West of ScotlandRegional Trainers Day 2013

“Just when we thought we had a handle on it….!”

Looking ahead!

“To improve is to change; to be perfect is to change often.”Winston Churchill

“Any change, even a change for the better, is always accompanied by drawbacks and discomfort.”

Arnold Bennett

Changes within NES

John McKay

Assistant Director for Quality Improvement and Performance Management

David Cunningham

Assistant Director for Continuous Professional Development

NES Vision Project

Professional Development Training Management Business Support Quality Multi-Professional leadership and external

engagement

Throughout Scotland all Deaneries should be doing the same things the same way.

2014 Single Scottish Deanery

5 Regional offices Glasgow Edinburgh Dundee Aberdeen Inverness

Scottish Wide ES and Training Practice Accreditation and re-accreditation standards and process

National Strategy for CPD

“NES should be the first port of call for all Doctors in Scotland meeting CPD needs”

2CQ Reconfiguration

Recruitment

Stage 2 Cut off score increasing

2012 6%

2013 11%

2014 14% Candidates Demonstrated Round 1

2012 74%

2013 84%

StART Alliance: Scotland’s Strategy for Attracting and Retaining

Trainees After round 2 - still 25 vacancies in Scotland Scotland: Home of Medical Excellence NES + stakeholder groups Improve recruitment and retention in specialty

training Revamped advertising, use of social medial Newly commissioned work on what ‘attracts’

trainees Trainee Ambassadors: Word of mouth is strongest

influence

Recruitment

Alternative Foundation Competency Certification more robust

ALS certification before commencing in training

NES will become Tier 2 Visa sponsor for whole programme from February 2014

RCGP

E-portfolio!

Curriculum update Oct 13:Prescribing Safety – Based on GMC commissioned survey More focus on knowledge of therapeutics and

demonstration of skills for safe/appropriate

prescribing and medication reviews Improved skills in management of polypharmacy

Mental Health – Co-morbidity of physical conditions in metal health Assessment and safety planning for suicidal

patients Promote hope and demonstrate compassion

Exam Changes:

AKT Wide selection of

questions Every AKT drug

calculations Free text to replace

choosing from lists Content shaped

towards prescribing safety

CSA At least 2 cases with

major prescribing component

New tests of prescribing behaviour

Child actors cases from Nov 13

may include paediatric prescribing

Handwritten scripts

WPBA: COT/CBD/SEA/Audit/Learning Log

Future Assessment Changes GMC mandated there should not be assessment for

assessments sake All assessments should have meaningful formative

feedback DOPS to be replaced by Integrated Clinical Skills

August 2014 Structured Learning Event (SLE) format in

development for August 2015 Will allow wider use of material for assessment

e.g prescribing, SEA/audit discussions in addition to existing WPBA

Focused CBD pilot due for reporting

How to pass the CSA?

A year of Reports!

Francis Report

Report into failing standards of care in Mid Staffordshire

290 recommendations 20 refer directly to medical

education

Impact of Medical Education: GMC set standards for educational

environments/approved practice settings Prioritisation of Patient Safety within Quality Assurance

Training Visits Routine quality visits to training environments Trainees actively encouraged to provide feedback on

standards of patient safety and quality of care (GMC survey and trainee post assessment questionnaires)

More information sharing between service providers and Deaneries

Any visit identifying patient safety concerns to be shared with PCOs

Clinical Leadership Training for all trainees (LaMP)

GMC Recognition and Trainer Approval:

Traditionally in place for GP Trainers

From 2013-14 will be extended to cover secondary care named ES/CS’s and undergraduate teachers

Based on standards already set out in ‘The Trainee Doctor’ and ‘Tomorrow's Doctors’

Academy of Medical Educators:7 Framework areas used to set standards – Ensure safe and effective patient care through

training Establish and maintain and environment for learning Teaching and facilitating learning Enhancing learning through assessment Supporting and monitoring educational progress Guiding personal and professional development Continuing professional development as an

educator

Adapted for GP by RCGP

New Self Submission Documentation for ES and Training Practice approval/re-approval

Scotland wide document Referenced to standards set in RCGP version of

AoME Framework areas More detailed document for each ES Approval for individual ES’s and the Practice as an

educational environment Re-focusing of questions and visits to meet set

standards GP Training in West of Scotland is already well

placed to comply will all requirements

Shape of Training Report

Why change?

Needs of patients are changing fast Increasing multiple-morbidity Super-specialisation can be a

hindrance in some instances to good patient care

Consensus opinion:

More generalists able to work across specialties Better preparation for working in multi-professional

teams Greater career flexibility Training needs to be tailored to meet changing

patient need Training should be based on what kind of doctors

are needed

More doctors capable of providing general care across a range of different settings

Doctors will progress to credentialing in specialist areas (including GP).

More opportunities for doctors to change roles Local workforce and patient need should drive

opportunity Full registration should move to the point of

Graduation with measures in place to demonstrate Graduates are fit for purpose

So what may it look like?

Two year Foundation Programme to remain initially Doctors will enter ‘themed’ broad based specialty

training e.g. ‘Community’ might include GP, Psychiatry, Paediatrics, COTE

Will last between 4 and 6 years Transferable competencies between specialties Exit point will be a CST (Certificate of Specialty

Training) Further career enhancement via ‘credentialing’ Delivery Board to be established

All Doctors to develop generic skills in:

Patient safety Communication with patients and

colleagues Teamwork, Management and

Leadership Evaluation and application of

research

19 Recommendations: 8. Appropriate organisations, including employers

must introduce longer placements for doctors in

training to work in teams and with supervisors

including putting in place apprenticeship based

arrangements.

9. Training should be limited to places that provide

high quality training and supervision, and that are

approved and quality assured by the GMC.

So where does this leave EGPT?

Educational case for UK 4 year GP Training widely accepted

RCGP still pressurising for 2 years in GP Cost neutrality imposed Re-focusing of some existing posts

towards ‘community’ slant

On a very positive note:

May CSA 3rd best pass rate in UK for 1st attempt takers

2013 GMC Survey West of Scotland Deanery rated 3rd top of 20 UK Deaneries for overall satisfaction for GP Training

1st among large Deaneries in UK