elective site
SNP 4 Surgical ST 1-2 Renal ST 1-2 Oncology/
Haem ST 1-2 Anaesthetic ST3-5 GCCU ST3-5
Surgery Urology Orthopaedics ENT Thoracics Breast
100
In-patient Services at Guys
  • ENT / Head and Neck / Maxillo-facial surgery
  • Thoracic surgery
  • Urology
  • Elective Orthopaedics
  • Elective Plastic surgery
  • Breast surgery
  • Oncology
  • Haematology including Bone Marrow transplantation
  • Renal services
  • Transplantation (kidney / bowel / pancreas)
  • Guys Critical Care Unit (GCCU)

Single Rota
101
Model based on
  • Handover x2 per day
  • Referral of unwell adults (based on PAR score) to
    SNP
  • SATTs assess, treat /or refer
  • Priority status 1-5 review
  • Clinical management pathways
  • Only SNP can call Doctors
  • Led by Senior Nurse Practitioners

102
Site Nurse Practitioner Skills
  • Clinical Skill set
  • Core clinical skills
  • Prescribing
  • Airway management
  • Cardiac arrest
  • Specialty skills
  • Managerial Skill set
  • Site management escalate to Exec. Director
  • Bed management
  • Clinical co-ordination
  • Hospital coordination
  • Leadership

103
Referral by specialty
Activity
104
Referral
105
Total Calls Received by Time of Day (GUYS 2009)
50
Dec
Jan
40
Feb
30
No. of
Referrals
20
10
0
0800
1000
1200
1400
1600
1800
2000
2200
0000
0200
0400
0600
Time
106
HSMR Data 2003-2008
H_at_N
H_at_DN
107
PMETB
Training National survey 2008
108
Finances
  • 2004 PCT uplift 1.5m 7 Doctors, 8 SNPs, 3
    Physios
  • Savings from Bandings 6 Specialist nurses, 12
    Phlebotomists
  • 2009 PCT uplift 1m 7 Doctors, 5 SNPs, 8 CAPs
  • Savings from bandings 3 Specialist nurses, 12
    Physiotherapists

If we had made all the rotas compliant with
doctors the cost would have been 5.5m in
2004 1.5m in 2009
Net recurrent saving 4.5m
109
Summary
Changes necessary to achieve EWTD can Improve
the quality of care for all patients Improve
patient safety through robust systems based on
prioritisation and competency
THROUGH
  • Multi-professional coordinated teams that
  • Promote patient safety
  • Maintain training and supervision of doctors in
    training
  • Provide clinical career opportunities for
    non-doctor grades

110
RCoA Overseas Doctors Training SchemeRichard
BryantThe Royal College of Anaesthetists
111
RCoA assistance and suggestions for the provision
of junior doctors
  • Richard Bryant
  • RCoA Training Examinations Director

112
Aims of the Overseas Doctors Training Scheme
(ODTS)
  • Assist doctors from overseas to gain GMC
  • Registration
  • Qualified from outside the UK/EEA
  • Proven ability in anaesthesia
  • Limited period of specialised training in the UK
  • GMC registration - PLAB exemption

113
Current RCoA criteria for ODTS sponsorship
  • Working / worked within last 6 months outside the
    EU
  • Minimum 3 years training in anaesthesia
  • 2 structured references from supervising
    consultants
  • Offer of a training post prospectively approved
    by the BJA (O)

114
Criteria for ODTS posts
  • Dept should have the training capacity (ratio of
    Consultants to Trainees should be 11)
  • Ideally18-24 months
  • Specific aims and objectives
  • Same training and supervision as other trainees
    on rotation in the hospital e.g.
  • DOPS, Anaes-CEX, CbD, MSF
  • Average of 3 attached lists per week
  • 6 monthly confirmation of achieving the set
    standards / goals
  • The trainee will have an ARCP-like appraisal at
    the end of 12 months
  • All of the above to be confirmed by the local CT/
    RA.

115
Eligibility for FRCA Examinations
  • Sponsored under ODTS - subject to some
    restrictions, are eligible to sit FRCA exams
  • Overseas doctors not requiring ODTS (i.e. PLAB
    exemption) - post must have been prospectively
    approved by BJA (O) before commencing. Must
    therefore submit an ODTS application
  • Further details available in the exams
    regulations, http//www.rcoa.ac.uk/index.asp?PageI
    D1158

116
Medical Training Initiative (MTI)
  • Enable International Medical Graduates (IMG) to
    experience UK training
  • Maximum 24 months
  • Training capacity not required for UK/EEA
    trainees
  • Posts to be approved by Deaneries Royal
    Colleges
  • Tier 5 UK immigration visa regulations

117
MTI - How does it work?
  • Role of the Postgraduate Deaneries
  • Consult with Speciality Trainers
  • Level of training capacity in the region
  • Annual
  • Posts to be approved by the Deaneries

118
MTI - How does it work?
  • Role of the Royal Colleges
  • Set standards of practice for entry to MTI posts
  • Identify potential appointees
  • Route into MTI for overseas doctors
    Professional Sponsorship
  • Sponsor PLAB exemption for GMC if necessary

119
MTI - How does it work?
  • Role of NHS Professionals
  • National scheme sponsor
  • Issue certificates of sponsorship for Tier 5
    visas

120
MTI How does it work?
  • Joint approach between
  • Postgraduate Deaneries
  • Royal Colleges
  • NHS Professionals
  • Support from DoH
  • Role of NHS Trusts

121
Tier 2 appointments
  • Appointments made solely or primarily to meet
    service needs
  • Grants Work Permits to doctors appointed to
    service posts which cant be filled by EU
    nationals
  • May still need GMC registration but because
    filling service posts, they will not be eligible
    to apply for PLAB exemption via ODTS, UNLESS the
    hospital can satisfy the BJA (O) the post meets
    the ODTS criteria

122
Further information
  • odts_at_rcoa.ac.uk
  • NHS Professionals Medical Training Initiative
    Guide
  • www.nhsprofessionals.nhs.uk
  • mti_at_nhsprofessionals.nhs.uk
  • http//www.ukba.homeoffice.gov.uk/

123
  • Thank you

124
Launching the MTI guide Tim LundSkills for
Health
125
Medical Training Initiative
  • Moving on Post EWTD Implementation
  • 8 October 2009
  • Tim Lund
  • Skills for Health Workforce Projects Team

126
Policy Context for MTI
  • NHS policy of self-sufficiency in our workforce.
    Doubled no. of graduates from UK medical schools.
  • Consultation results on international medical
    graduates supported the policy of
    self-sufficiency and the MTI
  • Self-sufficiency should not get in the way of
    supporting the international exchange of clinical
    expertise
  • Cant rely on lots more doctors. Smarter
    solutions e.g. Working Time Directive pilots
    programme

127
The MTI in Summary
  • Designed for overseas doctors to undertake up to
    two years training in the UK
  • Operates under Tier 5 of UK Borders Agencys
    Points Based System, Government Authorised
    Exchange
  • Supported by stakeholders including a number of
    Royal Colleges, Deaneries, NHS Employers, NHS
    Professionals
  • Up to two years of training at present. Academy
    leading efforts to extend maximum period
  • Efforts to increase number of MTI doctors to 750

128
MTI Roles/Sponsorship in Summary
  • Employers identify spare training capacity with
    Deanery and employ doctors on agreed terms
    conditions
  • Deanery ensure appropriate training capacity and
    quality is available (without detriment to UK
    medical graduates)
  • Candidate doctors express an interest and seek to
    meet eligibility standards ensure immigration
    papers are in order
  • Locate eligible candidates assess them against
    College criteria/standards work with deaneries
    to match MTI the doctors with placements or
    provide own sponsor scheme
  • NHS Professionals are administrative sponsors for
    the MTI

129
Do we need a guide? Recruitment myths

We said there would be a medical workforce
crisis
The MTI solution involves too much paperwork
  • Tap hasnt been turned off to international
    recruitment
  • Need to demonstrate how the MTI is working well
    in practice

130
Benefits of Medical Training Initiative
  • Win-Win increased NHS medical capacity and
    doctor returns to home country with better skills
    and experience
  • David Grantham Head of Programmes at NHS
    Employers, says the MTI will support
    international development through the sharing of
    knowledge, experience and best practice and
    strengthen reciprocal links
  • Robust QA involving Colleges, Deaneries and
    employers etc
  • Training motivational for trainers as well as
    trainees
  • Very flexible scheme compatible with
    self-sufficiency policy

131
Help Avoid Workforce Planning Feast or Famine
132
MTI Guide Content
  • Articles and case studies feature MTI doctors,
    the Royal Colleges, NHS Employers and services
  • Top tips and flowcharts help employers and
    candidate doctors through the MTI process
  • Summaries of the MTI /international sponsorship
    schemes signpost readers to contact details for
    College leads
  • Flyers and a MTI Calling Time article have been
    published
  • See our portal www.healthcareworkforce.nhs.uk
    for MTI guide by end of the month

133
MTI Flyers and Calling Time
134
In Conclusion
  • The MTI offers flexibility for employers and
    improved skills and experience for doctors to
    return home with
  • The scheme is already working in many hospitals
    and there is plenty of scope for expansion
  • Time to hear about practical and ethical examples
    from the Royal College of Physicians and Obs
    Gynae leads
  • tim.lund_at_skillsforhealth.org.uk
  • Tel  0161 266 2137
  • Mob 07771 371 918

135
MTI RCP London Matt Foster Naa NoiRoyal
College of Physicians
136
International Medical Graduates and the MTI
  • Matthew Foster
  • Head of International Affairs

137
  • Sponsoring doctors for GMC registration for over
    25 years
  • Numbers increasing following introduction of the
    MTI visa
  • MTI offers opportunity to strengthen
    international relationships

138
  • Valuable training
  • Sharing knowledge
  • Promoting international collaboration and
    dialogue
  • Supporting training in health systems overseas
  • Promoting the NHS

139
3 Schemes
  • International Sponsorship Scheme
  • Clinical Placements Initiative
  • Medical Training Initiative

140
ISS
  • Facilitates GMC registration
  • RCP not involved in placement
  • Funding usually comes from outside of the NHS

141
Clinical Placements Initiative
  • Facilitates GMC registration
  • RCP identifies spare training capacity
  • RCP works with partner organisations overseas on
    selection
  • Overseas organisation funds scholarship

142
Medical Training Initiative
  • Aims to match IMGs to paid NHS International
    Training Fellowships
  • RCP has partners overseas who will assist in
    identifying suitable candidates
  • Posts must be identified well in advance cannot
    be used to fill locums at short notice
  • Posts must provide an appropriate educational and
    training experience

143
Selection
  • Partner institution draws up short-list
  • RCP representative sits on interview panel
  • Selected candidates matched to posts
  • Host/supervising consultant

144
Criteria for applicants
  • Includes
  • Appropriate postgraduate qualification
  • 3 years minimum postgraduate experience
  • IELTS
  • References from Fellows of the RCP

145
Criteria for post
  • Approved/supported by Deanery
  • Educational approval/support from Regional
    Specialty Advisor or Specialty Advisory
    Committee
  • ST3

146
  • Cannot sponsor
  • service only posts must have educational
    content
  • Short term locums doctors should be coming for
    1 to 2 years
  • Research elements of postgraduate degrees

147
Applications panel
  • Assess applications against set of core
    competencies
  • Clinical skills
  • communication skills
  • interpersonal skills
  • Review references
  • Assess the post (job description and timetable)
    to ensure
  • Training is appropriate to the candidate
  • Post contains appropriate educational content

148
Immigration
  • UK now has Managed Migration System
  • Tier 5 Short term training
  • Overarching national visa sponsor NHS
    Professionals

149
Paperwork
  • Posts need to be identified in advance
  • There is some paperwork involved!
  • Easier second time around, once process set up

150
In summary
  • Been a difficult few years for IMGs in UK
  • Situation improving
  • Relationships take time to build
  • The MTI can be of benefit to the NHS and IMGs,
    but lead in time needed.

151
Before end of 2009
  • RCP will be visiting each region to meet
    stakeholders.
  • Work through how the MTI can work for you
  • Guidance on process.

152
Contact details international_at_rcplondon.ac.uk0
20 3075 1304www.rcplondon.ac.uk/international
153
MTI RCOG Dr Su ChariRCOG, Morcambe Bay
154
RCOG OVERSEAS TRAINING SCHEME
  • INNOVATIVE SOLUTION OR
  • The Lancaster experience
  • SU CHARI
  • RLI

155
Brief Background
  • RCOG had run the IDTF scheme for many years with
    success
  • IMGs come for 2 years
  • GMC Limited registration
  • Attachments - SHO for 6 months or SpR for 18
    months
  • Rarely did not make the SpR grade
  • 70 pass MRCOG approx
  • Many IMGs have successfully applied for the
    training programme through NTNs and settled in
    the UK
  • Others have returned to their own country or
    emigrated

156
Strengths of the scheme
  • High calibre of doctors
  • Usually from countries with historical
    connections with the UK
  • Arranged via Overseas rep committee
  • Access to selected Deanery training posts
  • Planned programme of training
  • Tailored to individual (sometime country) needs
  • Appraisal at RITA and Sponsorship officer

157
2007 changes
  • Concern about brain drain
  • gt1000 increase in medical school places
  • Expansion of EU membership states
  • Introduction of Foundation programme and run
    through grade
  • Sudden withdrawal of permit free training-after
    limited consultation
  • EWTD, reducing working hours, increased
    feminisation of specialty

158
Subsequent Immigration changes
  • 29/6/08- several former immigration categories
    closed
  • HSMP- closed and changed to Tier 1 (currently
    closed temporarily)
  • New Tier 2 for skilled workers in shortage posts
  • Tier 5 for temporary workers
  • TWES MTI remains

159
Leading to..
  • Sudden reduction in available posts for IMGs
  • Very few posts at ST12
  • RCOG ODTF programme suspended for 1 year and
    restarted in August 2008
  • Significant shortage of trainees in all
    specialties to fill in short term gaps bearing in
    mind EWTD etc

160
TWES/MTI Package.
  • To enable individuals to gain skills and
    experience or obtain specialist qualifications
  • Max 2 year stay in UK
  • No extension allowed
  • Leaves UK at the end of training
  • Repeat applications are not considered within 2
    years
  • Not counted toward CCT
  • No scope for unpaid/self funded posts
  • Cannot take up supplementary employment

161
RCOG Scheme
  • ODTF Scheme relaunched from August 2008
  • Trainees apply with
  • Part 1 MRCOG 4 years of training in OG
  • List of competencies
  • 2 structured references
  • Referees confirm competency checks
  • Interview by Chair/member of overseas
    representative committees
  • Appropriate IELTS score

162
Selection process.
  • Runs exactly like UK Deanery NTN SELECTION
    PROCESS
  • Varied and experienced selection panel- STC
    Chairs, TPDs, College tutors, Large/small DGH
    reps
  • Each part of application scored by 2 panel
    members and then scores agreed jointly
  • All marks added up and top candidates selected
  • Agreed cut off points
  • Process supervised by senior vice president

163
List of competencies.
  • LSCS
  • ERPC
  • Hysteroscopy
  • Diagnostic laparoscopy
  • Ventouse and forceps delivery
  • (LSCS for prematurity and at full dilatation)
  • (Laparoscopy for ectopic)
  • No mention of CTG interpretation or FBS

164
Checks..
  • Rigorous checks of competency list
  • Matched with Referee/Chairpersons assessment
  • Cut off point below which applicants are not
    selected
  • But applicants are not interviewed by UK
    Consultants
  • Potential for interviews during overseas trips
    but not all countries are visited and may be
    regarded as unfair/biased
  • May not really solve the problem

165
Latest changes in Feb 2009
  • New sub-category of Tier 5 titled- Govt
    Authorised Exchange (GAE) to cover MTI
  • NHS Professional National Tier 5 sponsor to
    provide certificate of sponsorship to help with
    visa application and work permit
  • MTI extended to include ST5-7 grade to include
    ATSM
  • Duration of posts range from 3 months to 2 years
  • Provision for posts where salary paid by
    overseas govt suitable for ATSM posts

166
Potential problems.
  • Selection process
  • Competency checks
  • Patient Safety Issues
  • Salary/funding of posts

167
Other issues
  • With the acute locum shortage, some urgency to
    continue with selection process
  • Anticipated high demand for and from IMGs- but
    quality of applicants and competency levels must
    be maintained together with a rigorous selection
    process
  • Salary package- imaginative
  • Quality of training offered- needs periodic check
  • Early identification of ATSM slots
  • Competency issue even more profound at ST6-7

168
Patient safety
  • Biggest concern!!!
  • Limited scope for more than 6 months experience
    at SHO level
  • Few suggestions
  • Acclimatisation for a min of 2 weeks
  • Shadowing programme similar to that for F1s
  • Mandatory structured induction programme
  • Competency assessment similar to ST3
  • ALSO/BSS courses within 2 months
  • Communication skills/ consent taking course
  • Practical skills training e.g. CTG/FBS
  • College based courses before the start of
    attachments

169
Lancaster experience.
  • Offered a post on the scheme or unfilled LAT
  • Spoke to colleagues and managers
  • Biggest challenge was to convince medical
    staffing that they had to apply for the Tier 5
    Visa and not Pennine Acute Trust
  • CRB clearance required
  • Hospital accommodation
  • Post has been filled since the 20th of August

170
Strengths
  • Speciality training post filled by a trainee
  • Good quality of trainees likely
  • Well motivated
  • Preliminary assessments done with regards to
    competence levels
  • By and large in view of language test
    requirement, language not a problem

171
Weaknesses.
  • UNKNOWN QUANTITY..
  • Needs to go though SHO job and then Registrar
    training
  • Variable quality of assessors
  • Variable competency levels
  • Needs time to settle into a new home and work
    place environment
  • Variable rates of learning

172
Opportunities
  • Learning opportunity for both parties
  • Can acquire new skills through ATSM
  • Can acquire a new qualification
  • Building relationships
  • Positive effect on the unit and institution long
    term
  • Agreed in region if required paperwork can be
    given to appointees

173
Threats..
  • Funding
  • MONEY!!!!!
  • Being paid as a Registrar when they are
    supernumerary
  • Need locums at additional costs as the registrar
    slot has to be covered
  • Possibly a stipendiary period with free
    accommodation
  • Close watch to identify gaps- gap management at
    deanery level with RCOG liaison or the slot may
    be lost for this kind of opportunity

174
Overall..
  • Usually College backed schemes are good
  • Teething problems
  • We will get better at putting things together
    quickly
  • Hopefully the applicants will achieve their
    training objectives in the time given
  • Rewarding for the trainee and the unit as in this
    Deanery it has been agreed that they stay in the
    same unit
  • Long term benefit to the country of origin

175
Acknowledgements.
  • Mani DAS
  • Andy Watson
  • RCOG Overseas Office and personnel

176
Thinking Hats with Mona Stokes
177
Thinking Hats
  • The main difficulty in thinking is confusion!
  • We try to do too much at once. Emotions,
    information, logic, hope and creativity all crowd
    in on us.
  • De Bono

178
(No Transcript)
179
Key Questions
  • 3 key questions..
  • What do you need to know?
  • How do you take this forward?
  • Where do we go from here?
About PowerShow.com