1. BTFP Case Study – St George’s Hospital Dr Nicola Walters FY1 Training Program Director St George’s Healthcare NHS Trust

2. Broadening the Foundation Program Report published by Health Education England in February 2014 Recommendation 1 - Educational supervisors should be assigned to foundation doctors for at least one year Recommendation 2 - Foundation doctors should not rotate through a placement in the same specialty more than once, unless this is required to enable them to meet outcomes in the Curriculum Recommendation 3 -  a) At least 80% of foundation doctors should undertake a community-based placement or an integrated placement from August 2015  b) All foundation doctors should undertake community-based placement or an integrated placement from August 2017

3. What did we need to achieve at St George’s Hospital? Increased numbers of community posts Review and possible decommissioning of surgical posts Meeting psychiatry targets Allowed us to review whole program, set up processes for formal feedback at the end of each post and for ES / CS Work was undertaken by Dr Sarah Hammond Close liaison with Dr Marcus Hughes, Liaison Psychiatry consultant

4. Identification of new posts Community scoping exercise  Queen Mary’s Hospital, part of St George's University Hospitals NHS Foundation Trust (community services)  Possibilities in the 3 rd sector Eventually, more opportunities identified than we needed Needed to establish whether posts were appropriate for FY1 or FY2 doctors

5. Important steps Site visits to meet team Meet Educational Supervisors Discussed training with trainees if there was already a trainee in post Review suggested job plans to quality assure posts Offer teams further contact with TPD / Foundation faculty if required

6. Review of surgical posts Maintaining transparency in this process Multiple resources used:  GMC survey 2014  HESL annual feedback 2013-14  Surgical focused visit report November 2013  SGH Foundation feedback July 2014  Educational and Clinical Supervisor feedback 2012- 2014  Foundation faculty minutes and inappropriate duties record 2012-2014

7. Next steps Paper presented to Executive Management Board of Trust All specialties that were affected were contacted and plans discussed 3 surgical FY1 posts / 1 medical FY2 post removed 2 established FY2 posts moved to FY1 1 FY1 psychiatry post → FY2 FY1 posts created in hospice and GU medicine FY2 posts created in dermatology and ‘Management of the elderly with complex conditions in the community’

8. Provision for lost posts MDT co-ordinator for surgical post Physician Associates (already established at SGH) Final plans for surgical post not completely clear as yet Medical post being replaced by core medical trainee for next year

9. Challenges Variation in post numbers that needed to be change – due to definitions not being clear Dealing with expectations of supervisors when posts changing to FY1 Responsibility of ensuring that decommissioned posts have plans in place to replace doctors Complexity of reconfiguring rotations for more than 80 doctors to ensure balance

10. Special thanks to Dr Sarah Hammond, Consultant Anaesthetist seconded to the NHS Leadership Academy

11. Thank you.