1. South Thames Foundation Schoolwww.stfs.org.uk Broadening the Foundation Programme Workshop Jan Welch Director, South Thames Foundation School

2. South Thames Foundation Schoolwww.stfs.org.uk Aims for the morning Current understanding of Broadening Local actions Sharing good practice How can we help? Current understanding of Broadening Local actions Sharing good practice How can we help?

3. South Thames Foundation Schoolwww.stfs.org.uk

4. South Thames Foundation Schoolwww.stfs.org.uk

5. South Thames Foundation Schoolwww.stfs.org.uk

6. South Thames Foundation Schoolwww.stfs.org.uk Previous targets Stated that, ‘by 2014, LETBs should have demonstrated credible progression towards existing targets for placements in general practice and psychiatry, in both F1 and F2’. 22.5% of F1 doctors in psychiatry 22.5% of F2 doctors in psychiatry 55% of F2 doctors in the community or primary care 5% of doctors in an academic placement 10% of F2 doctors in shortage specialties

7. South Thames Foundation Schoolwww.stfs.org.uk

8. South Thames Foundation Schoolwww.stfs.org.uk

9. South Thames Foundation Schoolwww.stfs.org.uk Implications for STFS Increase in community posts Developments of integrated community placements Increases in psychiatry posts (some are community based, so contribute to both targets) Medical posts including community-facing experience Reductions in surgical foundation doctor (FD) posts

10. South Thames Foundation Schoolwww.stfs.org.uk What is a community placement? A four month placement with a named clinical supervisor Primarily based in a community setting, such as general practice, community paediatrics, palliative care or community psychiatry Defining ‘community’ is challenging The named clinical supervisor must be based in the community.

11. South Thames Foundation Schoolwww.stfs.org.uk What is an integrated placement? A four month placement with a named clinical supervisor where the foundation doctor is primarily based in a community setting. The named clinical supervisor must be based in the community.

12. South Thames Foundation Schoolwww.stfs.org.uk What is a clinical supervisor? A registered and licensed medical practitioner, responsible for overseeing a foundation doctor’s clinical work and providing oral and written feedback during a training placement Clinical supervisors must have adequate training, support and resource to undertake their training role, including adequate time in their job-plan Cover for absences important

13. South Thames Foundation Schoolwww.stfs.org.uk What is a community facing placement? A four month placement in which the foundation doctor is primarily based within an acute setting The placement should include opportunities to develop holistic skills including long-term conditions and the increasing role of community care

14. South Thames Foundation Schoolwww.stfs.org.uk Timing of community placements Typically community placements take place during the F2 year F1 doctors are consolidating acute skills and can be at risk of isolation if distantly community based, especially for their first placement F1 posts based in the community should include opportunities to attend host acute trust for teaching and maintenance of acute clinical skills

15. South Thames Foundation Schoolwww.stfs.org.uk Where can new community placements be developed? GP excellent but capacity limited Psychiatry expansion underway – most posts have ‘community supervisors’ Existing community eg sexual health, palliative care New services eg musculo-skeletal Trusts with strong community links in good position to develop innovative community based placements (can include some time in acute trusts, eg in on call rotas)

16. South Thames Foundation Schoolwww.stfs.org.uk What activities can FDs carry out in community placements? Sections of Foundation Doctor Curriculum 2012/14 1Professionalism (p17-19) 2Relationship and communication with patients (p20-22) 4Ethical and legal issues (p25-26) 7Good clinical Care (p30-37) 8Recognition and management of the acutely ill patient (p40-41) 10Patients with long-term conditions (p44-47)

17. South Thames Foundation Schoolwww.stfs.org.uk Other necessary provision for training placements Access to e-portfolio during working day Robust departmental induction, in addition to that provided by the employing trust and at a different time, so that the FD can attend both FDs must be able to attend weekly teaching at their host acute trust. At least one hour a week of departmental teaching in the community placement should also be provided Time to complete SLEs and staff to supervise Engagement with employing acute trust foundation faculty group/FD monitoring processes Involvement in ARCP process Administrative support

18. South Thames Foundation Schoolwww.stfs.org.uk Supervision and safety Foundation doctors must never be left without appropriate clinical supervision good safety of foundation doctors in community placements also crucial eg many new doctors cannot drive, and so should not be expected to cover several different sites at night, along country roads, by bicycle Local guidance on safety is on http://www.stfs.org.uk/sites/stfs/files/Safety%2 0of%20foundation%20doctors%20Final%20- %20February%202014.pdf http://www.stfs.org.uk/sites/stfs/files/Safety%2 0of%20foundation%20doctors%20Final%20- %20February%202014.pdf

19. South Thames Foundation Schoolwww.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

20. South Thames Foundation Schoolwww.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

21. South Thames Foundation Schoolwww.stfs.org.uk Support roles (Skills for Health role directory) Role level 1 (£14,294 – £15,013 pa: Band 1 AfC scale ex HCA) Support worker role based care Support worker, phlebotomy Role level 2 (£14,294 – £17,425 pa: Band 2 AfC scale ex HCA) Phlebotomist Role level 3 (£16,271 – £19,268 pa: Band 3 AfC scale ex HCA) Integrated support worker

22. South Thames Foundation Schoolwww.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

23. South Thames Foundation Schoolwww.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

24. South Thames Foundation Schoolwww.stfs.org.uk Physician associates Dependent health professionals who are trained in the medical model to obtain medical histories, conduct examinations, request and interpret tests and diagnose and treat injuries 2 year postgraduate diploma - more training places being commissioned locally Do not yet prescribe Not yet a regulated profession

25. South Thames Foundation Schoolwww.stfs.org.uk

26. South Thames Foundation Schoolwww.stfs.org.uk Any questions?