Strategic Framework 2010-13
Our Vision for Postgraduate Medical Education in the South West Peninsula
The South West Peninsula Deanery was established in April 2005 and was the first entirely new postgraduate deanery in England for at least two decades.
For the last four years we have seen enormous changes, both locally and nationally, in the way that postgraduate medical education is provided.
The Deanery is responsible for providing and quality managing postgraduate medical education across Devon and Cornwall.
It provides support for general practice training, foundation training and for trainees in both core and run through specialties.
The Deanery is part of the South West Strategic Health Authority (NHS South West) and has been under the leadership of Professor Martin Beaman (pictured) since it was opened on 1st April 2005.
The original vision of the Deanery was to promote the delivery of high quality patient care through the provision of a highly skilled medical workforce. That vision remains relevant today and needs to be intimately linked with the NHS South West Strategic Framework ‘Improving Health: Ambitions for the South West’ so that we develop the workforce required for the care pathways in the Peninsula.
Our aim is to produce a workforce that is skilled in all aspects of patient care. The clinicians produced will be equipped to develop and modify their knowledge and skills in line with the changing needs of the service in the future. This means that all doctors completing training in the South West Peninsula should be fit to practice, fit for purpose, able to adapt and provide appropriate clinical leadership for the teams in which they work.
Our ambition is just the start of this process. We know there will be challenges ahead and we look forward to those as we continue to work with our stakeholders to ensure that the next generation of doctors emerging from the South West Peninsula are seen as excellent examples of the NHS workforce.
The senior management team of the Deanery have agreed some core values which it shares with all its staff and would like to ensure that they are values adopted by all those in clinical training in the Peninsula. These values include:
- Good leadership
- Professional enjoyment
- Valuing people
- Highly regarded as individuals
- Efficiency and effectiveness
We regard them as key to a successful and enjoyable career, as well as ensuring good team based patient care.
I welcome your views on this Deanery Strategy, how it is implemented and what more we can do to improve training and education in the Peninsula.
Structure and relationships
From the outset the Deanery set one of its key targets as good communication with local education providers (LEP’s) [the trusts] and those individuals who are intimately involved with the delivery of postgraduate medical education and training.
One of the first structures established by the Postgraduate Dean was the Dean’s Education Group (DEG), which meets on a quarterly basis to discuss the operational and strategic direction that postgraduate medical education should follow. Membership of that group is wide ranging and includes representatives from Postgraduate Centre Managers/Medical Education Managers, trainees, medical staffing, clinical tutors and Directors of Medical Education as well as members of the Deanery senior management team. Lay representation is being sought. It provides an excellent forum for communication, synthesis and implementation of new initiatives.
The Deanery is part of the Workforce Directorate of NHS South West and the Postgraduate Dean is managerially accountable to the Director of Workforce. The structure of the Deanery is constantly being refined and reviewed as it reflects on the changing patterns of healthcare delivery and the workforce required to support it.
As we strive towards excellence the quality agenda becomes more important and a greater emphasis on quality management is reflected by the development of a Quality Committee to support the Quality Manager in ensuring all our training programmes are fit for purpose and meet the requirements of our regulator, the General Medical Council.
The current structure of the Deanery is shown here, represented in a diagrammatic form to demonstrate the roles and responsibilities that are currently in existence.
Challenges for 2010-13
The NHS faces a number of changes in the future which have been outlined by Lord Darzi in his report “High Quality Care For All” and include:
- Demands driven by changing demographics.
- Rising expectations from patients and those working in the NHS.
- Advances in treatment and technology.
- The changing nature of disease and improving the quality of care.
We also need to be cognisant of the local NHS South West Strategic Framework which outlines a number of local ambitions within nine clinical pathway groups.
There is an emphasis towards improved and increased care in the community, which will be reflected in the increased number of training posts in primary care over the next three years and the importance that these doctors have in ensuring appropriate management of patients locally, with an increasing emphasis on staying healthy.
The Working Time Regulations (WTR) reduction to a 48 hour working week for doctors in training is a challenging development and we will need to watch closely the effects on postgraduate medical training to ensure that there is an appropriate balance between service delivery, education and training.
The Deanery’s strategy is articulated within the context of “Improving Health: Ambitions for the South West”. There is an increasing drive towards more community based care with an emphasis on staying healthy, minimising inappropriate hospital admissions, maximising the return from secondary care into the community and a greater emphasis on treating patients closer to home, particularly for chronic disease.
With these themes in mind, our strategy starts not in Foundation, which would be a natural educational starting point for all medical graduates, but instead looks at primary care and reflects the national and local NHS workforce needs. We need to ensure that training in the community and in particular training in general practice is seen as attractive to both medical students and graduates and of excellent quality to meet the needs of the changing patient demographics. We need to ensure that approximately 50% of medical graduates enter this form of postgraduate training and that will represent a significant shift from current career aspirations. Many of our strategic aims that follow in this document focus on developing and maintaining an excellent workforce in the areas of specialisation that our patients need, identifying and supporting those doctors who encounter difficulties and ensuring that new doctors are given appropriate support to allow them to make realistic career choices.
1. GP expansion
We are committed to increasing the GP training numbers across the Peninsula in line with national and local needs. Collaborative working with our Careers Team at a local and national level will ensure effective marketing of the excellent training opportunities here in the South West. In 2008 the PMETB trainee survey identified the Peninsula as top of the trainee overall satisfaction outcome data.
We have worked effectively with colleagues in secondary care to ensure that only posts appropriate for GP training are used in our programmes and we continue to find new ways of teaching to maximise the use of existing GP educators so that we can optimise the learning experience for all our trainees.
2. We will ensure a ‘fit for purpose’ GP programme to meet local workforce needs
Professionalism and clinical leadership are core to a successful workforce in primary care. This will be taught and assessed through a three year programme as part of the GP curriculum, producing doctors who are capable of transforming community services and who are quick to respond to the changing needs of the local NHS. We will provide opportunity for ST4 extensions to allow GPs to develop special areas of clinical interest in alignment with primary care workforce needs, in addition to training GPs with research and educational skills.
We will continue our expansion of primary care National Institute for Health Research (NIHR) funded academic clinical fellowships, focusing on heath service research at the primary/secondary care interface.
We will continue to promote the Progress Testing pilot to identify excellence, as well as doctors with additional training needs, so that we can ensure all doctors who successfully achieve Certificate of Completion of Training (CCT) in the Peninsula are fit to practice in the primary care environment.
3. To continue to refine and improve the training faculty
By expanding and improving the faculty of GP educators the quality of doctors emerging from the training programme will improve. We plan a prospectus of courses designed to cater to the educational needs of our faculty and make attendance a requirement for all those involved in training.
4. Quality assuring the performance of the post CCT GP workforce
This is an important goal. We must ensure the doctors in primary care who work independently are not only fit at the time of CCT, but maintain that fitness to practice throughout their professional career so that they are capable of delivering excellent patient care in the years that follow. By working closely with the primary care organisations across the Peninsula we will support the quality assurance of the GP workforce by means of appraisal training and preparing the workforce for impending revalidation.
We will continue to develop the work already under way with remediation packages for doctors in difficulty, which includes professional coaching and placements in ‘advanced training practices’.
The natural starting point for all doctors in training is now the foundation programme. These early years prepare the doctor for the years ahead. The programmes available should allow an early insight in to some of the many specialties that exist for those following a medical career. Foundation allows trainees an opportunity to reaffirm or change their future career aspirations. Complemented by our excellent careers service we want all our trainees are able to make informed, realistic and good quality applications to their next career post beyond foundation. Our three key strategic goals for 2010 and beyond are:
5. Reflect workforce demands
To reflect the workforce demands of the future of the NHS in the nature of the foundation training posts we offer. We will ensure that small specialties are represented in some of our programmes, along with an increased opportunity for academic research. This will also help to provide feeder opportunities into our expanding academic clinical fellowship and clinical lecturer programmes.
6. Primary and community care expansion
To continue to increase the placements in primary care and community care so that at least 55% of our programmes have a community placement in the future. This will require additional capacity for primary care training, as well as financial resource, but is a key development in ensuring the NHS vision of expanding the delivery of care in the community.
7. High quality supervision
To provide foundation trainees with the highest quality of educational and clinical supervision so that the training provided is highly recommended by our foundation trainees to their colleagues and through the national trainee survey. This will require continuous quality improvement of the placements in the LEPs through an iterative dialogue and support with our stakeholders through a robust process of inspection, survey and feedback.
OVERARCHING TRAINING STRATEGY
The Deanery has identified several strategic aims that overarch all of our training areas:
8. Faculty development
By ensuring all clinical and educational supervisors are trained to Deanery standards we can be confident that educational opportunities are maximised and appropriate assessment conducted.
The process is well underway and is being led by our newly appointed Associate Dean for Faculty Development. We will ensure a database of clinical/educational supervisors is maintained and their training documented, thereby ensuring their fitness to undertake the role required. Our postgraduate schools are also engaged with this process and are ensuring that specialty specific training for the trainers is made available.
We will commission a programme for specialty training doctors and GP registrars that includes training in how to provide clinical supervision so they are well prepared to support consultants in the training of more junior colleagues and are prepared themselves for post CCT employment as a clinical supervisor. This programme will be delivered over six days, spread over three academic terms, in the Peninsula. Funding is already in place to facilitate this and the programme will commence in October 2010.
We will ensure that educational appraisal is in place for all trainers with significant educational roles through engagement with the school structure. All Heads of School and Associate Deans will receive an annual appraisal through the Deanery.
9. Enhance academic training
The Deanery is committed to academic medicine. Prior to 2005, when the Deanery was first established, there was only one academic lecturer post linked to a training grade doctor. We will now have 14 academic fellowships/clinical lecturer posts available by the end of 2010. They support our research themes in Molecular Medicine, Medical Education and Health Service Research. By using these platform research areas we have appointed trainees across a number of clinical areas, which include Paediatrics, Plastic and General Surgery, Acute Medicine and General Practice. By using this approach we hope many of these academic trainees will develop into our future academic workforce here in the Peninsula, one day themselves supporting academic trainees.
The Deanery supports and promotes educational research and over the next three years (2010-13) aims to increase its presentation and publication of locally generated educational research.
The Deanery is committed to high quality training. The aim of the Deanery Quality Team is to achieve the highest standards in the training of junior doctors within the Peninsula Deanery. The purpose of quality management is to gather information to ensure that the curriculum is being delivered by trainers to all trainees within the Peninsula Deanery. The ultimate beneficiaries of a robust quality management process are patients who will be treated by well trained doctors coming from an environment that has provided for their needs.
11.Support innovation and creative development
The Deanery will continue to develop the opportunity for trainees who want to develop a specific aspect of professional development through the availability of competitive bursaries which will provide financial support that complements the workforce needs of NHS South West.
We will support and map out the simulation requirements that both currently exist and that are aspired to by our trusts and specialty schools. Over the last two years the Deanery has provided over £500,000 to increase simulation and educational opportunities across our LEP’s.
12.All trainees will have access to careers guidance to meet their own personal needs
Building on the notable practice identified by PMETB in 2009 we will increase the availability of expert career guidance in the Peninsula. Each postgraduate school will identify a ‘careers champion’ who will receive training in careers information/guidance, both in terms of deliverability, as well as availability in the Peninsula. They will know the resources that can be accessed through the careers team to support trainees with specific and sometimes complex training needs.
13.Supporting SAS doctors
The Deanery has seen significant investment in the professional development and support of this cohort of the workforce. Previously outside of Deanery responsibility it is becoming increasingly clear that the Deanery is well placed to support and provide guidance through the LEP structures for this group of doctors. We will provide, during 2010, a clear strategic plan for these doctors. Investment will continue, but through a process of audit we will ensure that the investment is based on an effective needs analysis and addresses those needs.
14.Value for money
We will use our resources effectively and efficiently, as well as ensuring the organisation is well managed with clear strategies that enhance learning and improve patient care. We have seen a period of growth and considerable investment since our genesis in 2005. The first five year Deanery cycle of growth and development concludes in March 2010. As an organisation we have made considerable progress, but must not rest on our current achievements and will look at the future of our training programmes, based on a continuous programme of quality improvement.
This strategic document is just the beginning of this next cycle. We will need to work harder, more efficiently and effectively both internally and with our stakeholders to grasp these new opportunities at a time when economic drivers become more challenging.