Policy for Clinical Supervision of Temporary or Locum Members of Junior Paediatric Medical Department / Service: Paediatrics Originator: Dr Andrew Gallagher Accountable Director: Dr Andrew Gallagher Approved by: Quality Improvement Meeting Date of approval: 25 th May 2016 First Revision Due: 25 th May 2018 Target Organisation(s) Worcestershire Acute Hospitals HS Trust Policy Overview: With increased vacancies at middle grade junior doctor level, we are often reliant on temporary staff and locum doctors to complete the middle grade junior doctor rota. While at the junior or SHO level vacancies, temporary staff and locums are less common, this policy can be extended to all junior medical staff working cross county within the Directorate of Paediatrics at WAHHST. This policy for the supervision of junior doctor staff will promote patient safety and provide evidence for clinical governance. It can also help to provide evidence for junior doctors in support of their appraisal and revalidation Latest Amendments to this policy: Sept 15 - ew document May 16 Departmental orientation added to policy at request of Divisional Team - Dr Gallagher WAHT-PAE-118 Page 1 of 16 Version 2
Contents page: Quick Reference Guide 1. Introduction 2. Scope of this document 3. Definitions 4. Responsibility and Duties 5. Policy detail 6. Implementation of key document 6.1 Plan for implementation 6.2 Dissemination 6.3 Training and awareness 7. Monitoring and compliance 8. Policy review 9. References 10. Background 10.1 Equality requirements 10.2 Financial Risk Assessment 10.3 Consultation Process 10.4 Approval Process 10.5 Version Control Appendices Appendix 1 Induction Meeting Form Appendix 2 Declaration of Competencies Form Appendix 3 Review of Progress Meeting Form Appendix 4 Raising Concerns Form Appendix 5 One to One Form Supporting Documents Supporting Document 1 Supporting Document 2 Equality Impact Assessment Financial Risk Assessment WAHT-PAE-118 Page 2 of 16 Version 2
Quick Reference Guide 1. Approval of appointment of Temporary or Locum by permanent Consultant. Any concerns needs to be discussed with Clinical Director. 2. Appointment of Temporary or Locum 3. Commencement of Temporary or Locum a. Temporary or Locum staff made aware of policy by Directorate Support Officer or Deputy. Consultant supervisor of junior rota ( afterwards referred to as rota coordinator)made aware of start date. b. Rota coordinator to a) allocate consultant supervisor to Temporary or Locum staff and b) notify first consultant temporary or locum doctor will work with. c. Temporary or Locum staff to be reminded of policy by first consultant they work with (often on call consultant). At this stage competencies to be discussed and appendix 2 completed (can be via phone) d. If appointment is for more than one week (or more than 5 shifts spread over a number of weeks)temporary or Locum staff to make appointment with their supervisor to complete Induction Meeting and Competencies reviewed within first week of attachment e. Forms to be stored by Directorate Support Officer or Deputy on M drive and temporary or Locum staff to also keep copy of Induction meeting form and Competencies form f. Temporary or Locum staff to make appointment with their consultant supervisor to complete Review of Progress Meeting Form and Record of concerns/comments on staff performance every 4 months or as required. These to be stored as above on M Drive by DSO WAHT-PAE-118 Page 3 of 16 Version 2
1. Introduction With increased vacancies at middle grade junior doctor level, we are often reliant on temporary staff and locum doctors to complete the middle grade junior doctor rota. While at the junior or SHO level vacancies, temporary staff and locums are less common, this policy can be extended to all junior medical staff working cross county within the Directorate of Paediatrics at WAHHST. This policy for the supervision of junior doctor staff will promote patient safety and provide evidence for clinical governance. It can also help to provide evidence for all doctors in support of their appraisal and revalidation 2. Scope of this document This policy applies to all temporary and locum junior doctors working within the Directorate of Paediatrics at WAHHST. This guidance is available for consultants who are responsible for the supervision of such doctors. Consultants who are not registered with the GMC as Educational or Clinical Supervisors are still expected to be responsible for the supervision of locums and temporary members of middle grade and junior staff. 3. Definitions Middle Grade: A doctor on the middle grade rota, working as resident 2 nd on call. This grade includes clinical fellows, specialty trainees, trust doctors, specialty doctors, staff grades and associate specialists. Junior SHO grade: A doctor on the junior or SHO grade rota working as resident 1st on call. Most doctors at this level are GP specialty trainees or first or second year career grade trainees but this grade also includes second year Foundation Doctors. Directorate of Paediatrics WAHHST includes the Paediatric and eonatal Units at Worcestershire Acute Hospitals HS Trust and the Alexandra Hospital Redditch. Temporary staff: members who are employed on a temporary basis either utilising a zero hours contract or an employment agency (the later also referred to as locums). Locum : employed via an employment agency for a short term appointment. Educational / Clinical Supervisor: An Educational Supervisor or Clinical Supervisor is a named individual who is responsible for supporting, guiding and monitoring the progress of a named trainee for a specified period of time. Temporary or Locum doctors will be allocated a named consultant clinical supervisor. 4. Responsibility and Duties This policy is to be followed within the Directorate of Paediatrics WAHHST. The Rota coordinator (or Clinical Director in the absence of the Rota coordinator) will allocate a consultant supervisor for all temporary or locum doctors fulfilling attachments at WAHHST. The named supervisor will often be a consultant that the temporary or locum WAHT-PAE-118 Page 4 of 16 Version 2
doctor will work with during their first few days. The Rota coordinator will try to allocate temporary doctors fairly across the consultant body. Temporary and locum members of staff must be alerted to the existence of this policy by the Directorate Support Officer or Deputy and it should be enclosed with their usual paperwork. The consultant working with the temporary or locum doctor during their first clinical commitment (often the on call consultant) should also raise the details of this policy and the need for the new doctor to make arrangements to meet their consultant supervisor. Temporary and locum staff members must make arrangements to meet with their consultant supervisor within the first week of their arrival. The consultant supervisors fulfilling this role for temporary and locum members of staff must follow this policy and appendices, escalating queries or concerns to the RCPCH Tutor or Clinical Director. 5. Policy detail Appointment of temporary or locum members of junior medical staff. Any doctor working at middle grade or junior level will have their appointment approved by one of the permanent consultants usually a consultant working at the site of the base hospital. If there are any concerns from the GMC, such as practice restrictions or supervision orders, then the appointment must be discussed with the Clinical Director before the appointment is finally approved. Ideally commencement of temporary or locum contracts should not be scheduled for night shifts. Consultant staff will not routinely be available to welcome and orientate new staff outside the working day (8 til 6 weekdays, 8-1 weekends). It is likely that temporary and locum staff will settle and perform better with a supervised start. Consultant supervision of temporary or locum members of junior medical staff. All temporary or locum members of middle grade or junior level medical staff will be formally allocated to a named consultant supervisor who will be in a position to support their clinical progress. While allocation of a named supervisor should happen at the beginning of the appointment, the consultant who is on call at the start of the attachment and meets with the temporary doctor for their orientation will fulfil this role until a formal supervisor has been allocated. All temporary or locum members of middle grade or junior level medical staff will have a named consultant supervisor allocated by the rota coordinator or Clinical Director. All temporary or locum members of middle grade or junior level medical staff must meet their named consultant supervisor within the first week of their attachment. The named consultant supervisor and temporary doctor will complete an Induction Meeting Form (Appendix 1) and Declaration of Competencies Form (Appendix 2). A copy of all documentation must be sent to the temporary doctor and the Directorate Support Officer or Deputy to be filed in their individual case record on the protected M drive. WAHT-PAE-118 Page 5 of 16 Version 2
Subsequent Review of Progress Meetings will take place as required and at least every 4 months (Appendix 3). This is in line with doctors in training. Temporary or locum members of middle grade staff who have already worked within the unit over the previous 6 months will be expected to have a Review of Progress at the start of their attachment rather than an Induction Meeting. Any raised concerns (Appendix 4), complaints or clinical incidents must be discussed with evidence of formal reflection on the part of the temporary doctor, either as part of the Review of Progress Meetings or as a face to face one-to one meeting (Appendix 5) led by the consultant supervisor. All doctors will be revalidated every 5 years and it is important that accurate records are kept to facilitate this process. Raising concerns about temporary or locum members of junior medical staff Any concerns to be raised must be discussed with the temporary doctor, recorded on the attached Raising Concerns Form (Appendix 4) and communicated to the Clinical Director, the doctors Clinical Supervisor (named consultant) and Directorate Support Officer as soon as practically possible. If any significant event or complaint is brought to a meeting such as a round table meeting, the temporary doctor must be invited to attend. This should be co-ordinated by the Clinical Risk Manager for Children s Directorate and Directorate Support Officer with the help of Human Resources at WAHHST. 6. Implementation 6.1 Plan for implementation Implementation to begin in August 2015 with the ratification of this policy via Quality Improvement meeting. 6.2 Dissemination To be circulated to all Paediatric Consultants in WAHHST and available on the intranet document finder. 6.3 Training and awareness Consultant Paediatricians will be alerted to this policy on the launch of the policy. It will not be part of mandatory training. WAHT-PAE-118 Page 6 of 16 Version 2
7. Monitoring and compliance Page/ Section of Key Document Key control: Checks to be carried out to confirm compliance with the policy: How often the check will be carried out: Responsible for carrying out the check: Results of check reported to: (Responsible for also ensuring actions are developed to address any areas of non-compliance) Frequency of reporting: WHAT? HOW? WHE? WHO? WHERE? WHE? Recorded supervision of temporary and locum Meeting documentation Results to be given to Clinical Director When requested junior doctors in Paediatrics WAHHST. at recorded and stored on shared M: Drive in individual staff folders. Temporary or Locum staff meet consultant supervisors within 2 weeks of start of post and then every 4 months in line with policy. Relevant documents to be completed and stored. Rota Coordinator to assess compliance with policy. WAHT-PAE-118 Page 7 of 16 Version 2
8. Policy Review Policy to be reviewed after 2 years. 9. References References: GMC Good Medical Practice April 2013 www.gmc-uk.org www.nact.org.uk Code: 10. Background Contribution List This key document has been circulated to the following individuals for consultation; Designation Miss Alex Blackwell, Consultant Obstetrician & Gynaecologist Dr Andrew Gallagher., Consultant Paediatrician Paediatric Consultants WRH and Alexandra Hospital ( July 2015) This key document has been circulated to the chair(s) of the following committee s / groups for comments; Committee 10.4 Approval process This policy will be approved at QI Meeting once finalised draft is available. 10.5 Version Control Date Amendment By: July 2015 ew document WAHT-PAE-118 Page 8 of 16 Version 2
Appendix 1 Induction Meeting Form Meeting Date: Doctors ame: Supervisors ame: Supervisors Contact Details: Date of Start of Appointment: Intended Employment End Date: Last Revalidation Date: Responsible Officer for Revalidation: Last Appraisal Date: 1. Knowledge, Skills and Performance: (Includes clinical competencies, qualifications, strengths and weaknesses) 2. Safety and Quality: (Includes complaints, incidents, significant events and audit, use of Datix) 3. Communication, Partnership and Team work: (Includes attitudes, attributes, relationships with patients, families, medical staff) 4. Maintaining Trust: (Includes patient respect and dignity, honesty and probity) Consultant Supervisor Signature:.. Locum or Temporary Doctor Signature:... WAHT-PAE-118 Page 9 of 16 Version 2
Appendix 2 Competencies of Paediatric Locums and Temporary Medical in Worcestershire Royal Hospital Date ame of Trainee / Locum & Grade Competency sheet filled by (ame / Signature) Procedure eonatal Intubation eonatal Resuscitation UAC and UVC Insertion eonatal Chest Drain (Seldinger Technique) eonatal Pneumothorax Aspiration Cranial Ultrasound Scan Recognition of the Sick Child Management of Status Epilepticus Management of Status Asthmaticus Management of Severe Bronchiolitis Management of Child with Decreased Level of Consciousness Management of Cardiac Arrest (VF/Asystole/PEA) Management of SVT Insertion of Intraosseus Line Lumbar Puncture of eonate and Child Recognition and Management of Child Abuse (excluding CSA) equivalent to Level 3 Child Protection Training Know when to call consultant at home for advice or attendance --this includes but is not limited to expected delivery < 30 weeks, child needing transfer to PICU, suspected child abuse presenting to the Competent to perform the procedure independently (Yes / O) WAHT-PAE-118 Page 10 of 16 Version 2
paediatric service and if asked to call by Senior nurse. Orientation to Dept to include ED Paed Resus bay and Delivery suite WAHT-PAE-118 Page 11 of 16 Version 2
Appendix 3 Review of Progress Meeting Form Meeting Date: Doctors ame: Supervisors ame: Supervisors Contact Details: Date of Start of Appointment: Intended Employment End Date: Last Revalidation Date: Responsible Officer: Last Appraisal Date: Last Progress Meeting Date: 1. Knowledge, Skills and Performance: (Includes clinical competencies, qualifications, strengths and weaknesses) 2. Safety and Quality: (Includes complaints, incidents, significant events and audit) 3. Communication, Partnership and Team work: (Includes attitudes, attributes, relationships with patients, families, medical staff) 4. Maintaining Trust: (Includes patient respect and dignity, honesty and probity) Consultant Supervisor Signature:.. Locum or Temporary Doctor Signature:... WAHT-PAE-118 Page 12 of 16 Version 2
Appendix 4 Record of concerns/comments on staff performance ame of Member: Designation in WHAT: Time Period Report is Related to: GMP domains 1.Knowledge, Skills & Performance Yes (Please explain below with specific examples) one Cannot Comment Action Taken 2.Safety & Quality 3.Communication, Partnership & Team work 4.Maintaining trust (Includes respect, dignity of patients, honesty, probity) Report Discussed with: (ame of Locum Temporary Doctor) Completed by: ame: Signature: Date:.B. Any concerns raised or clinical incidents must be communicated to the Clinical Director as soon as practically possible. WAHT-PAE-118 Page 13 of 16 Version 2
Appendix 5 Case Based Discussion Following an Incident Patient details Title of incident Datix Web incident number Date of discussion Person investigating Case discussed with ISSUES DISCUSSED ACTIOS Arrangements for sharing the learning points This form should be completed at the time of every one to one discussion following an incident and emailed to Divisional Governance Team. WAHT-PAE-118 Page 14 of 16 Version 2
Supporting Document 1 - Equality Impact Assessment Tool To be completed by the key document author and attached to key document when submitted to the appropriate committee for consideration and approval. 1. Does the policy/guidance affect one group less or more favourably than another on the basis of: Race Ethnic origins (including gypsies and travellers) ationality Gender Culture Religion or belief Sexual orientation including lesbian, gay and bisexual people Yes/o Comments Age 2. Is there any evidence that some groups are affected differently? 3. If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable? 4. Is the impact of the policy/guidance likely to be negative? 5. If so can the impact be avoided? /A 6. What alternatives are there to achieving the policy/guidance without the impact? 7. Can we reduce the impact by taking different action? If you have identified a potential discriminatory impact of this key document, please refer it to Assistant Manager of Human Resources, together with any suggestions as to the action required to avoid/reduce this impact. For advice in respect of answering the above questions, please contact Assistant Manager of Human Resources. /A /A WAHT-PAE-118 Page 15 of 16 Version 2
Policy Supporting Document 2 Financial Impact Assessment To be completed by the key document author and attached to key document when submitted to the appropriate committee for consideration and approval. Title of document: 1. Does the implementation of this document require any additional Capital resources 2. Does the implementation of this document require additional revenue Yes/o O O 3. Does the implementation of this document require additional manpower O 4. Does the implementation of this document release any manpower costs through a change in practice 5. Are there additional staff training costs associated with implementing this document which cannot be delivered through current training programmes or allocated training times for staff O O Other comments: Will be additional work for consultant supervisors and Directorate Support staff. If the response to any of the above is yes, please complete a business case and which is signed by your Finance Manager and Directorate Manager for consideration by the Accountable Director before progressing to the relevant committee for approval WAHT-PAE-118 Page 16 of 16 Version 2