GP and Primary Care Update John Howard, Vijay Nayar & Janet Rutherford March 2018
Goodbye to. Dr Cyrus Fernandes Leaving TPD role in April Dr Nicholas Foreman - Leaving TPD role in April Dr Pauline Foreman - Leaving TPD role in April
Welcome to Dr Sunil Gupta AD for Essex (Basildon & Chelmsford) Dr Krish Radhakrishnan AD for Essex (Harlow & Southend) Dr Andrew Wright AD for Foundation Dr Samuel Ajetunmobi - TPD Basildon Dr Janet Malcolm - TPD Cambridge (MAT leave cover post)
HEE. New ADs M&E Primary Care Programme ARCP review Review of GP educators by March 2019
PCSE/Performers List Capita now solely responsible for PCSE.. Application portal progressing!?! Pensions expect problems February intake uploaded to NPL 2013 Directions to HEE. We (still) hope to remove the need for HEE trainees to be on the NPL from August 2018
Lead Employer and Contracts. New contract appears to be settling. StH&K now taking on Public Health GP educators Indemnity central discussions state backed indemnity.. In EoE, StH&K will provide from August 2018 Still seeking solution to apprenticeship levy issue OOH new COGPED guidance in discussion New RCGP GP with Extended roles framework
GMC s General Professional Capabilities Curriculum must align by August 2019
Dr Bawa-Garba Reflection is our best defence Statements from AoMRC, HEE, Defence Societies Best guidance letter from Regional Medical Directors
Workforce Joint work with NHSE including shared data group M&E STP Primary Care Workforce plans Specialty training and International GP recruitment New support/retention proposals GP Nursing M&E GPN 10 point plan Delivery Board PAs Clinical Pharmacists Medical Assistant Role Apprenticeships Primary Care Leadership Collaborative Preceptorships/Fellowships
Primary Care STP Workforce Plans 71% looking at Primary Care Home with GP at the centre Workforce plans are rudimentary gap with reality Capacity and capability at STP level an issue Unified capitated budget envisaged in most Care provision to units of 30,000-50,000 patients Mostly reliant on international recruitment little creativity in terms of skill mix Regional team is realistic
M&E - GP numbers
2018 ST Recruitment 2873 offers made 200 more applicants appointable than last year 250 on reserve list (london) EoE 331 offers We will fill
International GP Recruitment Expansion of international recruitment to achieve 5000 target by 2020 current England aim 3000 GPs M&E aspiration c1,200 international GPs. Recruitment agencies 2 for M&E select by CV and then matched to CCG/practices in recruitment exercise in UK HEE commissioning language courses Preparatory (observational) phase HEE education HEE will support supervisors National discussion and contract awaiting funding and timescales
Other elements Essex pilot continues Learning from Essex.. I&R assessments Supervised placement in employing practice using HEE hub and spoke model April Norfolk, Waveney and Suffolk July - Cambridge and Peterborough October Mid and South Essex
New Retention scheme
GP Nursing 10 Point Plan England - 3m this year 2017-18 1m for GPN educational Leadership 2017-18 1m to map mentors & Placements Support career framework, Preceptorships, returners etc Target increased placements by 15% 2017-18, 20% 2018-19
GP Nursing 10 Point Plan M&E Regional workshop 22 nd December M&E GPN Conference 21 st March, Loughborough New GPN leads 0.6(8)WTE in each HEE Local Office 23k per STP for 0.2WTE GPN lead nurse hopefully will attract matched funding c 22k per STP footprint CEPN/TH to increase GP pre-registration placements 50k evaluation of multi-professional preceptorships at Anglia Ruskin informing HEE nationally
Training hubs (CEPNs) Conference 21 st March London Nomenclature CEPN Training Hub To be based on STP footprint to feed in to LWAB, but maintain local network M&E programme 4 months interim funding on STP footprint for all New operating framework Post-CCT GP Fellows (q.v.) 2019 4 Placement pilots
Training Hubs
Postgraduate Medical Placement Fee Average district general hospital 200 total postgraduate medical posts 50 Trust funded posts 150 national tariff posts PG Tariff placement fee total ( 12,152 x 1.2) = 2,187,360 50 undergraduate medical posts UG Tariff placement fee total ( 33,286 x 1.2) = 1,997,160 Medical Placement fee total = 4,184,520 Based on MFF of average 1.2 N.B. For ease local tariff posts not included
Post CCT GP Fellowships 2017-18 Model: 19 GP post CCT Fellowships 14 PA preceptorships 34 GP nurse preceptorships 300,200 in total GP post CCT - 4,200 + 1,800 = 6,000 PA preceptor - 3,000 + 1,800 = 4,800 GP nurse preceptor - 1,700 + 1,800 = 3,500
Post CCT GP Fellowships 2018-19 model: M&E programme - Training Hubs/STP joint bids Educational and training allowance support : 5k 20% (1 day / 2 sessions) salary support for 12 month programme (to cover the education and training element only) = 18,963 Total per Fellowship: 23,963 75 across M&E Single BMJ advert late March/early April
PAs New course payment framework from January 2018 510 hours in primary care, 5k programme support and additional 5k if student contracts to work in GP Placements paid at SIFT rate Further Primary Care incentives in discussion Preceptorship criteria in development Physicians Associates Ambassadors appointed Pauline Weir, Lauren Rottman
Clinical Pharmacy New pre-registration programme NHS England Clinical Pharmacist scheme: 1500 clinical pharmacists on track; 3229 practices Interim evaluation published Surprisingly few problems; patient facing role vs. meds management; statement of progress
Primary Care Leadership Collaborative Now on to 2 nd cohort Selected as preferred model nationally Evaluation positive Will continue
Conclusions Be optimistic grasp opportunities Things will get more complex We need a single primary care education network and educational governance I believe the values we live by will be replicated in the next generation Use technology..
Assessment Changes in the Gold Guide ARCP Development Group QA results BLS, audit and level 3 safeguarding Audio-COTs.
Gold Guide Latest version issued 31.01.2018 Ability to consider educator reports at ARCP has been removed Usual length of GP extensions changed to 1 year + 6 months All panel members need training every 3 years ARCP needed prior to an IDT More reasons for applying for OOPE
ARCP Development Group A big thank you Amended panel checklist Amended divvy sheets Amended panel handbooks Various policies agreed eg late unavailability, COI, TOOT etc Local phrases document
QA Results - RCGP Reviewed all unsatisfactory and 10% satisfactory outcomes, huge spreadsheet. 276 in total New indicators Record that have reviewed the recommendations of the last panel Translate required development points into competencies, rather than list them as actions
QA main learning points from satisfactory outcomes Mandatory evidence as opposed to naturally occurring evidence Mandatory 5 observed intimate examinations ESRs should be based on eportfolio evidence only and not on exam results And then..
BLS and the final ESR BLS and AED training in the ST3 year such that it is still in date beyond the trainee s CCT date ALS training if undertaken during GP training and still in date beyond the trainee s CCT date NB ALS training is not a curricular requirement for GP training and so is not eligible for study leave reimbursement NB We think BLS may need to be face to face
Audit 2 cycle audit or QiA both acceptable Trainee needs to have been personally involved in either of these, although it might be a group/practice audit Could happen at any point during the training programme ES needs to be confident that evidence in place before ticking it off at the final ESR
Level 3 Safeguarding Log entry detailing the acquisition of level 3 knowledge eg course, emodules etc Certificare and reflections on the above At least one more log entry detailing the practical application of that knowledge eg case reviews, MDT meeting etc Again, the ES needs to be confident that the evidence is present
A few last things.. Form R every year, no matter what ATC trainees will now have their ST1 ESR centrally Any breaks in training need to be covered by an OOP application Attending a local ARCP panel is a great learning opportunity, so do please volunteer!
Addressing Differential Attainment in Postgraduate Medical Education in the east of England
Understanding Differential Attainment Differential attainment is a symptom not a diagnosis Causes are complex and multifactorial Differential access to the curriculum Perceived bias Level of support Cultural factors
Understanding Differential Policies Exam structures Attainment Wider educational & sociocultural landscape (macro) Recruitment Induction Support Assessment Institutional culture & resources (meso) Learning styles Culture Language Interactions Individual factors (micro)
GMC Promoting excellence: standards for medical education and
Theme 1. Learning environment and culture Promoting Cultural competence through Faculty Development Developing Educators who support fairness and diversity in clinical education and training Tackling bullying, harassment and discrimination Appropriate adherence to the Public Sector Equality Duty
Cultural Competence Ability to interact with people from different cultures and respond to their health needs Individuals and Organisations Creating a working culture and practices that recognise, respect, value and harness difference for the benefit of the organisation and individuals
Cultural Competence Self-awareness of own culture Assumptions Stereotypes Biases and their impact
Theme 2. Educational governance and leadership Involve trainees and PPV members in our activities eg faculty board meetings, assessment processes, interviews HEE Quality Framework for raising concerns about education and training Systems for recruiting, selecting and appointing learners and educators are open, fair and transparent Equality, diversity and fairness training for anyone involved in recruitment and selection Analysis of E&D to address issues of Differential Attainment
PSU referrals 100 90 total as % 80 70 % referred to PSU 60 50 40 30 20 10 0 Total UK Non-EU EU
Theme 3. Supporting Learners All learners have an appropriate induction Cultural Induction Effective Professional Support Unit Learning plans and career advice based on individual needs Early warning systems to identify trainees who may face difficulties in training Tailored support systems available for all and trainees Detailed and constructive feedback for learners
Referral to PSU Not punitive Supportive Confidential Impartial advice
Performance Workload Psychological Factors Life events Sleep Loss Family Pressure Training and Education Health Issues Cultural factors
Professional Support Unit Psychological support Occupational Health LTFT/ OOPC Placement transfer Supernumerary placement Rotations to reduce travel times Tackling bullying, harassment and discrimination Exam Support Communication Skills Emotional Intelligence testing Dyslexia Screening Careers coaching Coaching and Mentorship Support for Educators
Cultural induction Resilience Support
Theme 4. Supporting Educators Fair recruitment and selection of Educators Appropriate induction to their role with regular appraisals and access to professional development Faculty of Education and Leadership Faculty development to address Cultural Competence and Differential Attainment Giving Effective Feedback, Role Modelling, Emotional Intelligence Coaching and Mentoring
Theme 5. Developing and implementing curricula and assessments Ensure that all learners have equitable access to the curriculum Assessments are fair, reliable and valid ARCP process Assessors are appointed using a fair recruitment and selection process Encourage and attract a diverse pool of assessors Assessors receive training relevant to issues of equality, diversity, fairness and bias Detailed and constructive feedback for all candidates E&D Analysis of exam and ARCP outcomes
Targeted GP Training scheme Doctors switching specialty Specialty and Associate Specialists (SAS) or Consultant level doctors looking for a career change into general practice Re-entry doctors GP trainees who have passed their Work Place Based Assessment and one of the two required exams (either Applied Knowledge Test (AKT) or Clinical Skills Assessment (CSA)) Top up training Overseas trained doctors who are planning on working in the UK but are required to undertake more training to demonstrate equivalence to the CCT via CEGPR route
Thank you john.howard@hee.nhs.uk vijay.nayar@hee.nhs.uk janet.rutherford@hee.nhs.uk @NHS_HealthEdEng