Executive summary
The feedback from resident doctors regarding their education and training experience has improved compared to previous visits. They reported that they are receiving a positive learning experience and working in a supportive unit with good clinical supervision. They described the consultants as keen to teach, approachable and personally invested in their training. Resident doctors did however express concerns about a perceived risk averse culture within the department which they felt caused some challenges for more junior resident doctors and their ability to gain the required clinical decision-making skills.
Resident doctors described a thorough induction with rotas received on time and clinical and educational supervisors allocated. Resident doctors across all grades reported improvements to the rota, however reported that it remains a challenge when colleagues are off sick. There was positive feedback regarding teaching with improved facilities, however, they did report some challenges in getting consultants to deliver teaching sessions. All resident doctors felt comfortable in raising concerns and felt that issues raised at junior doctor forums (JDF) were quickly resolved where possible.
There were some significant delays reported in the completion of the forms for work-based assessments (WBAs) and supervised learning events (SLEs), however, it was recognised by resident doctors that this was due to the consultant teams’ own workload. Educators acknowledged the challenges with their own sparse rota but felt they were doing their very best, and were optimistic about four new consultants due to start in March 2025 which they hope will ease some of the pressure.
Resident doctors expressed concerns about a lack of experienced paediatric nurses within the department and a lack of paediatric experience within the Emergency Department, both of which is having an impact on their workload. Educators acknowledged these challenges and reported that the trust is actively addressing these concerns.
There was good engagement by resident doctors and educators during the meetings and it was evident from the feedback that the department have taken steps to address some of the previous issues and that progress is satisfactory.
Based on the review findings and overall positive feedback we will be recommending that the Intensive Support Framework (ISF) category 2 is reduced to an ISF category 1 and the sustainment of those improvements and addressing the remaining challenges will be monitored through the improvement plan.
Review overview
Background to the review
Initial concerns were identified with Paediatric training at Kettering General Hospital (KGH) in the 2022 General Medical Council (GMC) National Training Survey (NTS) outcomes. The survey showed scores which were below the national average for several areas. In addition, the Postgraduate Head of School for Paediatrics was made aware of further challenges in relation to rotas, which was reported to be impacting on the quality of training being offered to resident doctors at the trust.
In November 2022, a learner educator meeting was held with resident doctors and educators to further explore the potential concerns. Feedback regarding the educational experience was positive overall, however, some concerns were identified regarding access to IT and gaps within the middle grade rota. Following the meeting, the trust provided an improvement plan to address these areas of concern.
The GMC 2023 NTS highlighted potential deterioration in the experience of resident doctors within the department. A follow up meeting was arranged in November 2023 and resident doctors described variable experiences regarding their training with some of the concerns identified at the previous visit having not improved. These concerns included access to IT systems, rota and workload, access to teaching and educational supervision. This item was increased from an intensive support framework (ISF) category 1 to ISF category 2 and added to the Quality Improvement Register.
The trust has provided updated progress reports; however, the response to requests for these have been somewhat delayed. The GMC 2024 NTS outcomes highlighted improvements. A further meeting was arranged for January 2025.
Who we met with
Learners
- ST1 – ST8 Paediatric resident doctors
Educators
- Consultant Paediatricians
- College Tutor
- Clinical Director
Education team
- Deputy Director of Medical Education
- Education Centre Manager
Review panel
Education Quality Review Lead
- Dr Joe Fawke, Head of School for Paediatrics
Specialty Expert
- Dr Lizzie Starkey, Deputy Head of School for Paediatrics
NHSE Education Quality Representative
- Sarah Wheatley, Quality Deputy Manager
Review findings
Culture and environment
Resident doctors reported that prior to starting at KGH there had been a degree of trepidation, however they all reported that they were receiving a positive learning experience. They described a friendly team and supportive unit with good clinical supervision and a good consultant team who were always approachable and keen to teach. They described the consultants as being ‘personally invested in training’ and always looking for opportunities for resident doctors to learn. They felt that the consultants were supportive of them going to teaching and they felt valued and had learnt a lot. Resident doctors felt comfortable raising concerns and advised that issues raised at JDF meetings had been quickly resolved where possible.
Discussions took place amongst resident doctors about a perceived risk averse culture within the department which they put down to historical reasons. They understood this cautious approach but felt it could cause some challenges for the more junior resident doctors from a training perspective. They felt that constant exposure to risk averse working may limit their readiness for working in other hospitals. Whilst they felt the risk averse approach might lead to overtreatment, they did not feel it impacted patient safety and commented that some parents of the children favoured this approach.
Induction
Induction was described as thorough with rotas received on time and clinical and educational supervisors allocated. However, resident doctors did describe a significant amount of online induction which had to be undertaken prior to starting. Whilst time was given back to some resident doctors for this, this did not appear to be the same for all. Resident doctors also felt that a paediatric induction handbook would have been useful.
Educators reported on the work that had been done to improve the recent induction and recognised that whilst there is still work to be done there had been some positive feedback received from resident doctors.
Access to IT systems
Resident doctors reported that the e-learning package which was sent out prior to joining the rotation worked well and there were no reports of difficulty accessing IT systems when starting which had been a previous issue.
Rota and workload
All grades of resident doctors reported improvements to the rota. Although they described the workload as busy, tier 2 resident doctors appreciated the two-registrar system on long days and weekends which had made the workload more manageable. They did however report that it remains a challenge when colleagues are off sick. The tier 1 rota was reported as working well with resident doctors acknowledging the addition of F1s to the rota which had taken off some of the pressure. Due to the busyness of the department, it was reported that sometimes taking breaks could be difficult and quite often lunch times are taken up by teaching sessions which some had raised at the JDF as an issue.
It was reported that there is a lack of rota administration and resident doctors described rotas as not always being up to date. This can leave them unsure who is scheduled to be on the rota and makes it difficult to identify gaps. They also reported that leave approvals can often take a long time to be actioned and often require several reminders before being resolved.
Resident doctors reported that the lack of substantively employed paediatric nurses in the department was impacting their workload. Educators acknowledged this issue and confirmed that the trust is actively addressing it by recruiting more permanent staff and supporting band 6 nurses in completing Paediatric HDU courses.
Resident doctors discussed the Emergency Department Paediatric Assessment Unit (EDPAU) describing it as not functioning like a proper paediatrics emergency department. They felt that due to the lack of paediatric expertise, a large number of children were being referred to the paediatric department which was having a significant impact on workload. This was described as a daunting experience for those coming from hospitals with wellestablished paediatric emergency departments.
They reported that referrals are sent by phone with an expectation that resident doctors attend within 30 minutes which is a demand they often find physically impossible due to workload and distance to the EDPAU. Educators acknowledged these challenges and believed there was high level oversight of this within the trust. They reported that monthly meetings are being held with the Emergency Department and operations teams to develop solutions at improving patient flow. They reported that plans are also underway to start joint teaching sessions with the Emergency Department.
Teaching
Resident doctors reported a hybrid model for teaching sessions which they felt was a welcome improvement over the previous fully online teaching. Whilst space had been an issue in the past, they reported that they had been able to pre book rooms for the entire year in the education centre. This has enabled them to leave the department and join in uninterrupted, bleep free teaching sessions. Facilities such as screens and webcams were also available in the rooms.
Although resident doctors are encouraged to attend teaching sessions, and consultants are supportive of teaching happening, they did report some challenges in getting consultants to deliver sessions due to their workloads.
Learning opportunities
Resident doctors reported that whilst all consultants were willing to do WBAs and SLEs there was a significant delay in completing the forms. Some resident doctors described that up to 90% of forms are completed in the last week before ARCP. Resident doctors recognised that this was due to work pressures.
All resident doctors discussed the advantages of setting up a dedicated case-based discussion (CBD) clinic which they felt would be highly beneficial. They were optimistic that the appointment of four new consultants would lessen the pressure on the team, freeing up the consultants to participate in more teaching days and make CBD clinics more viable.
Educational supervision
Educators acknowledged the challenges with their own sparse rota but felt they were doing their very best and were optimistic about four new consultants due to start in March 2025 which they hope will ease some of the pressure. Supervision was described as ‘tricky’, with some consultants being educational supervisor for many resident doctors. Despite the challenges, they felt that overall things were functioning well.
Educators did highlight the lack of office space with one shared space between four consultants which was making it difficult to hold educational supervisor meetings or one to one meetings, they also recognised that this would become even more difficult with four new consultants sharing the same office space.
Areas that are working well
| Description | Domain(s) and standard(s) |
|---|---|
|
Access to IT Systems (previous mandatory requirement) Previously resident doctors had reported issues with access to the IT systems when commencing their training post. Resident doctors reported no issues with IT systems describing the introductory online learning allowing immediate access. |
1.11, 3.9 |
|
Rota (previous mandatory requirement) Previously resident doctors had reported challenges with both tier 1 and tier 2 rota. Resident doctors across all grades reported improvements to the rota. |
5.6 |
|
Access to Teaching (previous mandatory requirement) |
5.1, 5.4, 5.6 |
|
Previously resident doctors reported challenges with attending teaching sessions, facilities for teaching and a lack of bleep free teaching. Resident doctors reported no issues with attending teaching sessions. There has been space allocated with good facilities to enable face to face teaching sessions. Teaching is bleep free and they are encouraged to attend. |
|
Areas for improvement
Mandatory requirements
| Review findings | Required action | Reference number and domain(s) and standard(s) |
|---|---|---|
|
Educational Supervision (previous mandatory requirement) Previously consultants with an educational supervisor role reported that due to workload, they were experiencing challenges with supporting relevant work-based assessments. Resident doctors reported that whilst all consultants were willing to do WBAs and SLEs there was a significant delay in completing the forms. Some consultants reported being educational supervisor for several resident doctors. |
The trust needs to ensure that resident doctors are supported to complete appropriate summative and formative assessments. The trust should provide short term and long-term plans on how this issue will be addressed. Ensure supervisors are appropriately supported, with allocated time in job plans/ job descriptions, to undertake their roles. |
MR1 3.7, 4.2 |
Recommendations
| Recommendation | Reference number and or domain(s) and standard(s) |
|---|---|
|
Facilities Educators reported a lack of space to hold educational meetings with resident doctors, 1-2-1 or confidential conversations within the paediatric area or near its vicinity. We would recommend the review of appropriate spaces for educational activities such as these. |
4.2 |
|
Additional resource With the appointment of four new consultants we would recommend that plans are made as to how the department can use this additional resource from an educational perspective. We would also recommend CBD clinics are considered to improve completion of SLEs in a timely manner. |
4.3 |
|
Induction Resident doctors highlighted that it would have been useful to have been provided with a paediatric specific induction handbook. We would recommend that this is considered as part of the induction package. |
3.9 |
|
Improvement plan oversight Despite the progress made on previous areas of concern, there appears to be a lack of oversight and ownership of the improvement plan. It is recommended that one individual either within the education department or paediatrics is the owner of the improvement plan who can monitor progress of individual elements and ensure that updates are completed within allocated timeframes. |
2.1, 2.4, 2.6 |
Report approval
Report completed by: Sarah Wheatley, Quality Deputy Manager
Review lead: Dr Joe Fawke, Head of School Paediatrics
Date approved by review lead: 16 January 2025
NHS England authorised signature: Professor Jonathan Corne
Date authorised: 5 February 2025
Final report submitted to organisation: 18 March 2025