Foundation School - Emergency Medicine F2 Level 2 Visit Review

Chair Miss Georgia Jones (Head of Peninsula Foundation Programme)
Level 2 Visit Date Wednesday 24th May 2017
Trust under review Royal Cornwall Hospitals NHS Trust

School/Programme/department under review

Foundation (Emergency Medicine)
Grade of trainees under review F2
Reason(s) for review

A follow up on the meeting held on Tuesday 24th January 2017

Visiting team

Miss Georgia Jones (Head of Peninsula Foundation Programme)

Dr Jeremy Langton (Deputy Postgraduate Dean)

Mrs Sophie Rose (Quality and Information Coordinator - note taker)

Trust team

Mr Karl Westgarth (Rota Manager)

Dr Toby Slade (Clinical Director)

Dr Jenny Ferrant (Emergency Medicine Consultant)

Dr Anna Shekhdar (Emergency Medicine Consultant)

Quality Register Item no. (s)  

 

This was a follow up meeting from the Level 2 review meeting held on Tuesday 24th January 2017. The meeting was held as a teleconference. The panel reviewed actions that had been taken in response to the educational requirements and recommendations outlined in the review report.

 

Educational Requirements and Recommendations

F2 EM – Rota

The department had changed the rota for the April post and has planned further changes for the August start. 

 

The Trust advised that the following changes have been put in place:

  1. For April, the average working week has been reduced from 47:20 hours to 44:30. It will reduce to 43:20 in August. This change will rely on the appointment of a trust grade doctor (advert out).  Currently the additional duties are being covered by a locum.
  2. The number of non-rostered days has been increased in the August rota, from 28 to 36 in 16 weeks.
  3. The department considered lengthening shifts to create more days off but concluded that a ten hour shift in ED was long enough. There is one “training” shift of 12 hours in 16 weeks, which has allows the trainee to be able to attend F2 and departmental teaching.
  4. The department hasn’t managed to incorporate more of a “step-wise” progression into night duties but it is hoped that a more set pattern of duties and additional time off will help to mitigate the negative effects of alternating night/day duties.
  5. Training commitments are now visible on the rota – there is a specific 1300-1700 Wednesday shift which allows the trainee to attend F2 and departmental teaching. Departmental teaching has been moved to the Wednesday afternoon which has increased attendance.
  6. The 1600-0200 shift has been changed to 1500-0100. The earlier finish has been welcomed. From August, there will be two people on rather than one which will help with workload management.

 

We discussed the two weeks fixed/proposed leave highlighted in the August rota and its status in the light of the new contract.  Karl explained that, while this looks like fixed leave, trainees are contacted before the post to choose their slot so that their leave requests can be accommodated. There have been no difficulties managing this so far.

 

Staggered starts and teaching attendance

The department has changed the 1345 start time to 1300 so that the F2 trainees can attend generic teaching. Specific attention has been given to rostering so that training can be attended. F2s should now be able to attend 69% of teaching, so no need to schedule additional study time.

 

Liaison with rota manager in Plymouth Hospitals

Karl is yet to contact the PHNT rota manager, however has set up a ‘rota group’ within the Trust where they have been sharing some ideas and good practice. He said that the next step would be to extend this group regionally.

 

Induction

Anna ran the recent induction which included handover times, details of the restructured rota, expectations of teaching attendance, roles and responsibilities of junior doctors and a tour of the clinical areas and procedures room where more clarity was provided on consent to practice. Study leave applications were encouraged at induction and also in the ED handbook.

 

Safeguarding protocol for late finishes

The department has clarified that anyone working for the trust on a late shift who lives more than an hour away can book a free room. Any staff member finishing after 10pm can call security to be walked to their car. From August, there will be 2 staff finishing at 1am who can leave together. This information is covered in induction and will be on the induction tab of the website page from August.

 

Handover Protocol

Full board handovers take place at 8am and 5pm with the Band 7 senior nurse. It has proved too difficult to free up all nursing staff to attend. The Band 7 nurse is also involved in 1pm and 10pm “huddles” which are focus on brief safety messages. A check on staff breaks is included at handover. There is a handover checklist which is filed.  Trust to send checklist to Georgia.

 

Educational Faculty

The Trust has identified its Educational Faculty (Rob Taylor, College Tutor; Jonathon Wyatt, Medical Students; Anna Shekhdar, in-house teaching/training; Sian Ireland, ACCS/Paeds), which they believe has already had a significant impact on the training environment. They shared evidence of its productivity:

 

Link to Twitter page - https://twitter.com/CornwallEMEd which already has 100 followers.

 

A registrar within the Emergency Department has also set up an app-enabled website which the Twitter page feeds into.  Link to website - https://www.cornwallem.com/

 

Other updates

The Quality team is yet to receive the GMC survey results, however were able to advise that no patient safety or bullying and undermining concerns have been raised within the Emergency Department at RCHT.

 

The Foundation team will complete an End of Post survey for the April changeover shortly and provide feedback. Most changes to the rota will happen in August; therefore the next end of post survey should provide a better evaluation and the Quality Panel review in the Autumn should capture the impact of the changes made.

 

The RCHT panellists said that they had found the review very helpful and were pleased to have had the visit as it had given them opportunities to make changes.

 

Peninsula PGME panellists thanked the team for the changes they had made. The department should be commended for the energy and hard work they have put into their response and we hope this is reflected in the trainees’ improved experience and feedback.

 

 

Signed off by Georgia Jones

08/06/17