Executive summary

This review aimed to assess the provisions for resident doctor (RD) wellbeing within the Trauma and Orthopaedics department, particularly in light of anticipated external media scrutiny. While initial concerns were present regarding the department’s capacity to support its RDs, the panel noted a commendable level of engagement and collaborative working from the placement provider (PP). The review panel thanked the PP for accommodating this review.

Following heightened media scrutiny on the department, the PP initiated a comprehensive improvement plan, involving various teams and holding a number of meetings to ensure an effective action plan is in place.

Regarding supervision, all RDs were reported to have assigned educational supervisors and were generally pleased with the support they received from them. It was reported that two consultants were in the process of attaining the appropriate accreditation to have their trainer status recognised on the General Medical Council (GMC) medical register.

It was also noted that feedback from RDs around inconsistent local inductions had been addressed by allocating a designated team member for in-person hospital tours and the development of a comprehensive induction handbook.

Previously, RDs had faced difficulties securing leave for regional teaching, and there was an absence of protected teaching time and a local teaching programme. The review panel was informed that this had been significantly improved with the implementation of several teaching initiatives following expansion of the consultant workforce, meaning at there was more capacity within the department to support training.

Persistent rota issues, largely due to vacancies, were acknowledged. A Standard Operating Procedure (SOP) was being developed for managing last-minute rota gaps, and the issue had been escalated to senior management. An action plan involving the rota coordinator and manager was being developed to address inconsistencies.

The PP reaffirmed its commitment to ensuring that RDs had various communication channels to raise concerns or seek wellbeing support.

NHS England’s Intensive support framework (ISF) rating of Trauma and Orthopaedics at Great Ormond Street Hospital for Children NHS Foundation Trust is at 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

NHS England – London undertook this senior leads education visit to seek reassurance around the educational and clinical supervision of resident doctors working in Trauma and Orthopaedics due to concerns for the department’s capacity to support resident doctors following heightened scrutiny of the Trust in the national press.

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

• Spinal and Ortho report

Who we met with

Education team

• Director of Medical Education
• Medical Education Manager
• Education Lead
• Co-Director of Education
• Freedom to Speak Up Guardian
• Responsible Officer
• Clinical Director
• Medical Director – Acting Chief Medical Officer
• Director of Human Resources

Review panel

• NHS England- London System Dean- North- Central London, Vivienne Curtis – Education Quality Review Lead
• NHS England – London Deputy Head of School of Surgery, Dominic Nielsen – London Specialty School of Surgery representative
• NHS England – London Education Quality Co-ordinator, Sahariyea Siddique – Education Quality representative
• NHS England – London Deputy Education Quality Manager, John Marshall – Education Quality representative (Supporting role)

Review findings

The review panel was initially concerned about the ability of the Trauma and Orthopaedics department to support the wellbeing of their resident doctors (RDs), however it was pleased to see a high level of engagement from the placement provider (PP). It was evident that the senior leadership team, clinical leadership and the Postgraduate Medical Education teams had worked collaboratively to ensure they had a working plan to support the wellbeing of their RDs prior to the upcoming anticipated external media scrutiny.

The PP representatives reported that, following media scrutiny, it had initiated efforts to improve departmental operations. The panel was presented with an overview of the ongoing work being undertaken to ensure an effective improvement plan was in place. This started with an initial Postgraduate Medical Education (PGME) meeting which was held with the Orthopaedics team in September 2024, during which it was concluded that the department was experiencing significant strain due to staffing. This shortage was found to adversely affect supervision, local induction processes, rota coordination, and the delivery of teaching programmes. A follow-up meeting conducted in December 2024 indicated that some progress had been made.

The PP representatives stated that all resident doctors had assigned educational supervisors and that they were satisfied with their clinical supervision and clinical experience. There had been no reports of RDs not being content with their clinical and educational supervision. An issue was identified concerning the documentation for two of the consultants as they were not recognised by the GMC as trainers. This matter was being reviewed and the consultants in question being enrolled into the next available educational supervisor’s course. Two new consultants had also been appointed and were due to start in the summer. The PP reassured the panel that the ability to supervise was never in question; the issue was solely due to the documentation.

It was also reported to the panel that the delivery of local inductions was inconsistent and that some RDs didn’t have a local induction, whereas others had virtual inductions delivered by individual supervisors. To resolve this, the PP representatives agreed with the unit manager to allocate a designated team member to walk new RDs around the hospital as part of their local induction. A manager also led on creating an induction handbook with engagement from consultants and RDs to ensure it includes everything it should do. This was shown to the panel during the presentation. The PP representatives confirmed that local inductions have since been conducted and that in the future, they will be held face to face with the support of the rota coordinator manager.

The panel were informed that many RDs had reported struggling to attend regional teaching and that there was no allocated protected teaching time. It was also reported that there was no local teaching programme. A senior fellow offered to lead on this with the support of the PGME team. It was evident from the LFG minutes from May 2025 that the weekly teaching programme was now running and was mostly led by a consultant. A regular journal club had also been set up, as well as multidisciplinary team and monthly audit meetings. The PP representatives shared the teaching schedule with the panel.

Regarding supervision, all RDs were reported to have assigned educational supervisors and were generally pleased with the support they received from them. It was reported that two consultants were in the process of attaining the appropriate accreditation to have their trainer status recognised on the General Medical Council (GMC) medical register.

It was also noted that feedback from RDs around inconsistent local inductions had been addressed by allocating a designated team member for in-person hospital tours and the development of a comprehensive induction handbook.

Previously, RDs had faced difficulties securing leave for regional teaching, and there was an absence of protected teaching time and a local teaching programme. The review panel was informed that this had been significantly improved with the implementation of several teaching initiatives following expansion of the consultant workforce, meaning at there was more capacity within the department to support training.

The representatives from the PP acknowledged multiple ongoing rota issues resulting in RDs being unable to take requested leave which was due to vacancies. Some of the issues included the assignment of shifts, absences not being reported resulting in no cover, leave allocation and no sickness management process. A SOP was being created to ensure a clear process for filling last minute rota gaps and this had been escalated to the Guardians of Safe Working, service leads for orthopaedics, and workforce leads. A meeting was held with the rota coordinator and manager to build an action plan for local inductions, staffing, rota rules and to create an agreement to share rota with local team members. Rota rules were still in the process of being established with the engagement of the rota coordinator and workforce team.

Persistent rota issues, largely due to vacancies, were acknowledged. A Standard Operating Procedure (SOP) was being developed for managing last-minute rota gaps, and the issue had been escalated to senior management. An action plan involving the rota coordinator and manager was being developed to address inconsistencies.

The PP representatives informed the panel of the various avenues the RDs had to raise concerns or seek support for their wellbeing. This included speaking to their educational or clinical supervisors, Local Faculty Groups (LFGs), signposting to the freedom to speak up guardians, PGME team, a WhatsApp group for all RDs and the Professional Support Unit (PSU) led by NHS England. They assured the panel that there were a number of colleagues with experience in raising and managing concerns who could be called upon for support if required. It was also reported that the RDs had reported that they were enjoying their roles and feel well supported by the clinical teams.

The panel was pleased to hear that in the event of any adverse publicity events around clinical activity at the organisation in the future, the PP representatives had demonstrated a commitment to transparency with their staff. They assured the review panel, that ahead of any press scrutiny, even with minimal notice, proactive measures were taken to inform staff through various communication channels such as, team meetings and e-mails. The panel was invited to review internal staff communication.

The PP representatives assured the panel they always had careful consideration of the RDs and that any decisions made were carefully thought through with the full support from the executive team. It was stated that they had a robust process in place to manage any allegations against their staff to support both the complainant and those subject to the complaint.

The PP reaffirmed its commitment to ensuring that RDs had various communication channels to raise concerns or seek wellbeing support.

Areas that are working well

Areas for improvement

Mandatory requirements

Report approval

Report completed by: Sahariyea Siddique, Education Quality Coordinator – NHS England
Review lead: Prof Vivienne Curtis, System Dean – NHS England
Date approved by review lead: 23 June 2025

NHS England authorised signature: Prof Vivienne Curtis, System Dean – NHS England
Date authorised: 10 July 2025

Final report submitted to organisation: 10 July 2025