Agenda Item 10.3 CENTRAL MANCHESTER UNIVERSITY HOSPITALS NHS FOUNDATION TRUST Report of: Professor Robert Pearson, Medical Director Paper prepared by: Dr Mark Forrest, Director of Medical Education Date of paper: August 2016 Subject: Outcomes of GMC Trainee Survey (2015/16) Indicate which by Information to note Purpose of Report: Support Resolution Approval Consideration of Risk against Key Priorities Risk that medical trainees are dissatisfied with the Training and Education provided, resulting in trainees being re-allocated to other Trusts, loss of income and difficulty in attracting and retaining a highly skilled workforce. Recommendations To provide the Board with an overview of the outcomes of the survey Contact: Name: Robert Pearson Tel: 701 0205
1. Background The GMC survey gives a snapshot of trainee opinion across England, Wales and Northern Ireland. It is conducted annually in March. Response rates are high (99.1%). In recent years, methodology has been stable allowing trends in training performance to be analysed. Even so, there are continual small changes. For example, the questions used to assess the quality of handover have changed significantly with the emphasis on moving from How is handover done? last year to Is the handover you do fit for purpose? this year. It is important to be aware that this is a comparative study and the denominator varies depending on the group being analysed. For the most part in the areas of interest to us, the denominator will be all UK trainees in the same specialty or sometimes parent specialty for small sub-specialties. It is for this reason that absolute score and ranking (and thus a specialty being flagged as an outlier need not necessarily move in the same direction). That is, overall satisfaction for a post or programme may not have changed from last year but by comparison it may have become a poor or good outlier. 2. Key headlines In recent years we have used the overall satisfaction domain as a single indicator of quality. Overall satisfaction marks across CMFT s programmes increased in 60% of programmes in 2015-16 compared with 41% last year and 61% in 2013-14. Overall satisfaction was above the national average in 61% of programmes in 2016 compared to 49% last year. As in previous years, there is wide variability between departments in terms of ranking. Genitourinary Medicine (GUM) is rated as the top such department in the country whilst the GP programme in Obstetrics was the worst. All areas have risen or fallen to some degree with departments showing sustained improvement over three years including Acute Medicine, General Paediatrics and Rheumatology. Looking at CMFT trainees as a single group, we lie in the interquartile range for all domains except Induction where the Trust has a red flag. Dr MacLennan, Associate Director of Medical Education, has done a lot of work with Divisions to improve local induction along with revamping Trust Induction. We would expect to see this recognised in next year s survey. In the past two years we have produced a plot of CMFT rank versus national rank for overall satisfaction in a rainbow scatter plot, (please see below). This has helped to inform Postgraduate Medical Education (PGME) decision making regarding allocation of support and resources. 2
Comparison of this year s plot with last demonstrates a general shift towards the top right corner that is a general improvement in overall absolute trainee satisfaction across the Trust which comes at a time when trainee morale is generally felt to be poor nationally 3. Areas that have improved significant/high ranking areas 3.1. Genitourinary Medicine Top ranked GUM Department in the country, ten green flags and sustained excellence over several years. This again demonstrates the effect of a proactive, highly enthusiastic Educational Lead and an engaged, positive Consultant workforce. 3.2. Clinical Genetics Clinical Genetics is second nationally for overall satisfaction. There are seven green flags and significant improvement in scores for all domains surveyed. This has been 3
brought about by active engagement with trainees, both as a group and individually to better understand and deliver their training requirements. Again an enthusiastic Educational Lead is crucial to this improvement. 3.3. Haematology Haematology has been perceived as a risk area with multiple red flags in previous years. This was reversed by intensive support through the Internal Quality Improvement Framework (QIF) and an increase in the junior doctor numbers. This improvement has been maintained with Haematology in the top ten programmes nationally with several green flags. 3.4. Ophthalmology MREH is subject to enhanced monitoring with respect to training and acute service provision. This followed successive years with multiple red flags. Work by the PGME team using the internal QIF coupled with a fundamental restructuring of the organisation of acute services, led by Mr Biswas and Mr Scala, in MREH has led to a significant improvement in the survey outcomes. There were no red flags in this year s survey. It is conceivable that they will become the first programme nationally to come out of enhanced monitoring. 3.5. Endocrinology and Diabetes This is a Directorate that has had poor reviews over the last two years, last year receiving seven red flags. A quality improvement visit by the PGME team along with significant input from the new Education Lead, Professor Steve Ball, has led to significant improvement with no red flags this year and an overall satisfaction ranking of 19 compared to the previous ranking of 45 th out of 46. 4. Areas that remain a cause for concern and action plans 4.1. Paediatrics There has been an improvement in General Paediatrics and a modest improvement in Paediatrics as a programme group. There has been the result of work by Raimondo Cervillione, Fiona Spencer and Peter-Marc Fortune around supportive behaviours along with a major restricting of the on call rota. However, this improvement has been offset by very poor surveys for training in Paediatric Tertiary Medicine, notably Oncology, Gastroenterology and Respiratory Medicine. A separate paper outlining an action plan to address this has been sent previously. 4.2. Obstetrics and Gynaecology GP programme This programme has performed very badly in the last two surveys. This year it was the worst of all such programmes nationally and had nine red flags. There was also a letter from the trainees to the Programme Director, Dr Tomkinson, outlining the trainees concerns. Some of the concerns raised were echoed in the recent CQC visit. This letter triggered an urgent visit by the PGME team to the Obstetrics and Gynaecological Department, and a suggested improvement plan came out of that visit. The initial response to the plan was felt to be unsatisfactory by the Director of Medical Education and after further discussions, a second response was delivered. This improved response and action plan is set to be delivered by the Directorate over the next two months, after which there will be a re-visit by the PGME team to assess the effectiveness of any changes. It has to be said that much of the problem does appear to be related to the significant increase in workload and it is not clear whether the changes proposed will fundamentally alter the effect of this. 4
4.3. Renal Medicine There has been deterioration in many of the educational domains over the past two years culminating in seven red flags this year. It is clear that workload is a significant factor but other areas including supervision and feedback have also deteriorated. There may have been an effect of losing a highly motivated Educational Lead to Health Education England (HENW) but it is not possible to quantify this in any way. The current Educational Lead and Clinical Director are discussing the results of the survey with current trainees with the aim of producing a suitable action plan in the near future. The PGME team will monitor developments. 4.4. Trauma and Orthopaedics There have been concerns for some time regarding some aspects of training in Trauma and Orthopaedics, particularly around clinical supervision. This has led to a reduction in training places within the Division and the possibility of removal of further trainees notably from the Foundation Programme where trainees could well be accommodated in other surgical specialties. These worries were borne out by the outlier results in the survey where there were several pink flags around supervision, workload and feedback along with free text comments suggesting poor supervision and undermining behaviour. The Division has acknowledged the shortcomings and developed a new Consultant trauma and on call rota designed to provide, amongst other things, better supervision for trainees. The effectiveness of these changes will be monitored by the PGME team. 4.5. Cardiothoracic Surgery There has been a marginal improvement in trainee satisfaction with a climb up the national rankings from last place to 19 th out of 24. Much of the issue relates to adequate experience for trainees and there remain issues with flow of patients through the unit that are beyond the control of the PGME team. 4.6. Core Anaesthesia and Medical Microbiology Both these specialties continue to be ranked poorly for overall satisfaction. The reasons for this, in the other domains, do not remain consistent and the dissatisfaction is despite significant efforts by the Educational teams. The PGME team will continue to work with the Educational teams to improve training. It may be appropriate to use the forthcoming visit by HENW to produce an external assessment of the problems. 5. Conclusion Significant improvement areas Ophthalmology Diabetes and Endocrinology Acute Internal Medicine ACCS Programme Highlights GUM Rheumatology Foundation training in Paediatrics Work still needed in Tertiary Paediatric specialties Renal Medicine O&G GP trainees 5
6. Single Hospital Service plans for Manchester As part of the Single Hospital Service work, a Joint Educational and Training Multiprofessional Clinical Working Group has been established to share learning from areas of excellence, and to work together to achieve a consistent high performance across the city. 7. Recommendation The Board is asked to note the report and support the monitoring of progress via reports to the HR Scrutiny Committee. 6