Executive summary
Following feedback in the GMC survey 2023 which showed several negative outliers against the Cardiology Department at Wycombe Hospital, Buckinghamshire Healthcare NHS Trust, the Trust developed an action plan to improve the education and training provision. However, subsequent feedback indicated that concerns were ongoing, and the issues had not been resolved as quickly as anticipated. There were concerns around the level of supervision and support on the ward, on the Cardiac and Stroke Referral Unit (CSRU) and on the consistency of ward rounds and review of new patients. In addition, Doctors in Training (DiT) were reporting a lack of education and training due to the demands of the rota and low staffing levels. There were also issues regarding the culture and the ability to raise concerns about training and some incivility. An Urgent Risk Review was carried out to explore the issues further.
The review heard that there were many positive changes that had taken place following implementation of the department’s action plan after initial feedback in the 2023 GMC survey. Following instability in the department’s educational leadership over the previous year, the appointment of a new education lead was a positive step and was supporting the department to re-establish its focus on education and training. This included an increase in formal face to face teaching sessions, more clinic opportunities, an educational oversight committee to review and discuss training and continuous monitoring of the training needs of the higher specialty trainees.
A significant step, and a major challenge for the department, has been to address the deficit in staffing levels which has impacted both supervisor capacity and training time. DiT have experienced a lack of sufficient training time due to gaps in the rota and have been frequently pulled from training to provide cover on the ward or the CSRU. Two new locally employed doctors have since started with a further three due to begin in August, and the Trust has since supplied evidence of a fully staffed rota for August and September. This will lighten the demands of the higher tier rota increasing more time for training. Agreement had also been given for two new consultant appointments (increasing their numbers from seven to nine) which will positively contribute to the levels of support and supervision.
The overall findings from the review were the differences in perception between the consultant body and DiT regarding the levels of supervision and support, feedback on performance and incivility.
One of the main concerns, and the primary reason for the review, was around the supervision arrangements in the department. In response to this, the Trust wrote a standard operating procedure (SOP) outlining arrangements for supervision on the ward and in the CSRU as well as describing the expectations of DiT. However, DiT believed this to be inconsistently followed and were not all aware of it. Daytime and out of hours supervision was also viewed as variable. Ward rounds were not being carried out as described in the SOP, with consultant input lacking particularly on the CSRU, leaving DiT feeling vulnerable.
Both consultants and DiT acknowledged the pressures the department was under due to a stretched workforce and high workloads. Consultants complimented their learners and valued them, welcoming their ideas for improvement. DiT appreciated the quality of training that could be available if accessible and were empathetic to the pressures on their consultant colleagues.
There were two immediate mandatory requirements made for supervision and senior support. This report includes the Trust response to these and outlines what further action is required. Further mandatory requirements were made in relation to maximising education and training time, raising concerns, incivility and handover.
On review of these findings, the risk will remain graded at Category 3 – Major Concerns on the Intensive Support Framework. This category is described as ‘Provider has fallen, or is at risk of falling, well below the standards expected by NHE England. Provider has not delivered on the improvement trajectory with NHE England and there is a significant risk/impact on the quality of education and training’.
In addition to the specific requests for further action relating to the immediate mandatory requirements, the Trust is asked to submit a further update at the end of November 2024 for review in the Education Quality Committee meeting in December and will seek further feedback from DiT in January 2025.
Review overview
Background to the review
- Concerns were reported regarding the quality of education and training in the Cardiology Department at Buckinghamshire Healthcare NHS Trust (Wycombe Hospital) in the 2023 GMC survey. These concerns were managed by the Trust, identifying and implementing actions to address the issues raised. Further feedback was sought in May 2024 which indicated that progress had not been as anticipated and therefore it required further support under the Quality Framework and Intensive Support Framework. As part of the process of improving the training in this department, NHSE-Workforce Training and Education organised an Urgent Risk Review to explore the issues further.
Evidence utilised
- GMC survey data 2023 & 2024
- Direct feedback from doctors in training.
Who we met with
Learners:
- High Specialty Trainees (x4) – Cardiology
- Foundation & Core doctors in training (x7) – working in cardiology or covering the Cardiac and Stroke Receiving Unit
Educators:
- Educational Supervisors and College Tutor (x4) – Cardiology consultants
Education team:
- BHT Senior management team – Chief Executive, Chief Medical Officer, Director of Medical Education, Deputy Director Organisational Development, Education & Inclusion, Foundation Training Programme Director
Review panel:
- Education Quality Review Lead – Mrs Rebecca Black, Deputy Postgraduate Dean
- NHSE Education Quality Representatives:
- Dr Simon Smith, Associate Dean, Education Quality
- Liesa Moore, Education Quality Manager
- Matthew Warwick, Education Quality Administrator
- Dr Sandra Duncan, Clinical Representative on TV Education Quality Committee
- Dr Muram El-Nayir, Trainee Representative
- Dr Matthew Giles, Deputy Head of School, Medicine
- Dr Beatrix Nagyova, Geriatrics & IMT TPD
- Dr Jeremy Langrish, Cardiology TPD
Review findings
Discussion with Doctors in Training (DiT)
Overview of department
Doctors in training (DiT) worked 12-hour shifts covering a 22-bed cardiology ward (2A) and the associated Cardiac and Stroke Receiving Unit (CSRU) which had nine beds. The CSRU took referrals from paramedics and the Emergency Department. Higher specialty trainees (HST) worked a 1 in 8 night rota and worked 1 in 4 weekend shifts.
Supervision
The panel heard that arrangements for supervision were inconsistent. Out of hours, DiT reported that it was not always clear who the named on-call supervising consultant was and that there was not always a response when they did make contact. The review team heard that the named supervisor was displayed on the rota and on the whiteboard, but it was not always accurate and there were often gaps. When help was not accessible, there were examples given of phoning other hospitals for advice or putting out an arrest call to ensure that senior help would arrive.
During the daytime, DiT reported that it could be difficult to get help even if they knew who to contact. DiT were encouraged to seek help from a consultant in the cardiac catheterisation laboratory (cath lab) who may or may not be the named supervising consultant.
It was reported that there were two to three consultant-led ward rounds on weekdays and there would not typically be a ward round on Mondays or Fridays. Ward rounds varied in length. Some were full ward rounds and others were partial, where not all patients were reviewed.
At weekends, the requirement was for full consultant-led ward rounds on both days but not all consultants were doing this, and the registrar would cover these.
Not all DiT had seen the standard operating procedure (SOP), especially the non-cardiology doctors. The SOP had been written by the department to clarify supervision arrangements, describe expectations of DiT whilst on the CSRU and the cardiology ward and outline how ward rounds and patient reviews were organised. DiT commented that the SOP was not consistently followed as described. For example, it was usual for consultants to see new patients on the ward (with some consultants only wanting to hear about new patients), but there was less consultant input from cardiologists in the CSRU, however this was also consultant dependent and some would do patient reviews on the unit. It was also more common for a stroke consultant to visit the CSRU. DiT felt that the responsibility rested with them to call a consultant to review a patient as it was not routine for them to visit the unit. DiT believed that patients could go a number of days without seeing a consultant and many expressed concerns around safety.
For the non-cardiology DiT, it was especially difficult knowing who was on call as they were less familiar with the consultant body. It was felt that the daily changing of the named consultant exacerbated problems leading to a lack of continuity and changing of plans. The junior tier doctors said they felt “saved by the registrars every day”.
The inconsistency in support was unhelpful both clinically and educationally, with missed opportunities to receive feedback on decisions and the lack of consultant input was leaving more junior grades feeling vulnerable.
Education and training
For higher specialty trainees (HST), time for training was limited due to the amount of cover needed on the ward and on CSRU.
There was very little general internal medicine (GIM) exposure and some HST found it difficult to achieve GIM competencies e.g. chest drains. There were some medical problems on the ward but few to supervise it.
HSTs received few opportunities to do clinics, citing other priorities on the rota taking precedence. One DiT reported they had only been to one clinic in a year, and another had completed four telephone clinics. Specialist clinics were face to face and general clinics were usually by telephone. Some clinics took place at Stoke Mandeville Hospital which required travel and were difficult to get enough time away from the ward to get to them. Regarding supervision of clinics, it was reported that consultants might not be onsite and therefore could be difficult to contact.
There were some scheduled echocardiography training sessions but there was little time left to attend these training slots after covering the CSRU and ward. Similarly, access to the cath lab was only possible when there was available time. DiT commented that it was challenging to pick up skills with limited training time available and some reported coming in on non-working days to increase their exposure to training. When able to access it, practical procedures training was said to be good quality.
HST attended the multidisciplinary team meetings and were allocated one in four of these to present at. They were said to be good educational opportunities. Fortnightly teaching sessions had recently returned with support from the new education lead.
None of the HSTs were achieving College requirements of one to two clinics and cath lab lists and one echocardiography session per week.
For core and foundation doctors workplace-based assessments (WPBA) were supported well by the HSTs. There were some challenges reported with consultants signing off competencies and completing relevant paperwork in readiness for ARCP. One DiT said they had very limited contact with their educational supervisor. Others commented that it was difficult to get WPBAs signed off by consultants if they didn’t know you.
Non-cardiology DiT were released to attend their core teaching but there were minimal cardiology specific teaching opportunities. Ward rounds were said to be rushed and had little time for education. There was some consultant-led teaching after a Thursday ward round, and one DiT had organised a journal club but had since rotated.
DiT felt there was a certain amount of “lip service” regarding the education and training provision but was not experienced in the way it was described.
Culture/supportive learning environment
The review panel asked DiT how comfortable they felt raising concerns about their education and training. DiT felt these were not received well and some had experienced negative consequences when doing so. Others commented that feedback was sought but the response to issues raised could be blunt or deflected and did not perceive it to be sincere.
DiT felt they had experienced a few instances of undermining and incivility from a small minority of consultants. The majority of consultants were described as supportive, helpful and thorough, while others could be brief, and a few could be sarcastic and rude. Others said it could feel daunting going into the cath lab, with a minority less likely to give you much time. DiT believed that the behaviours experienced were an outlier from other departments.
DiT felt they received very little feedback on their performance with some citing they had more from nurses and other specialties than from cardiology consultants. Although DiT reported that in recent months they were starting to receive more positive feedback. DiT reported hearing second hand from others that management plans they had made were “suboptimal”. Others said they heard negative comments about the work of others.
Some DiT expressed disappointment in changes made to the consultant body, believing that some support had been lost as a result.
Rota
The review panel heard that currently there were four registrars working a 1 in 8 rota as four people were not employed as expected. There were frequent rota gaps and DiT were often pulled at short notice to cover these, impacting training time. The rota was designed as a 1 in 12 but other specialties have since been pulled from the rota.
HST said that they were expected to cover gaps at the last minute despite knowing about gaps in advance and would be pulled from procedural training lists. DiT had felt threatened by the central medical rota team to fill gaps and had been challenged over the submission of an exception report. Some DiT were expected to stay beyond their hours as there was no-one to hand the bleep to. More recently there had been two long term locum appointments made but DiT were still being moved to cover gaps, with CSRU being the most affected.
Core and foundation doctors were also impacted by last minute rota changes and told the review team that they were often expected to change their place of work. Some reported that they could arrive at work and find out they had been moved without any prior notice.
Handover
DiT reported that there were no formal handover arrangements. Nurses handed over from overnight and at weekends notes might be left. Regular handover timings were challenged by unpredictable finish times due to rota gaps.
General comments
The review panel asked DiT what improvements would make a difference to their education and training experience. Responses included a reliable, consistent and accessible consultant presence, predictable, daily ward rounds – so patients can be seen by a consultant – and increased workforce/numbers of the rota to increase training time.
DiT acknowledged and were empathetic to the challenges the department faced and how stretched the consultant body was.
Some DiT expressed reluctance to recommend relatives to come to the department for cardiology care or for colleagues to come for a training placement.
Good practice
DiT spoke positively about the echocardiography service which was friendly and had a culture of community and collaborative learning. When there was time for cath lab training, consultants were helpful, and the training was good quality.
Others complimented the support from nursing staff and others mentioned that there were some very nice and supportive consultants who do teaching and ward rounds well.
Discussion with Cardiology Consultants (Educational Supervisors/ Education lead)
Supervision
Consultants described the supervision model that was currently used explaining that consultants see all patients on CSRU before going to the ward to do a ward round and then returning to CSRU. There was always one consultant in the cath lab who provided cover in the afternoons until 18.00. At weekends, there was a consultant ward round on Saturday and Sunday on CSRU and the ward and the on-call consultant contacts the registrar via phone later in the afternoon/evening. The weekend hours were job planned but it was usual for most consultants to stay beyond their rostered hours, especially to support more junior or less experienced DiT. Consultants said they hoped to move to a ‘consultant of the week’ model soon.
Consultants added that the consultant body was overstretched and were managing heavy workloads across the ward, cath lab, and clinics. However, it was their perception that there was always someone available to offer support and had an open-door policy. The consultant numbers were currently six (with a further consultant based exclusively at Stoke Mandeville Hospital). It was commented that at similar Trusts they believed there to be around 12.
Regarding the perception differences between DiT and consultants, consultants confirmed that contact details were available and DiT were encouraged to speak to them. In their experience, they were frequently stopped for advice. However, the limited number of consultants available made it challenging but specialist nurses on CSRU were knowledgeable and a good source of help. One suggestion made was for an external, neutral person to come to the department to support the work to address the perception issues, remarking that it had been done before and made a difference.
Education and training/rota
Consultants cited the removal of the non-cardiology registrars from the rota as impacting the training experience of cardiology HSTs. Locums were currently providing cover with several locally employed doctors due to start in September with the aim of a 1 on 10 rota. There were also plans to employ Physician Associates to help release DiT for training. Consultants confirmed that DiT were often pulled to cover CSRU despite training provision throughout the day and said that where training days were lost, they made every effort to provide this elsewhere, stating that competencies were on track. It was also acknowledged by consultants that DiT come to the lab on their non-working (zero) days.
The education lead explained that the portfolio of every HST had been reviewed to identify issues early and raise these with supervisors.
Educators said that it was not uncommon for consultants to act down as registrars and stay overnight.
Consultants confirmed that there was currently only one face to face clinic with the remainder carried out by telephone. From August, clinics will be face to face, supernumerary and DiT will be able to self-roster. Consultants believed there to be a sufficient number of clinics for DiT to attend but required some self-motivation by DiT to do so.
Regarding GIM experience for HST, consultants said this was more challenging now that other specialties have been withdrawn from cardiology, limiting the exposure.
Culture/supportive learning environment
Consultants were not aware of any approachability issues but did comment that they were stretched clinically. The department was run by a small number of consultants and if a consultant was on-call then they were also likely to be doing other activities due to the workload. Consultants were also not aware of any specific incivility or hostility issues, but DiT were given opportunities to speak up. They also acknowledged that approaching someone working in the cath lab could be a physical barrier. Consultants said they were aware of instances where DiT felt bullied and harassed by the rota coordinator and try to intervene where possible when last minute rota changes were made.
When responding to DIT’s concerns about their training, consultants stated that the focus had been on obtaining additional staffing and seeking agreement from the Trust so that the education provision could be enhanced. Consultants added that it had been challenging to achieve this with the limitations. They hoped that it was clear to DiT that they were trying to improve training. Consultants also acknowledged DiT as a valuable source and were open to ideas and suggestions for better ways of doing things. An Educational Oversight Committee was introduced as a forum to raise and address concerns.
Consultants felt they had time to give (and gave) constructive feedback citing dedicated sessions with Education/Clinical supervisors, support from the education lead and debriefs in cath lab sessions.
Consultants said they felt supported in their roles as educators and had received the necessary training. The educational supervisor role was job planned and there were other educational programmes available. There had been an academic half day session with a speaker who focused on communication.
General comments
A business case for two new consultants had been approved which would bring the numbers from seven to nine.
The business case for five new locally employed doctors was approved and two had started with one beginning in August. The review panel heard that some of these posts were to be shared with Stoke Mandeville Hospital, but the aim was for the rota team to create a 1 in 10 rota.
Consultants felt that more time together with DiT would make a difference in bringing unity to the department and help to break down the intimidation barrier.
Consultants commented that they have been lucky with their higher specialty trainees, they work hard and appreciate their hard work.
Requirements
Mandatory requirements and immediate mandatory requirements (IMRs) should be identified as set out below. IMRs are likely to require action prior to the draft Quality Review Report being created and forwarded to the provider. The report should identify how the IMR has been implemented in the short term and any longer termed plans. Any failure to meet these immediate requirements and the subsequent escalation of actions to be taken should also be recorded if there is a need to.
Immediate mandatory requirements
| Requirement reference number | Review findings | Required action, timeline and evidence |
|---|---|---|
| BHT 2024-01 (IMR) Domains 1, 3 Standard 1.6 Standard 3.5 Standard 3.6 | Supervision and support The panel heard that the named on-call consultant was given on the rota. However, it could sometimes be incorrect or have gaps. Consequently, doctors in training (DiT) were not always clear who the named on-call consultant was. It was common practice for DiT to seek support from whoever they could find (whether this was the on-call consultant or not) and were encouraged by consultants to find help in the cath lab. When the on-call consultant was known, DiT did not always receive a response. On occasions this led DiT needing to call other units (outside of the Trust) for advice. The inconsistency in support was leaving more junior grades vulnerable and there were some examples given where DiT had put out an arrest call to ensure that senior help would arrive. | The Trust must ensure that doctors in training (DiT) are informed who is responsible for their supervision and who, and how, to ask for help. There must be a named on-call consultant allocated at all times, the name of which must be clear to DiT and must be accessible. Timeline: Friday 6 September 2024 Suggested evidence: Rota, trainee feedback, audit e.g. Cappuccini test. |
| BHT 2024-02 (IMR) Domains 1, 3 Standard 1.6 Standard 3.5 Standard 3.6 | Supervision and support The department had written a standard operating procedure (SOP) which described the expectations of DiT whilst on the CSRU and the cardiology ward (2A) and their supervision arrangements. It also described how ward rounds and patient reviews were organised. The review panel heard that not all DiT had seen the SOP. Feedback indicated that there were inconsistencies with the SOP and procedures were not always carried out as described but was dependent on the individual consultant. For example, the panel heard that there were no ward rounds on Mondays or Fridays. Ward rounds were variable in format, some were full ward rounds and others were partial, thus not all patients were reviewed. Most new patients were seen on ward 2a, with some consultants only wanting to hear about new patients. New patients were not always seen on the CSRU. At weekends the consultant led ward round did not always take place, leaving the registrar to do this. This inconsistency could leave patients without consultant input for a number of days. | The Trust must provide evidence of adhering to the SOP. This includes undertaking ward rounds and reviews of new patients in both the CSRU and on the cardiology ward as described in the SOP, to ensure that DiT feel supported adequately. Timeline: Friday 6 September 2024 Suggested evidence: Trainee feedback, audit, evidence of inclusion of information at induction e.g. SOP/supervision arrangements/ward rounds |
Trust response to the Immediate Mandatory Requirements (IMR)
Requirement reference no. | Trust response to IMR | Required action, timeline and evidence |
|---|---|---|
BHT 2024-01 (IMR) Domains 1, 3 Standard 1.6 Standard 3.5 Standard 3.6 | Adherence to SOP and compliance with timely review of patients and Educational Ward Rounds. There were concerns that on occasion patients were not reviewed in a timely way by consultants and sometimes ward rounds did not take place. Consultant body have been written to and re-iterated that this was not acceptable. Following this communication, there has been a meeting with all the senior nurses and Deputy Divisional Director in August 2024 and all confirmed that the consultants had been consistent in carrying out their ward reviews. At this meeting a Sitrep was developed to be filled in at regular intervals during the 24 hour period both on CSRU and Ward 2A. Evidence submitted: Sitrep forms; an update from matron for Cardiology. The Trust intends to carry out a formal audit after one month but to date no non-attendances by consultants have been reported. | The Trust is requested to supply further evidence of adherence to the SOP by Monday 14 October 2024. Please submit evidence of ward rounds (e.g. sitrep reports, formal audit results). In addition, NHS England will seek further DiT feedback via the School of Medicine within this timeframe.
|
BHT 2024-02 (IMR) Domains 1, 3 Standard 1.6 Standard 3.5 Standard 3.6 | DIT should have clear points of Escalation and Contact; these need to be clearly visible. The consultant rota is populated onto Health Rota by the rota team, all trainees have access to this. In addition the senior nurses on CSRU have been given access to this and on a daily basis, they will write up the names of consultants covering throughout the 24 hour period on a whiteboard in CSRU. Evidence submitted: photo of the whiteboard and a health rota example.
| The Trust is requested to supply further evidence of accessible and available supervision and support both in and out of hours by Monday 14 October 2024. Please submit evidence such as results from Cappuccini tests in and out of hours to evidence accessibility/availability. In addition, NHSE will seek further DiT feedback via the School of Medicine within this timeframe. |
Mandatory requirements
| Requirement reference no. | Review findings | Required action, timeline and evidence |
|---|---|---|
| BHT 2024-03 Domain 3 and 5 Standards: 3.6, 3.7, 5.1, 5.6 | Impact of the rota on education and training Time for education and training was significantly impacted by the demands of the current rota and requests to cover rota gaps, often with short notice, especially on the CSRU. This was affecting the amount of training time available for DiT to achieve practical procedural competencies and to meet minimum curriculum requirements set by the College. There was little exposure to general medical problems and obtaining GIM exposure was therefore limited. The review panel heard that access to clinics, which were predominantly by telephone, had been minimal in the past year. With increased staffing expected in August 2024, the department was aiming to increase access to more face-to-face clinics which will be supernumerary and with the ability to self-roster. The panel heard that it could be difficult to contact a supervisor during a clinic especially if they were not onsite. Non-cardiology DiT reported difficulties obtaining consultant sign off for WPBAs and opportunities for cardiology-specific teaching limited. | The Trust must ensure that there is a suitable balance between education and service provision and that there is adequate staffing and supervision capacity. The department must ensure that it is delivering the learning opportunities required to meet curriculum requirements and appropriate breadth and depth of experience to meet individual learner needs. This should include supporting DiT to complete WPBAs. DiT must receive sufficient protected time to attend scheduled educational sessions within their rostered hours. This should include access to the required number of clinics, cath lab lists and echocardiography sessions as set out in the curricula. DiT should be encouraged to submit exception reports when they miss scheduled educational activities. Timeline: 29 November 2024 Suggested evidence: Trainee feedback, logbooks, trainee e-portfolio, training session attendance records, rota sample, exception reports, records of clinic timetables/schedules. Recommendations: It is strongly recommended that the Trust continues its plans to increase the workforce numbers by employing more locally employed doctors. This will improve gaps in the registrar rota and release DiT to more scheduled training slots. It is recommended that the trust continues to review the consultant establishment and reviews the impact of any additional consultant appointments to ensure that the department can deliver the required level of supervision, support and training to DiT. It is recommended that the education lead role in the department is made permanent promptly to provide stability to DiT and ensure sustainability of the improvements made so far. |
| BHT 2024-04 Domain 1, 2, 3 Standards: 1.1, 1.3, 1.4, 1.7, 2.1, 2.6, 3.8 | Culture: raising concerns The review team heard that DiT had not found it easy or comfortable to raise concerns about their education and training. The department gave opportunities to raise these but when they had it was not always responded to in a supportive manner, were deflected, or in some cases had received negative consequences for doing so. | The department must build a culture of trust to encourage the reporting of concerns openly and safely, without fear of adverse consequences. The Trust and department must restore confidence among DiT of the effectiveness of its educational and clinical governance processes. The Trust must ensure that concerns raised are dealt with rapidly and effectively and that there are processes in place to monitor and review these. The department should provide feedback to DiT about how they have responded to these. Timeframe: 29 November 2024 Suggested evidence: Trainee feedback, minutes from educational oversight committee or other training forums, log of issues raised, and actions taken. Recommendations: It is recommended that the department continues to run its educational oversight committee as a forum to raise and respond to concerns. |
| BHT 2024-05 Domain 1, 3 Standards: 1.1, 1.3, 1.4, 1.6, 3.8 | Culture: supportive learning environment While the majority of the consultants were said to be supportive and helpful, a small minority could on occasions be rude or undermine. DiT said they sometimes felt undermined and heard negative comments criticising their management plans from other colleagues. DiT had also felt threatened by the central medical rota team when requested to cover shifts or to stay beyond their hours when there was no-one to hand the bleep to. This included being challenged over the submission of an exception report. | The trust must ensure that the learning environment is one in which education and training is valued and all staff, including learners, are treated fairly, with equity, consistency, dignity and respect. The department must provide a learning environment where DiT, and other staff, are not subjected to behaviour that undermines their professional confidence, performance or self-esteem. The Trust must ensure that DiT feel secure and able to raise concerns about poor behaviour such as bullying and undermining. DiT should receive regular, constructive and meaningful feedback on their performance. DiT should be encouraged to submit exceptions reports when working beyond their hours and without fear of adverse consequences. Timeframe: 29 November 2024 Suggested evidence: Trainee feedback, exception reports Recommendations: The trust is recommended to reiterate, and effectively operationalise, its policies for bullying and undermining in the department. |
| BHT 2024-06 Domain 1 Standard 1.5 | Handover It was reported that there were no formal handover arrangements. Nurses would handover or notes were left. | The handover must be organised and scheduled appropriately with DiT present so that it can provide continuity of care for patients and maximise learning opportunities. The Trust must ensure that there is clarity around the mechanisms used for patient handover. Timeframe: 29 November 202 Suggested evidence: Trainee feedback, audit. |
Recommendations
Recommendations are not mandatory but intended to be helpful, and they would not be expected to be included within any requirements for the provider in terms of action plans or timeframe. It may however be useful to raise them at any future reviews or conversations with the provider in terms of evaluating whether they have resulted in any beneficial outcome.
NHS England has made additional recommendations/ suggestions against many of the mandatory requirements. For the purposes of flow for the reader these have been included within the relevant mandatory requirement in the above section. Further recommendations below are given to support the Trust to enhance the education and training experience.
| Related education quality framework domain(s) and standard(s) | Recommendation |
|---|---|
| Domain 1, 2, 3, 5 Standards: 1.1, 1.3, 1.4, 1.5, 1.7 2.1, 2.6 3.5, 3.6, 3.7, 3.8 5.1, 5.6 | Culture: differences in perception of the learning environment The department is encouraged to seek independent/external support to help the department in identifying and resolving the issues pertaining to the differences in perception regarding supervision and support, feedback and incivility. The department could consider options for bringing consultants and DiT together to enhance and facilitate a cohesive and harmonious learning experience and working environment. This could be achieved through: utilising the educational oversight committee as a forum for discussion and feedback between consultants and DiT professional development training interventions, away days external support (as referred to above) additional support such as coaching to resolve behavioural issues encourage and increase the routes and frequency of communication enhancing its departmental induction to introduce new and existing members of the department. |
Good practice
Good practice is used as a phrase to incorporate educational or patient care initiatives that, in the view of the Quality Review Team, deliver quality above and beyond the standards set out in the Quality Framework. Examples of good practice may be worthy of wider dissemination.
| Learning environment/ Professional group/ Department/Team | Good practice | Related education quality framework domain(s) and standard(s) |
|---|---|---|
| Cardiology | Echocardiography training was good quality and well regarded. | 5.1 |
| The appointment of a new education lead was welcomed and was supporting improvements to the education and training provision. | 2.1, 2.6 | |
| Educational supervisor roles were job planned and educators felt well supported in their roles. | 4.2, 4.3 | |
| There was good peer support from registrars and nursing staff. | 1.12, 2.1 | |
| There were good quality training opportunities when accessible. | 5.1 |
Report approval
Report completed by: Liesa Moore, Education Quality Manager
Review lead: Mrs Rebecca Black, Deputy Postgraduate Dean
Date approved by review lead: 3 October 2024
NHS England authorised signature: Dr Paul Sadler, Postgraduate Dean and Regional Dean
Date authorised: 3 October 2024
Final report submitted to organisation: 3 October 2024
Publication reference: PRN01548