HEE Training Programme Director Handbook

Introduction

We hope that you find this Training Programme Director (TPD) Handbook useful, either as a newly appointed TPD or as someone who has been in the role for a number of years. It contains links to documents and websites which cover the remit of work which you will be involved in with all the staff members in the PGME Team.

HEE provides leadership for the education and training system and ensures that the workforce has the right skills, behaviours and training to support the delivery of excellent healthcare and drive improvements through supporting healthcare providers and clinicians to take greater responsibility for planning and commissioning education and training.

As a TPD your role is to work with and support the Head of School in leading the delivery of a wide range of functions, aligned to the HEE mandate. You are professionally and managerially accountable to the Head of School, who in turn is accountable to the Deputy Postgraduate Dean(s).

You will focus upon the improvement of learner supervision, assessment and experience, engagement of faculty and ensure effective educational outcomes, both now and in the future. As you will know change is constant in the NHS and your role will also evolve to focus on workforce transformation and develop multi-professional links. To keep abreast of developments within HEE TPDs are required to attend TPD Development days throughout the year.

To support the Regional Postgraduate Dean, TPD’s will work across the spectrum of health and where relevant, social care, within the context of a team, so that the provision of education reflects changing service models. This will deliver an integrated workforce comprising individuals from a spectrum of professional and other backgrounds.

You will work closely with the Education Programme Manager and Heads of School

The Education Programme Manager who is supported by their administrator will need your help on:

  • managing the recruitment of doctors in training (including calculating vacancies, website information).
  • managing the assessment (ARCP/) process for doctors in training
  • Planning rotations: submitting rotation grids which account for all doctors in training including those who are on statutory leave; OOP, new starters, etc.

Key areas of the TPD Role include:

  • Ensuring that the curriculum can be delivered within the local training programme; and that all posts are in line with this
  • Developing a network of educational supervisors who need to be trained in the necessary tools for supervising and assessing doctors in training. Ensuring our trainers are trained and able to undertake their role is of high priority to us as an organisation and for the GMC as the regulator. We use the Academy of Medical Educators Professional standards for medical, dental and veterinary educators (AoME 2014) as the criteria against which trainers in recognised roles must provide evidence of their training and accreditation and ongoing professional development. Providing careers information, guidance and advice to doctors in training and be involved in the Induction.
  • Provide support to doctors in training in their wellbeing and also be familiar with the services offered by the Professional Support and Well-being Services (PSW).
  • Supporting doctors with differing/individual training needs.
  • Ensuring that the interests of less than full time and academic doctors in training are accommodated
  • Attending regional and national meetings (potentially including School Board / STC / SAC – affiliated with colleges)
  • Potentially arranging and participate in specialty / School visits to Local Education Providers
  • Liaise closely with Health Education England staff i.e. Regional Postgraduate Deans, Deputy Postgraduate Dean(s), Heads of School, other TPDs and the Senior Leadership Team.
  • Liaise with Local Employer Trust staff for example change to rotas, training site, doctor in training absence
  • Escalation of training programme concerns to Heads of School.

 

Table of Contents

Academic
Acting Up
Annual Review of Competency Progression (ARCP)
CESR
Early Achievement of CCT
Educational Supervisors
Inter Deanery Transfers (IDTs)
Less Than Full Time Training
Managing Rotations/Programmes
Medical Training Initiative (MTI)
Out of Programme (OOP)
Period of Grace (POG)
Professional Support and Wellbeing
Relocation and Travel Expenses
Revalidation
Rotations
Study Leave
Supported Return to Training
Supporting and Escalating Concerns
Transfer of Information

 

Academic

Integrated Clinical Academic Training Lead

Responsibilities of the Specialty TPD

It is important to note that ACF and CL posts are all ‘in addition’ and this needs to be born in mind when managing rotations

  • Bids process: liaising with Academic Lead that academics can or cannot be accommodated
  • Recruitment: confirm level of grade and placement with academic lead
  • CL and ACF JDs: to check and approve these with the academic lead
  • Appointment of doctor in training and rotating them: identify placements (ACFs and CLs are both ‘in addition’) and start dates.
  • ARCPs: Academic doctor in trainings should have an academic rep on the ARCP panel

IAT PGME Lead

Categories of IATs: ACFs/CL and Locally Funded IAT posts

ACFs

  • 75% of time in specialist clinical training
  • 25% of time in research or educationalist training.

CL

  • 50% of time in specialist clinical training
  • 50% research or educationalist training.

Locally Funded IAT ACF and CL posts

NIHR will recognise locally funded posts developed by IAT partnerships providing they meet the following criteria relating to the appointment and support for doctors and/or dentists in schemes that:

  • Appoint through national competition
  • Offer 3-year ACF (4 years for GPs) and 4-year CL appointments with 25% and 50% protected academic training, respectively
  • Provide access to formal training in research methods and research governance
  • Have a joint clinical and academic Annual Review of Competence Progression (ARCP)
  • Provide similar supervision/mentorship arrangements for ACF and CL appointees
  • Offer a £1k per annum travel bursary to attend conferences.

Acting Up

Doctors in training may be able to take time out of programme to act up as a consultant and may be able to credit this time towards a CCT or CESR(CP) if there is specific provision for this in their specialty curriculum. This would normally be undertaken in the final year of training.

Doctors in training acting up as consultants will need to have appropriate supervision in place. If the experience afforded by this post is in a location already approved for training in the relevant specialty by the GMC, additional prospective approval is not required from the GMC.

If acting up as a consultant is undertaken in another location, prospective approval will only be necessary if the acting up placement is relevant to gaining the competences, knowledge, skills and behaviours required by the curriculum. In these circumstances, OOPT will normally be for a period of three months or pro rata for LTFT doctor in trainings. However, length of periods approved for acting up as a consultant may be specified in the relevant curricula and where referenced in a curriculum specific provisions around acting up roles need to be adhered to.

Acting Up Policy

Annual Review of Competency Progression (ARCP)

ARCPs should be set so that they specifically align with rotation dates, to allow enough time for planning, to get rotation grids accurate and for this information to be validated before being published to the Trusts at 12 weeks according to Code of Practice.

The Education Programme Manager will contact the TPD to help set the dates; draft timetables and provide the latest guidance.

ARCP panel

It should consist of at least three and a maximum of five panel members of which one should be the TPD, HoS or Postgraduate Dean (or their nominated deputy). Where a trainee is undertaking subspecialty training in parallel with the main specialty or where the trainee is on an integrated academic programme, the panel will include relevant specialist/ sub-specialist/ academic input.

ARCP Outcomes

Outcome 1 – achieved targets
Outcome 2 – Development of specific competencies require: targets set with no extended time
Outcome 3 – Inadequate Progress: targets set with extended training time
Outcome 4 – Released from training programme
Outcome 5 – Incomplete evidence presented – additional training time may be required
Outcome 6 – Gained all required competencies and capabilities – recommended for completion of programme
Outcome 8 – Out of Programme for clinical experience, research, or a career break

When an outcome is not issued

There are circumstances when the ARCP panel would not issue an outcome, such as when the doctor in training is absent on statutory leave (e.g. maternity/paternity/adoption or sick leave) or where training has been paused. In these cases, the panel will record the reasons for this

Force majeure outcomes

Outcome 10s are a ‘no fault’ outcome to enable progression or additional time where training has been disrupted due to a ‘force majeure’ such as a global pandemic. Outcome 10s must only be used following a directive from the UK statutory education bodies.

Outcome 10.1 – Progress is satisfactory but the acquisition of capabilities by the doctor in training has been
delayed by national emergency / force majeure disruption such as a global pandemic.

Outcome 10.2 – Progress is satisfactory but the acquisition of capabilities by the doctor in training has been
delayed by national emergency / force majeure disruption such as a global pandemic. The doctor in training is at a critical progression point in their programme and additional training time is required.

Management of Outcomes 5’s

An outcome 5 is a holding position to allow the missing evidence to be provided for the ARCP to review; that review should be no more than 8 weeks from the date of the ARCP. If an outcome 1 is likely authority can be given the chair to receive the evidence an issue an Outcome 1. If the panel considers an Outcome 2, 3 or 4 is likely the panel the panel should reconvene ‘virtually’.

Post ARCP Feedback

Post ARCP feedback should be offered to all doctors in training in a timely and supportive way that minimises the need for doctor in trainings to take protracted time away from service an removes the need for additional discussion panels to be set up. The options available to support this are: -

  • Remotely through ARCP outcome letters or via the doctor in training being directed to the eportfolio ARCP outcome section, with planned follow up and with a clear feedback discussion at the doctor in training’s base
  • Locally delivered through, for example, feedback from the educational supervisor ensuring trainers are also informed of doctor in training outcomes in a timely way
  • For outcomes other than 1 or 6 the doctor in training could meet one, or sometimes two, experienced member of the Training Committee

It is a widely expressed view that a meeting between the doctor in training and members of the panel post ARCP is greatly valued to enable discussion around career and training opportunities. Supplementary information is available on our website to support this process but it must be absolutely clear that the meeting is not mandatory (other than for an unsatisfactory outcome) and that it should take place virtually. Please note that the programme team will not provide administrative support for meetings with doctors in training on an outcome 1 or 6.

CESR-CP

The GMC issues three types of specialist or general practice certificates that confirm eligibility for entry onto the Specialist Register or General Practice (GP) Register:

  • Certificate of completion of training (CCT)
  • Certificate of eligibility for specialist registration (CESR)
  • Certificate of eligibility for general practice (CEGPR)

The Certificate of Eligibility for Specialist Registration Combined Programme CESR(CP) – Confirms that a doctor has joined an approved specialist training programme and has previously trained in other, non-approved posts, that this has already provided some of the CCT curriculum competencies. The doctor can enter training at a later starting point, complete the rest of the programme and gain the remaining competencies. This is known as the ‘combined programme’ and confirms that the doctor is eligible to apply for entry onto the Specialist Register via a CESR (CP) or to the GP Register via a CEGPR (CP). Within the UK, there’s no difference in the recognition of a CESR/CEGPR and a CCT. Both certificates allow specialist or GP registration on the same terms. Please refer to the GMC website for further information.

Early Achievement of CCT

Where a doctor in training progresses more rapidly than the expected rate of progress the completion date can be brought forwards, however, this can only occur if:

  1. The doctor in training has gained all the relevant capabilities in the curriculum
  2. The doctor in training has completed all the necessary examinations and assessments

The early achievement of CCT must be planned via the penultimate ARCP process (typically approximately 12 months before estimated CCT date) and should not be adjusted related to post-CCT job offers. Firstly the doctor in training must discuss with their Educational Supervisor and if in agreement will make a formal request to the TPD to bring forward their completion date. This will then be reviewed at ARCP and if supported the TPD will recommend to the Postgraduate Dean that the CCT is brought forward. The final decision rests with the Postgraduate Dean.

Educational Supervisors

There is a dedicated Faculty Development area with information for educators and clinical supervisors.

Inter Deanery Transfers (IDTs)

There are two IDT windows per year: February and August which are advertised on IDT page.

Process for TPDs

The Education Programme Manager will ask TPDs to confirm if they are able to accommodate any incoming IDTs into their training programme and identify posts with them. Once the national IDT team have processed the applications the Education Programme Manager will be sent spreadsheets with details who has been approved and will liaise with the TPDs regarding start dates and placement.

TPDs must not discuss specific posts with any IDT applicant wishing to apply into the South West as this can lead to misunderstandings and complaints.

Exceptional Dean to Dean Transfers

An exceptional Dean to Dean transfer is designed for very urgent moves when it felt to be needed prior to the next IDT window. The ‘rules’ are the same as for an IDT, so if a doctor in training is not eligible for an IDT, then nominally they are not eligible for the exceptional route either. There is some discretion at Regional Dean level for complex situations that may merit agreeing a transfer outside of the national windows with the decision being made between the two Deans involved.

If a TPD is considering an exceptional transfer, or a doctor in training asks for one, this should initially be discussed with the HoS. The doctor in training must not be told to contact the receiving Deanery nor should the TPD contact their opposite number to see if there is a place – this undermines the agreed process and means that the Deans cannot make a balanced decision.

The HoS will discuss the case with the Deputy Postgraduate Dean who will escalate to the Postgraduate Dean should it be felt that the situation warrants an exceptional Dean to Dean transfer.

Less Than Full Time Training (LTFT)

All doctors in training can apply for LTFT training and the Gold Guide provides a list of illustrative examples for requesting LTFT training: 

  1. Doctor in training with a disability or ill health – This may include ongoing medical procedures such as fertility treatment.
  2. Doctor in training with caring responsibilities (e.g. for children, or for an ill/disabled partner, relative or other dependant)
  3. Welfare and wellbeing – There may be reasons not directly related to disability or ill health where doctor in trainings may benefit from a reduced working pattern. This could have a beneficial effect on their health and wellbeing (e.g. reducing potential burnout).
  4. Unique opportunities – A doctor in training is offered a unique opportunity for their own personal/professional development and this will affect their ability to train full time (e.g. training for national/international sporting events, or a short-term extraordinary responsibility such as membership of a national committee or continuing medical research as a bridge to progression in integrated academic training).
  5. Religious commitment – A doctor in training has a religious commitment that involves training for a particular role and requires a specific time commitment resulting in the need to work less than full time.
  6. Non-medical development – A doctor in training is offered non-medical professional development (e.g. management courses, law courses or fine arts courses) that requires a specific time commitment resulting in the need to work less than full time.
  7. Flexibility for training and career development with the option to train less than full time with flexibility that might enable development of a broad career portfolio

All those applying due to disability or ill health and caring responsibilities (1 and 2 above) will be accommodated.

Applying for LTFT training

Requests to work LTFT can either be made at point of application for entry into training or at any time they have been accepted into training. The policy and application process is available on our website.

Requests to work LTFT must be submitted at least 16 weeks before the proposed start date for a change in working hours. This is to allow at least 12 weeks’ notice to the employer of the proposed changes.
Approval of the LTFT training plan will be subject to the agreement of the employer / host training organisation before the placement can commence.

Approval to work LTFT will normally be given for the duration of the training placement / programme but may be subject to annual review around renewal. This is likely where the reasons for requesting LTFT working are no longer applicable, i.e. a request to undertake professional development such as a management course is completed.

Where a doctor in training wishes to increase or decrease their whole time equivalent (WTE), they must make an application providing at least 16 weeks’ notice. Any decrease in working hours will be subject to the minimum requirements for recognition of training set by the GMC’s 2017 position statement on LTFT training.

Managing Rotations / Programmes

There are many elements to be aware of when planning your rotations - both for short, medium and long-term planning. These include:

  • Post management – know your posts, how many you have, how to utilise these to manage your doctors training pathways. If possible, use a grid that shows the National Post Numbers (NPNs) that the programme team and Trusts use to identify posts.
  • Recruitment and Inter-Deanery Transfers – knowing your post numbers helps you to accurately assess numbers for recruitment and if any IDTs can be accommodated.
  • Deferrals
  • Academic doctor in training
  • Less than full time
  • Out of Programme
  • Statutory Leave
  • Period of Grace
  • Acting up
  • Doctor in trainings in need of professional support

It is important to work with your Education Programme Manager closely to achieve the best management of programmes.

Medical Training Initiative (MTI)

The Medical Training Initiative (MTI) is a national scheme that allows doctors from outside the UK to undertake up to 24 months of training and development in NHS services before returning to their home countries. The scheme is aimed at doctors from the Lower Income and Lower Middle-Income Countries as defined by the World Bank. The Academy of Medical Royal Colleges oversee the MTI scheme and are responsible for sponsoring doctors for their Tier 5 (Government Authorised Exchange) visa.

The HEE and Academy of Medical Royal Colleges’ National Standards for the administration and delivery of the MTI scheme outlines the overarching minimum standards for the MTI scheme. The role of HEE is to approve MTI applications to ensure that the posts do not disadvantage UK doctor in trainings nor adversely affect the training of existing doctor in trainings in the training location and provides sufficient educational and training content.

Applications should be submitted to the Deputy Postgraduate Dean for approval along with confirmation that the post will not adversely affect existing doctors in training on the programme.

Further information regarding the MTI scheme can be found on the following sites:

Out of Programme (OOP)

HEE offers doctors in training the opportunity to take a planned period out of their training programme, subject to agreement of their Training Programme Director and Head of School.

There are six main types of time taken out of programme:

  1. Out of Programme Training (OOPT): Time out of programme for approved clinical training in a post which has prospective approval from the GMC
  2. Out of Programme Research (OOPR): Time out of programme for research
  3. Out of Programme Experience (OOPE): Time out of programme for clinical experience in a post which will not count towards the award of a CCT
  4. Out of Programme Career Break (OOPC): Time out of programme for a planned career break related to personal circumstances or other requirements.
  5. Out of Programme Pause (OOPP): Time out of programme to undertake NHS work or similar patient facing work in the UK which can be assessed upon return and may count towards the award of a CCT.
  6. Acting up as a Consultant (AUC): Time out of programme to act up as a consultant.

Application Process

  • At least 6 months before applying the doctor in training must discuss their plans with the TPD
  • The Postgraduate Dean has delegated responsibility for approving the application to the Head of School
  • If an application is not supported the TPD or HoS must meet with the doctor in training to discuss the reasons for that decision and inform them of their right for appeal.

Declining Applications

If an application is not supported the TPD should meet with the doctor in training to discuss the reasons for that decision. If the doctor in training is not satisfied with that decision then they have the right to appeal which will be considered by the Deputy Postgraduate Dean.

Further information is available on our website.

Period of Grace (POG)

Period of Grace enables doctors who have completed training and not yet obtained a consultant post to continue in the Specialty Registrar grade contract for a time limited period whilst they find employment. The standard POG is six calendar months following the date of the CCT/CESR (CP). The doctor is no long considered to be in training but in a post for the purposes of service.

Doctors in training must notify the TPD at last 6 months prior to their CCT of their intent to take up the option of a period of grace. The policy and request form is available on our website.

Professional Support and Wellbeing (PSW)

The support of doctors in training is a key role of any Training Programme Director (TPD). If you or a supervisor is concerned about a doctor in training, please talk to them and encourage them to seek support (see below).

Please inform the Head of School prior to ARCP if you have concerns about long term sick, exam failure, other health and wellbeing issues. Documentation is crucial, however remember confidentiality and discuss with individual.

Support meetings can be arranged with the doctor in training, supervisor, TPD, HoS and occupational health if necessary; and these can be arranged by your Education Programme Manager

Support:

  • Locally- Employee Assistance Programme, Occupational health through the Lead Employer, GP, local wellbeing team;
  • Nationally- BMA counselling Tel: 0330 123 1245;
  • Practitioner Health programme, Text: PHP to 85258; 
  • Samaritans Tel: 116123

Regionally:

  • WARD- Well and Resilient Doctors. Peer support
  • Professional Support and Wellbeing (PSW) HEE SW: a confidential service, separate from training. Self -referral and supervisor referral available. Short term support with access to counselling, coaching, careers, exam support etc Full details of our PSW support services can be found via our website links below.

For more information, email: psw.sw@hee.nhs.uk

To refer: Professional Support and Wellbeing - South West.

Relocation and Travel Expenses

Arrangements for the payment of relocation and associated travel expenses for doctors, dentists and Public Health doctor in trainings in accredited HEE training programmes can be found on our website.

Revalidation

For doctor in training doctors, the five-year revalidation cycle will start at the point of full registration with a license to practice, which usually occurs at the start of Foundation Year Two (F2).

The GMC have set revalidation dates for approximately 60 days after expected CCT date. For those whose training programme lasts less than five years, as in General Practice, their first revalidation will take place at CCT. The designated body for doctors in training will be Health Education South West, and the Responsible Officer (RO) is Dr Geoff Smith, Regional Postgraduate Dean.

The RO will base their recommendations for revalidation on information supplied for the Annual Review of Competence Progression (ARCP). The RO has three options in making a recommendation. These are, in summary:

  1. Recommendation to revalidate
  2. Deferral request
  3. Notification of non-engagement

In order to incorporate revalidation, the Annual Review of Competence Progression (ARCP) has been enhanced by developing the existing documents. The Form R Part B, Educational Supervisor's report and ARCP Outcome form include sections relevant to revalidation. The ARCP panel will determine whether or not there are any causes for concern, and the chair of the panel will relay this to the Responsible Officer via the ARCP Outcome Form. This will happen annually, although revalidation itself is on a five-year cycle.

Rotations

HEE must adhere to the NHS Code of Practice rules and therefore has strict deadlines to meet. These deadlines are part of the Junior Doctors Contract Terms and Conditions.

The key point in the 2018 version which HEE must comply with are:

  • Provide information to employers (at least 12 weeks before the doctor in training is due to start in post. The employer can then ensure that relevant information is sent to the doctor in training. This will include providing a generic rota at 8 weeks and the duty roster at least 6 weeks in advance of the doctor in training starting in post.

Role of the TPD

  • TPDs will be informed by the Education Programme Manager of when they need to submit rotation charts, this will be approximately 17 weeks prior to the rotation date to ensure we comply with Code of Practice. Should any delay be anticipated, the TPD will need to inform the Education Programme Manager of the reasons.
  • When submitting the rotation charts the TPD will need to account for all doctor in trainings, including LTFT, academic doctor in trainings’ placements, maternity leavers and those on sick leave
  • TPD will respond to HEE’s queries if there is any further information required, i.e. if there is perceived to have been an overfill of posts or if there is a vacancy whether this needs to be filled by the trust and for how long.
  • TPD will inform HEE if there are any last-minute changes to the rotation grid.

Study Leave

Roles and responsibilities of the TPD (and HoS)

  • To work collaboratively with Educational Supervisors to assist with identifying their educational training programmes - both local and regional.
  • To support the Head of School to provide the Postgraduate Study Leave Team with their Annual Development Plan and funding for these programmes.
  • To work collaboratively with the PGME Study Leave Team to ensure that study leave funding is managed with integrity, according to the principles of this guidance, ensuring equity and fairness is applied in the process.

The TPD will also work with the study leave team to provide a list of courses to aid doctors in training to identify the most appropriate time to attend courses during their programme. Courses are classified into three categories: -

CAT 1

Required with the curricula and unable to achieve competences through their training programme or regional teaching

CAT 2

Enhanced knowledge - doctors in training will have met their core curriculum competencies for their stage of training and attending a specific course will help the doctor in training complete parts of the curriculum

CAT 3

Career progression - these courses should only be required at the latter stage of training

Further information is available on our website.

Supported Return to Training

Doctors in training who have been out of training for longer than three months can access the SuppoRTT (Supported Return to Training Programme) programme. This flexible programme has been designed to include enhanced supervision, no unsupported night-time or weekend on-call for the initial two weeks following return, clinical simulation days, mentorship and coaching, resilience training, practical advice and sign posting.

Each Trust in the region has a SuppoRTT Champion (details are available on our website). It is important to link in with the Champions to ensure returners are given the right support needed for when they start back in training.

Further information is available on our website.

Supporting and Escalating Concerns

It is important that doctors in training are able to raise and where appropriate escalate concerns. Doctors in training should be encouraged to follow the appropriate pathway starting with the clinical learning environment in the first instance. Further information is available on our website or by contact the Quality Team.

 

Transfer of Information

There will be situations where there is a need for a transfer of information between employers for the sake of patient safety and to support the doctor in training. Examples would include: -

  1. Situations where an employer has taken action because of concerns about a doctor in training’s conduct or performance
  2. Where a doctor in training has a significant health issue that may impact on their training
  3. Any relevant information regarding any completed or outstanding disciplinary or competence issue
  4. Where there is potential fitness to practice concerns or information relating to a doctor in training revalidation

In all circumstances any information shared must comply with the General Data Protection Regulation (GDPR). The TPD is advised to seek the support of their HoS to undertake this process and if necessary for it to be escalated to the Deputy Postgraduate Dean.