nhs shetland: providing healthcare services in shetland - … · 2019. 10. 9. · past 12 months...

Shetland Islands Council

Meeting: Shetland NHS Board

Date: 15 October 2019

Report Title: Medical Director Annual Report 2019

Reference Number: Board Paper 2019/20/50

Author / Job Title: Brian Chittick, Interim Medical Director

Decisions / Action required:

The Board is asked to note the contents of the report

High Level Summary:

This report highlights:

1. The evolution of the medical leadership cadre within NHS Shetland Board over the past 12 months and the impact on healthcare delivery.

2. The current establishment for the workforce in NHS Shetland and the challenges across Primary care and Acute services within the Board.

3. The delivery of the “Rediscover the Joy” project for the recruitment of GPs to substantive posts across some remote and rural Health Boards.

4. The NHS Shetland application of Realistic Medicine principles through development of local projects.

5. The NHS Shetland Duty of Candour (DoC) process including the first annual report.

6. The role of NHS Shetland in undergraduate & postgraduate medical education. NHS Shetland undertakes both undergraduate and postgraduate training. NHS Shetland facilitated an informal visit by Professor P Johnston the Postgraduate Dean in the Scotland Deanery (North) who provided positive feedback on the team approach taken to medical training in NHS Shetland.

7. NHS Grampian are supporting NHS Shetland with Responsible Officer duties as the current interim Medical Director is not a GMC registrant. The report also outlines the appraisal and revalidation data for NHS Shetland for 2018-19.

Corporate Priorities and Strategic Aims:

To create the right conditions for front-line staff to deliver safe and effective service, ensuring high quality care is provided by skilled workforce that is appropriate for remote & rural settings in Shetland.

Agenda Item

13

Key Issues:

Noting

Changes in medical workforce.

Challenges in recruitment and retention and an area od success (Rediscover the Joy project)

New approach to healthcare delivery via Realistic Medicine

Implications : Identify any issues or aspects of the report that have implications under the following headings

Service Users, Patients and Communities:

Maintaining high quality care across the specialties for Shetland communities

Human Resources and Organisational Development:

Enhancing individual and organisation resilience.

Equality, Diversity and Human Rights:

N/A

Partnership Working Developing capabilities within the teams to work in collaboration & across organisational boundaries

Legal:

Ensure compliance with NHS Shetland statutory obligation.

Finance:

Significant reduction in locum cost

Assets and Property:

NA

Environmental:

NA

Risk Management:

The high proportion of locum medical staff results in higher levels of risk for the NHS Shetland Board

Policy and Delegated Authority:

NA

Previously considered by:

Clinical Care & Professional Governance Committee (CCPGC)

03rd September 2019

“Exempt / private” item

Explain reason why report is being discussed as an “exempt” / in private item

The main report is to be attached together with a list of the appendices and references to any background documents or material e.g. include web links.

Medical Director’s Annual Report 2019 Including, the Duty of Candor Annual Report, Director of Medical Education Annual Report

and Annual Appraisal Report for NHS Shetland

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Final Version

Medical Leadership The previous Medical Director, Dr Gilbert Ozuzu retired in September 2018. Following Dr Ozuzu’s departure, NHS Shetland Board appointed an Interim Medical Director, Mr Brian Chittick the Dental Director, who remains both in this post and that of Interim Medical Director. NHS Shetland Board has continued to employ an Associate Medical Director (AMD), Primary Care, Dr Dylan Murphy to support Mr Chittick’s role. Due to Mr Chittick being registered with the General Dental Council (GDC) and not the General Medical Council (GMC), this has meant that the Responsible Officer (RO) responsibilities have fallen to NHS Grampian. NHS Grampian has embraced this supportive role and has provided a Deputy Medical Director on a medium term basis, namely Dr Malcolm Metcalfe. He visits Shetland on a fortnightly basis providing RO support. In particular, he has been undertaking job planning for the Consultant cadre. Dr Pauline Wilson is the Interim Director or Medical Education. This development of a quasi Medical Directorate has contributed significantly to the Medical Leadership role within NHS Shetland and closed many of the gaps in management and leadership across Primary and Secondary Care leading to improvement in healthcare delivery. Workforce - Primary Care Recruitment to GP posts in Shetland has been challenging for several years and our largest practice in Lerwick (9000 patients) took the decision several years ago to employ Advanced Nurse Practitioners (ANPs) to augment the existing clinical team. This proved to be successful and has provided additional on the day access for patients. There is now a wider training programme with six trainee ANPs undergoing training across the Health Board within Primary Care. The Board has been successful in recruiting new GPs to two practices namely Bixter and Walls. NHS Shetland has also been the Lead Board in the facilitation of the “Rediscover the Joy” project which has been implemented to recruit to vacant substantive GP posts and to develop a rural GP Support Team to provide highly motivated GPs work in rural practices. “Rediscover the Joy” is a collaborative pilot project involving NHS Shetland, Orkney, Western Isles and Highland with support from the Scottish Rural Medicine Collaborative (SRMC). This work has been crucially supported by the AMD in Primary Care, working with his counterparts across other Island and Remote and Rural Boards. Team members are typically contracted for 12-18 weeks of clinical commitment each year, but this can be shorter or longer depending on team member’s ability to commit. To date, there are 27 team members recruited to the GP hub with a commitment of 11 placements within NHS Shetland in the short to medium term. It is hoped an outcome from the project will be a decreased dependency on locums to cover gaps in Primary Care.

Our largest practice is also a GP training practice and over the last year, the trainees who qualified have chosen to take up posts in Shetland. These positive steps welcomed by NHS Shetland Board. This means from the end of August 2018, our largest practice has been fully staffed with GPs for the first time in eight years. We have further work ongoing looking at how best to configure services across Shetland. At present we have 8 practices which are salaried (out of a total of 10 practices) and as a number of these practices are single handed, we are having discussions on how best to position staff, share best practice and reduce professional isolation.



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Final Version

General Practitioner with Special Interests (GPWSI’s) The use of GPWSI’s to supplement niche areas of the medical specialties in NHS Shetland has decreased over the last year. Previously some of the hospital based services ran wholly with GPWSI medical cover or the GPWSI was an integral part of the consultant based service. An example of this model was that for Obstetric Care; there were three GPWSI’s in Obstetrics well supported by the Grampian consultants. However, due to the risk profile of this specialty, there was a sudden decrease in numbers GPWSI’s willing to undertake this work. There has been an evolution of the Obstetric Service from being underpinned by GPWSI’s to being a Consultant led service. Paediatrics remains a Grampian consultant based service supplemented by a locally based GPWSI. There will need to succession planning in this area to ensure continuity of service moving forward in the medium term. Plans to develop a GPWSI in Dermatology to supplement the service provided by NHS Grampian have been realised with the development of a GPWSI able to undertake minor surgical procedures in this specialty. Workforce - Secondary Care Consultants - NHS Shetland Consultant medical staffing establishment is set as follows: Consultant Physician - 4.0 Whole Time Equivalent (WTE); Consultant Anaesthetist - 4.0 WTE; Consultant General Surgeon - 3.0 WTE (plus 0.75WTE additional locum support for periods of leave); Consultant Psychiatrist- 2.0 WTE Middle Grade doctors - NHS Shetland has 1 permanent full time surgical middle grade doctor. Middle grade doctors support the work of the consultants and work closely with junior doctors to ensure safe delivery of care. They contribute to service improvement, clinical audit and undertake In-service training aligned to the needs of the service. Junior Doctors - These are doctors in training posts. NHS Shetland Board currently has an establishment of 13 posts ranging from FY1 to GPSTs. They provide cover to the Hospital wards and A&E. NHS Education for Scotland (NES) has the responsibility for advertising and recruiting to some of these posts through a national process. To maintain a safe Junior Doctor rota, NHS Shetland also recruit to service posts which are not recognised for training which are filled by locums. NHS Shetland operates a compliant junior doctor rota. NHS Shetland has developed Clinical Development Fellow (CDF) posts in conjunction with the University of Aberdeen. These posts are non-training and have a 12 hour per week allocation to a developmental project. Post holders are given an honorary clinical lectureship with the University. NHS Shetland Board currently has two CDF posts. Recent changes in medical workforce Over the past 12 months there has been minimal significant turnover in Consultant staff but it should be noted that apart from the surgical team, there has been a reliance on locum consultant



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Final Version

staff to cover Physician and Psychiatric Consultants to maintain a day to day service. There has been success in the recruitment of two substantive Consultant Anaesthetists which has decreased a significant reliance on locums but one of those Consultants has resigned his contract from September 2019. It is anticipated that the Board will recruit a new Consultant Physician in November 2019 which bucks the trend of an inability to recruit in this cadre. There has also been investigation in new innovative ways of recruiting staff. The Board has engaged with the national international recruitment pathway for Psychiatrists without success. However, it is reviewing the workforce model for staffing the Obstetric rota looking at a novel plan of recruiting staff to work at least 17 weeks in Shetland with a further 12 weeks being funded for an individual to work in a busier tertiary centre to maintain skills. Recruitment and retention of consultant staff will remain a challenge in the current workforce atmospherics, but this may lead to new ways in engaging staff to work in Shetland. Quality Assurance NHS Shetland has a Clinical, Care and Professional Governance Framework in place which provides assurance to the Integration Joint Board (IJB), the Council and the Health Board, that effective processes for health and social care professional practice are in place and implemented to develop, support and monitor care standards within agreed accountability and governance frameworks. The Medical Director is one of the identified Professional Lead Officers responsible for ensuring that lines of professional accountability are explicit, that staff are supported to practice safely and professionally and there are systems in place to provide professional assurance to the Health Board, IJB, Council and Scottish Government. The Clinical Care and Professional Governance Committee (CCPGC) is a statutory committee which provides assurance that appropriate clinical governance mechanisms are in place and effective throughout the organization. The Medical Director is the Executive Sponsor to the CCPGC. Reporting to the CCPGC, the Joint Governance Group (JGG) is a group of professional leads which oversees and supports the implementation of clinical, care and professional governance. The Medical Director and Director of Medical Education are both members of the JGG and provide feedback from the Medical Education Governance Group (MEGG). The MEGG minutes are also tabled at the JGG meetings. Risk Due to the disestablishment of the Strategy and Redesign Committee in September 2017, corporate risks are overseen by the Board. Individual corporate risks are reviewed by the relevant standing committee with exception reporting by the Committee Chair to the Board. The corporate risks overview is maintained by the Risk Management Group (RMG). The corporate risk register is presented to the Board every 6 months and reviewed by the RMG quarterly at each meeting. The Medical Director has responsibility for a number of corporate risks and these are reviewed on a quarterly basis before the RMG meeting.



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Final Version

Duty of Candour (DoC) The Medical Director is the organisational lead for the DoC which came into effect from 1st April 2018 and has responsibility for making the decision to activate the DoC procedure within NHS Shetland. An implementation plan has been developed and is being overseen by the Medical Director with updates on progress reported to the JGG, CCPGC and RMG. An ongoing weekly meeting with members of the clinical governance team reviews all adverse events and complaints to identify if they are DoC reportable events. The Medical Director Annual DoC report is attached (Annex A). Realistic Medicine The Medical Director is also the Realistic Medicine Executive lead for NHS Shetland Board. The Realistic Medicine Steering group led by the Medical Director was constituted in June 2018 and directs the implementation of the 6 Domains of Realistic Medicine within NHS Shetland Board. These include

1. Reducing unwarranted variation in practice and outcomes 2. Changing our style to ‘Shared Decision Making’ 3. Building personalized approach to care 4. Focus on Innovation and Improvement 5. Reducing harm & waste 6. Managing risk better

The Realistic Medicine vision is that, ‘By 2025, everyone who provides healthcare in Scotland will demonstrate their professionalism through the approaches, behaviours and attitudes of Realistic Medicine’. Realistic Medicine is the thread that runs through all our projects within NHS Shetland Board. In March 2019 a Realistic Medicine Symposium was organised to explore the ethos of Realistic Medicine and how this could be implemented within a local setting in Shetland. Funding has been secured to review the diabetes management pathway to understand fully how Realistic Medicine could be utilised within the management of Long Term Conditions. Education & Training NHS Shetland continues to facilitate both undergraduate and postgraduate training. Undergraduate students mainly come from Aberdeen Medical School with smaller cohorts from St Andrews University and few elective students from medical schools all over the world. Trainee feedback during this academic year has again been consistently high and the Interim DME has been instrumental in liaising with external agencies to ensure good governance of the training pathways. During this year NHS Shetland opened its onsite Education Centre in the Gilbert Bain Hospital. This facility has a large meeting room with VC capacity (to link in with teaching) as well as one large clinical skills space and a dedicated SIM room. This on site facility has allowed easier access to teaching and training opportunities for the whole team. The works were funded by NHS



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Final Version

Shetland and ACT monies. Junior doctors now have easier access to VC linked programme specific teaching as well as other educational opportunities

In May 2019, NHS Shetland has an informal visit by Professor P Johnston the Postgraduate Dean in the Scotland Deanery (North). He had an opportunity to meet with trainees, trainers and medical students. He concluded that “that the training community is well tuned to what their junior colleagues want and need in their development” and was complimentary about the team approach and support given to trainees working in NHS Shetland.

NHS Shetland has continued to support the Rural Boot Camp for foundation doctors. The feedback from the trainees has been very positive, in that they feel better equipped for a post in remote and rural hospitals.

In 2019, two GP has undertaken training to become GP Educational Supervisors. This will allow for GP training to be continued in Shetland and widen the training practices beyond the Lerwick Health Centre.

The DME report is attached (Annex B) as part of this report. Appraisal & Revalidation The annual data collection and publication of the Annual Report on Medical Appraisal in Scotland is undertaken by NHS Education for Scotland (NES). All doctors are required by the GMC to undertake an annual appraisal, leading to revalidation of the doctors’ license to practice every 5 years. The total number of doctors with a prescribed connection to NHS Shetland Board and eligible for appraisal within the Board on 31 March 2019 was 49 (28 Primary Care & 21 Secondary Care); all 49 doctors had completed appraisals. There were 9 doctors with a prescribed connection to NHS Shetland Board on 31 March 2019 who were identified by the GMC for revalidation between 1 April 2018 and 31 March 2019. One doctor was deferred for revalidation due to insufficient evidence provided for revalidation. The Appraisal Lead is working with all doctors to ensure that their appraisal history is kept up to date in advance of revalidation date. Annex C is the Annual Appraisal Report for NHS Shetland. Brian Chittick Interim Medical Director August 2019

1

Draft - NHS Shetland Annual Duty of Candour Report

2018/2019

All health and social care services in Scotland have a duty of candour. This is

a legal requirement which means that when unintended or unexpected events

happen that result in death or harm as defined in the Act, the people affected

understand what has happened, receive an apology, and that organisations

learn how to improve for the future.

An important part of this duty is that we provide an annual report about how

the duty of candour is implemented in our services. This short report

describes how NHS Shetland has operated the duty of candour during the

time between 1 April 2018 and 31 March 2019. We hope you find this report

useful.

1. About NHS Shetland

NHS Shetland is responsible for health care for a population of around

23,000. Local Hospital and Community Services are provided from the Gilbert

Bain Hospital. In addition, visiting consultants from NHS Grampian provide

out-patient clinics as well as in-patient and day-case surgery to complement

the service provided by our locally-based Consultants in General Medicine,

General Surgery, Anaesthetics and Psychiatry. Community Health, Health

Improvement and Social Care services are delivered from a network of

locations, including health centres, resource centres, care centres, community

centres and in people’s own homes.

Shetland’s Health and Care Vision:

Our Vision is that by 2025 everyone is supported in their community to live

longer, healthier lives and we will have reduced health inequalities.

Agenda Item 14b Annex A

03 September 2019

2

2. How many incidents happened to which the duty of candour applies?

Between 1 April 2018 and 31 March 2019, there have been two incidents (one

was a complaint and one an adverse event) where the duty of candour

applied. These were unintended or unexpected incidents that resulted in

death or harm as defined in the Act, and do not relate directly to the natural

course of someone’s illness or underlying condition.

NHS Shetland identified these incidents through our adverse event

management process and complaints and feedback process. Since the duty

of candour was introduced in April 2018, until the end of March 2019, a total

of 16 adverse events/complaints have been considered for the duty of

candour process with 14 of them not requiring the duty of candour process to

be followed and two were considered to be duty of candour. These events

include a wider range of outcomes than those defined in the duty of candour

legislation as we also include adverse events that did not result in significant

harm but had the potential to cause significant harm.

The Medical Director undertakes a weekly review of the incidents to identify

any with a potential for the application of the duty of candour process.

Consideration for applying the process is then assessed using the duty of

candour trigger checklist.

We identify through the significant adverse event review process if there were

factors that may have caused or contributed to the event, which helps to

identify duty of candour incidents.

3

Type of unexpected or unintended

incident (not related to the natural

course of someone’s illness or

underlying condition)

Number of times this

happened (between 1

April 2018 and 31 March

2019)

A person died 0

A person incurred permanent lessening

of bodily, sensory, motor, physiologic or

intellectual functions

0

A person’s treatment increased 1

The structure of a person’s body

changed

1

A person’s life expectancy shortened 0

A person’s sensory, motor or

intellectual functions was impaired for

28 days or more

0

A person experienced pain or

psychological harm for 28 days or more

0

A person needed health treatment in

order to prevent them dying

0

A person needing health treatment in

order to prevent other injuries as listed

above

0

TOTAL 2

3. To what extent did NHS Shetland follow the duty of candour

procedure?

Both of the incidents were only confirmed at the end of April 2019/beginning

of May 2019 as a duty of candour therefore are in the early stages of following

the procedure.

Both were out with the normal one month window from the date the incident

occurred. The first incident was due to there now being confirmation of a

change in clinical outcome which has increased the patient’s care pathway

some time after the initial incident. For the second incident which was a

complaint, the stage 2 complaint process aligns well with duty of candour

procedures and therefore there has already been an initial apology issued, an

investigation and learning outcomes were communicated to the patient; this

4

mitigates the duty of candour being raised out with the normal one month

window from the date the incident occurred.

4. Information about our policies and procedures

Every adverse event is reported through our local reporting system as set out

in our Learning from Adverse Events Through Reporting and Review Policy

and Procedure. These are based on the Health Improvement Scotland (HIS)

national adverse event management framework which was revised in 2018 to

incorporate the requirements of the duty of candour legislation. Our policy and

procedure were reviewed and updated to reflect these changes to the national

framework. Through our adverse event management process and complaints

we can identify incidents that trigger the duty of candour procedure. We use

the Scottish Government organisational duty of candour guidance for

implementation of the procedure. The duty of candour process map has been

developed and includes a link to the guidance, the duty of candour outcomes

(definitions), the apology factsheet and our duty of candour trigger checklist.

There is also a duty of candour intranet which includes these documents and

a section of useful tools and resources for staff.

Each adverse event is reviewed to understand what happened and how we

might improve the care we provide in the future. The level of review depends

on the severity (using the NHS Scotland risk assessment matrix) of the event

as well as the potential for learning.

Recommendations are made as part of the adverse event review, and local

management teams develop improvement plans to meet these

recommendations.

All staff receive training on adverse event management and implementation of

the duty of candour as part of their induction. Awareness sessions are also

available and delivered to staff and teams. We have introduced sessions for

managers on adverse events and risk management (including the duty of

5

candour) and investigations skills as part of the management bundles. We are

awaiting the outcome of a national pilot for a train the trainer duty of candour

training pack and then this will be included in our management bundles. We

have included the duty of candour e-learning module for staff to complete as a

mandatory module in our e-learning system and report the numbers in our

adverse event quarterly report.

We know that adverse events can be distressing for staff as well as people

who receive care. We have support available for all staff through our line

management structure as well as through occupational health and resources

are available on our intranet.

5. What has changed as a result?

We have made a number of changes following review of the duty of candour

events. There are these significant changes that we wish to highlight:

We have conducted a review of the pre-operative information and

consent process for patients undergoing certain surgical procedures.

As a result the patient information leaflets were updated.

We have reviewed our Being Open policy and procedures to ascertain

how this links to the duty of candour process.

We have included “having difficult conversations” as part of the NHS

Shetland Management Training Bundles.

We have reviewed how we include the consideration of duty of candour

criteria on the Datix Reporting System. The adverse event reporting

form has been adapted which has allowed early identification of

potential duty of candour incidents.

6

6. Other information

This is the first year of the duty of candour being in operation and it has been

a year of learning and refining our existing adverse event management

processes to include the duty of candour outcomes.

As required, we have submitted this report to Scottish Ministers and we have

also placed on our website.

If you would like more information about, please contact us.

Scotland Deanery

Director of Medical Education Report

Note to DME: Please complete all sections of the report in relation to the last training year. For assistance, please

contact Duncan Pollock at [email protected] or 0141 223 1625.

Please complete and return to [email protected] by 16th August 2019.

NHS Board Shetland

Responsible Board Officer Mr Brian Chittick

Director of Medical Education Dr Pauline Wilson (Interim DME)

Reporting Period From 01/08/2018 To 31/07/2019

Scotland Deanery Director of Medical Education Report

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1. Year in review: 2018-19

1.1 Please outline the main training achievements in your board in the last training year:

1. Education Resource Centre In November 2019 NHS Shetland opened its onsite Education Centre. This facility has a large meeting room with VC capacity (to link in with teaching) as well as one large clinical skills space and a dedicated SIM room. This on site facility has allowed easier access to teaching and training opportunities for the whole team. The works were funded by NHS Shetland and ACT monies. Junior doctors now have easier access to VC linked programme specific teaching as well as other educational opportunities. There are links to the RCP (Edinb) evening teaching session as well as remote and rural teaching sessions. Clinical governance teaching sessions are held monthly. The resource centre continues to be developed as more teaching kit continues to be purchased. One of the recommendations from the GMC visit, in October 2017, was the provision of space for educational and clinical governance so as to maximize learning opportunity. The GMC are satisfied with progress made and have closed this action off.

2. Informal visit by Deputy Postgraduate Dean, The Scotland Deanery (North) In May 2019, NHS Shetland has an informal visit by Professor P Johnston. Professor Johnston had an opportunity to meet with trainees, trainers and medical students. His feedback was that opportunities in the workplace were personally tailored to the trainee’s educational needs and that this was coupled with a breadth of clinical experience. The feedback from the trainees was that consultants were available, supportive and approachable. He praised the rostering of clinic time for the CMTs in order to meet curriculum requirements. He concluded that “that the training community is well tuned to what their junior colleagues want and need in their development”.

3. New GP Educational Supervisors Two of our long standing GP trainers expressed that they will be stepping down from this role within the next few years. They have provided a commitment to support the current trainees under their supervision but will not be taking on new trainees. The notice period given has allowed NHS Shetland time to train up new GP trainers. In 2019, two GP has undertaken training to become GP Educational Supervisors. This will allow for GP training to be continued in Shetland and widen the training practices beyond the Lerwick Health Centre.

4. Rural Boot Camp. NHS Shetland has continued to support the Rural Boot Camp for foundation doctors. The feedback from the trainees has been very positive, in that they feel better equipped for a post in remote and rural hospitals. There is a focus on non-technical skills as well as technical skills across multiple systems and specialties. There are simulated sessions demonstrating the management of acute scenarios, including myocardial infarction and trauma.


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5. Utilisation of other health care professionals in the delivery of teaching and training. Due to the numbers of medical staff NHS Shetland has been using the wider multi- disciplinary team in the provision of teaching and training. This has provided a depth to the teaching and has provided both medical students and junior doctors with an understanding of the skills of the wider clinical team.

6. Skills bus (May 2019). In May 2019, the Skills Bus visited Shetland. A number of teaching and training events were

hosted in the bus, some by local staff and other by visiting specialists, such as the management of stroke.

1.2 Please highlight any sites where you have identified good practice

Site Details about good practice

Lerwick Health Centre and Psychiatry GP Training

Lerwick Health Centre has continued to provide high quality training for 5 GPStRs. Of the 5 trainees one has just completed training and has commenced work as a substantive GP in the practice. The remaining 4 trainees continue to rotate between hospital, GP and psychiatry placements. The first GP trainees to undertake psychiatry training on Island was in August 2018. Since then we have had a 3 further trainees undertake a 6 month psychiatry block. The feedback has been overwhelming positive both from the trainee and trainer perspective. The work undertaken alongside the Denary and GP Training Programme Directors to provide high quality Shetland based GP training is an area of good practice. Allowing GP trainees to undertake training on Island has meant that at least 4 trainees have continued in a formal training scheme (personal circumstance where as such that going off Island for 6 months would have put their training in jeopardy). The Rural GP training scheme remains popular with native Shetlanders choosing to come back to the Island to GP complete training. There are two local GP trainees due to take up GPStR posts in February 2020. This is healthy not only for our training schemes but for future GP recruitment.

Educational Governance The Medical Educational Governance Group (MEGG) was re-established in January 2017. The group is well embedded in to NHS Shetland’s governance and reporting systems. The group meets monthly to discuss;


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1. Educational matters pertaining to medical students and trainees 2. Operational matters such as – rota and the meeting of curriculum requirement for each grade of

trainee. The membership of the group has extended to include other members of the MDT team involved in teaching and training. There are also representation from the Executive management Team and Human Resources Department. There is also junior doctor representation on the group. The action plan from the MEGG is reviewed at the Joint Governance Group and then the Clinical Care and Professional Governance Committee, which is a standing committee of the board.

Surgical Training Towards the end of 2017 we worked together with NES to seek GMC approval to become a training site for General Surgical trainees. With the introduction of the Improving Surgical Training (IST) pilot programme in Scotland, these were the standards we had to meet. GMC approval was granted by December 2017. This allowed us to take a core surgical trainee from February to July 2018 who had expressed interest in spending time in Remote and Rural surgery. Our trainee was involved in the care of a wide variety of surgical patients including general surgery, urology, orthopaedic trauma, upper and lower GI endoscopy, emergency gynaecology, and operative obstetrics. Working part of her time in A & E, the trainee was also able to be involved in initial resuscitation of acutely ill patients, deal with trauma victims, and see and treat minor wounds, dislocations and minor ENT and eye cases. As there is only one SAS doctor in this unit, and no middle grade trainees, supervision was often directly by consultants. The stringent IST requirements were met and the feedback from the trainee on her training experience was overwhelming positive.

1.3 Please outline the main issues that your board has faced in the last training year:

The postgraduate administrators post was remove from NHS Shetland in 2017, with NES centralising this resource to Inverness. This continues to be an area of concern. A number of the roles that the postgraduate administrator fulfilled are now being picked up by clinical staff, creating a considerable burden on a small and busy clinical team. We feel that one day a week of postgraduate administration time locally (along with the ACT funded undergraduate administration hours) would provide for a more cohesive approach to postgraduate administration.


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The Medical Director of Educations post remains an interim post. This has now been an interim post since April 2017.

A number of training posts were unfilled in 2018 and 2019. This has created some rota uncertainty for the junior team. The rota gaps have been filled with a range of post holders – Clinical Development Fellows and Locum appointment for service posts. This has created an administrative burden in a small hospital with no dedicated medical staffing department or postgraduate support structure.

One of the main issues in 2018/19 has been the unfilled medical consultant posts. These have been filled with locums of some variable quality. While we have secured some excellent locums the burden of Educational Supervision falls to a small number of trainers. NHS Shetland was aware of negative comments made by trainees in November 2018. As these comments were related to bullying and undermining a response was required at the time. The comments related to a particular locum and incident. There was a local investigation and the locum was asked to leave NHS Shetland’s employment with immediate effect. A detailed response of the actions taken was sent to NES on the 19/01/19. The actions taken by NHS Shetland in relation to the matter were felt by NES to be timely and reassuring. NHS Shetland acknowledge the findings of the Stuirrock Report, published this year, and have ensured that Board procedures remain aligned to supporting staff and ensuring that Junior Doctors ‘working environment is conducive to learning in a supportive and compassionate manner.

NHS Shetland hopes to employ another substantive physician in November 2019, which should provide stability to the team and aid with teaching and training. The new post holder will be expected as part of their role to be part of the teaching team and in time become a recognised trainer.

1.4 Please outline any new issues that your board is likely to face in the coming training year(s)

There is an ongoing issue with unfilled consultant posts at the Gilbert Bain Hospital. There is a real appetite to maintain the site as a teaching training hospital as we see this as integral to the sustainability of remote and rural medicine. There is however a real concern that the burden for teaching and training, educational supervision and administration will fall on an already pressed teams. It would be really helpful if NES could give support in re-creation of local postgraduate support. This support was withdrawn in 2017 and has lead to a gap, which is increasing administrative work by clinicians.

It is unfortunate that the surgical post remains unnumbered as this excellent training opportunity This is despite 14 consultant posts in Rural Surgery in the North of Scotland, nearly half of which are unfilled long-term, while two thirds of the permanent appointments are overseas graduates.

A number of senior posts are on an interim basis in NHS Shetland – this includes Chief Executive, Medical Director as well


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as the Director of Medical Education post. This leads to a general sense of uncertainty.

1.5 Please identify any sites that should be considered for a visit

Site Reason why a visit may be necessary

1.6 Is medical education and training (MET) a standing item on the agenda of the Health Board (HB)?

Medical Educational Governance Group’s action plan is sent to the Clinical and Professional Governance Committee, which is chaired by a non-executive Board member.

1.7 Is there a non-executive board member with responsibility for MET?

The chair of the Clinical and Professional Governance Committee has responsibility for providing the Board with assurances regarding governance as a whole and this includes Medical Education and Training.

1.8 If you answered ‘No’ to questions 1.6 and/or 1.7, how are education and training issues raised with the HB?

N/A

1.9 Describe the quality control activities in relation to MET that have been undertaken by your HB in this training year?

RAG data and training survey reports are discussed at consultants group and the Medical Education Governance Group.

Informal visit by Deputy Postgraduate Dean, The Scotland Deanery (North) in May 2019.


Page 7 of 25

1.10 Are there forums within your HB whereby senior officers (CEO, MD) or site-based senior clinical management have regular, scheduled meetings with trainee doctors to discuss their training and receive feedback? Please provide full details.

Director of Medical Education meets with all trainees at induction.

The Medical Director has a meeting with the junior doctors. The Medical Director (MD) offers the juniors the opportunity to spend time with the MD in order to understand the importance of medical leadership within the organisation. The MD also outlines NHS Shetland procedures for escalation of concerns.

The interim DME is one of the small team of clinicians based at the Gilbert Bain Hospital. This allows the DME to keep in regular contact with all the medical students and junior doctors.

All Educational Supervisors are encouraged to have a mid way through meeting with trainees in addition to the initial and end of block meetings

1.11 At each site, how many DATIX submissions have been made by trainee doctors within this training year?

Site Unit/Specialty Number of DATIX

What are the mechanisms in place for trainees to receive feedback on their submissions?

Gilbert Bain Hospital Medical and Surgical 3 Director of medical Education feedback to trainees on issues raised in datix

Lerwick Health Centre GP Training 0

Psychiatry GP Training 0

1.12 At each site, how many trainee doctors have been involved in an SAE?

Site Unit/Specialty Number of SAE

Was the Deanery notified and involved in the follow up?

Gilbert Bain Hospital Medical and Surgical None

Lerwick Health Centre GP Training None

Psychiatry GP Training None


Page 8 of 25

1.13 At each site, how many trainee doctors have required ‘reasonable adjustments’ to their training in relation to a declared disability?

Site Number of trainees

Gilbert Bain Hospital None

Lerwick Health Centre None

Psychiatry None

1.14 Have you had any external reviews that have impacted on training? Please provide full details, e.g. GMC / HIS etc..

Details of external review: DME comment required:

None


Page 9 of 25

2. Training Quality Lead Funding Report for 2018/2019 Financial Year

2.1 Financial Breakdown of Use of TQL Funding:

Funded Staff Positions/Sessions

Amount: Financial Year 18/19

Projected Amount: Financial Year 19/20


None

Other Expenditure of TQL Funding: Please Specify

Amount: Financial Year 18/19



None


Page 10 of 25

2.2 Please provide information relating to the objectives for the use of TQL funding:

Outline the systems, structures, personnel and events that have been put in place to deliver this

Outline the systems, structures and personnel you use to monitor the effectiveness and quality of this delivery

Highlight what has changed since the previous 2017/18 report

Describe any planned changes over 2019-20

1. Successfully deliver against GMC standards

Each trainee has a named Educational Supervisor responsible for the trainee during their placement. There is an Undergraduate lead for Medicine and Surgery. They are responsible for the medical students during their placements. Educational Supervisors and Clinical Supervisors have undertaken appropriate training as stipulated by the GMC. The Director of Medical Education chairs the Medical Educational Governance group (MEGG). The action plan from the MEGG goes to the Clinical and professional Governance Committee, which is a sub-committee of the Board and is chaired by a non-executive director.

Educational Supervisors ensure the trainees they are responsible for complete their on line training portfolios and meet the curricular requirements. The MEGG meets monthly to review both operational and educational matters pertaining to trainers, trainees and medical students. The group is also responsible for monitoring feedback data and any action plans.

NHS Shetland was visited in its role as a Local Educator Provider, by the GMC in October 2017.

The GMC had one requirement and 2 recommendations. The 2 recommendations have been closed off as actions. The requirement concerned job plans. This work is still ongoing.

Each consultant and GP will have a job planning meeting with the Interim Medical Director. This process will look at the educational components of each individual’s job plan.

The job planning process will aid in the re-alignment of ACT funding to cover departmental teaching time. There has been a request via ACT monies to fund a session of DME time.


Page 11 of 25

2. Support Deanery Visits and manage the timely return on information as required for quality management purposes e.g. NTS, PSI, LEP report, visit action plans

The Director of Medical Education (DME) and the Medical Director (MD) are responsible for facilitating any Deanery visits. They are also responsible for timely return of information required for quality management purposes.

The DME along with the MD will review the survey data.

The DME is responsible for collating the data and communicating this to trainers and the Medical Educational Governance Group.

The MEGG is responsible for monitoring any action plans.

In 2017 the postgraduate administrative role was removed from Shetland. This role is now remotely provided by Inverness. This has lead challenges; in particular pulling together the documentation and administration required by NES.

NHS Shetland would like NES to re-consider funding a postgraduate administrators post. The GMC National review of training in Scotland 2017-18 acknowledges that

“educators cover multiple educational roles alongside their clinical duties, and where this happens it is important that there is adequate support in place.”

3. Provide pathways for delivery of information to trainees.

Pre- induction information sent out. Formal on site induction day. Written information provided. Start of block meetings with Educational Supervisors.

During the block emails sent regarding teaching/training events as well as general block specific information.

Start of block meeting with Educational Supervisors (ES). This is recorded along with a personal development plan in e-portfolio. ES then meets the trainees mid block and at the end of each block to complete e-portfolios.

Once a month Staff Development email out teaching / training opportunities. This is followed up by a weekly email

reminder.

NHS Shetland has a part- time undergraduate administrator. This post became vacant in January 2018. These ACT funded hours are now being covered in the interim by bank staff.

There are a number of consultant staff vacancies. This coupled with no local postgraduate support creates additional workload for already busy clinical staff.

NHS Shetland would like NES to re-consider funding a postgraduate administrators post. The GMC National review of training in Scotland 2017-18 acknowledges that

“educators cover multiple educational roles alongside their clinical duties, and where this happens it is important that there is adequate support in place.”

4. Organisation of hospital induction and documentation of attendance

FY1 shadowing/induction - this covers the requirements as set out in the directive on FY1 induction.

There is an all day induction on arrival. As Shetland has only one middle grade surgeon careful thought has to be given with regards the

The FY1 is provided with a structured shadowing timetable and a Shadowing log book that is required to be signed off. The Educational Supervisor reviews the log book at the start of block meeting.

Staff development help

The postgraduate administrator was responsible for the trainee’s induction and the scheduling of Educational Supervisor meetings with trainees. Since this role was removed it has fallen to the individual supervisors and DME to help administer this role with help

The Postgraduate administrator was responsible for the induction days. Again having someone in this role would help with co-ordination and monitoring of induction and progress of the trainees e learning log.


Page 12 of 25

mitigation of risk at changeover.

If a doctor joins the organisation late a bespoke day induction is pulled together for them.

monitor attendance at induction. If a trainee misses a part of induction this is then rescheduled for the individual.

from the Staff development team.

5. Support effective departmental induction and documentation of attendance

There are specific slots in the induction day for trainees to meet with the teams they will work with. This includes departmental orientation and familiarisation with departmental procedures and guidelines. NHS Shetland provide faculty for the Rural Boot camp, where foundation trainees due to work in rural general hospitals are given the opportunity to have practical teaching and training. This is held in Inverness three times a year. The boot camp covers many of the common scenarios that trainees might face for the first time in a remote and rural setting. It is a bespoke programme that better equips trainees for rural practice.

Each department retains responsibility for departmental specific induction.

Feedback from the rural Boot Camp is collated by the team in Inverness. The feedback has allowed for closer refinement of the programme to meet the trainees needs.

More emphasis is to be placed on the management of children. Trainees are to be encouraged to complete the on line module on spotting the sick child alongside direct teaching by clinical staff.

We are always looking for ways to make induction more effective and fit for purpose.

6. Ensure compliance with and documentation of appropriate Faculty development for Clinical and Educational

Clinical and Educational Supervisors have undertaken Role of the Trainer training.

Monitored by the Medical Director and is part of the appraisal and revalidation.

Full compliance with GMC Role of the Trainer. Two GPs have completed the training and are about to be

In 2019/20 NHS Shetland is looking to appoint permanent consultant physician.


Page 13 of 25

Supervisors Documentation on SOAR. accredited to become Educational Supervisors.

7. Provide local monitoring and management of doctors in difficulty

The Educational Supervisor for the trainee retains the responsibility for the management of a trainee in difficult with help and advice from the Medical Director and DME as appropriate. The Training Programme Director (TPD) may be consulted.

The Educational Supervisor keeps a log of the interviews/meetings with the trainee. An action plan is put in place. If this requires a change in working practice the DME and MD would be made aware. The TPD would be consulted.

If the needs of the trainee cannot be met in Shetland or more remedial help is required it may be decided in conjunction with the TPD to move the trainee back to the larger teaching hospital.

No changes planned No changes planned

8. Facilitating provision of training on work placed based assessment for all staff involved.

Each Educational Supervisor and Clinical Supervisor is familiar with the work place based assessment process and the systems used to record this.

Senior nurses & supervising pharmacists also complete work place based assessments. They are familiar with the methodology behind this as they also have profession specific trainees to supervise with similar requirements.

Any updates on e-portfolio activities should come via the postgraduate administrator. They should ensure all trainers are happy they understand the updates and can use new systems. The Medical Educational Governance Group monitors any changes.

We are aware that in larger boards that there are often updates and training for staff on systems and process. In a small geographically remote board it is difficult for educators to attend up dates session held on the mainland. NHS Grampian TPD had an update session on the new ITM programme. This was available by VC link so NHS Shetland were able to be part of the update on the programme and assessments required.

To continue to work with the TPD on the IMT work placement requirements and assessments.


Page 14 of 25

9. Providing training and updates on e-portfolio activities

The DME meets with other DMEs and attends educational meetings. It is the responsibility of the DME to inform/update local trainers.

Any updates on e-portfolio activities should come via the postgraduate administrator. They should ensure all trainers are happy they understand the updates and can use new systems. The Medical Educational Governance Group should then monitor any changes.

In the absence of a postgraduate administrator pulling together local training can be difficult.

We are aware that in larger boards that there are often updates and training for staff on systems and process. In a small geographically remote board it is difficult for educators to attend up dates session held on the mainland.

It is always appreciated if larger boards/NES/Deanery providing any training on the use of systems can facilitate rural boards ability to VC in.

10. Provide a local focus for careers advice

The Educational supervisor should identify the career aspirations of the trainee at the induction interview.

Trainees have some floating days built into their rotas. They can use this time for quality improvement work or audit. Some trainees have used this opportunity to sit in with visiting consultant or do GP taster days.

Trainees VC into programme specific teaching – there are sessions on careers.

The Educational Supervisor

on identifying the career aspirations of the trainee aids

them in identification of a

suitable Quality improvement Project. A QIP forms part of

the trainees e-portfolio log.

A high proportion of GP trainees are keen to make Shetland their permanent home. This is testament to the commitment of the local trainers and the support from the GP Training Director, who has help support bespoke training schemes for Island GP trainees.

No changes

NHS Shetland is to support the careers day held by the University of Aberdeen in August 2019.


Page 15 of 25

11. Provide a local contact for educational research activities

The Educational Supervisor identifies either an audit or a quality improvement project with each trainee. The trainee is then directed to the audit officer and a project outline document is completed and the project title, aims and methods are captured on a spreadsheet.

The audit or QIP is captured and included in the ward governance action plan. On completion of the audit/QIP a findings document is produced or a presentation is made. This then goes back to the audit officer to record.

The audit and QIP results are then presented to the Joint Governance Group. This then in turn reports to the Clinical and Professional Governance Committee, which is a sub-committee of the Board chaired by a non-executive director.

CFD fellow is undertaking a research project (linked with the with the RCP Edinburgh) looking at training for remote and rural practice

.

Completion of the work undertaken alongside RCP Edinburgh on what training is expected for a remote and rural physician.

12. Provide local advocacy for concerns raised by trainees.

The trainees are encouraged to approach their Educational Supervisor with any concerns. If they feel they cannot do this then they are encouraged to contact the DME or Medical Director. Each trainee can also contact their Training Programme Director directly. Trainees are made aware they can contact Human Resources or Occupational Health. Our local Chaplin also offers pastoral support and care to all staff and this included

Educational Supervisors meet with trainees throughout the block formally at three points during the block as well as informally as part of the day to day work. As the Educational Supervisors are visible they tend to know what is happening and if any concerns being raised.

Trainees can also feedback anonymously via the NTS, STS and the GMC survey.

Monitor through Medical Education Governance

As part of induction process the trainees to have a session on:

Duty of Candor

Raising Concerns

Bully and harassment

Reporting and support structures

The Medical Director has a session at induction to go


Page 16 of 25

trainees and medical students.

Group. over issues in relation to raising concerns.

13. Ensure accountability at Board level for performance in the delivery of PGMET.

The DME is the chair of the Medical Education Governance Group. Executive managers are members of the Medial Education Governance Group and are sited on operational and educational matters related to medical students and trainees.

The annual DME report goes to the Board via the MD.

The DME chairs the medial Education Governance group, which in turn reports to the Clinical and Professional Governance Committee, via the Joint Governance group. The Clinical and Professional Governance Committee is a sub-committee of the Board is chaired by a non-executive director.

The Interim MD and the

interim DME have met on several occasions to discuss

matters pertaining to PGMET.

Through 2019 it is hoped that the posts of MD and DME will filled by permanent post holders.

14. Provide to the Board regular reports on PGMET Quality Management data including GMC NTS, PSI & NES QM data including reports of QM visits highlighting strengths & weaknesses of training in LEPs in the Board area.

The DME report which covers PGMET, Quality Management data goes to the Board.

The report covers the strengths and weakness of the Local Educator Provider. It also identifies the resources required to provide high quality education.

The DME chairs the medial Education Governance group,

which in turn reports to the

Clinical and Professional Governance Committee, via

the Joint Governance group. The Clinical and Professional

Governance Committee is a sub-committee of the Board

is chaired by a Non-executive

Director.

As training needs gap analysis was prepared by the

interim DME. This went

Medial Education Governance Group for consultation and

action.

In 2018 continued work on

GMC action plan. The 2 recommendations have been meet and work is ongoing to meet the requirement of up-to-date job plans

To continue to ensure that the board is sighted on these via the Medical Directors report to the board and other governance structures


Page 17 of 25

Any other use made of TQL funding


Page 18 of 25

3 Postgraduate Medical Education: Quality Report

Key to survey results

Scottish Training Survey (STS)

Key

R Low Outlier - well below the national benchmark group average

G High Outlier – performing well for this indicator

P Potential Low Outlier - slightly below the national benchmark group average

L Potential High Outlier - slightly above the national benchmark group average

W Near Average

▲ Significantly better result than last year**

▼ Significantly worse result than last year**

▬ No significant change from last year*

No data available

No Data

** A significant change in the mean score is indicated by these arrows rather than a change in outcome.

GMC National Training Survey (NTS)

Key

R Result is below the national mean and in the bottom quartile nationally

G Result is above the national mean and in the top quartile nationally

P Result is in the bottom quartile but not outside 95% confidence limits of the mean

L Result is in the top quartile but not outside 95% confidence limits of the mean

W Results is in the inter-quartile range

▲ Better result than last year

▼ Worse result than last year

▬ Same result as last year

No flag / no result available for last year

Aggregated results have been provided where there are fewer than 3 responses in the current year’s NTS survey and therefore no data is available. The aggregated RAG outcomes have been generated by NES using the 2017-2019 NTS data. They are not attributable to the GMC.


Page 19 of 25

3.1 Site: Gilbert Bain Hospital, Specialty: General Internal Medicine

GMC NTS (Trainee)

Level O

vera

ll

Sati

sfa

cti

on

Cli

nic

al

Su

pe

rvis

ion

Cli

nic

al

Su

pe

rvis

ion

ou

t o

f h

ou

rs

Han

do

ver

Ind

uc

tio

n

Ad

eq

uate

Exp

eri

en

ce

Su

pp

ort

ive

en

vir

on

men

t

Wo

rk L

oad

Ed

uc

ati

on

al

Su

pe

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ion

Fe

ed

ba

ck

Lo

cal

Te

ach

ing

Reg

ion

al

Te

ach

ing

Stu

dy

Le

ave

Rep

ort

ing

Syste

ms

Te

am

wo

rk

Cu

rric

ulu

m

Co

vera

ge

Ed

uc

ati

on

al

Go

vern

an

ce

Ro

ta

Desig

n

N

F2 (aggregated) W - W ▲ W - W - W - W - W - W - W - W - W - W - 3

Scottish Training Survey

Group

Cli

nic

al

Su

pe

rvis

ion

Ed

uc

ati

on

al

En

vir

on

men

t

Han

do

ver

Ind

uc

tio

n

Te

ach

ing

Te

am

Cu

ltu

re

Wo

rk L

oad

N

Core - Medical W W W G W W W 5

Foundation - Medical W G W W W W W 5

GP - Medical 1

GP - Medical (aggregated)

2

GMC Trainer Survey

Specialty

Overa

ll

Sati

sfa

cti

on

Wo

rk L

oad

Han

do

ver

Su

pp

ort

ive

en

vir

on

men

t

Cu

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ulu

m

Co

vera

ge

Ed

uc

ati

on

al

Go

vern

an

ce

Tim

e f

or

Tra

inin

g

Ro

ta D

esig

n

Reso

urc

es f

or

Tra

ine

rs

Su

pp

ort

fo

r T

rain

ers

Tra

ine

r

Develo

pm

en

t

Resp

on

se

rate

General (internal) medicine

100%

DME Comment Required: e.g. Do outliers relate to a known issue or good practice? If not, can they be explained? What is the good practice in place? Can it be shared? What are the actions in place to resolve known issues?

It is recognised by NHS Shetland that for an FY2 the job can be challenging particularly out of hours for the FY2 grade doctor.

Working in a remote and rural environment is a very unique experience for the trainees and as a LEP we need to be mindful of this.

Dealing with a truly unselected medical take can leave the junior doctor anxious. This is understood and we are looking at ways to support the junior staff. NHS Shetland has adopted the #saynotoSHO, has help the nursing staff understand the competencies of the grade of doctor.

We have put a lot of effort into identifying the senior nurse as the first line support to the juniors overnight, backed up by consultant colleagues.

We are looking at making our induction process more robust and are part of the Rural Boot camp concept, at which the trainees coming to remote and rural areas are provided with teaching on scenarios they may encounter in a rural general hospital setting.

We are looking at “edge of practice” areas of medicine and surgery that both senior and juniors doctors working in a remote setting may be exposed too.


Page 20 of 25

3.2 Site: Gilbert Bain Hospital, Specialty: General Psychiatry


Group C

lin

ical

Su

pe

rvis

ion

Ed

uc

ati

on

al

En

vir

on

men

t

Han

do

ver

Ind

uc

tio

n

Te

ach

ing

Te

am

Cu

ltu

re

Wo

rk L

oad

N

GP - Psychiatry 3

GP - Psychiatry (aggregated)

3


In order to make GP training more robust a psychiatry block was added. This has allowed trainees to stay on Island to complete their GP training. Due to the personal family circumstances of some of the trainees they had considered giving up medicine if they would have had to travel of Island to finish their GP training scheme. Working with the Deanery and the Training programme Director has allowed us to develop the psychiatry block. The informal feedback has been overwhelmingly positive form the trainees and trainers alike.


Page 21 of 25

3.3 Site: Gilbert Bain Hospital, Specialty: General Surgery

GMC NTS (Trainee)

Level O

vera

ll

Sati

sfa

cti

on

Cli

nic

al

Su

pe

rvis

ion

Cli

nic

al

Su

pe

rvis

ion

ou

t o

f h

ou

rs

Han

do

ver

Ind

uc

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n

Ad

eq

uate

Exp

eri

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ce

Su

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ive

en

vir

on

men

t

Wo

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oad

Ed

uc

ati

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Su

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ion

Fe

ed

ba

ck

Lo

cal

Te

ach

ing

Reg

ion

al

Te

ach

ing

Stu

dy

Le

ave

Rep

ort

ing

Syste

ms

Te

am

wo

rk

Cu

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ulu

m

Co

vera

ge

Ed

uc

ati

on

al

Go

vern

an

ce

Ro

ta

Desig

n

N

F2 (aggregated) W - W - P ▼ W - W - W - W - W - W - W - W ▼ W - W W W 3


Group

Cli

nic

al

Su

pe

rvis

ion

Ed

uc

ati

on

al

En

vir

on

men

t

Han

do

ver

Ind

uc

tio

n

Te

ach

ing

Te

am

Cu

ltu

re

Wo

rk L

oad

N

Foundation - Surgical 2

Foundation - Surgical (aggregated)

W ▬ W ▬ W ▬ W ▬ W ▬ G ▬ L ▬ 7

GMC Trainer Survey

Specialty

Overa

ll

Sati

sfa

cti

on

Wo

rk L

oad

Han

do

ver

Su

pp

ort

ive

en

vir

on

men

t

Cu

rric

ulu

m

Co

vera

ge

Ed

uc

ati

on

al

Go

vern

an

ce

Tim

e f

or

Tra

inin

g

Ro

ta D

esig

n

Reso

urc

es f

or

Tra

ine

rs

Su

pp

ort

fo

r T

rain

ers

Tra

ine

r

Develo

pm

en

t

Resp

on

se

rate

General surgery 100%


It is recognised by NHS Shetland that for an FY2 the job can be challenging particularly out of hours for the FY2 grade doctor. Working in a remote and rural environment is a very unique experience for the trainees and as a LEP we need to be mindful of this.

Dealing with a truly unselected medical take can leave the junior doctor anxious. This is understood and we are looking at ways to support the junior staff. NHS Shetland has adopted the #saynotoSHO, has help the nursing staff understand the competencies of the grade of doctor.

We have put a lot of effort into identifying the senior nurse as the first line support to the juniors overnight, backed up by consultant colleagues.

We are looking at making our induction process more robust and are part of the Rural Boot camp concept, at which the trainees coming to remote and rural areas are provided with teaching on scenarios they may encounter in a rural general hospital setting.

We are looking at “edge of practice” areas of medicine and surgery that both senior and juniors doctors working in a remote setting may be exposed too.


Page 22 of 25

.4 Site: Gilbert Bain Hospital, Specialty: Core Medical Training GMC NTS (Trainee)

Level

Overa

ll

Sati

sfa

cti

on

Cli

nic

al

Su

pe

rvis

ion

Cli

nic

al

Su

pe

rvis

ion

o

ut

of

ho

urs

Han

do

ver

Ind

uc

tio

n

Ad

eq

uate

Exp

eri

en

ce

Su

pp

ort

ive

en

vir

on

men

t

Wo

rk L

oad

Ed

uc

ati

on

al

Su

pe

rvis

ion

Fe

ed

ba

ck

Lo

cal

Te

ach

ing

Reg

ion

al

Te

ach

ing

Stu

dy

Le

ave

Rep

ort

ing

Syste

ms

Te

am

wo

rk

Cu

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ulu

m

Co

vera

ge

Ed

uc

ati

on

al

Go

vern

an

ce

Ro

ta

Desig

n

N

Core (aggregated)

P - P - P - W - W ▼ W - R - W - W - W - P - W - P - W - W - W - W - 4

(aggregated)


The difficulty with interpretation of aggregated data is it is hard to make meaningful comments on the last year of training as less than 3 CMTs feedback in 2018/19. It with aggregated data also takes a few years to turn pink flags to white/green. In 2017, when the aggregated data dates back to NHS Shetland had a very favourable GMC visit. “The foundation doctors in training we met with all had named supervisors, and all had met with them. We heard from doctors training in general practice, core medical training and the clinical development fellows that they also felt well supervised and supported. The doctors in training we met with had undergone induction at the hospital, and we heard positive comments about induction compared to their experience of induction at other LEPs. We heard that they feel part of the team, and that there are good learning opportunities at the LEP, and that it is a valuable experience. We heard from the senior team that the rota design allowed doctors in training to follow the patient from the front door, to the ward and then discharge. The doctors in training we met with valued this and also told us their experience at Gilbert Bain Hospital had been positive. The senior team told us about the introduction of floating days, which were encouraged to be used for quality improvement projects or shadowing areas they are interested in. All learners we met with told us they would recommend the post to a friend. The doctors in training told us that they had no difficulty in contacting the Deanery, and we heard examples of the use of video conferencing to access formal teaching on the mainland, for example foundation doctors were all able to access weekly teaching from NHS Grampian via video conference. We also heard that this type of access was not suited to all learning styles, and that it was also important to attend the teaching in person.

The generalist model of healthcare also shapes the medical education and training delivered at the hospital, and we heard from learners we met with that they feel part of the wider team, and have more opportunities for a wider exposure to a range of patients than in other placements. We also heard from the educators that due to the low number of learners at the site, much of the teaching was informal rather than lecture based.


Page 23 of 25

We also heard from the doctors in training of the value of this type of placement, not just for those with an interest in remote and rural medicine. For example we heard from the foundation doctors that their experience at Gilbert Bain will make them better doctors”

It is acknowledged that there was a problem from August 2018-December 2018. This was related to a particular locum who was asked to leave NHS Shetland’s employment with immediate effect after a particular incident relating to bullying of junior staff. NHS Shetland was asked to comment on this at the time as there had been comments made about bullying and harassment in the NTS. A response was made to NES in January 2019 and the reply back from NES to NHS Shetland was that the actions taken had been very detailed and reassuring. Whist the trainees may not have felt supported by the locum, NHS Shetland supported the trainees during this time –Educational Supervisor level, DME as well as having input from the Director of Acute Services who met with them on more than one occasion. Clinical Supervision/OOH supervision/ Supportive environment. In order to understand this better I as DME have spoken to the junior team. It appears that the juniors feel that the support given by the majority of the consultants is very good as is the clinical supervision. It appears most of the negative feelings in this area pertain to a locum consultant who was not as accessible as they could have been. This had already been identified by the substantive consultants and this had been addressed by our Medical Director. This individual no longer works for NHS Shetland. Professor Johnston visited NHS Shetland for an informal visit in May 2019 and he wrote to the Medical Director with the findings of his visit. “Specifically, the trainees are enthusiastic about:

The way that opportunities in the workplace are personally tailored to their educational needs;

This is coupled with the breadth of the case mix to which they are exposed;

The enthusiasm of all staff groups for interdisciplinary working, teaching and sharing experience;

The arrangement for clinics to be rostered which is very helpful and not usual in most places;

Completing supervised learning events is easy with ready access to consultants to do this;

The close working relationship between specialties and the ease with which they communicate;

Consultants availability is “fantastic” and they are “supportive and approachable”;

Staff out of hours and overnight are very helpful.”

Study Leave NHS Shetland has not turned down study leave requests. We have been supportive of CMT attending MRCP teaching on the mainland.


Page 24 of 25

Local Teaching In November 2018 the onsite teaching resource centre was opened on the Gilbert Bain site. The opening of this centre will hopefully allow us to consolidate the teaching programme and make its delivery more robust. There have however been efforts to provide the trainees with other local teaching opportunities such as:

The skills bus visit and teaching by visiting teams Evening update – RCP Edinburgh Monthly evening teaching meeting between GP and hospital teams Palliative care teaching day Teaching at clinics – one to one with each trainee Teaching ward round One to one teaching for preparation for PACES exam

Another issue for NHS Shetland is that a number of our post holders are LAS post or CDF post- these doctors are not part of the training survey and hence our results are skewed. NHS Shetland has a number of medical vacancies. There have been a number of locum physicians. This has led to extra pressures on the substantive post holders. Every effort has been made to protect the trainees from the impact of this. Protecting the reputation of NHS Shetland as a good place to train, work and live is central to the future of remote and rural healthcare. Every effort is made to maintain the standards of teaching to our trainees. Indeed, it is noted that some rota gaps in 2019 have been filled by applicants who are friends of the current junior doctors. 5 out of 7 recent applicants were recommended to apply for the post by the current cohort of trainees/ LAS doctors.


Page 25 of 25

4 Sign-off

Form completed by Role Signature Date

Pauline Wilson DME (Interim)

Pauline Wilson 17/07/19

2018 - 2019 Please complete all orange fields

Organisation details:

NHS SHETLANDOrganisation Name:

Address: GILBERT BAIN HOSPITAL, SOUTH ROAD, LERWICK, SHETLAND ZE1 0TB

Medical Appraisal & Revalidation Quality Assurance: Self-Assessment

Part 2 - Data

Please return the completed self-assessment pack (02, 04 and 01 if applicable) to [email protected] no later than 17 June 2019.

1

Primary Care Secondary Care Total

1.1 28 21 49

1.2

1.2.1 0 0 0

1.2.2 0 0 0

1.2.3 0 0 0

1.2.4 0 1 1

1.2.4.1

1.3

Number of

doctors eligible

for appraisal

Number of

completed

appraisals

1.3.1 3 3

1.3.2 6 6

1.3.3 0 0

1.3.4 5 5

1.3.5 0 0

1.3.6 0 0

1.3.7 14 14

1.3.8 0 0

28 28

Doctors with a prescribed connection

Please confirm the total number of doctors who were unable to be appraised for a valid reason (those issued with Form 5A)

Please confirm the total number of doctors with a prescribed connection to your organisation on 31 March 2019

General Practitioner (doctors on a General Practitioner Performers List): Sessional (Locum)

Primary Care

General Practitioner (doctors on a General Practitioner Performers List): Principal GP

General Practitioner (doctors on a General Practitioner Performers List): Other

Primary Care: TOTAL

[This cell will automatically calculate the total for your organisation.]

General Practitioner (doctors on a General Practitioner Performers List): Salaried

sabbatical

ARCP completed so no appraisal required for 18/19.

Number of primary and secondary care doctors eligible for appraisal with whom the organisation has a prescribed connection on 31 March 2019. The appraisal period for all

eligible doctors under review is 1 April 2018 - 31 March 2019. DO NOT include doctors with a Form 5A: Exemption from Appraisal.

Note: Only doctors with whom the organisation has a prescribed connection should be included in this section. Each doctor should be included in only one category. Fields 1.3.1 - 1.3.15

must not be left blank. Where the answer is nil, please enter '0'.

other (please provide details below in 1.2.4.1)

long term sick

maternity leave

General Practitioner (doctors on a General Practitioner Performers List): Employed GP

General Practitioner (doctors on a General Practitioner Performers List): Retainee

General Practitioner (doctors on a General Practitioner Performers List): Associate

General Practitioner (doctors on a General Practitioner Performers List): Retired

The Medical Profession (Responsible Officers) Regulations 2010 state that the Responsible Officer (RO) must keep an accurate record

of all doctors for whom the organisation has a prescribed connection. The number of doctors in each category should be entered below.

The categories relate to current roles and job titles rather than qualifications or previous roles. Some doctors (for example, research, civil

service, locums, other employed or contracted doctors, independent doctors, MOD etc) may not be included in these categories and

should be entered under Other - 1.3.8 and 1.3.12 .

Number of

doctors eligible

for appraisal

Number of

completed

appraisals

1.3.9 11 11

1.3.10 1 1

1.3.11 0 0

1.3.12 3 3

1.3.13 6 6

1.3.14 0 0

1.3.15 0 0

21 21

1.2.16 49 49

2


2.11 0 1

2.1.1 1 0 1

2.1.2 0 0 0

2.1.3 0 0 0

2.1.4 0 0 0

Doctors deferred from revalidation during 2017-2018 (last year)

How many had a positive recommendation by 31 March 2019?

Independent healthcare providers only - doctors with practising privileges. All doctors with practising privileges who have a

prescribed connection to the organisation should be included in this section, regardless of their grade.

Clinical Fellows

Secondary Care: TOTAL

[This cell will automatically calculate the total for your organisation.]

Total [This cell will automatically calculate the total for your organisation.]

Of the total number of deferred doctors, how many no longer have a prescribed connection to your organisation (for

example, left the organisation) by 31 March 2019?

How many have deferred for a second time by 31 March 2019?

Of the total number of deferred doctors, how many were notified as non-engagement on 31 March 2019?

Secondary Care

Consultant, including honorary contract holders. For example, university employed staff with a licence to practise, clinical

academics and NHS lecturers.

Staff, Associate Specialists, and Specialty Doctors. This includes hospital practitioners and clinical assistants who do not

have a prescribed connection elsewhere.

University employed staff with a licence to practise (who are neither a Consultant, nor on the performers list) and who do

not have a prescribed connection to NHS Education for Scotland.

Please confirm the number of doctors who had a prescribed connection with your organisation on 31 March 2018 and who were

identified for revalidation by the GMC between 1 April 2017 and 31 March 2018 and who were deferred in that year.

Other; this includes doctors in management or leadership roles, the civil service, doctors in wholly independent practice,

and doctors not directly employed, agreed as responsibility of the RO.

Number of Secondary Care Locums, employed for 2 months or more, in the 12 months up to 31 March 2019 (this could be

2 consecutive months' employment, or a combined total of 2 months during the appraisal year).

This section relates to doctors who had a prescribed connection with your organisation on 31 March 2018 and who were identified for

revalidation by the GMC between 1 April 2017 and 31 March 2018.

3


3.18 1 9

3.1.1 7 1 8

3.1.2 0 0 0

3.1.3 1 0 1

3.1.4 1 0 1

3.1.4.1 How many of the deferred was because "the doctor is subject to an ongoing process"? 0 0 0

3.1.4.2 How many of the deferred was because of "Insufficient evidence for a positive recommendation"? 1 0 1

3.1.4.2.1 Of these (from 3.1.4.2), how many were because of the sub-reason: "Appraisal activity"? 0 0 0

3.1.4.2.2 Of these (from 3.1.4.2), how many were because of the sub-reason: "Colleague feedback"? 0 0 0

3.1.4.2.3 Of these (from 3.1.4.2), how many were because of the sub-reason: "Compliments and Complaints"? 0 0 0

3.1.4.2.4 Of these (from 3.1.4.2), how many were because of the sub-reason: "CPD"? 0 0 0

3.1.4.2.5 Of these (from 3.1.4.2), how many were because of the sub-reason: "Interruption to practice"? 0 0 0

3.1.4.2.6 Of these (from 3.1.4.2), how many were because of the sub-reason: "Patient feedback"? 0 0 0

3.1.4.2.7 Of these (from 3.1.4.2), how many were because of the sub-reason: "QIA"? 0 0 0

3.1.4.2.8 Of these (from 3.1.4.2), how many were because of the sub-reason: "Significant events"? 0 0 0

3.1.5 0 0 0

3.1.6

Doctors identified for Medical Revalidation in 2018-2019.

This cell will calculate how many of those who were due for revalidation have been not accounted for in the

above categories. If this calculation does not equal '0' please explain why below:

O P

T I O

N A

LPlease confirm how many doctors with a prescribed connection to your organisation on 31 March 2019 were identified by the GMC

for revalidation between 1 April 2018 and 31 March 2019.

Of these, how many deferral requests were made?

How many individual doctors were deferred within the period 1 April 2018 and 31 March 2019?

(we acknowledge that an individual doctor can have more than one deferral within any revalidation year)

Of these, how many non-engagement notifications were made?

This section relates to doctors with whom your organisation has a prescribed connection on 31 March 2019 who were identified for

revalidation between 1 April 2018 and 31 March 2019, excluding 2017-2018 deferrals.

Of these, how many positive recommendations were made?

Please enter your response here.

4


4.110 9 19

4.1.1 10 5 15

4.1.2 10 5 15

4.1.3 9 8 17

4.1.4 10 8 18

4.1.5 10 9 19

4.1.5.1 10 9 19

4.2

0 0 0

4.2.1 0 0 0

4.2.2 0 0 0

4.2.3 0 0 0

4.2.4 0 0 0

4.2.5 0 0 0

4.2.5.1

Doctors identified for Medical Revalidation in 2019-2020 (next year)

Please confirm how many doctors with a prescribed connection to your organisation on 31 March 2019 are identified by the GMC

for revalidation between 1 April 2019 and 31 March 2020.

This section relates to appraisal for those doctors with whom your organisation has had a prescribed connection on 31 March 2019 and

who are identified for revalidation between 1 April 2019 and 31 March 2020.

How many had an appraisal between 1 April 2017 and 31 March 2018




This cell will calculate how many of those who have not completed an appraisal have not been not accounted for

in the above categories, if this calculation does not equal zero please explain why below:

Of these, how many were due to not being signed off?

Of these, how many Notification of clinical governance issues (Form 5C) were completed?

Of these, how many Notifications of exemption from appraisal (Form 5A) were completed?

Please confirm how many doctors with a prescribed connection to your organisation on 31 March 2019 who were identified by the

GMC for revalidation between 1 April 2019 and 31 March 2020 did not complete an appraisal between 1 April 2018 and 31 March

2019.

Of these, how many Notification of non-participation in appraisal (Form 5B) were completed?

How many of these appraisals (from 4.1.5) were undertaken by appraisers who have completed NES National (enhanced)

Medical Appraiser Training?


5


5.1 0 0 0

6 Primary Care Secondary Care Total

6.1 1 0 1

7


7.1.1 3 0 3

7.1.2 3 0 3

7.1.3 0 0 0

7.1.4 3 0 3

7.1.5 1 0 1

How many of your appraisers are scheduled to attend the NES National Medical Appraiser Refresher Training?

How many of your appraisers have undergone an annual performance review in 1 April 2018 and 31 March 2019?

How many local appraisers meetings/trainings were organised for your appraisers in 1 April 2018 and 31 March 2019?

Doctors not identified for Medical Revalidation by 31 March 2019.

Trained appraisers

This question relates to the target that most doctors will have revalidated by March 2018.

How many doctors who have had deferral recommendations in previous years, will complete revalidation by 31 March 2020?

7.1 As of 1 April 2015, it was recommended that all appraisals are undertaken by NES-trained appraisers.

How many appraisers do you have in your organisation?

How many of your appraisers have completed the NES National (enhanced) Medical Appraiser Training?

How many doctors in your organisation had not entered into the revalidation process by 31 March 2019?

(Please exclude trainee doctors and those who have entered the process but have been deferred beyond 31 March 2019).

Doctors deferred from revalidation and expectations for 31 March 2020.

nhs shetland: providing healthcare services in shetland - … · 2019. 10. 9. · past 12 months...

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