Executive summary

The panel thanked the Trust for accommodating this education quality review of postgraduate medical training at Farnham Road Hospital. The review commenced with a presentation delivered by the Director of Medical Education, followed by separate sessions to hear feedback from Foundation and Core Psychiatry doctors in training and supervisors.

The panel observed that the Trust had demonstrated good insight into the issues which had led to this quality intervention and were impressed by the Trust’s rapid and comprehensive response to identify and implement actions. Feedback from doctors in training indicated that actions taken had led to some improvement in placement experiences.

The panel were aware that management of physical health concerns on inpatient wards had been a particular area of concern and were encouraged to hear of the successful implementation of National Early Warning Score (NEWS2) training across inpatient wards. It was recommended that the Trust next focus on appropriate communication of NEWS scores where required.  

Doctors in training indicated they were generally well supported by seniors and the Medical Education team and that aspects of their placements provided useful educational experience, although a high proportion of administrative work was reported by all groups of doctors in training. The weekly academic programme held each Friday was generally well regarded by doctors in training. The Balint group was particularly appreciated by doctors in training.

A number of areas for improvement were identified. Personal safety was highlighted as an area of concern for doctors in training and the panel noted that doctors in training had not received breakaway or de-escalation training. The panel heard concerns regarding the adequacy of handover provided to doctors when patients were transferred between wards and to and from private providers. Feedback from doctors in training indicated that formal inductions to inpatient wards had often been lacking.

Doctors in training recognised that their on-call work was a valuable educational opportunity, however it was noted that doctors in training did not routinely receive consultant feedback on patients they had admitted during their on-call shifts. Furthermore, the panel heard that doctors working on call were generally unaware which registrar or consultant they were working with that shift until they needed to contact them.

Six mandatory requirements and two recommendations were issued in relation to identified concerns. Progress with mandatory requirements will be monitored via an action plan.

Review overview

Background to the review

This education quality review was arranged following specific concerns raised via the Kent, Surrey and Sussex (KSS) Foundation and Psychiatry Schools relating to the quality of the clinical learning environment on one ward at Farnham Road Hospital and Patient Safety comments received in the 2024 General Medical Council National Training Survey (GMC NTS).

The review focused on Foundation, General Practice (GP) and Core Psychiatry postgraduate medical training at Farnham Road Hospital, part of Surrey and Borders Partnership NHS Foundation Trust (SABP). Readiness and support for Advanced Practice training was also considered as part of this review.

Who we met with

The panel met with the following Trust representatives:

• Chief Medical Officer
• Director of Medical Education
• Director for Education
• Senior Medical Education Manager
• Associate Medical Director
• Locality Tutor
• Associate Director of Therapies
• Associate Director of Working Age Adult Services
• Nurse Consultant

The panel with 10 doctors in training from Foundation and Core Psychiatry training programmes. General Practice Specialty Training (GPST) doctors were invited to provide their feedback however none attended the review. There was doctor in training representation from four inpatient wards at Farnham Road Hospital, as well as some community posts. The panel met with six consultant supervisors based on inpatient wards at Farnham Road Hospital.

The concluding session to receive initial feedback was attended by the Chief Medical Officer, Director of Medical Education, Associate Medical Director and Non-Executive Director.

Review panel

Education Quality Review Lead

• Dr Peter Anderson, Associate Dean

Specialty Experts

• Dr Paul Reynolds, Head of Foundation School
• Dr Mo Eyeoyibo, Training Programme Director – Psychiatry of Intellectual Disability
• Sarah Goodhew, Advancing Practice Faculty Lead

Lay Representative

• Jacqueline Codrington

NHSE Education Quality Representative

• Sarah Stanbridge, Education Quality Project Officer

Review findings

Introduction

The Director of Medical Education (DME) presented an overview of training sites within Surrey and Borders Partnership NHS Foundation Trust (SABP) and services at Farnham Road Hospital (FRH). The presentation also outlined the timeline and themes of the specific concerns which had been raised in relation to postgraduate medical training and the actions taken by the Trust in response.

The panel were informed that FRH has three general adult wards (Magnolia, Mulberry and Juniper), an older adult ward (Victoria) and a Psychiatric Intensive Care Unit (Rowan). The site also hosts four health-based places of safety where patients who have been detained under Section 136 of the Mental Health Act are assessed.

The Trust explained that currently FRH was their only training site providing experience of a working age adult inpatient setting and the complexity of patients was relatively high. The panel were informed that Silverwood, the new hospital being built on the St Peter’s Hospital site in Chertsey, is expected to open in February 2025. The Trust confirmed that this would expand inpatient capacity with four new wards, and the inpatient bed base at the FRH site would be retained. The panel heard that the Trust’s contract with the private sector will cease and patients will return to these NHS beds. The Trust anticipated that the opening of the new hospital would reduce the acuity of patients at FRH, as both sites would be able to accommodate patients with complex needs.

The panel heard that when the Medical Education team became aware of the concerns regarding the specific ward, this had triggered a same-day response from the locality tutor and senior leadership to investigate and identify actions to be taken. It was reported that the Head of Safety had met with the doctors concerned the following day, and various members of the Senior Leadership Team had also met with the doctors concerned. The DME summarised that there had been a multiprofessional response with six themes: personal safety, supervision and support, roles and responsibilities of a doctor and all other staff (including management of physical health), workload pressure, state of infrastructure, and support after incidents. Further details are outlined within the relevant domains of this report.

The review team were aware that the Trust had recently declared Operational Pressures Escalation Level (OPEL) Black and a critical incident related to bed pressures. Doctors in training indicated they been well supported within the Trust during this challenging time.  

Quality Domain 1: Learning environment and culture

Management of physical health

The panel were aware that management of physical health concerns on inpatient wards had been a particular area of concern. The panel heard that implementation of a National Early Warning Score 2 (NEWS2) training programme across the inpatient wards at FRH had been a major focus over the past three to four months. It was explained that training now included assessment of competency to act on deterioration in addition to theory-based training. The panel heard that the current pass rate was 91% and anecdotal feedback had indicated a positive impact in terms of staff knowing when to escalate observations. The panel also heard of work in progress to increase the use of interprofessional simulation-based learning in relation to managing physical health concerns.

In response to a question, the Trust explained that staff taking observations wrote these on paper before transferring these to the electronic patient record system (SystemOne). The panel heard there was an aspiration to move to a digital system once training around observations was embedded.

The Trust described other measures in place to support the management of physical health concerns and noted there was a strategic transformation programme within the Trust focused on the interface between mental health and physical health. It was reported that SystemOne had been updated to include a new front sheet with prompts for recording information related to physical health. The panel also heard there was a physical health practitioner team consisting of nursing staff of various levels and areas of expertise, such as wound care. It was explained that there was a link nurse for each ward and a weekly board round took place.

Feedback from doctors in training indicated some variation between wards in terms of being notified by nurses of patients’ physical health concerns. An example was shared where the ward doctor had not been notified of the onset of seizures in a timely manner. Concern was also expressed that tasks handed over to nurses were sometimes not completed, for example bloods not being sent to the laboratory. This was attributed to the pressures that nursing staff experienced.

Doctors in training expressed some concerns about the information received when nurses or support workers contacted them with concerns about a patient’s physical health. It was reported that this was inconsistent between wards, shifts, and staff members, and was worsened by staffing pressures. The panel heard that emergencies may not be portrayed as such to the doctor, information required to prioritise may be missing, and the SBAR (Situation, Background, Assessment, Recommendation) communication technique had not been consistently implemented. It was suggested that SBAR prompt cards next to telephones could be helpful. See recommendation reference REC-FRH1.

Doctors in training had observed that there was a high proportion of junior nursing staff on some wards and reported a tangible difference in terms of leadership on the ward when experienced nurses were away. It was suggested that if junior nursing staff were more supported, then doctors in training may feel more supported in their roles on the ward.

Learner and staff safety

The Trust referred to several measures taken or planned, relating to personal safety as part of their response to concerns raised by doctors in training. For example, it was reported that a new alarm and pager system was in operation at FRH. The panel heard that ‘violence reduction education’ would be part of induction for doctors in training from August. It was explained to the panel that this training focused on how staff could work together rather than restraint.

The Trust confirmed there was a policy on use of chaperones, and this had been reiterated, including clarification that the use of chaperones in mental health settings was different to other settings such as General Practice. It was reported that nurses received five days of training in relation to chaperoning. Doctors in training indicated that chaperone availability varied between wards and was dependent on which staff were working. One doctor in training commented on importance of doctors in training feeling empowered to say that they would not proceed without a chaperone and perceived this may be easier for Core Psychiatry doctors in training compared to Foundation or GP.

Doctors in training commented on several safety aspects which they felt could be improved, drawing comparison with their experiences of other mental health providers. Specific details have been shared with the placement provider.  See mandatory requirement reference MR-FRH1.

Doctors in training reported that they had not received breakaway training at any point during their placements within the Trust and when they had enquired about this, they had been told this had been in place before the COVID-19 pandemic but was no longer part of induction. See mandatory requirement reference MR-FRH2.

The panel heard that induction had included a discussion around general safety, however this was perceived to have been generic and missing useful information. For example, it was reported that how to check the battery in personal safety alarms had not been covered.

Supportive environment and working relationships

During the Trust presentation, it was recognised that many doctors in training on placements at SABP may not have prior experience in mental health settings. The panel noted examples in which doctors in training perceived a mismatch of expectations of doctors on the ward between the medical and nursing teams. Examples included expectations of Foundation doctors which were perceived to be beyond their knowledge and comfort in clinical situations, and nursing staff calling doctors to de-escalate patients despite doctors not having training or experience with this.

In response to a question around leadership and responsibilities on the wards, the panel heard that efforts had been made to clarify that in some cases the doctor in training would be the staff member with the least experience in mental health settings. The Trust explained that improving working relationships between doctors and nursing staff had been one of the priorities following the concerns raised. The Trust recognised induction was a key time to ‘set the tone’ regarding working relationships and reported that senior managers and ward leaders were now introduced at induction. It was recognised that it could be difficult for staff and learners from different professional groups to get to know each other, especially during relatively short placements, and there was an aspiration to increase informal ‘corridor conversations’ between doctors in training and staff from other healthcare professions.

The panel heard mixed feedback from doctors in training regarding whether they felt included as part of the team they worked in. Some indicated that they felt included and reported good working relationships. One doctor in training commented that they had perceived an improvement in communication between doctors and nurses. However, the panel heard some feedback indicating a disconnect between medical and nursing staff at times. It was perceived that nurses were under a lot of stress.

The panel heard that there had been a high turnover of consultants on one particular ward, which was perceived to have impacted on leadership, stability and monitoring of educational progress. However, the panel were informed there were now two consultants and a new ward manager, which was reported to have had a positive impact, including increased educational opportunities. Optimism was expressed in terms of potential for further improvement with increased stability.

The panel heard that a local ward group including the consultant, matron and clinical nurse specialist was established and met weekly to identify issues affecting the ward, and an upper quartet included the divisional director. The Trust explained that this was intended to create a more robust approach to identifying and resolving problems at an early stage. The panel heard that the focus of the divisional group’s work had been to support doctors in training and ensure staff in the unit were working together to support each other.

Raising concerns

The panel were informed that the locality tutor met with doctors in training during the weekly academic programme to see how things were going. However, a comment was noted that it could feel intimidating to raise concerns within a group setting.

The panel heard an example from a doctor in training where the concerns they had raised via the Medical Education Team had been acted on and resolved. The Deputy Medical Education Manager, Tish, was specifically mentioned during sessions with both doctors in training and supervisors in terms of being someone who doctors in training could approach for support with concerns.

There was an awareness among doctors in training of the role of the Freedom to Speak Up guardian, but some doctors in training reported they would not know how to contact them.

Handover processes

Doctors in training expressed concern regarding the level of detail provided when patients were transferred between wards and to or from private providers. It was reported that a nursing handover took place, but doctors did not always receive a medical handover and were sometimes not made aware that a patient would be arriving or departing the ward. It was explained that admissions were accepted by nursing staff, however nursing staff would sometimes advise that they did not have information, such as past medical history, about the patient who had arrived. See mandatory requirement reference MR-FRH3.

Doctors in training observed that assessments were often repeated when patients were admitted from Accident and Emergency departments due to different patient record systems being used. See recommendation reference REC-FRH2.

The Trust explained that a face-to-face on-call handover meeting attended by the duty doctor and duty manager had been introduced in response to feedback from doctors in training. The panel heard that the on-call registrar was based at home and they sometimes called into the meeting.  The Trust noted that there had been some concerns regarding the duration of the meeting and the documentation had been audited by a doctor in training with the intention of streamlining this. Doctors in training reported the meeting was helpful as it provided foresight which allowed them to start prioritising.

Doctors in training explained that an email handover was used to handover from night to day; this was described as useful. The panel heard examples of different systems used by ward teams during the day, such as a jobs book, a colour-coded word document and a whiteboard.

Infrastructure

The Trust confirmed that damage to ward equipment had been repaired and the state of ward equipment remained subject to ongoing review by the senior leadership team.

The panel heard that doctors in training had been required to clerk new patients in the ‘136 suite’ (health-based place of safety). Doctors in training understood this was due to bed pressures but highlighted that it was very difficult to take a full history in this setting. The panel asked the Trust to clarify whether this was a temporary arrangement during the recent critical incident. The Trust confirmed that the decision for a patient to be clerked in this area would be taken at senior level and only by exception due to clinical need.

A comment was noted regarding a lack of phone signal within side rooms, which could delay the on-call doctor from receiving calls.

Equality, diversity and inclusion

When doctors in training were asked about equality and diversity, the panel heard there was a lot of diversity within the Trust and some patients had targeted specific staff. It was reported that some staff had raised that they had not felt supported with this, but the outcome was not known by those present.

Doctors in training were unaware whether there was a Trust lead for Equality, Diversity and Inclusion.

Overall satisfaction

The panel heard that Foundation placements in the community would be recommended from a work-life balance perspective, although some concerns were noted regarding clinical experience in these posts (see domain five). Foundation placements on inpatients wards were perceived to provide some useful experience which could be drawn upon when seeing patients in secondary care. However, the panel also noted feedback suggesting such placements could be exhausting and that Foundation doctors working on the wards could feel under a lot of pressure. Foundation year one doctors reported that they enjoyed spending Thursdays in an acute hospital and found the crossover of experience helpful.

Core Psychiatry doctors in training gave mixed responses when asked if they would recommend their placements. The panel heard some positive feedback regarding the training and educational opportunities, however concerns about personal safety and high levels of administrative duties were cited as reasons not to recommend. There was noted to be variation in placement experiences between different wards, for example it was reported that doctors in training had more autonomy when working on Rowan ward due to the patient to doctor ratio. Doctors in training agreed that variation in experiences might also reflect their differing levels of seniority.

When doctors in training were asked if they would recommend FRH to a relative who needed the services provided, responses were mixed. Some doctors in training believed that patients were taken care of very well once in the system, however there was an awareness of the stress the system was under. Reservations were expressed relating to the case-mix and age-mix of patients within individual wards, patient transfers between wards and settings, and delays in discharging patients who were awaiting an appropriate discharge destination.

Quality Domain 2: Educational governance and commitment to quality

The Chief Medical Officer (CMO) explained that one of the Trust’s strategic priorities has been to increase the numbers of doctors in training at the Trust and ensure an environment where people want to train. It was noted there would be an increase in Foundation and Core Psychiatry doctors at FRH from August 2024, however GP placements were moving into the community.

The DME explained that the Trust were driven by the feedback they received through both national and local surveys. The panel heard that anonymised feedback from the local survey was fed back into individual consultant appraisals. It was explained that the multiprofessional Academy Board meeting provided an opportunity to triangulate feedback from surveys and this group reported to the People’s Committee and the Board via the CMO. The perspective of the Education and Leadership Fellow was valued in the analysis of feedback received from doctors in training.

The panel were informed that the Trust had created various forums to feedback to doctors in training regarding concerns that had been raised. The panel heard that a Junior Doctors Forum was established within the Trust, however mixed views were noted in terms of how well attended this was.

Quality Domain 3: Developing and supporting learners

Induction

The panel heard that Foundation doctors on community placements may have benefited from a longer period of shadowing, including assessment of new patients, at the beginning of their placements.

The panel heard that formal inductions to inpatient wards for doctors in training had often been lacking; examples were shared including a CT1 doctor staying after their night shift to show a new doctor around the ward. Doctors in training reported that some information around systems and processes had been missing from induction, for example an introduction to SystemOne and how to follow up referrals. (Also see feedback regarding personal safety information in domain one). See mandatory requirement reference MR-FRH4.

The panel heard a perception that some nursing staff were unwilling to support doctors in training to become familiar with local systems and doctors in training may feel alone trying to work things out themselves. However, the panel also noted examples where a doctor in training had felt extremely well supported by individuals upon starting their role.

No concerns were expressed by doctors in training regarding the adequacy of induction to prepare them for their on-call shifts. The panel heard an example where a doctor in training had received a helpful and reassuring introduction to their night shifts from a CT3 doctor.

Wellbeing

In terms of support following incidents, the panel were informed that the Staff Incident Support Team (SIST) offered support to all staff following any notable incident in clinical practice. The Trust added that efforts had been made to ensure that doctors in training were included in debriefing. The Trust reported this had been effective in terms of developing relationships so that everyone has a voice in relation to improving safety.

The Trust acknowledged that doctors in training may sometimes miss opportunities for debriefs and support. The panel were informed that a meeting took place at 07:00 to identify any incidents which doctors in training had been involved in and follow up promptly. The panel heard that a clinical psychologist had recently come to talk with all ward managers and clinical nurse specialists about how to implement support. The Trust noted there was a guidance document outlining the support available to doctors who had been involved in the care of patients who had died by suicide.

The panel heard that doctors in training were encouraged to discuss incidents with their supervisors and that attendance at the weekly Balint group with a psychotherapist was mandatory.  The panel heard that the Balint group was appreciated by doctors in training and was noted to have been effective in addressing issues.

Doctors in training were aware of the SIST although none indicated they had had direct experience of the team’s support. One doctor in training shared that, in their experience of being involved in a discussion following a serious incident, the discussion had a greater focus on what had gone wrong and how a similar situation could be prevented than how staff were feeling. However, doctors in training suggested that that not everyone would feel comfortable discussing how they were feeling following an incident in a group setting, thus it could be difficult to capture everyone through such discussions.

Supervision

The panel heard that the Medical Education team placed a strong emphasis on regular supervision. Supervisors reported that doctors in training received sufficient supervision time to meet their learning needs and no concerns had been raised to the locality tutor regarding this.

Supervisors reported that doctors in training generally received weekly supervision away from the ward, however it was explained that it could be difficult to schedule supervision sessions at a consistent time each week due to the unpredictable nature of inpatient psychiatry work.

Senior support with inpatient ward work

The panel were informed that the psychiatry experience of F1 doctors based on inpatient wards usually consisted of observing and documenting ward reviews and they mainly saw patients from a physical health perspective. The panel heard that F1 doctors could discuss concerns about patients’ physical health with their seniors on the ward or colleagues at Royal Surrey County Hospital.

Doctors in training recognised that many of the inpatients at FRH had complex medical needs. The panel heard mixed views from doctors in training in terms of feeling supported by consultants in managing physical health concerns, with some Foundation doctors feeling that a lot of responsibility was placed on them.

The panel heard examples indicating that doctors in training felt supported by seniors during periods of short staffing.

Workload and support out of hours

The panel were informed that Foundation year two (F2), GPST (except those in Integrated Training Posts), and Core Psychiatry doctors in training worked on the on-call rota which covered the inpatient wards and health-based places of safety at FRH. It was explained that each of the three hubs within the Trust had a separate junior doctor on-call rota, with the higher specialty training doctor and consultant on-call rota covering the whole Trust.

It was noted that most admissions to FRH occurred at night, although this was less common on Victoria ward. Doctors in training perceived the on-call workload at night to be manageable if doctors in training were aware of the jobs list from the beginning of the shift to allow them to triage. It was commented that doctors and nursing staff may have differing priorities and expectations in this respect.

In terms of senior review of patients clerked overnight, the panel heard that if the clerking doctor was concerned about the patient they could discuss with the registrar and consultant to manage this. Doctors in training explained that consultant reviews of new patients had to be accommodated around scheduled ward reviews, so new stable patients may not be seen by the consultant until the end of the day, and stable patients admitted during a Friday night would not be seen by the consultant until the following Monday. It was noted that on one ward all patients including new admissions were discussed at the MDT meeting, however this was considered to be a ‘safety net’ rather than a consultant review.

The panel heard that doctors in training did not routinely receive feedback from consultants on patients they had admitted overnight. It was reported that the consultant may call or email them if there had been something wrong. Doctors in training recognised that on-call shifts were a valuable learning experience and agreed they would welcome the opportunity to discuss with the consultant following the consultant’s review of the patient. See mandatory requirement reference MR-FRH5.

In response to a question, Core Psychiatry doctors in training indicated that they were able to obtain support when needed and were able to contact the consultant if they could not reach the registrar. However, the panel heard that doctors working on call were generally unaware which registrar or consultant they were working with that shift until they needed to contact them, and in some cases the switchboard operator refused to tell them which registrar or consultant was on call. The panel heard this could be problematic for documentation as some doctors may not feel they can ask their senior to spell out their name. It was explained that sometimes the registrar would call or attend the handover meeting, however this was not an expectation. Doctors in training felt it would be helpful to know who they were working with and that it would help them to feel like part of a team. See mandatory requirement reference MR-FRH6.

Quality Domain 4: Developing and supporting supervisors

Support, training and development for supervisors

The DME reported that supervisors received face-to-face education and training three to four times per year, which included how to manage concerns raised by doctors they supervised, and the wellbeing support on offer within the Trust. It was noted that there was a drop-in session with the Locality Tutor for supervisors at FRH and that Educational Supervisor Guides were available to all supervisors.

The panel heard that supervisors felt well supported in their educator roles by the Medical Education team, who were described as strong and well-led. Supervisors recognised there were difficult periods where operational pressures would impact on their ability to support doctors in training, but overall, there was perceived to be a positive culture around supporting training.

It was expressed that it could be challenging to provide educational supervision for the remainder of the year for F1 doctors based at acute hospitals once they had left FRH, for example supervisors at FRH may not be aware of who to contact in the acute hospital in case of issues. The panel offered advice on this. 

The panel heard that several supervisors at the Trust had received national recognition for work they had done, for example a project on how to respond to medical concerns on the ward, leading to development of upskilling resources for consultants and other staff not trained in acute physical health.

Time for supervision

Supervisors perceived they provided a reasonable amount of supervision considering their workload. The panel heard that individual supervisor responsibilities may lead to supervisors working beyond their contracted hours. Supervisors explained that the Trust also hosted undergraduate medical students and physician associate students, and whilst supervisors welcomed these students it could be challenging to find time to support all learners.  

In response to a question, supervisors reported they were not currently being asked to supervise Advanced Practice learners and highlighted the importance of clarity for prospective supervisors in terms of the amount of supervision required, as they recognised this could be significantly different to postgraduate medical training.

In terms of job plans, the panel heard that most supervisors were allocated 0.25PA per doctor in training ‘on paper’. Supervisors were aware that the number of doctors in training was increasing and indicated there had been conversations regarding the time available for supervision. The panel noted mixed views from supervisors regarding group supervision. Supervisors suggested that specialty doctors could provide clinical supervision.

Quality Domain 5: Delivering programmes and curricula

Adequate experience

Some concerns were expressed regarding lack of clinical exposure in F1 community psychiatry placements, which were perceived to be mainly service provision. It was reported that administration was a significant part of these jobs and F1 doctors may only see three to four patients per week. The panel heard that F1 doctors would appreciate the opportunity to follow-up patients they had seen.

The panel heard that F1 doctors in the community were each assigned to one consultant, so when this consultant was on leave they did not have any patients to see. F1 doctors were aware of the workload pressures on the inpatient wards at FRH and suggested that some of their time might be better spent helping with ward work and gaining ward experience. Supervisors noted that doctors in training were offered the opportunity to formally swap placements in the last month of their rotations however there was very low uptake of this.

Foundation and Core Psychiatry doctors in training based on inpatient wards also reported there to be a high proportion of administration within their roles. Such tasks were not always perceived to have psychiatry educational value or to require a doctor to complete them. The panel heard some examples of Core Psychiatry doctors in training being asked to arrange ward meetings, however those present indicated this was no longer occurring and supervisors confirmed this would not be endorsed.

The panel heard that some inpatients required regular input from departments such as urology at the acute hospital and contacting the acute hospital regarding this could be a source of frustration for doctors in training. It was reported that meetings to address this had not yet resulted in an effective system and doctors in training may have to make daily contact to try to secure an appointment for a patient. Doctors in training agreed that appropriate delegation and responsibilities for administration tasks would improve their placement experiences at FRH.

Supervisors recognised the time that doctors in training spent on administration and explained that there was a high level of scrutiny of documentation in psychiatry. The panel heard that some supervisors had had conversations with doctors in training to manage expectations around completing documentation within the time available. One supervisor described how they insisted doctors in training did not take their laptops home to complete work and encouraged them to submit exception reports if they could not finish their work within contracted hours. The Trust had reported that 14 exception reports had been received during the previous six months, all of which had related to doctors working late on one ward. The Trust confirmed that exception reporting was monitored through the Junior Doctors Forum and the Guardian of Safe Working reported to the Trust board.

Supervisors perceived that doctors in training received plenty of psychiatry exposure including complex cases, and that engagement in MDT and professional meetings was helpful to their training. Supervisors believed that some documentation supported learning, for example it was suggested that doctors in training could learn vicariously how to complete a mental state examination (MSE) through documentation. However, it was acknowledged that that writing notes of a multiprofessional meeting did not usually need to be completed by a doctor. The panel heard that, where appropriate, consultants would request that the meeting was recorded and the notes typed up by an administrator. Supervisors explained there was no standardisation between wards in terms of administrative responsibilities and understood there was limited administrative support available on the ward.

The panel heard that staffing impacted on educational opportunities for Core Psychiatry doctors as they may often be required to cover Foundation doctor or Consultant work during leave. However, it was confirmed that with full staffing there was opportunity for Core Psychiatry doctors to lead ward reviews with consultant presence. It was suggested that an additional ward doctor would make the placement more educational.

Teaching

The panel heard that an academic programme took place every Friday, this included case presentations, journal club, simulation, and the Balint group. The panel heard that this time was protected, and although the programme had been cancelled the previous week due to the critical incident, the Trust assured the panel this was not a regular occurrence.

The panel noted that the academic programme was generally well regarded. It was explained that the case presentations and journal clubs were led by doctors in training, however consultants facilitated and were involved in discussions. One doctor in training suggested that monthly consultant-led teaching would be beneficial as part of this programme.

Quality Domain 6: Developing a sustainable workforce

The Trust shared their intention to support the role of Advanced Clinical Practitioners on the wards and this was being considered as part of workforce plans for the new hospital.

Areas that are working well

Good practice is used as a phrase to incorporate educational or patient care initiatives that, in the view of the Quality Review Team, deliver quality above and beyond the standards set out in the Education Quality Framework.  Examples of good practice may be worthy of wider dissemination.

Areas for improvement

Immediate mandatory requirements

No immediate requirements were issued.

Mandatory requirements

Recommendations

Recommendations will not be included within any requirements for the provider in terms of action plans or timeframe. They may however be raised at any future reviews or conversations with the provider in terms of evaluating whether they have resulted in any beneficial outcome.

Report approval

Report completed by: Sarah Stanbridge, Education Quality Project Officer
Review lead: Dr Peter Anderson, Associate Dean
Date signed:  16 August 2024

NHS England authorised signature: Professor Jo Szram, Postgraduate Dean
Date signed: 9 October 2024

Final report submitted to organisation: 10 October 2024