Broadening the Foundation Programme Workshop

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Broadening the Foundation Programme Workshop

• Jan Welch
• Director, South Thames
• Foundation School

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Aims for the morning

• Current understanding of Broadening
• Local actions
• Sharing good practice
• How can we help?

• Current understanding of Broadening
• Local actions
• Sharing good practice
• How can we help?

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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

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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
•  

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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.

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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.

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What is a clinical supervisor?

• A registered and licensed medical practitioner,
  responsible for overseeing a foundation doctors
  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

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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

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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

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Where can newcommunity 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)

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What activities can FDs carry out in
community placements?

• Sections of Foundation Doctor Curriculum 2012/14
• 1 Professionalism (p17-19)
• 2 Relationship and communication with patients
  (p20-22)
• 4 Ethical and legal issues (p25-26)
• 7 Good clinical Care (p30-37)
• 8 Recognition and management of the acutely ill
  patient (p40-41)
• 10 Patients with long-term conditions (p44-47)

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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
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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/Safety20of20foundation20do
  ctors20Final20-20February202014.pdf

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Covering the workload

• 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

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Fewer FDs roles providing support

• Many common FD activities are unnecessary for
  their training, eg
• 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

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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

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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

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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

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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

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Any questions?