Obstetrics and Gynaecology - Level 2 visit report


Local office name: Health Education England, working across the South West

Organisation under review: Northern Devon Healthcare NHS Trust

Placements reviewed: ST1

Date of Review: 11th September 2019



Reason for Review

To review placement of 1 or 2 ST1’s in O&G in NDDH. Investigate Tier 2 staffing as requested by Devon LMS Chair

No. of Learners met


No. of Supervisors/Mentors met


Other Staff members met


Duration of review


Intelligence sources seen prior to review

Previous review in 2017



Name Job Title
Miss Susie Bates CHAIR Head of Quality, HEE (Chair)
Mr Ben Peyton-Jones GP Associate Dean, HEE-SW



A Quality Review was conducted at North Devon District Hospital (NDDH) by the School of Obstetrics & Gynaecology (O&G) in September 2019.  The intention was to review the learning environment for trainee doctors and consider whether it would be appropriate to introduce a second trainee doctor (ST1) to the department in addition to the current ST1 post that is supported.  On request of the LMS Chair the panel also had the remit to investigate Tier 2 staffing.

The panel noted that efforts to improve patient safety at NDDH were evident although it was also recognised that there is still further progress needed.  The atmosphere within the department is reportedly more educational than it was, but still variable depending on which senior doctors are on duty.  Doubt remains as to whether there is enough clinical opportunity within the department if two specialty trainees were to be allocated to NDDH.

The conclusion following the visit is that 1 ST1 post will remain allocated to NDDH in the O&G rotation from October 2020.  The department are advised to develop its training offer through MTI doctors or similar so that it can demonstrate effective delivery of training at such a time as it becomes feasible to allocate an additional trainee.



Outcome report completed by (name) Miss S Bates
Chair's signature  
Date signed 23/10/19
HEE authorised signature Dr Martin Davis 
Date signed 13/11/19
Date submitted to organisation 13/11/19



Job title Name
Interim Care Group Director Neil Liversedge Consultant in O&G
Care Group manager NDDH Neil Schofield 
RCOG Clinical Tutor Dr Eleni Lekoudis Consultant in O&G


Risk Scores

Scores prior to review 2 x 3 = 6
Proposed scores following review 2 x 3 = 6



Any concerns listed will be monitored by the organisation. It is the organisation's responsibility to investigate/resolve.

Were any patient/learner safety concerns raised at this review?  NO



Were any requirements to improve education identified?  NO



Related Domain(s) & Standard(s) 1, 2, 3 & 5
Summary of findings

NDDH has not trained doctors above ST1 since 2011/12 (ST2), so it would be useful for the department to devise and then offer training opportunities initially to doctors outside the training programme, e.g. MTI doctors or similar.  Currently there is some doubt as to whether NDDH can offer the clinical environment through which trainees can gain required competences.  


NDDH should attract MTI doctors and appoint Trust doctors with more flexible contracts who will run an 1 in 8 rota with prospective cover.



There is no doubt the efforts to improve patient safety at NDDH are effecting change. The HR work undertaken by the consultants/midwives, the new appointments and the plans for future changes in the middle grade are all appropriate and have made a considerable difference. It is described as a ‘work in progress’ by the management team and there is some way to go, particularly in the middle grade.


ST1 post

There is a strong view that the atmosphere is becoming more educational but that this is still variable depending on which senior doctors are on duty. The current ST1 (as well as predecessors) does not believe there is enough opportunity to gain clinical experience if two specialty trainees were in post concurrently.


Tier 2 (‘the Middle grade’)

The team at NDDH are keen to attract specialty trainees in order to stimulate the educational environment. It remains a quiet unit, particularly on the obstetric side, and whilst some trainees may benefit from ‘time to study for exams’ or ‘gain elective surgical experience’, overall the training programme of 7 years is considered short and most trainees will go on to practise obstetrics which means they need to gain valuable experience in their training years. There is concern that 12 months in NDDH would be detrimental to gaining obstetric experience. Other training may be available and perhaps doctors at RD&E could be allocated week day sessions for particular experience.


NDDH has not trained doctors above ST1 since 2011/12, so it would be useful for the department perhaps to devise and then offer training opportunities initially to doctors outside the training programme; eg MTI doctors or similar. The RCOG would need to approve a programme and then NDDH could demonstrate that it can effectively deliver training. This would provide some reassurance to the School Board but also to the trainees themselves who might otherwise remain sceptical.



Date of report: 13th November 2019

HEE authorised signature: Dr Martin Davis

Job Title: Head of Quality