1. Developing an FY1 post in a Crisis Resolution & Home Treatment Team
Newly created in community psychiatry with Merton Home Treatment Team
(MHTT) (South Thames deanery), based at Springfield University Hospital,
South West London & St George’s Mental Health NHS Trust (Image 1).
By Dr Holly Blair

2. Introduction Aims Background Methods Results Key messages Conclusion
References

3. Aims To describe and review this innovative four month FY1 post
To evaluate the extent to which it meets FY1 curriculum
To view this post as an enriched training opportunity

4. Background FY1 Psychiatry FY1 posts have been increasing nationally
Aims
Requirements
Psychiatry FY1 posts have been increasing nationally
St George’s Hospital saw a 75% increase from
This post was awarded to the home treatment team in 2013
FY1 curriculum based on GMC good medical practice.
The UK foundation programme curriculum states FY1 aims as to 1.build on undergraduate education 2. offer generic training to provide a range of interpersonal and clinical skills 3. To develop leadership, team working and supervisory skills 4. To offer a variety of workplace experience which will help will career decision.
Requirements include assessments for e-portfolio to demonstrate clinical competencies.
To meet FY1 curriculum and provides a unique training opportunity.
The responsibilities of an FY1 working in MHTT include assessing people
presenting in crisis on home visits and in A&E, psychiatric history taking, risk
assessments, clinical documentation, formulation, management planning and
contribution to team meetings.

5. Methods Evaluate the HTT FY1 doctor’s experience
Assess the extent to which it meets the FY1 core curriculum.
Review a logged record of activities undertaken during the firm

6. Weekly timetable during post.
Importantly there were good teaching opportunities including FY1 compulsory teaching, grand round and additional education meetings depending on work commitments.
Additionally one day per week was dedicated to an AMU on call doing the take. The aim of this was to ensure integration with other FY1s as the rotation was based off site, however this also enabled achievement of core procedures and the maintenance of medical skills and confidence.

7. Results FY1 assessments: Curriculum SLE’s TAB Core procedures
Mini CEX
CBD
DOPS
Developing the clinical teacher
LEADER
TAB
Core procedures
Additional: audit, presentations, teaching, courses
Firstly touching on key curriculum aspects, with how this firm successfully achieves
them as a model of psychiatry education, doctor in training and service development.
• Professionalism
o Leadership: The opportunity to closely observe a leadership role. The
FY1 doctor working alongside the consultant as one of only two doctors
in the team.
o Continuity of care: Patients are monitored within
the community for up to six weeks alongside re-referrals before or after hospital
admission.
Team working: all work undertaken as an MDT with daily meetings, opportunity to see the value of each individual.
• Relationship and communication with patients
o Clear communication with patients in a crisis is vital and challenging.
Patients may be unwilling to engage due to the nature of their symptoms.
• Ethical and legal issues
o Exposure to making complex risk assessments and prescribing
decisions, as well as Mental Health Act assessments.
o Home visits enable a unique view on how people live and cope with
mental illness.. This includes developing an awareness of the
stigma and social barriers faced by people living with mental illness.
• Teaching
o Regular 1-to-1 teaching sessions and opportunities to learn from other
healthcare professionals as part of a multidisciplinary team.
FY1 assessments are based upon supervised learning events. The nature of working in pairs within a
multidisciplinary team results in the majority of clinical work being under direct
observation which is not achieved to the same extent within other foundation year posts. Additionally
there are many opportunities for multidisciplinary feedback.
One day a week on the acute medical ward (AMU) enables completion of the
core clinical procedures aspect of the curriculum which is not normally possible
in a community psychiatry firm.
Finally as an unbanded job (which has its pros and cons) hours are generally 9am-5pm. This means there is opportunity for further career development in which other firms there is not always time.

9. Summary
Aims
Background
Methods
Results

10. References
GMC. Annual speciality report for uk.org/RCPsych_ASR.pdf_ pdf (accessed 27 September 2013)
UKFPO. The UK Foundation Programme Curriculum. The Foundation Programme 2012.
Dein K, Livingston C et al. ‘Why did I become a psychaitrist?’: survey of consultant psychiatrists. Psychiatric Bulletin 2007; 31:227-30

11. Key Messages
New FY1 psychiatry posts provide an enriched opportunity for new doctors.
Skills are transferrable.
Analytical and holistic formulation
Decision making
HTT offers a different challenge for FY1 doctors which will enhance them in their future careers.
This firm successfully achieves key curriculum aspects as a model of psychiatry education, doctor in training and service development.
Resulting in a well rounded FY1.