Learner / Educator Meeting to discuss progress of action plan following the Triggered Visit to review Foundation Surgical posts at Royal Cornwall Hospitals NHS Trust (November 2017)
24th July 2018
Dr Martin Davis (Chair), Associate Dean for Quality, HEE-SW
Ms Jane Bunce, Quality Manager, HEE-SW
Mrs Sophie Rose, Quality Support Administrator, HEE-SW
Mrs Johanna Gilbert, Senior Manager Medical Education, RCHT
Mr Mike Clarke, College Tutor, RCHT
Katja Adie, F1 Programme Director, RCHT
A review of the Foundation surgical programme at Royal Cornwall Hospitals NHS Trust was instigated in response to concerns raised by trainees through the 2017 GMC National Training Survey (NTS) and 2016 Quality Panel process. A Triggered Visit to investigate concerns took place at the Trust on 16th November 2017 and the report published following the visit can be found on the HEE-SW website.
Requirements following the visit included:
- Clarify how trainees should access senior support
- Improve communication of rotas
- Allow trainees more flexibility around annual leave
- Improve consistency in how The Lounge is managed
- Embed a culture of learning within the department
- Raise the issue of unacceptable behaviour, by a minority of senior staff, within a senior staff departmental forum
A Learner/Educator meeting took place on Tuesday 24th July 2018 to review progress against the above action plan.
Update on action plan
- 1. Clarity on how trainees should access senior support
It was agreed that it is hard to judge if this situation has improved as the current trainees in post are more experienced than those who raised the original concerns and who had only just started their programme at the time. It was confirmed that consultants ask trainees to phone them if they are uncertain about something. There is a commitment to include this during induction to ensure it is clear.
- 2. Communication of rotas and
- 3. Allow more flexibility around annual leave
It was confirmed that rotas are distributed earlier in line with the Code of Practice and communication was reported as being better. Fixed leave is still allocated but swaps can be proposed and the trainee representative present was not aware at the time of any swaps being turned down. The rota is being circulated before trainees move in to post and they are asked to let the rota office know if they need any specific leave allocation. This is accommodated where possible. The original rota coordinator has left this post since the Triggered Visit took place.
- 4. Improve consistency in how The Lounge is managed
The department has been trying to improve the flow through The Lounge and are trying to get there at lunchtime. All consultants have been reminded that it is their responsibility to get there as frequently as possible. If they do not attend, nursing staff report it. Constant consultant cover for The Lounge has been investigated but it hasn’t been possible to fit this within the job plan and they would have to lose elective clinics to accommodate it.
It was confirmed that this is a good learning experience for F1s and is recognised by them as such.
Steps are being taken to train nursing staff in cannulation and bloods which would help ease pressure on the department. Ultimately MC would like a nurse specialist on every firm and the intention is to train them for a variety of ward jobs and to also assist in theatre. It is hoped that this will help with workload, which is very busy at all levels, thus easing pressure on a very busy department.
ACTION: JB/MD to put nurse specialists on the agenda for this year’s SLV with the Trust to help gain Executive support for funding.
- 5. Embed a culture of learning within the department
Departmental teaching is about to commence and will take place between 8 – 9am before the ward round. Consultants will present a topic and trainees will have the opportunity to do a Case Based Discussion (CbD). KA to include at induction to reinforce the requirement for trainees to attend.
- 6. Unacceptable behaviour by a minority of senior staff
A consultant away day was held to discussed the Triggered Review report and trainee feedback on individuals was shared at this event. No individuals within the department have been named by trainees in this respect and therefore no further action can be taken.
2018 GMC NTS results
Feedback for F2 trainees has improved and feedback at ARCP was also reportedly very positive. Supportive Environment for F1 trainees is still of concern. It is felt that this may relate to the lack of physical presence of the consultants on the ward.
ACTION: Quality Team to share detailed question outcomes for Overall Satisfaction for F1s in the 2018 GMC NTS (appendix 1).
The trainee representative made the suggestion that time is given at handover for trainees to voice any ongoing concerns so that consultants have the opportunity to rectify any quick fixes. It was recognised that the physical stress of the job can be wearing for trainees. The trainee also felt that it would be helpful to pinpoint some key skills Foundation trainees could get out of the placement, for example, to become an expert at catheterisation.
MC has established a Surgical Faculty group and the aim is to discuss Quality Panel and NTS results for all groups of trainees.
- Progress is being made
- Information regarding the rota is improving and flexibility is better
- HEE will support the department in terms of pushing for a skill mix on the ward through nurse specialists
- The department will continue to work on educational opportunities offered
- F1s to continue to be given the confidence that it’s acceptable to contact senior
- Formal teaching will continue to be embedded
- In order to further address any issues of undermining, specific incidents will need to be flagged