Executive summary
The panel would like to thank the Trust for participating in this Senior Leadership Conversation which was arranged to discuss areas of concern following the General Medical Council’s (GMC) National Training Survey (NTS) in 2024.
The panel met with senior members of the medical education team, clinical leads and managers from the Paediatrics department including the Advanced Clinical Practitioner (ACP) lead.
The Trust reported that Paediatrics is a multiprofessional team of six KSS trainees and 33 doctors that provides clinical exposure in neonatal care, paediatric surgery, and specialist clinics. There are 18 middle grade doctors on a 14-slot rota, and 14 junior doctors on a 15-slot rota with three registrars available throughout the week.
The panel emphasised that, though there were only a small number of respondents to the GMC’s 2024 NTS in Paediatrics at Frimley Park Hospital (FPH), the outliers could not have been caused by a singular trainee’s feedback.
The panel recognised the hard work and progress that has taken place over the last eight months to address feedback from the NTS survey. The panel heard that the following Local Faculty Group (LFG) feedback, the Trust have made improvements to their leave policy, teaching opportunities, and trainee resources.
In conclusion, the review panel issued two mandatory requirements and gave one recommendation, they request updates on the requirements later in the year via the education quality action plan process.
Review overview
Background to the review
Kent, Surrey & Sussex (KSS) Education Quality, as part of Health Education England, conducted a Senior Leadership Conversation in February 2023 regarding Medicine, Surgery, Foundation and Paediatrics. One of the four mandatory requirements issued related specifically to concerns around protected teaching time which were monitored via the Local Faculty Group meetings. It was closed in April 2023 by the intervention lead.
This senior leadership conversation was triggered by six red outliers in Paediatrics in the GMC’s NTS 2024 results. The key areas of concern were around rota design, teaching opportunities, clinical supervision, and trainees’ overall satisfaction. Additionally, feedback from trainees reported unequal access to training and poor facilitation of teaching.
As the Trust have two funded Advanced Clinical Practitioner (ACP) posts in Paediatrics, the clinical learning environment for ACP Paediatric learners was included in the scope.
Who we met with
- Deputy Director of Medical Education
- Advanced Clinical Practitioner, Wellbeing and Coaching Lead
- Deputy Medical Director
- College Tutor for Frimley Paediatrics
- Clinical Lead Frimley Paediatrics
- Strategic Lead for Medical and Dental Education
- Clinical Tutor for Frimley Park Hospital
- Medical Education Manager
- Deputy Director of Medical Education
Review panel
- Education Quality Review Lead, Dr Peter Anderson, Associate Postgraduate Dean, KSS
- Specialty Expert, Dr Catherine Wynne, Head of School Paediatrics, KSS
- Specialty Expert, Sarah Goodhew, Advancing Practice Faculty Lead, SE Region
- NHSE Education Quality Representative, Alex Bamford-Blake, Education Quality Project Officer, KSS
- Supporting Roles, Jacqueline Codrington, Lay Representative
Review findings
Quality Domain 1: Learning Environment and Culture
The panel heard that the Trust are trying to encourage more collaboration between doctors on community and paediatric attachments with those on community attachment also spending two weeks on the ward so that everyone can get to know their colleagues better. Please see Mandatory Requirement MR-PAED-01.
When asked why neonatal nurses may choose to refer to middle grades and consultants rather than resident doctors, the Trust reported that this is due to nurses not knowing the trainees. Please see Mandatory Requirement MR-PAED-02.
Quality Domain 2: Educational Governance and Commitment to Quality
This requirement was not specifically discussed as part of the review, however themes in other sections may link to this domain.
Quality Domain 3: Developing and Supporting Learners
Teaching
The Trust reported that, following GMC NTS feedback, that there is now a well-structured weekly teaching schedule that includes simulation, case review presentations, journal clubs, clinics, regional study days, as well as ward-based teaching opportunities. When asked if scheduled teaching is bleep free, the panel heard that it is not consistently for junior and middle grades due to availability of middle grades and consultants to cover the bleep. The Trust reported that reinstating bleep free teaching sessions for junior and middle grade trainees is a part of their action plan going forward.
The panel asked if resident and middle grade attendance of teaching sessions and opportunities is monitored. The Trust reported that missed opportunities are flagged and highlighted to trainees by the team.
The panel asked how the Trust are ensuring KSS doctors-in-training are given equal opportunity to procedures on the unit. The Trust reported that they provide an open-door culture for feedback as well as a number of different forums outside of LFGs and the GMC NTS. The review panel advised organising a monthly meeting where consultants can discuss resident doctors and any missed opportunities in a structured way. Please see Mandatory Requirement MR-PAED-03.
Handover
The panel heard that there had been consistent feedback in LFGs that handover had delayed trainees’ finishing time, with some consultants using it as a teaching opportunity. The Trust reported that evening handover is now consultant supervised seven days a week to ensure timeliness.
Additionally, the panel heard that trainees felt consultant presence between 5:00-8:00pm had been inconsistent. It was reported that consultants now conduct in-person review during twilight hours and use this time to address any concerns.
Advanced practitioners
When asked what opportunities current ACP trainees are accessing, the panel heard they are a part of all training and simulation. The Trust reported they are on slightly reduced hours, but that this is to ensure they have clinic and private study time.
The Trust reported that ACP are an integral part of the paediatrics and neonatal units, and that resident and middle grade doctors know that ACPs are accessible and supportive members of the team. The panel heard that the Trust will be hiring a permanent 0.6 ACP educational lead and that an ACP strategy will be included in the department’s education strategy next year.
The panel asked if the consultant body has requested to provide coordinating educational supervision or associate supervision for trainee ACPs and ANPs. It was reported that educational supervision is ringfenced in supervision job plans in accordance with ACP faculty funding.
Quality Domain 4: Developing and Supporting Supervisors
This requirement was not specifically discussed as part of the review, however themes in other sections may link to this domain.
Quality Domain 5: Delivering Programmes and Curricula
Rota design
The Trust reported that they recognised feedback regarding inconsistent leave policies between junior and middle grade doctors. The panel heard that SD junior shifts will either be removed or mandatory on weekends.
The panel heard that middle grades do not currently have the eight hours a month of personal/private study time juniors do. The panel heard that self-development time for middle grade doctors will be incorporated into their rota once it has been signed off my HR. This time will also allow more experienced trainees to seek out opportunities more suited to their needs.
Quality Domain 6: Developing a Sustainable Workforce
This requirement was not specifically discussed as part of the review, however themes in other sections may link to this domain.
Requirements
Mandatory requirements
Requirement reference number | Review findings | Required action, timeline and evidence |
---|---|---|
MR-PAED-01 | The panel heard that there lacks a collaborative working relationship between those in community and paediatric attachments. | Resident paediatricians who are working in community paediatrics but covering acute paediatrics on-call must have a period of familiarisation in the hospital paediatrics department. This should be a minimum of 5 days working in a supernumerary capacity in the general paediatric/neonatal departments before starting out-of-hours duties. This is to allow them to become familiar with departmental processes and the multi-disciplinary team. However, if residents have previously worked at in general paediatrics/neonates at FPH on tier 2/middle grade rota, this requirement can be waived. Please submit evidence by Friday 3 October 2025. |
MR-PAED-02 | The panel heard that neonatal nurses choose to refer to middle grades and consultants rather than resident doctors as they do not know the residents. | To encourage working relationships, it is advised that a ‘who’s who’ photo board of all colleagues in the unit with name, title, grade which is updated as residents progress. Please submit evidence by Friday 3 October 2025. |
MR-PAED-03 | There is currently no official process of monitoring junior and middle grade attendance of teaching. | To audit attendance at scheduled teaching sessions, including the reasons why resident paediatricians have not attended the sessions. Please audit for six months and share data with us. Please submit evidence by Friday 2 January 2026. |
Report approval
Report completed by: Alex Bamford-Blake, Quality Project Office
Review lead: Peter Anderson, Associate Dean for Kent, Surrey & Essex
Date signed: 1 July 2025
NHS England authorised signature: Jo Szram, Postgraduate Dean, KSS
Date signed: 14 July 2025
Final report submitted to organisation: 16 July 2025