Learner / Educator Meeting to discuss progress of action plan following the Triggered Visit to review CST posts at University Hospitals Plymouth NHS Trust (December 2017)

 

9th October 2018

Visiting Team:

Dr Martin Davis (Chair), Associate Dean for Quality, HEE-SW

Ms Jane Bunce, Quality Manager, HEE-SW

Mr Eng Ong, TPD

Ms Esther McLarty, Head of School for Surgery

 

Trust attendance:

Will Chambers

William Thomas

Chris Mulgrew

Bex Snell

Angela Cottrell

Polly Budden

 

Further to a Triggered Review in December 2017, of the Core Surgical Training (CST) Programme at the Royal Devon & Exeter NHS Foundation Trust (RD&E), a supportive follow-up review meeting was held on 9th October 2018 to assess progress against actions.

The original review took place in response to concerns raised about a number of placements in the Core Surgical Training Programme running within the Peninsula footprint, including the RD&E.  The concerns were raised through the quality panel outcomes and individual trainee issues raised with the TPD. The concerns were primarily focussed around insufficient access to training opportunities to allow satisfactory progression of trainees.

Actions agreed following the December 2017 review were:

I. A potential patient safety issue was raised by trainees that patients can leave theatre without their drug chart having been written up.  Trust to put plans in place to address urgently.

II. To ensure trainees are exposed to a wider case mix.  Ensure progression of trainee’s competence in line with their PDP. This post is unsuitable for a 6 month CST placement with the current case mix. If this cannot be rectified then the trainees will need to be rotated to other general surgical subspecialties.

III. CSTs should only have to cover Foundation doctors duties when the situation is unavoidable e.g. sickness. Ensure adequate provision of Allied Healthcare Professionals to cover service commitment

IV. Detailed work schedules (timetables) for all CST to be produced that are consistent with CST Quality Indicators.  If trainees are not able to get to assigned theatre sessions etc. trainees should exception report and a subsequent discussion held between the trainee and their educational supervisor to identify alternate training sessions.

V. All AESs should maintain a regular review of a trainee’s progression against their PDP and if this is failing a remedial package put in place and the issue raised with the college tutor. College Tutors are expected to maintain oversight of Core Surgical trainees progress towards completing their global objectives and raise concerns with trainees, trainers and the TPD so issues are resolved prior to ARCP.

VI. The rotas for CST both in T&O and General Surgery presented in the Trust’s review of CST need implementation with the addition of detailed work schedules that conform to the CST Quality Indicators. Clarity is required about when annual and study leave can be taken and how this affect overall exposure to consultant led training sessions.

VII. Recognise the need to look at alternative workforce models to substitute for gaps in doctor rotas and that this needs to be followed through to ensure a sustainable, effective and achievable action plan is in place. 

VIII. All departments need to ensure adequate time and opportunity is available to allow CST QI’s to be met and the required Work Place Based Assessments to be completed (particularly Consultant validated WBA’s)

 

 

  • 1.1       CST – T&O

 

William Thomas presented a summary of actions put in place since the Triggered Review.

  • It was confirmed that work schedules are now in place which meet the JCST requirements
  • Elective theatre opportunities are timetabled
  • Trainees virtually removed from service roles
  • A T&O peri-operative team are in place, addressing previous patient safety concerns
    • Supported by medical director
    • Protocol driven
    • Multi-disciplinary team
    • Good for patients and trainees
    • Continuity of care better
  • By August 2019 the intention is to have recruited an extra person on the rota.  At the time of the meeting, a short list of candidates had been completed
  • No study leave requests have been declined since August 2018
  • CTs released from on call duties to attend Regional teaching

ACTION: Work schedule for CSTs should include clinic time.  Schedule to be provided to EM / MD/ JB.

Ongoing work is in progress to look at weekend on call frequency, WBA evidence and improved case mix.

 

  1. 2.       CST – General Surgery

Will Chambers presented a summary of actions put in place since the Triggered Review.

  • Rota redesign to balance emergency and elective work, and leave
  • Improved timetabling of training opportunities and planned meetings
  • Regular consultant ward rounds
  • Doctors whiteboard
  • Freed up from covering F1s
  • Support from nursing, pharmacy and secretarial staff – e.g nurse practitioner is fielding calls with aim of freeing up trainee time when on-call
  • Increasing consultant led teaching
  • Increase in GI consultant numbers
  • Urology – opportunity to attend consultant led ward round every day
  • Trainees encouraged to attend Tiverton Hospital

Action: Cluster Manager, PB to send through last couple of months of General Surgery work schedule to EM / MD / JB

 

Actions that remain outstanding include

  • To move the upper GI post to lower GI whilst allowing access to upper GI lists to ensure case mix
  • SCP in upper GI to assist in theatre
  • Improve oversight of trainees by AES and CT
  • To continue to look at reducing intensity of on call
  • Daily consultant ward round from April 2019
  • 6 PAs joining Trust 2019; 8 PAs 2020; clinical practitioners also being considered
  • Working on recruitment plans – 2 years in advance, links to university, split posts across different specialties to attract trainees

 

Jane Bunce / Martin Davis

Quality Manager / Head of Quality

November 2018