South Thames Foundation Schoolwww.stfs.org.uk Broadening The Foundation Programme The Experience of MTW Dr Paul Reynolds Clinical Tutor & Dr Alexander Brazier FY1 Trainee Rep

South Thames Foundation Schoolwww.stfs.org.uk MTW NHS Trust Two main sites Maidstone Hospital (MGH) and Tunbridge Wells Hospital with two separate but integrated Foundation Programme schemes Serves a population of over 500,000 MGH- 27 FY1’s & 27 FY2’s 30 FY1’s & 27 FY2’s Linked with a single Mental Health Trust - KMPT

South Thames Foundation Schoolwww.stfs.org.uk MGH Of 27 FY1’s – 9 Gen Surgery, 3 Psychiatry, 2 ITU, 13 Medicine Only Surgical FY1’s do night shifts Of 27 FY2’s – 9 Emerg Medicine, 2 Psychiatry, 4 GP 4 T & O, 2 Paeds, 2 Ophalm, 4 Medicine Target to reduce 4 “surgical posts”

South Thames Foundation Schoolwww.stfs.org.uk Of 30 FY1’s – 10 Gen Surgery, 2 Psychiatry, 2 ITU, 2, T & O, 15 Medicine Only Surgical FY1’s do night shifts Of 27 FY2’s – 4 Emerg Medicine, 2 Psychiatry, 5 GP 6 T & O, 2 Paeds, 2 ENT, 2 O & G, 4 Medicine Target to reduce 9 “surgical posts” and to find an extra 1 Psychiatry FY1 and 2 extra Community posts across the schemes

South Thames Foundation Schoolwww.stfs.org.uk Planning trialled a 2 year rotation from 2013/2014 and early feedback was positive – so ? increase to a second rotation as it gives “you” control of linkage and so the community placements – (which means being unable to do both Psychiatry and GP in a FY2 year) A trial of 4 weeks in Old Age Psychiatry during a 4 month Care of the Elderly Rotation had received mixed feedback from the trainees, but Psychiatry felt that they could accommodate an extra FY1 The Hospice were interested in a mixed acute and community Palliative Care Placement with the Trust The 9 Planned reduction in Surgical posts was actually 8 when we checked the figures

South Thames Foundation Schoolwww.stfs.org.uk Planning Trust Service Reconfiguration meant we already rotated our FY1’s in Gen Surgery across both sites with a 19 week rotating cycle that gave a good mixture of emergency and elective care with opportunities for OPD and Theatres, and better Consultant Supervision (3 rd design) Trust Service Reconfiguration meant we had already centralised T & O onto the site, resulting in a very busy Orthopaedic site with largely Foundation Trainees and HST’s – In effect all 12 posts at Foundation level (10 FY2 and 2 FY1 were needed to be non-surgical) We had introduced an Ortho-Geriatric service, but feedback from our Foundation Faculty and our CQC preparation suggested that we needed to give them trainees to support the service

South Thames Foundation Schoolwww.stfs.org.uk Planning Discussions with out-going Foundation Trainee Reps at Foundation Faculty June 2014 about possible changes led to an options list Discussions with Psychiatry, Gen Surgery Tutor, T & O Tutor, T & O Clinical Director, and Hospice and Trust Palliative Care colleagues led to some possible solutions Implications of these changes were discussed with CEO and Finance Director, DME to take account of the back-fill requirements and costs and Trust agreed to fund them and to commit to Physicians Assistants These initial plans were then taken to the respective Faculties in October 2014

South Thames Foundation Schoolwww.stfs.org.uk Revision and Submission The Palliative Care & Hospice placement fell through Psychiatry were happy to take an additional TW FY1 Discussions at the Surgical Faculty, with input from the trainees from FY1 FY2 MGH and FY2 raised concerns about the plans due to the high workload – which led to last minute changes These revised plans were then taken through the management cycles again with less than a week turn round – this Guillotine helped to focus the minds and reach a decision

South Thames Foundation Schoolwww.stfs.org.uk Submission By 5pm 31 st October we submitted our proposals Loss of a Surgical FY1 and Formation of Psychiatry FY1 for Change of 2 FY1’s in T & O to Ortho-Geriatrics for Change of 2 FY2’s in T & O to Ortho-Geriatrics for both MGH and Request for a second 2 year Foundation Programme rotation in TW

South Thames Foundation Schoolwww.stfs.org.uk Submission Disaggregation and Redesign of all FY2 programmes to limit to one Community placement per year Fulfilled all of the Psychiatry and Community Placement Targets for the Trust Led to a reduction in 7 rather than 12 “surgical posts”, all but one, in T & O with a change to Ortho-Geriatrics – any more would not fit with the current ward based system Failed Hospice plans may lead to two Community leaning posts in time

South Thames Foundation Schoolwww.stfs.org.uk Submission Anaesthetics Geriatrics and Stroke MedicineGeneral Surgery Anaesthetics Geriatrics and Stroke Medicine General Surgery Anaesthetics Respiratory MedicineGeneral Surgery Anaesthetics Respiratory Medicine General Surgery Anaesthetics DiabetesOrtho-GeriatricsGeneral Surgery DiabetesOrtho-Geriatrics General SurgeryDiabetes Ortho-GeriatricsDiabetesGeneral Surgery Ortho-GeriatricsDiabetes General SurgeryOrtho-Geriatrics Psychiatry Respiratory MedicineGeriatric Medicine Obstetrics & Gynaecology Trauma and OrthopaedicsPaediatrics Geriatric Medicine Psychiatry Respiratory MedicinePaediatrics Obstetrics & Gynaecology Trauma and Orthopaedics Respiratory MedicineGeriatric Medicine Psychiatry Trauma and OrthopaedicsPaediatrics Obstetrics & Gynaecology Psychiatry GastroenterologyGeneral Surgery Otolaryngology (ENT) Ortho-Geriatrics Emergency Medicine General Surgery Psychiatry Gastroenterology Emergency MedicineOtolaryngology (ENT) Ortho-Geriatrics GastroenterologyGeneral Surgery Psychiatry Ortho-Geriatrics Emergency MedicineOtolaryngology (ENT) CardiologyGeneral SurgeryGeriatrics and Stroke Medicine General SurgeryGeriatrics and Stroke MedicineCardiology Geriatrics and Stroke MedicineCardiologyGeneral Surgery Geriatrics and Stroke MedicineCardiologyGeneral Surgery Geriatrics and Stroke MedicineCardiology General SurgeryGeriatrics and Stroke Medicine Geriatric MedicineRespiratory MedicineGeneral Surgery Geriatric MedicineRespiratory Medicine General SurgeryGeriatric Medicine GastroenterologyGeriatric MedicineGeneral Surgery GastroenterologyGeriatric Medicine General SurgeryGastroenterology Emergency Medicine Ortho-GeriatricsGeneral Practice Emergency Medicine Ortho-Geriatrics General Practice Emergency Medicine Psychiatry Gastroenterology Emergency MedicinePsychiatry Gastroenterology Emergency Medicine General PracticeGastroenterology Emergency Medicine General Practice Gastroenterology Emergency Medicine Trauma and OrthopaedicsGeneral PracticePaediatrics Trauma and OrthopaedicsGeneral Practice PaediatricsTrauma and Orthopaedics General Practice Otolaryngology (ENT) Trauma and OrthopaedicsGeneral Practice Otolaryngology (ENT) Trauma and Orthopaedics General PracticeGastroenterology Trauma and OrthopaedicsGeneral Practice GastroenterologyTrauma and Orthopaedics Psychiatry Gastroenterology Obstetrics & Gynaecology Psychiatry Gastroenterology Obstetrics & GynaecologyPsychiatry Acute MedicineGeneral SurgeryIntensive Care Medicine Acute MedicineGeneral Surgery Intensive Care MedicineAcute Medicine General SurgeryIntensive Care Medicine Acute MedicineGeneral Surgery Intensive Care MedicineAcute Medicine DiabetesGeneral SurgeryOld Age Psychiatry DiabetesGeneral Surgery Old Age PsychiatryDiabetes GastroenterologyGeneral SurgeryPsychiatry GastroenterologyGeneral Surgery PsychiatryGastroenterology General SurgeryPsychiatry GastroenterologyGeneral Surgery PsychiatryGastroenterology DiabetesGeneral SurgeryCardiology DiabetesGeneral Surgery CardiologyDiabetes Respiratory MedicineGeneral SurgeryAcute Medicine Respiratory MedicineGeneral Surgery Acute MedicineRespiratory Medicine General SurgeryGeriatrics and Stroke Medicine Respiratory MedicineGeneral Surgery Geriatrics and Stroke MedicineRespiratory Medicine Acute MedicineGeneral SurgeryGeriatrics and Stroke Medicine Acute MedicineGeneral Surgery Geriatrics and Stroke MedicineAcute Medicine Emergency MedicineGeneral PracticeTrauma and Orthopaedics Emergency MedicineGeneral Practice Trauma and OrthopaedicsEmergency Medicine General PracticeGeneral Internal Medicine Emergency MedicineGeneral Practice General Internal MedicineEmergency Medicine General PracticePaediatrics Emergency MedicineGeneral Practice PaediatricsEmergency Medicine General PracticePaediatrics Emergency MedicineGeneral Practice PaediatricsEmergency Medicine Trauma and OrthopaedicsHaematology Emergency MedicineTrauma and Orthopaedics HaematologyEmergency Medicine Ortho-GeriatricsOphthalmology Emergency MedicineOrtho-Geriatrics OphthalmologyEmergency Medicine Ortho-GeriatricsOphthalmology Emergency MedicineOrtho-Geriatrics OphthalmologyEmergency Medicine PsychiatryGeneral Internal Medicine Emergency MedicinePsychiatry General Internal MedicineEmergency Medicine PsychiatryGeneral Internal Medicine Emergency MedicinePsychiatry General Internal MedicineEmergency Medicine

South Thames Foundation Schoolwww.stfs.org.uk Back Fill Gen Surgery feel that they can probably cope - and an 18 week rotating cycle might be fairer to trainees The Trust is considering that the 4 planned Physicians Assistants will be on the MAU’s and T & O wards T & O may have to switch back to a ward based system to help the new proposals and facilitate the back fill plans We have looked at the T & O rota template and there is the potential to change the rota design to allow a more efficient use of FY2’s

South Thames Foundation Schoolwww.stfs.org.uk Any Questions?