Meeting Date 14 October 2014 Report Title General Medical Council (GMC) National Training Survey Results - Wessex Report Paper Number 141007 Report Author Felicity Sladen, Nikkie Marks Lead Director Simon Plint FOI Status To Be Published Report Summary This report provides an overview of the 2014 General Medical Council National Training Survey (GMC NTS) results for Health Education Wessex and outlines the next steps. The National Training Survey has ranked Wessex Deanery as 7 th (out of 21) for Overall Satisfaction, identified 13 programmes ranked in the Top five nationally, and a reduction in programmes ranked as below outliers (an improvement on 2013). Purpose (tick one only) Recommendation Approval To Note Decision The Board is asked to: discuss and comment on the results as part of the Performance Development Session. Strategic Objective Links Impact on: Authorisation Quality VFM Identified risks and risk management actions Resource Implications Support to NHS Constitution 1. Caring Culture 2. Integrated Patient Care 3. Quality and Excellence of the Current Workforce 4. Productive People 5. Training for Innovation 6. Excellent Training and Education Authorisation Domains: 1. Vision and Leadership 2. Engagement with Partners 3. Good Governance 4. Effective Financial Control 5. Organisational Capability 6. Outcome Led Improvements As outlined in the paper None Identified Seven Key Principles: The NHS provides a comprehensive service, available to all Access to NHS Services is based on clinical need, not ability 1
to pay The NHS aspires to the highest standards of excellence and professionalism The NHS aspires to put patients at the heart of everything it does The NHS works across organisational boundaries and in partnership with other organisations The NHS is committed to providing best value and the most effective, fair and sustainable use of finite resources The NHS is accountable to the public communities and patients Legal implications including equality and diversity assessment None identified 2
1. Purpose GMC National Training Survey Results - Wessex Report This report provides an overview of the 2014 General Medical Council National Training Survey (GMC NTS) results for Health Education Wessex and outlines the next steps. 2. Background Conducted annually, the GMC NTS gathers feedback from doctors undertaking postgraduate medical training in order to aid monitoring of the quality of education and training in the UK. The survey is conducted nationally and the results are in the public domain via the GMC website http://www.gmcuk.org/education/national_summary_reports.asp 2.2 The NTS is made up of a set of generic questions about trainees current post, and are aggregated into the following indicators: overall satisfaction; clinical supervision; handover; induction; adequate experience; work load; educational supervision; access to educational resources; feedback; local teaching; regional teaching and study leave. 2.3 Nationally, a total of 53,077 trainees completed the survey, a response rate of 98.2%. Within Wessex 1,989 trainees completed the survey, a response rate of 96.9%, our highest to date. 2.4 The results of the survey give us an opportunity to assess trainee perceptions about education and training. These are triangulated with other sources of data, such as annual reports and visits to education providers to give an overall picture of the quality of our training posts. 3. Key Issues 3.1 Overview This year we achieved results above the national UK average in five of the 12 indicators measured by the survey: overall satisfaction; handover; adequate experience; educational supervision and access to education resources. See Appendix 1 for further detail. Areas below the national average were clinical supervision, induction, work load, feedback, local teaching, regional teaching and access to educational resources. Study leave, local teaching and work load are the only three indicators where our upper range is not higher than the national mean. This is reflected in 3
analysis of our longitudinal data showing that they consistently remain our lowest results when compared nationally. The overall satisfaction indicator combines general questions about the quality and usefulness of the training post to provide a singular, global satisfaction score. Wessex has ranked 7 th out of 21 Deaneries for this indicator with a mean satisfaction score of 81.9. The national range was 83.36 to 79.33. Appendix 2 shows the national ranking. When looked at by programme specialty, 13 programmes ranked in the top five nationally for overall satisfaction. However eight programmes fell within the bottom five rankings for this indicator. There are 57 programmes in total. Further details can be found at Appendix 3. 3.2 Outliers The NTS results are also published as outliers against each indicator; these are defined as above or below outliers, which respectively stand out positively or negatively compared to the national benchmark. This shows how well a is performing overall for a particular indicator, based on the data collected from all trainees within that, compared against national benchmarks. Looking at s overall, Dorset Healthcare University NHS Foundation and Solent NHS both have above outliers for workload (i.e. workload was favourable). By contrast four trusts had below outliers - Dorset Healthcare University NHS Foundation and Southern Health NHS Foundation (both handover), Isle of Wight NHS (clinical supervision) and Portsmouth Hospitals NHS (feedback). Most of Wessex analysis looks at NTS results by Programme Group by. This allows below outliers to be investigated and monitored, and above outliers constituting good practice, to be shared at a programme, school and trust level. Each and School have been asked to review cases where three or more below outliers are identified against a particular programme in a this year or where longitudinal data shows below outliers for three or more years. Where there are fewer than this, trusts and schools manage them locally. Feedback is then reviewed at the annual confirm and challenge meetings with schools. 4
A summary of outliers is at Appendix 4. Overall, the number of above outliers has increased by 17% and below outliers has decreased by 11% on 2013, showing an improving trend. 3.3 Areas of Focus In many cases the margin between the National and Wessex average is small; nonetheless we are proactively reviewing all areas to pursue excellence. In particular the following areas: Induction locally performance has shown a slight decline since 2011, with national performance gradually improving. This is the first year in which we have not performed above the national average. This area relates to induction and not Deanery induction (which is monitored internally). Work Load a decline is shown nationally that is reflected locally for this indicator since 2011. This has been discussed at length and it is worth noting that setting trainee expectations is important regarding potential shift patterns in some specialties. Some rotations have been amended to provide a balanced training experience for trainees. Where workload was seen to be high, however, supervision was appropriate. Local Teaching local performance shows a slight decline on 2011, never performing above the national average. Local teaching is in place for all programmes but for some specialties (especially those with high workload), it is not always possible for trainees to attend. This is managed at a local level and systems are in place to monitor and deal with incidences where trainees are not meeting minimum attendance. This is followed up at School visits but improvements are needed to reverse the trend. Study Leave The trend nationally and locally has improved year on year. However, and again, we need to show improvements across Wessex to reach the national average. We propose that the number and variety of local courses delivered by the Deanery which reduce an individual s study leave allocation, may perversely be adversely affecting this indicator. Access to Educational Resources Locally we are performing slightly above the national average. However, both nationally and locally, there has been a marked decline in results over the last 4 years. The reasons for this need further exploration. Areas explored in this area include access to e-learning resources, internet access at work, space for private study, facilities for group teaching and simulation facilities. 5
4. Next Steps/Way Forward s and Schools have been provided with their survey results. They are asked to review and formulate action plans for the concerns i.e. where there are multiple and longitudinal outliers, and feedback to us. The quality team will review these responses at annual school confirm and challenge meetings in the autumn. The quality team is continuing to analyse in more detail the most prevalent below outliers, lowest rankings and those indicators which have failed to improve over the past four years and report to the Postgraduate Medical Dean. We are looking at the best way of sharing good practice identified via NTS above outliers. 5. Conclusion The GMS National Training Survey has provided a wealth of valuable data on trainees experiences of training within Wessex. Analysis allows us to compare our performance nationally and across trusts and schools. The data forms an important component of our quality monitoring intelligence and we are grateful to our trainees for their honest feedback. Identification of concerns enables us to address performance that is below standard and then track our progress in resolving these issues. Similarly data on above outliers is vital in building a good practice reference for Wessex. 6. Recommendation The Board is asked to discuss and comment on the results as part of the Performance Development session. 7. Author and Date Felicity Sladen and Nikkie Marks September 2014 6
Appendix 1 Comparison of the Wessex and national mean scores 2014 The table below compares the Wessex and national mean, and shows the statistical range of the responses within Wessex. Indicator Source: NTS Survey Report by Deanery 2014 National 2014 Wessex Upper Wessex Range Lower Wessex Range Y/Y Score Change Overall Satisfaction 81.24 81.9 82.54 81.25 up 1.18 Clinical Supervision 88.91 88.65 89.14 88.16 up 0.56 Handover 67.84 68.69 70.01 67.37 down 0.02 Induction 84.8 83.92 84.82 83.02 down 0.2 Adequate Experience 81.46 82.26 82.93 81.59 up 1.02 Work Load 45.98 44.93 45.77 44.09 up 0.95 Educational Supervision 89.96 90.42 91.15 89.7 up 1.81 Access to Educational Resources 68.72 68.76 69.49 68.03 up 1.92 Feedback 76.53 76.42 77.46 75.39 up 0.63 Local Teaching 63.94 62.55 63.43 61.67 up 0.28 Regional Teaching 71.3 70.82 71.63 70 down 0.09 Study Leave 68.84 63.49 64.81 62.16 down.01 Please note that the variance between scores nationally is in many cases minimal, though the exception is study leave. 7
Appendix 2 - Overall Satisfaction by Deanery Deanery Ranking Defence Postgraduate Medical Deanery 2014 2013 2012 Ranki ng Ranking National 83.36 1 80.73 13 81.88 3 2014 Northern Deanery 82.93 2 82.39 1 81.77 4 2013 80.75 South West Peninsula Deanery Northern Ireland Medical & Dental Training Agency NHS Education for Scotland (South-East Region) Pharmaceutical Medicine Virtual Deanery 82.61 3 82.2 3 81.17 8 2012 82.48 4 81.41 5 81.61 5 82.46 5 82.26 2 82.58 1 82.11 6 n/a n/a n/a n/a Wessex Deanery 81.9 7 80.72 14 81.26 7 Wales Deanery 81.88 8 81.53 4 81.03 9 Severn Deanery 81.62 9 80.96 7 81.4 6 NHS Education for Scotland (North Region) North Western Deanery 81.53 10 80.95 8 80.41 13 81.51 11 80.88 11 79.97 16 Mersey Deanery 81.44 12 80.95 9 80.91 10 NHS West Midlands Workforce Deanery 81.32 13 80.69 15 80.42 12 London Deanery 81.28 14 80.8 12 80.11 15 NHS Education for Scotland (West Region) NHS Education for Scotland (East Region) Yorkshire and the Humber Postgraduate Deanery 81.11 15 81.03 6 80.29 14 80.89 16 80.95 10 82.12 2 80.75 17 80.45 16 79.81 17 Oxford Deanery 80.63 18 80.07 17 80.67 11 East of England Multi- Professional Deanery East Midlands Healthcare Workforce Deanery Kent, Surrey and Sussex Deanery Source: NTS Survey Report by Deanery 80.56 19 79.88 18 79.65 18 79.85 20 79.55 19 79.13 19 79.33 21 79.45 20 78.88 20 81.24 80.37 8
Appendix 3 Overall Satisfaction by Programme Wessex programmes ranking in the top five nationally Programme Type National Wessex UK Ranking Denominator Core Anaesthetics Training 79.27 92.4 1 20 Respiratory medicine 83.08 84.48 1 19 Palliative medicine 83.08 93.71 1 15 Obstetrics and gynaecology 83.08 83.14 2 20 Paediatrics 83.08 85.18 2 19 Medical microbiology and virology 83.08 92 2 17 Forensic psychiatry 83.08 95 2 16 Genito-urinary medicine 83.08 91 2 16 Rehabilitation medicine 83.08 92 2 14 Anaesthetics 83.08 86.33 3 20 Dermatology 83.08 89.33 4 19 Emergency medicine 83.08 82.74 5 20 Public health medicine 83.08 89.33 5 14 Source: NTS Survey Report by Programme type by Deanery Wessex programmes ranking in the bottom five nationally Programme Type National Wessex UK Ranking Denominator F1 76.58 74.91 17 20 Gastroenterology 83.08 80.24 15 19 Geriatric medicine 83.08 76.46 16 19 Medical oncology 83.08 76 12 14 Neurology 83.08 71 14 16 Old age psychiatry 83.08 82.67 18 19 Otolaryngology 83.08 84 14 18 Trauma and orthopaedic surgery 83.08 82.15 18 20 Source: NTS Survey Report by Programme type by Deanery 9
Appendix 4 Outlier summaries Above outliers - programmes for which three or more above outliers were identified Dorset County Hospital NHS Foundation Hampshire Hospitals NHS Foundation Programme Type Number of Above Outliers Core Anaesthetics 3 GP Prog - Paediatrics and Child Health GP Prog - Paediatrics and Child Health Jersey GP Prog - Emergency Medicine 3 Poole Hospital NHS Foundation GP Prog - Emergency Medicine 6 Portsmouth Hospitals NHS Anaesthetics F2 4 Dermatology 4 Salisbury NHS Foundation Paediatrics 5 The Royal Bournemouth and Christchurch Hospitals NHS Foundation University Hospital Southampton NHS Foundation Source: NTS Survey Report by Programme Group by /Board Obstetrics and gynaecology 3 Palliative medicine 3 4 3 Below outliers - programmes for which three or more below outliers were identified Hampshire Hospitals NHS Foundation Portsmouth Hospitals NHS University Hospital Southampton NHS Foundation Programme Type Number of Below Outliers Core Medical Training 3 Gastroenterology 5 GP Prog Medicine 4 Clinical Oncology 3 Surgery F2 3 Urology 3 Medical oncology 3 Neurology 3 Surgery F1 6 Trauma and orthopaedic surgery 6 Source: NTS Survey Report by Programme Group by /Board 10
Longitudinal outliers - programmes for which an indicator has been identified as a below outlier for three consecutive years Programme Group / Board Indicator Anaesthetics University Hospital Southampton NHS Foundation Study Leave CMT Hampshire Hospitals NHS Foundation Local Teaching Emergency medicine Poole Hospital NHS Foundation Study Leave Emergency Medicine F2 Portsmouth Hospitals NHS Work Load Emergency Medicine F2 The Royal Bournemouth and Christchurch Hospitals NHS Foundation Work Load Emergency Medicine F2 University Hospital Southampton NHS Foundation Work Load General surgery Portsmouth Hospitals NHS Regional Teaching General surgery University Hospital Southampton NHS Foundation Regional Teaching GP Prog - Emergency University Hospital Southampton NHS Foundation Medicine Work Load GP Prog - Medicine Hampshire Hospitals NHS Foundation Local Teaching GP Prog - Psychiatry Solent NHS Handover GP Prog - Psychiatry Southern Health NHS Foundation Handover Haematology University Hospital Southampton NHS Foundation Handover Surgery F2 Portsmouth Hospitals NHS Induction Trauma and orthopaedic surgery University Hospital Southampton NHS Foundation Source: NTS Survey Report by Trend Analysis by Programme Group by Overall Satisfaction; Adequate Experience; Work Load; Study Leave Total number of outliers for Wessex 2013 and 2014 2014 2013 Above Below Above Below Indicator Outliers Outliers Outliers Outliers Overall Satisfaction 18 10 13 17 Clinical Supervision 13 3 11 11 Handover 14 20 17 15 Induction 17 10 22 5 Adequate Experience 13 5 12 10 Work Load 21 25 13 31 Educational Supervision 0 1 0 5 Access to Educational Resources 16 11 9 13 Feedback 9 2 8 9 Local Teaching 11 15 5 14 Regional Teaching 8 14 8 10 Study Leave 2 25 3 18 Total Outliers 142 141 121 158 Source: NTS Survey Report by Programme Group by /Board 11