Executive summary

The panel would like to thank the senior leadership team at ESHT for accommodating this Senior Leadership Conversation and for their positive engagement in discussions around the quality of education and training for doctors-in-training within their organisation. The visit and subsequent discussions focused on the Trust’s response and actions regarding GMC NTS 2024 red outliers and open mandatory requirements from previous interventions.

The panel recognised the Trust’s efforts to maintain delivery of education and training despite the considerable service pressures faced by the Trust and noted evidence of improvements further to previous quality interventions and the 2024 GMC National Training Survey results. 

College Tutors presented an overview of Medicine training at the Trust. The panel heard there are twenty-five Internal Medicine Trainees (IMT) and eighteen Higher Specialty Trainees (HST) Doctors at Eastbourne District General Hospital (EDGH), and eight IMT and ten HST Doctors at Conquest Hospital. The education and training opportunities in GPSTs in medicine, Respiratory medicine, and Cardiology were highlighted within the Trust’s presentation, as well as an overview of their Medical Workforce Review.

Areas reported by the Trust as improved are consistent positive feedback about teaching, practical procedures and 1:1 teaching in the Acute Medical Unit, Bronchoscopy & sleep studies training for Respiratorycross site excellence in research & clinical care, Clinical Simulation Suite, Intensive pastoral fellow support for Cardiology, Grand Rounds, SIM training, Practical Procedures Courses, Leadership Faculty Course, PACES host site, Improved Internal Medicine Trainee (IMT) Clinic Accessibility. The Trust noted challenges around financial constraint, recruitment, and medical workforce review for rota design.

The panel were pleased about the positive engagement and impressive collaboration of all key people in the organisation, the Chief Medical Officer, and the executive team. The obvious commitment of the consultants to their trainees and the excellent pastoral support available to all staff is highly commendable.

The Trust presented actions they have taken to address areas of concerns identified through the GMC NTS details of which have been included within the relevant domains of this report. The panel identified areas for improvement and considered that further assurance was required to ensure that NHSE Education Quality Standards are being met. The four mandatory requirements detailed within this report will supersede existing mandatory requirements issued following previous quality intervention in 2023 and will be monitored via an action plan. The panel concluded that the feedback heard during this review demonstrated significant improvements in the quality of education and training being provided.

Review overview

Background to the review

NHS England Kent, Surrey & Sussex (KSS) Education Quality arranged this Senior Leadership Conversation further to previous interventions in Medicine in 2022 and 2023 and in response to the GMC National Training Survey (NTS) 2024 results that showed below outliers in Internal Medicine Training (Core Medical Training) at East Sussex Healthcare NHS Trust (ESHT) on the Eastbourne District General Hospital (EDGH) and Conquest Hospital sites.

Following the 2024 GMC NTS results for Medicine at ESHT, the existing quality action plan encompassed many of the outliers, however, updates from the Trust at the time of NTS results analysis had not provided adequate assurance of progress on thirteen mandatory requirements related to:

• Staffing in Care of the Elderly, Stroke and Gastroenterology impacting on patient experience, supervision, workload, and rota gaps
• Accessibility of the take lists
• Trainees’ experiences of the patient tracking system
• Escalation processes at weekends, ward cover overnight and consultant presence at handover
• Departmental induction for Internal Medicine Training
• Delays in obtaining surgical opinions at Eastbourne District General Hospital and transfers of surgical patients to Conquest Hospital
• Rota processes (requests to cover gaps, timing of zero days)
• Clinic attendance not protected for Internal Medicine Training
• Staffing levels at AAU at Conquest Hospital
• Access to Clinic opportunities for IMT and HST doctors
• Access to Annual Leave and study leave for IMT and HST doctors
• Improving Regional Training days for IMT doctors.

Medicine training at ESHT is currently rated as Intensive Support Framework (ISF) category 2 on the NHSE KSS quality register.

This review aimed to understand progress in addressing the concerns raised by the NTS 2024 results, review progress with existing mandatory requirements, and identify any further quality improvement actions aligned with the HEE Quality Framework.

Who we met with

Education team

• Interim CEO
• Interim Chief People Officer
• Chief Medical Officer & Deputy Chief Medical Officer
• Directors of Medical Education
• Assistant Director HR (Education)
• Deputy Head of Medical Education & Knowledge Services
• College Tutor for Conquest Hospital
• College Tutor for Eastbourne DGH
• Deputy Chief of Medicine & Foundation Year 2 Lead
• Clinical Lead for Acute Internal Medicine
• Clinical Lead for Respiratory Medicine
• Divisional Director of Operations
• Deputy Divisional Director of Operations
• Guardian for Safe Working Hours at Conquest Hospital
• General Manager for Acute Medicine & Frailty

Review panel

Education Quality Review Lead

• Dr Sarah Rafferty, Deputy Dean for Secondary Care, Kent, Surrey & Sussex
• Dr Michael Hobkirk, Associate Dean

Specialty Experts

• Mike Wood, Deputy Head of School for Medicine
• Harriet Patmore, Deputy Head of Foundation School

NHSE Education Quality Representative & Scribe

• Chidi Onyeze, Education Quality Project Officer

Lay Representative

• Sallie Nicholas, NHSE Lay Representative

Review findings

Quality Domain 1: Learning Environment and Culture

Acute Take

When asked about the amount of time HSTs spend on Acute medical take and how it affects their time in their specialties, the Trust reported that they consistently have coverage for HSTs to attend their specialty commitments. Additionally, they provide a Buddy system for HSTs to help cover duties while they attend specialty training. The Trust reported that they are considering recruiting 9 extra trainees (FY1s) to reflect the increased workload. The panel heard that the Trust intend to use locally employed doctors (LED) to cover the 9-to-5 medical unit on call. This is to allow the HSTs focus on their specialty commitments during this period. Please see Mandatory Requirement MR-MED 02.

The Trust were asked about their process of tracking patients admitted to the surgical unit. The panel learned that both sites now use a “pink list” for effective tracking, and additional wards will open for the upcoming winter period. Please see Mandatory Requirement MR-MED 04.

When asked about how the site manage and support surgical patients, the panel heard that there is always one surgeon available in the Surgical Assessment Unit (SAU) five days a week, ensuring a clear pathway for patient recovery.

Handover

The panel heard that the Trust’s management team meets with Respiratory Medicine resident doctors biweekly to discuss daily board rounds and handover meetings. The pastoral fellow noted no concerns about the handover process. The Trust reported that evidence of daily Consultant-led multidisciplinary meetings and Board Rounds was confirmed through Resident Doctor surveys.

Clinical Supervision out of Hours

The panel were informed that the General Practice (GP) in EDGH have a robust front-loaded on-call team with two Registrars, one GP SpR, one IMT3 & two IMT1s.

Study Leave

The panel heard that Conquest Hospital effectively communicates the study leave process to resident doctors. Challenges in securing leave are addressed by having additional doctors available and a clear policy, with an escalation protocol for last-minute gaps considered on a case-by-case basis. The Trust reported that induction is utilised to emphasise the study leave process. There are no reported concerns about access to study leave or training opportunities, as noted in a structured questionnaire by the Pastoral fellow. Additionally, resident doctors shared examples of specialty-specific medical education in Respiratory Medicine, which were recorded in a survey.

Overall Satisfaction

The panel heard that consultant supervision is consistently available on all wards at ESHT. The Trust maintains agreed minimum staffing levels by reallocating non-training doctors as needed. The panel heard that the Deputy Chief of the medicine division visits the wards twice a week to ensure visible leadership and address concerns directly. This feedback mechanism ensures that issues are communicated promptly to medical administration and senior leadership for timely resolution.

Quality Domain 2: Educational Governance and Commitment to Quality

Feedback and support mechanisms

The Trust reported that they have two pastoral fellows provide support for all staff but are a helpful channel of communication between resident doctors and consultants and can help to identify and resolve problems at an early stage. A pastoral fellow confirmed that they organise events and social meetings, as well as signposting them to support opportunities. The panel heard that these posts have been in existence in the trust for 6 years and had made a significant difference in identifying and helping to resolve problems.

The panel heard that EDGH have enhanced support to trainee doctors by establishing GP trainee reps and establishing stronger links with GP programme directors through Medicine College Tutors now attending GP Local Faculty Group (LFG) meetings and vice versa which is recorded.

Reporting Systems

The Trust noted that at Conquest Hospital information about the reporting system is now better disseminated at time of induction, and there is a safety pin system in place to facilitate feedback from investigated incidents. The panel heard that both sites have daily board round and handover meetings in which each member of the team is encouraged to highlight any concerns. Resident doctors are invited to monthly Morbidity and Mortality meetings to discuss any concerns and learning from any events. The panel heard that there are no concerns about reporting systems recorded by pastoral fellow at resident doctor meetings.

Quality Domain 3: Developing and Supporting Learners

Appraisals

The panel heard from the CMO that they now had a 100% appraisal completion rate for consultants.

Senior supervision and support

When asked about the support provided to LEDs through the LFG, the Trust reported that there are currently several LEDs in the cardiology department who are supported by the LFG. The panel heard that additionally, the GP school offers support to doctors to positively influence the experiences of trainees. The panel learned that the Trust has appointed an International Medical Graduate (IMG) lead and has introduced a mentoring system for these doctors. The Trust also outlined several mechanisms implemented to promote educational supervision of trainees at Conquest Hospital. These include regular Educational Supervisor Refresher courses organized by the Medical Education department to keep Educational Supervisors updated on their training requirements. The Trust reported that they have employed an additional medical administrator, provided rota information eight weeks in advance, and ensured that Educational Supervisors must attend at least 2 out of 3 LFG meetings. The panel heard that trainees receive clear email documentation regarding their educational supervisors, both generally and during their induction.

Induction

When asked if the Resident doctors feel confident following inductions, the panel heard that the Trust have developed a comprehensive electronic local induction pack that contains practical information at local, Trust and divisional levels across all sites. Please see Mandatory Requirement MR-MED 03. The Trust explained that for GP trainees, they conduct medical and interdepartmental inductions by compiling various inductions for respiratory medicine, cardiology, and gastrointestinal medicine. This ensures all materials are readily available, including video inductions for those who are unable to attend in person.

The panel learned that the Cardiology team provides both formal and informal inductions led by a Cardiology consultant on the first day of rotation. They distribute a Cardiology manual that includes instructions and protocols related to coronary care, which is also accessible on the intranet. Additionally, the panel was informed that further information is provided during the initial meeting with clinical supervisors for the rotation. The panel noted that while the Acute Internal Medicine team at Conquest Hospital had previously faced challenges with inadequate space for induction sessions, a new seminar room has been constructed. This space will be shared by Emergency and Acute Medicine and has already been reserved for the upcoming inductions. The Trust reported that the Clinical Lead personally handles and oversees the induction process.

Quality Domain 4: Developing and Supporting Supervisors

Educational supervision

When asked about support for Educational and Clinical Supervisors, the panel noted that they are utilizing resident doctors to address the growing workforce demands. They provided advanced training through the Educational Supervisor Resource (ESR) as well as refresher workshops to better prepare educational supervisors for their expanded responsibilities. However, senior doctors confirmed that they are primarily responsible for conducting the main medical inductions.

Quality Domain 5: Delivering Programmes and Curricula

Workload and staffing levels

When asked about the workforce workload issue in recent surveys, the Trust reported that, Cardiology at Conquest had increased its staffing to address workload problems, and recent interim Annual Review of Competence Progression (ARCP)s had demonstrated that all trainees were gaining sufficient experience.

The panel was informed that the Trust has increased the number of consultants by four across various sites and has secured funding for clinical leads. Additionally, the panel learned that in the respiratory medicine team, there are 28 beds in the ward, staffed by two consultants along with locum doctors. They are also in the process of recruiting two new colleagues for Conquest by end of mid-April.

The panel observed that addressing intervention times for respiratory medicine, particularly regarding gaps in rotas for Higher Specialty Trainees (HSTs), does not fully alleviate the burden on registrars. The Trust acknowledged the challenge and is considering adopting rota models from Maidstone and Tunbridge Wells NHS Trust or University Hospitals Sussex NHS Foundation Trust, while also hiring a consulting company to create an effective rota at a significant cost. Please see Mandatory Requirement MR-MED 02. Currently, the Trust has engaged 2-3 agency “floater” doctors to boost the workforce. The main shortage areas seemed to be Stroke and Respiratory Medicine, they recently hired a new stroke consultant which has positively impacted staffing and other areas are fully staffed at consultant level.

When asked about the appropriate use of finance, the panel heard that the Trust is committed to spending wisely and maintaining their budget without any plans for reallocation.

Rota Design

The panel were informed that the Trust currently have a high percentage of less than full time (LTFT) trainees with 40% in IMT at present – and the challenge that the increase in numbers posed for rota design. Trust representatives wondered whether this trend was now permanent.

To address these challenges, the Trust has reported that they have added two FY1 doctors and increased medical admin support. A separate budget is in place to cover on-call rota gaps, with rotas provided eight weeks in advance and ‘floater’ doctors available for coverage. The panel were informed that the Cardiology team circulates their weekly rota through email, while the Respiratory Medicine team holds monthly meetings with consultants and managers to review staffing. The panel noted that the first of these meetings has occurred, with ongoing fortnightly discussions with residents. Additionally, the Trust has conducted five informal meetings between resident doctors and a pastoral fellow to discuss their working environment. Feedback was gathered by a structured questionnaire and shared with the Clinical Lead and Medical Education team. The panel reported that no rota-related concerns have been raised during regular debriefings with the Clinical Lead and Medical Education team.

Adequate Experience

The panel heard that in General practice medicine, teams allocate speciality specific jobs during on calls to enhance training. The Trust reported that the Chief Registrar will be looking into improving teamwork and leadership for registrars, encouraging more ward-based teaching, and liaising with GP tutors regarding specialty teaching.

The Trust reported that opportunities are currently available at both sites for doctors in training to participate in diagnostic activities and outpatient activities within the cardiology department.

Rota Coordinator is to include protected sessions allowing all individuals to participate. The panel heard that they have Timetabled lab slots (1x per week), Timetabled echo slots half day per week, Formal feedback sessions from trainees once per month to ensure compliance and the last meeting was 14^th March 2025. The panel also heard that informal weekly sessions are held with a consultant in the lab.

The Trust noted excellent progression rates through interim ARCP and review of PDPs with educational supervisors every two months (formally) and weekly (informally) at Conquest Hospital.

Local Teaching

The panel were informed that the Cardiology Team at Conquest Hospital will reinstate weekly teaching sessions. The panel also heard that the Rota Coordinator and education department will provide a suitable lunchtime slot which does not conflict with other mandatory sessions. The panel heard that teaching will be delivered by Conquest based consultants, SpRs and cardiac physiologists which will be evidenced by attendance registers for weekly teaching (lunchtime), One months’ worth of data has been collected, Journal Club, new guidelines, and interesting cases.

Quality Domain 6: Developing a Sustainable Workforce

Medical Workforce Review

The Trust began a Medical Workforce Review in 2024, involving the Associate College Tutor. The review was based on the tiers set out by the Royal College of Physicians (RCP) and identified a need for more doctors at tiers 1 and 2. As a short-term measure, they have engaged 2-3 agency “floater” doctors to boost the workforce, while in the longer term they are looking at rota re-design and gradual IMT recruitment to address the tier 2 deficit. The rota design is currently with a consulting company. Please see Mandatory Requirement MR-MED 01.

Areas for improvement

Immediate mandatory requirements

No immediate mandatory requirements were issued.

Mandatory requirements

Report approval

Report completed by: Chidi Onyeze, Education Quality Project Officer, KSS
Review lead: Dr Sarah Rafferty, Associate Dean, KSS
Date approved by review lead: 12 May 2025

NHS England authorised signature: Professor Jo Szram, Postgraduate Dean, KSS
Date authorised: 23 May 2025

Final report submitted to organisation: 12 June 2025