Broadening the Foundation Programme – overview for trusts

South Thames Foundation School

South Thames Foundation School

www.stfs.org.uk

South Thames Foundation School

www.stfs.org.uk

Implications for trusts

Requirements

• 4 month placements for foundation doctors – –

psychiatry - 45% community

• 80% by 2015 • 100% by 2017 • Reductions in surgical posts South Thames Foundation School

Implications

• Development and education infrastructure for new posts – –

new psychiatry posts new community posts

• Service pressures on acute trusts –

covering workload of post reconfiguration www.stfs.org.uk

Targets . . . .

Specialty MEDICAL

General (Internal) Medicine Geriatric Medicine Intensive Care Medicine

F1 Acute

20 12 6 2

Community F1 Total

20 12 6 2

F2 Acute OTHER PSYCHIATRY SURGERY GRAND TOTAL

Emergency Medicine General Practice Obstetrics and Gynaecology Paediatrics General Psychiatry General Surgery Trauma and Orthopaedic Surgery Urology

Targets

Surgical post reduction 22.5% F1 doctors in psychiatry 22.5% F2 doctors in psychiatry 55% F2 doctors in primary care 80% community placement 100% community placement 0 10 9 1

30 0

By when (August) Shortfall 2015 2015 2015 2015 2017 2 1 Target met 3 5 Over supply 2 10 9 1

30

2 16 9 3 1 2 4 2 1 2 9 7

Community 29

7 7 1 1

F2 Total

9 7 2 20 9 7 4 2 2 2 3 1 2

Grand Total 6 36 29 19 6 4 22 9 7 2 4 2 2 13 10 2 1 66

South Thames Foundation School

www.stfs.org.uk

Guidance – general principles

• •

FDs based in an acute trust for a year, and continue to be employed by this trust (‘lead employer’) while on 4/12 placement in community / psychiatry Travel must be considered (driving licence not in national person specification)

South Thames Foundation School

www.stfs.org.uk

Designated clinician

• • • •

Facilitates management of community / psychiatry placements Has time in their job plan Organises placements and teaching in liaison with acute trust Has access to some administrative support

South Thames Foundation School

www.stfs.org.uk

Supervision

•

‘Foundation doctors must always have direct access to an appropriate senior colleague for advice in any clinical situation. They must never be left in a situation where their only help is outside the hospital or the place where they work’ (GMC The Trainee Doctor 2011)

•

The senior colleague may be a non doctor, if both competent to supervise the relevant activities being supervised and fully appraised of this responsibility

South Thames Foundation School

www.stfs.org.uk

Covering the workload

• • • • • •

Significant numbers of surgical post reductions Posts will move away from acute trusts Workload will need to be provided differently Crucial both for patient safety and avoiding impact on other trainees Other staff will need to be recruited and trained Solutions will depend on whether:

–

fewer doctors to be supported in some activities

–

doctors to be replaced entirely

South Thames Foundation School

www.stfs.org.uk

Fewer FDs – roles providing support

• • •

Many common FD activities are unnecessary for their training, eg

– – – – –

routine phlebotomy finding medical records portering samples, forms and patients organising meetings filing Others are m ore valuable but can be carried out by others eg IV cannulation Arranging scans etc and reviewing results require clinical input but workload reduced by effective EPR systems

South Thames Foundation School

www.stfs.org.uk

Clinical activities of foundation doctors

Important activities contributing to service work include:

• history taking, examination and differential diagnosis • management of acute and chronically ill patients and diagnostic testing • prescribing • clinical skills eg taking arterial blood gases, proctoscopy etc.

• assessment of elective admissions • communication skills and counselling including breaking bad news • co-ordinating treatment and investigations • discharge planning • writing discharge letters and other communications South Thames Foundation School

www.stfs.org.uk

Roles to replace foundation doctors

Many of these activities can be carried out by other types of staff but: may require significant additional training for role, eg prescribing and practical procedures

• Role level 7 (£30,764 – £40,558 pa: Band 7 AfC scale ex HCA) • Advanced practitioner • Role level 8 (£39,239 – 47,088 pa: Band 8a AfC scale ex HCA) • Consultant nurse practitioner • Cross cutting role (£30,764 – £47,008 pa: Band 7/8a AfC scale ex HCA) • Physician associate South Thames Foundation School

www.stfs.org.uk