Executive summary
The NHS England, Workforce, Training and Education (WT&E) Quality team met with members of the Sheffield Teaching Hospitals Trust (STHT) education team to discuss concerns in Clinical and Medical Oncology at Weston Park Hospital, Sheffield. The group also reviewed data for specialties showing deterioration in the General Medical Council (GMC) National Training Survey (NTS) scores and data for specialties to monitor.
It was established that the trust has invested a lot of time and effort into working with Postgraduate Doctors in Training (PDiTs) and the consultant body in establishing what the key issues are at Weston Park Hospital and how best to address these. It was agreed that Intensive Support Framework level 1 (ISF1) requirements would be opened per relevant Oncology training group, to tailor them specifically to the concerns experienced by specific PDiT levels. In terms of deteriorating scores, the trust will complete action plans for the specialties showing triple red outlier data and deteriorating scores as part of the annual Yorkshire and Humber (YH) GMC NTS action plan process which is completed by all trusts in the YH region.
NHS England will draft ISFs and then work together with the trust to agree actions and timescales for completion. Further meetings will be arranged to allow discussion of progress.
Review overview
Background to the review
The meeting was triggered in response to concerns raised about Oncology training at Weston Park hospital and following review of the General Medical Council (GMC) National Training Survey (NTS) data.
Evidence
- GMC NTS data 2024
- GMC NTS data 2023
- NETS 2023
- School SAR
Who we met with
Education team:
- Associate Medical Director for Education
- Deputy Associate Medical Director for Education
- Head of Medical Education
Review panel
- Chair, Adam Burns, Quality Associate Dean
- Specialty Expert, Stephen Bianchi, Head of School of Medicine
- Quality Lead, Kim Mills, Quality Support Manager
- Quality Observer, Sandra Furniss, Quality Coordinator
- Admin, Michele Hannon, Quality Administrator
Review findings
Oncology
At the MLE it was established that the concerns within Oncology are complex and affect the various levels of PDiT in different ways. The Higher Specialty doctors in training are managing significant workload pressures, particularly in delivering outpatient care, and are reluctant to seek support from the consultant body as the Specialty doctors are aware that the consultants are also facing significant workload challenges. The Higher Specialty doctors in training are also experiencing difficulty in accessing specialist clinics. The Foundation and Internal Medical Training (IMT) doctors have experienced challenges relating to access to senior support. In addressing the concerns, it was ascertained that the solution requires more than the addition of senior staff but also a change in the manner in which the departmental workload is organised and the way in which the workforce interact.
The 2024 GMC NTS scores for Clinical Oncology are overall positive with high scores seen for supervision and adequate experience. Scores have improved for induction, supportive environment, and overall satisfaction. Medical Oncology, however, displays persistent red outliers and a deterioration in scores for the majority of indicators. When viewed from a programme perspective, the scores for medical oncology specific to Higher Specialty PDiTs are relatively positive with high scores seen for clinical supervision, teamwork, and educational supervision. Conversely, the scores for the IMT cohort are in general low and are red outliers, the lowest scores being those for rota design, workload, and overall satisfaction. The scores for clinical supervision for this cohort have deteriorated over the last three years, however, educational supervision received a high score.
Dialogue has been encouraged between learners, educators, the Clinical Director, and Training Programme Directors, facilitated by the trust Associate Medical Director for Education (AMDE) to explore the concerns and potential solutions. There is a clear sense of collaboration and joint understanding between those affected by the challenges and those supporting who are concerned to work towards change. There is also interest and input from the trust executive team.
Feedback from PDiTs indicates that though consultants are available, they may not be able to advise on specific diseases outside of their own areas of expertise. To address this the trust plan to adopt a team-based structure to ensure that disease specific support is available at all times. There have been challenges around the organisation of this due to working across split sites, but consideration is being given to the management of this and to improve communication around the location and availability of disease specific support. The trust has increased the number of consultants in the department by six so far and has plans for further expansion including the addition of acute oncology consultants and acute medical consultants. A nurse consultant is to be appointed to lead the non-medical workforce.
Continued communication and collaboration with both learners and educators should foster investment in the drive for change and, it is recognised that change will be gradual and will be made with the interests of all parties considered. Maintaining the recently forged communication channels should boost PDiT confidence in the senior team and their decision making. The importance of providing updates to the PDiTs around proposed changes was emphasised.
It is to be noted that although the issues within Oncology are recognised and the GMC NTS feedback for the specialty indicates some significant areas of learner dissatisfaction, all learners are achieving positive Annual Review of Competency Progression (ARCP) outcomes. It is also recognised that the trust is making good progress with identifying and addressing the concerns.
It was agreed that a number of ISF1s will be written in conjunction with the trust in order to capture the training level specific concerns. The ISFs will include jointly agreed, focussed, and measurable outcomes aimed at improving trainee feedback and crucially maintaining it over time.
Deteriorating GMC NTS scores
Dermatology
The trust received triple red outliers for teamwork via the GMC NTS data and there has been a general deterioration in scores for this specialty. The trust reported that there are issues with the on-call rota as they cover the Children’s Hospital and other sites too. Discussions are being held at Integrated Care Board (ICB) level as this is not an issue that the trust can address in isolation. Wider issues around budgetary constraints were discussed. The trust will provide an update as part of the YH GMC NTS action plan process, and this will be discussed further at the next progress meeting.
Neurology
When the GMC data is viewed from a programme perspective for Neurology, it shows triple red outliers for overall satisfaction and persistent pink outliers. From a post view the scores are good, suggesting that the least satisfied group are the Higher Specialty PDiTs. The trust will respond with an action plan as part of the YH GMC NTS action plan process.
Plastic surgery
The trust will respond to the triple red outlier for local teaching as part of the YH GMC NTS action plan process. It was noted that work will be undertaken to improve induction which was recognised as requiring some attention.
Respiratory medicine
The data viewed from a programme perspective shows deterioration of scores across the indicators and a greater prevalence of pink and red outliers. When viewed from a post perspective there are few outliers suggesting that the concerns are present in the Higher PDiT group. School intelligence was shared around staff shortages, issues with bulletins and reporting systems, and on-call systems. It was also noted that the programme group data for IMT and Foundation years, reflects the challenges around delivering an integrated acute and general medicine rota by medical specialties.
Areas for monitoring
Cardiology
The post and programme data for Cardiology shows some deterioration in scores which may require attention. The trust recognises that there are concerns in IMT across specialties and this is reflected in the GMC NTS data. The AMDE has approached Cardiology colleagues who are aware of the concerns, and they are monitoring these. It was thought that the work to integrate the new requirements of General Internal Medicine (GIM), as well as conflict with the Respiratory team and those looking after heart patients on wards, may have led to some decreased satisfaction in training experience.
Action: AB to speak to JH about cardiology
Report approval
Report completed by: Kim Mills, Quality Support Manager
Review lead: Adam Burns, Quality Associate Dean
Date approved by review lead: 14 November 2024
NHS England authorised signature: Jon Hossain, Deputy Postgraduate Dean
Date authorised: 18 November 2024
Final report submitted to organisation: 9 December 2024