Executive summary

The review panel was grateful to the placement provider (PP) for accommodating this review. PP representatives described actions that had been taken to address issues highlighted by the 2025 General Medical Council (GMC) National Training Survey (NTS) along with plans for future improvements. The review panel noted that the PP Executive team was working hard to address these issues.

The review panel heard that the learning environment was not always supportive, and the approachability of some consultants within the Medicine department was variable. PP representatives acknowledged that this was an ongoing issue and committed to ensuring the dissemination of GMC NTS results to consultants in acute and general medicine so that they were aware of the feedback. It was also reported that PP representatives would consult resident doctors (RD) through Local Faculty Group (LFG) meetings to gather feedback about the current situation.

PP representatives acknowledged that there were inconsistencies with supervision standards in medicine. PP representatives informed the review panel that they intended to embed an education charter for both clinical and educational supervisors to address this problem and intended to include RDs in the development of the charter.

PP representatives confirmed that they had introduced changes to make it easier for RDs to attend teaching sessions, by embedding teaching within the rota. The review panel was pleased that RDs were being released to attend teaching and welcomed this change. However, PP representatives reported that not all specialties were delivering regular departmental teaching.

PP representatives reported that they had received several concerns from RDs about the transition to a new rota system in the Intensive Care Unit (ICU). It was advised that this rota change was resulting in confusion and uncertainty for RDs.

NHS England’s Intensive Support Framework (ISF) rating of Foundation medicine at Barking, Havering & Redbridge University Hospitals NHS Trust remains at ISF 2 and Internal Medicine Training has been set as ISF 2. This report includes specific requirements for the PP to take forward, which will be reviewed by NHS England – London as part of the three-monthly action planning timeline.

Review overview

Background to the review

This Urgent Concern Senior Leader Engagement Visit (SLEV) was initiated to explore the negatively outlying 2025 General Medical Council (GMC) National Training Survey (NTS) results within the medicine specialties at King George Hospital. These results showed a significant deterioration within the specialties from the 2024 GMC NTS results.

Negative (red) outliers were observed in the following areas for medicine Foundation Year 2 (FY2) for the programme group: overall satisfaction, clinical supervision, reporting systems, workload, teamwork, handover, supportive environment, induction, adequate experience, educational governance and supervision, feedback, rota design and facilities. Outliers were observed in the following areas for Internal Medicine Training (IMT) Stage One for the programme group: overall satisfaction, clinical supervision (including out of hours), reporting systems, teamwork, handover, supportive environment, induction, adequate experience, educational governance, feedback, local teaching, rota design and facilities.

The content of the review report and its conclusions are based solely on feedback received from review attendees. The following evidence provided by the placement provider (PP) was used by the review panel to formulate the key lines of enquiry for the review:

• Acute Medicine Local Faculty Group (LFG) meeting minutes – May 2025
• Medical Education Group (MEG) meeting minutes – February 2025
• Freedom To Speak Up (FTSU) annual report – April 2024 – March 2025
• Clinical and educational supervisors on the Acute Medical Take (Queen’s Hospital and King George Hospital) – July 2025
• Medical learner groups within Acute Medicine (King George Hospital) – August 2025

Who we met with

• Director of Medical Education
• Deputy Director of Medical Education
• Director of Research & Chief Medical Officer Operations 
• Head of Undergraduate Medical Education & NHS England Quality Lead 
• Foundation Year 2 Training Programme Director
• College Tutor/Education Lead for medicine
• Workforce team Representative
• Divisional Director /Clinical Lead for medicine at King George Hospital
• Site Medical Director at King George Hospital
• General Manager for Acute Medicine / Emergency Medicine
• Head of Postgraduate Medical Education & Simulation/Human Factors Training Manager, Less than Fulltime Training Champion & Supported Return to Training Champion (SuppoRTT)
• Interim Postgraduate Medical Education Manager & LED/SAS Champion

Review panel

• System Dean- North East London, NHS England – London, Louise Schofield, Education Quality Review Lead
• Head of London Specialty School of Medicine, NHS – England, Catherine Bryant, Specialty School of Medicine Representative
• Deputy Foundation School Director, NHS – England, Charlotte Huddy, Foundation School Representative
• Education Quality Coordinator, NHS England – London, Lauren Thomson, Education Quality Representative       

Review findings

Culture and Supportive environment

The review panel was very concerned about the negative feedback regarding supportive environments within the 2025 General Medical Council (GMC) National Training Survey (NTS) and asked the Placement Provider (PP) representatives to provide explanations of these outcomes. PP representatives confirmed that cultural problems existed within acute medicine, and medicine as a whole at King George Hospital (KGH), and that structural leadership changes had been made in order to address these. PP representatives also noted that the PP Executive team were responsive to these concerns and willing to explore new options to make improvements.

The review panel enquired about the implementation of an Internal Professional Standards (IPS) document which was previously highlighted by the PP. PP representatives acknowledged that implementation of this document was still a work in progress. It was advised that the IPS was challenging to implement across the PP.

PP representatives reported that burnout among a number of consultants was observed across multiple areas of KGH, including the Acute Medicine department, due to workforce gaps and financial pressures. PP representatives informed the review panel that they were trying to rebuild the morale of the team to improve the culture within medicine.

Clinical and educational supervision

The review panel enquired about the culture of education and clinical supervision in medicine at KGH. PP representatives reported there were problems with some consultant’s behaviour which was contributing to issues with supervision. However, the PP representatives described a close relationship between training grades which encouraged a supportive environment.  

The review panel asked the PP representatives to confirm the allocation of supervisors to Queen’s Hospital (QH) and KGH. PP representatives advised that most supervisors worked across both sites, however the specialties of geriatrics, endocrinology and diabetes mellitus, cardiology and gastroenterology were site specific.

PP representatives acknowledged challenges in improving supervision and outlined current initiatives to support supervisors at KGH. It was reported that members of the PP Education team were running monthly sessions and Local Faculty Group (LFG) meetings with supervisors to improve engagement. PP representatives advised that they were meeting individually with consultants in acute medicine to discuss leadership skills, feedback and provide avenues for additional support.

PP representatives acknowledged that there were inconsistencies with supervision standards in medicine. PP representatives informed the review panel that they intended to embed an education charter for both clinical and educational supervisors to outline expectations, including responding to the GMC NTS. PP representatives advised the review panel that they intended to include RDs in the development of the charter.

Raising concerns and feedback

The review panel asked the PP representatives how they were engaging with RDs to understand feedback on the current environment. PP representatives advised that they had setup regular LFG meetings with Training Programme Directors, including a meeting where no consultants were present to ensure a psychologically safe environment for raising concerns. However, the PP representatives described this process as challenging due to low attendance of RDs at LFG meetings. PP representatives reported that RDs were actively raising concerns to the PP education team within medicine. The PP representatives advised that raising concerns early was highly encouraged across both sites at QH and KGH and this was communicated to new RDs. The review panel was pleased to hear of instances where RD feedback resulted in changes to rostering and creating designated workspaces within the Emergency department.

Teaching

The review panel asked the PP representatives to outline the teaching programme for Foundation RDs within medicine. PP representatives confirmed teaching occurred for 3 days a week, cross-site in acute medicine, in addition to their core teaching sessions It was further advised that the PP had established a medical grand round and learning from incidents session to promote further education. It was also reported that the post take ward round, case of the night and handovers were utilised as teaching opportunities. However, PP representatives acknowledged that several specialties were not delivering departmental teaching and that they intended to introduce this moving forward.

The review panel asked the PP representatives to confirm the location of teaching for Internal Medicine Training (IMT) RDs. PP representatives confirmed that teaching was held across both sites at QH and KGH. It was further advised that IMT and foundation RD’s received dedicated simulation training.

The PP representatives advised that core teaching was now embedded in the rota and RDs were no longer required to use study leave to attend teaching. The review panel was pleased that RDs were being released to attend teaching and welcomed this change.

Workload

PP representatives acknowledged that workload had increased at the King George Hospital within the last 18 months. It was noted that challenges had been observed within patient flow resulting in significant backlog. PP representatives described issues with rota gaps and sickness which were contributing to increased pressures for the RDs on the Acute Take.  

PP representatives informed the review panel that they had changed the rota in November 2024 to improve workload and patient flow. However, it was noted by the PP representatives that when rota gaps arose, RDs were required to be reallocated resulting in dissatisfaction.

Rota design

The review panel asked the PP representatives to clarify the rota design of the Acute Take. PP representatives outlined that the Acute Take was run by the Acute Medicine department from Monday to Friday, and on weekends was covered by a General Medicine consultant. It was further advised that one consultant covered the Acute Take within a 24-hour window. PP representatives confirmed that this consultant was responsible for both the morning and evening handovers. However, PP representatives noted that they were reviewing current processes as result of difficulties with workload and patient flow.

PP representatives informed the review panel of recent changes to the way the rota had been organised particularly within anaesthetics and the Intensive Care Unit (ICU), with the transition to a new system called ‘Loop’. It was reported that PP representatives had received several concerns from RDs about the system. It was further advised that this rota change was resulting in confusion and uncertainty for RDs.

Areas that are working well

Areas for improvement

Mandatory requirements

Recommendations

Report approval

Report completed by: Lauren Thomson, Education Quality Coordinator, NHS England-London
Review lead: Louise Schofield, System Dean North East London, NHS England – London
Date approved by review lead: 17 September 2025

NHS England authorised signature: Elizabeth Carty, Postgraduate Dean, NHS England- London
Date authorised: 29 September 2025

Final report submitted to organisation: 29 September 2025