Executive summary
Resident doctors spoke positively about their training and education experience within anaesthetics at Northampton General Hospital (NGH). They described the department as a nice, friendly place to work with good support and supervision. Those working in Intensive Therapy Unit (ITU) also described a supportive environment. Resident doctors noted a significant number of improvements that had taken place since our previous visit, and it was recognised that the department has put in a lot of work to improve the training experience.
Improvements were noted with the rota which had been one of the main frustrations identified by resident doctors previously. Study leave, exception reporting, raising concerns and facilities were all noted as areas of improvement. Some areas of the induction had also improved although access to IT systems was raised as an issue.
Resident doctors expressed a concern around the lack of time available to gain curriculum competencies in general anaesthetics due to spending longer periods of time in obstetrics. However, the department are aware of these concerns and although steps taken so far have not provided additional opportunities, this is something that will be explored further.
The educators and the College Tutor all felt very well supported in their roles and reported that since the previous visit, they all now have allocated time in job plans.
To summarise, the areas to be addressed by the trust are as follows:
- Regional teaching
- Clinical supervision
- Induction
Based on the review findings we will be recommending that the Intensive Support Framework (ISF) category 2 is reduced to an ISF category 1. A trust improvement plan will be required against the mandatory requirements in this report.
Review overview
Background to the review
In the 2023 General Medical Council (GMC) National Training Survey (NTS), the results showed multiple categories where responses were below the national average at NGH for resident doctors within anaesthetics. To better understand their experience of the clinical learning environment, a learner educator meeting took place in February 2024. The resident doctors described a welcoming and friendly department with supportive consultants however, several areas of improvement were identified. These included induction, clinical supervision, teaching, escalating concerns, rota, study leave and facilities.
Based on the review findings this item was increased to an ISF Category 2 and added to the Quality Improvement Register. The trust has provided updated improvement plans, and a further meeting was organised for 3 February 2025 to review progress.
Who we met with
Learners
- Stage 1 Anaesthetic Resident Doctors
- Stage 2 Anaesthetic Resident Doctors
Educators
- Consultant Anaesthetists
- College Tutor
- Clinical Director for Anaesthetics
Education team
- Deputy Medical Director
- Medical Education Manager
Review Panel
- Education Quality Review Lead
- Dr Sujata Handa, Training Programme Director for Quality
Specialty Expert
- Dr Nicola Hickman, Deputy Head of School
NHSE Education Quality Representative
- Sarah Wheatley, Quality Deputy Manager
Review findings
Culture and environment
All resident doctors spoke positively about working in anaesthetics at NGH and described it as friendly and a nice place to work and appreciated the very supportive network around them. The ITU department was also described as supportive and helpful.
All resident doctors are aware of the exception reporting process and how to raise concerns. Additionally, there is a lead resident doctor in anaesthetics and ITU who can feedback any issues to the Chief Registrar in the hospital and there are also regular resident doctor forums held. They reported no issues with accessing study leave and reported that the local teaching and support for exams is extremely good.
Facilities were reported to be adequate within anaesthetics with resident doctors being allocated an on call lockable room with bathroom. There is also the option to use the consultant room during the night as the on-call consultant is non-resident. Additionally, they also have access to the Operating Department Practitioner (ODP) room. Resident doctors working in obstetrics and ITU also reported having adequate rest facilities.
There were some frustrations expressed regarding mandatory training requirements at the trust which are spread over 3 or 4 different websites, however, when this issue was reported back to the trust it was acknowledged and confirmed that this is under review.
Educators reported feeling very well supported and reported that they now had allocated time in job plans. The College Tutor also reported feeling very supported in their role and felt that any issues raised have been listened to. There was positive feedback given about the educational supervisor days offered by the postgraduate school and positive feedback given about the support offered by the Training Programme Directors.
Rota
It had been previously reported that there was a lack of understanding of how less than full time (LTFT) rotas should work, however, feedback around LTFT rotas were overall positive with no issues raised. It was also highlighted that rota coordinators were very amenable should resident doctors want to make changes to the rota.
The rota was reported to be working well in ITU with always having at least one Stage 1 and one Stage 2 doctor overnight.
Learning opportunities
Stage 1 resident doctors raised concerns about the nine-month placement in obstetrics stating that despite some rota changes, they still felt it did not allow enough time to achieve their anaesthetic competencies. However, some resident doctors did report that they had managed to complete their anaesthetic competencies after the full nine-month period. Although these concerns have been raised previously, the steps taken have not provided sufficient time outside of obstetrics for resident doctors to adequately focus on their anaesthetic modules. In the educator session, discussions took place around possible ways for Stage 1 resident doctors to spend more time in general anaesthetics.
Stage 2 resident doctors in ITU raised the lack of opportunities to manage trauma calls as this responsibility falls to the resident doctor in anaesthetics covering the bleep. They were unsure how to gain experience and have this competency signed off. During the educator session, ways to create these opportunities were discussed, however, it was noted that trauma calls are infrequent, with only a few occurring over the course of an entire week.
Induction
Resident doctors described the induction as variable and generic. Whilst all resident doctors received their rotas well in advance and exception reporting was covered, there were issues reported with IT system access with some resident doctors unable to log in for up to two weeks. It was acknowledged by resident doctors that induction must cover a lot of information, but some felt this led to information overload. Several lectures on infection prevention, basic life support and how to put on a mask were not seen as the best use of time. There was no induction on how to use the computer systems which they thought would have been helpful. Although they were shown inside theatres and where equipment is kept, it was suggested that more time could also have been spent on this.
Clinical supervision
Clinical supervision overall was described as good with no issues reported regarding the completion of work-based assessments. However, it was noted that certain consultants had a poor understanding of what could be signed off as direct supervision and the required levels of sign off. Additionally, there were reports of certain consultants expecting unnecessary requirements for final module sign offs.
Previous concerns within obstetrics were discussed, however, those currently working in obstetrics felt that measures had been put in place to support resident doctors to feel more confident and competent. Experiences within obstetrics were described as good and supportive overall. However, Stage 1 resident doctors did report that they could sometimes feel unsupported at the weekends due to there being only one Stage 1 resident doctor allocated on the rota, whilst others working at the weekend are allocated to main theatres. Although the on-call consultant comes to obstetrics to review the workload it was felt that this does not adequately cover the support required in an emergency situation.
Teaching
Local Teaching was reported to be very good and had improved significantly since the appointment of a lead consultant for teaching. Departmental teaching takes place every Tuesday afternoon, and efforts are being made to ensure this time is protected in the rota so that all resident doctors can attend. Resident doctors also spoke positively about the preparation for Objective Structured Clinical Examinations (OSCE). However, concerns were raised about the succession planning for this role as they felt teaching could decline without the current leadership. The educators recognised the benefit of the role of lead consultant for teaching and confirmed that they are looking for someone to takeover.
Resident doctors spoke positively about the obstetric teaching which had previously been in place, however, reported that now there is no formal obstetric teaching due to the absence of a teaching lead.
Regional teaching is still not timetabled into the rota with communication issues between the department and regional anaesthetic teaching leads being reported. There were reports of some resident doctors ‘giving up’ on the regional teaching programme, due to late notice of dates and changes in dates. Ways to access the East Midlands School of Anaesthetics (EMSA) teaching timetable were confirmed in the educator session including access through the EMSA calendar and through emails which are sent out in advance.
Local teaching was reported to be very good and had improved significantly since the appointment of a lead consultant for teaching, However, with these responsibilities soon to be relinquished, there were some concerns raised that teaching could decline without adequate succession planning. There remain some issues with regional teaching still not being timetabled into the rota with communication issues between the department and regional anaesthetic teaching leads.
Although resident doctors spoke positively about clinical supervision, Stage 1 resident doctors did report that they could sometimes feel unsupported at the weekends when working in obstetrics. It was also noted that certain clinical supervisors had a lack of understanding of what could be signed off as direct supervision and the requirements for final module sign offs.
Areas that are working well
| Description | Domain(s) and standard(s) |
|---|---|
| Rotas (previous mandatory requirement) Previously it was reported that there was a lack of understanding of how LTFT training rotas should work. There were reports of rota templates being frequently changed, salaries fluctuating and LTFT resident doctors working more hours than their full-time colleagues. Feedback around LTFT rotas was overall positive with no issues raised. | 1.1, 1.3, 5.6 |
| Study leave (previous mandatory requirement) Previously it was reported that approval of study leave is happening too late causing a degree of stress and uncertainty and the need for multiple emails which are then not responded to. No issues were reported with the current study leave processes. | 1.1, 5.6 |
| Clinical Supervision (previous mandatory requirement) Previously challenges were reported in achieving initial obstetric competencies to be ready for covering obstetric on-calls. Resident doctors currently working in Obstetrics felt that measures had been put in place to support resident doctors to feel more confident and competent. | 1.1, 3.5, 3.7, 5.1 |
| Teaching (previous mandatory requirement) Previously it was reported that department teaching for junior resident doctors is entirely resident doctors led with no one to guide them, leaving them to teach themselves. Teaching was reported to be very good and had improved significantly since the appointment of a lead consultant for teaching. | 1.1, 4.6 |
| Facilities (previous mandatory requirement) Whilst the facilities for anaesthetic resident doctors were generally considered to be reasonable in comparison to other hospitals, there were reports of broken locks on the door in the registrar on call room and heating issues in the doctor’s room. All resident doctors reported adequate rest rooms with lockable doors. | 1.1, 1.11 |
| Induction (previous mandatory requirement) Previously there were reports of no option for an out of sync induction and resident doctors that were unable to attend induction were told they would have to learn on the job. Although it was confirmed that exception reporting was covered in induction, resident doctors were not aware of the process for this. All resident doctors had received an induction, and all were aware of the process for exception reporting. | 1.1, 3.9, 3.10 |
| Escalation of concerns (previous mandatory requirement) Previously there were some frustrations that escalations of concerns were ‘swept under the carpet’ and that resident doctors were not listened to leaving them reluctant to raise concerns. Resident doctors all described a supportive department, were aware of how to raise concerns and felt comfortable to do so. | 1.1, 1.7 |
| Job plans (previous mandatory requirement) Previously it was reported that there was a lack of time in job plans, which was also inconsistent with other trusts, leaving much of the educational workload on the College Tutor. Educators and the College Tutor reported feeling very well supported in their roles and reported that they now had allocated time in job plans. | 4.2 |
Areas for improvement
Mandatory requirements
| Review findings | Required action | Reference number and domain(s) and standard(s) |
|---|---|---|
| Regional Teaching (previous mandatory requirement) Previously the department were not aware of the dates for regional teaching, despite them being planned six months in advance. Resident doctors and educators both reported that regional teaching is still not timetabled into the rota due to communication issues between the department and the regional teaching lead for anaesthetics. | Communication issues to be resolved and robust lines of communication developed between the EMSA regional teaching lead and the department to ensure that dates for regional teaching are noted and incorporated into the rota. | MR1 5.6 |
| Clinical supervision Some resident doctors noted that certain consultants had a poor understanding of what could be signed off as direct supervision and about the required levels of sign off. Additionally, there were reports of some consultants expecting unnecessary requirements for final module sign offs. Stage 1 resident doctors did report that they could sometimes feel unsupported at the weekends when working in obstetrics. | Plan and evidence how consultant understanding and awareness of the curriculum will be improved across the department. Ensure that resident doctors receive clinical supervision appropriate to their level of experience, competence, and confidence. | MR2 4.4, 4.6 |
| Induction There were issues reported with IT system access with some resident doctors unable to log in for up to two weeks when starting the rotation. | Ensure that all resident doctors receive appropriate access to IT systems prior to starting shift. | MR3 3.9 |
Recommendations
| Recommendation | Reference number and or domain(s) and standard(s) |
|---|---|
| Teaching Resident doctors are concerned about a decline in the teaching if there is no succession planning for the role of lead consultant. We would recommend that succession planning for a lead consultant for teaching is prioritised to ensure the continuity and further development of the teaching programme. | 1.1, 5.6 |
| Curriculum competencies Stage 1 resident doctors raised concerns about the nine-month placement in obstetrics. Whilst they acknowledged that some rota changes have been made to improve this, many still felt it did not allow enough time to achieve their anaesthetic competencies. The panel would recommend the exploration of all possibilities for stage 1 resident doctors to spend more time in general anaesthetics. Stage 2 resident doctors in ITU raised the lack of opportunities to manage trauma calls as this responsibility falls to the anaesthetic resident doctor in anaesthetics covering the bleep. We would recommend that the department explore ways to increase those opportunities. | 3.7 |
| Induction We would recommend that the department enhances the induction programme to include suggestions from resident doctors such as more time spent on the IT systems and more time inside theatres familiarising themselves where equipment is kept. | 3.9 |
Report approval
Report completed by: Sarah Wheatley, Quality Deputy Manager
Review lead: Dr Sujata Handa, Training Programme Director, Anaesthetics
Date approved by review lead: 13 February 2025
NHS England authorised signature: Professor Jonathan Corne, Regional Postgraduate Dean Midlands
Date authorised: 27 February 2025
Final report submitted to organisation: 20 March 2025