Executive summary

This was a follow up review visit.  There have been 18 previous visits to Weston General Hospital (WGH) between 2009 and 2025, both before and after the merger into University Hospitals Bristol & Weston NHS Foundation Trust.  These culminated in a decision to escalate into ISF4 (Intensive Support Framework Level 4) and therefore relocate Resident Doctors (RDs) to other specialities or the BRI (Bristol Royal Infirmary) site.  From August 2023, most posts returned to their original specialities.

During the last visit in June 2024, further requirements for improvement were set and a follow up visit planned for 12 months after.  The requirements for improvement included; educational governance, ward level clinical supervision for foundation doctors, allocating appropriate learning opportunities in the acute medicine placement of the IMT programme and local teaching.  Further work was required on job planning for supervisors and development of adequate numbers of supervisors to support learners across the Trust.

At this recent visit, there is evidence of improvement; particularly handover, quality of clinical supervision and educational governance.  However, post-take clinical supervision of F1 RDs is still too variable.

Induction has improved but not universally; it needs to improve for mid-academic year starters.

Teaching sessions are reliably delivered and are protected, which is a substantial improvement, but hybrid teaching is not always successful and leads to a difference in experience between WGH-based and BRI-based RDs. 

Shuttle bus timings do not coordinate well with RD shift patterns and should be adjusted. 

Due to the low number of RDs who attended the session, the visiting panel would like to triangulate more data before making a final decision.  The GMC NTS data and WGH Foundation Quality Panel data will become available in July 2025.  The Deputy Dean for Foundation and Head of School (Foundation) will discuss the data at their programme planning meeting in July 2025.

Review overview

Background to the review

This was a follow up review visit.  There have been 18 previous visits to Weston General Hospital (WGH) between 2009 and 2025, both before and after the merger into University Hospitals Bristol & Weston NHS Foundation Trust.  These culminated in a decision to escalate into ISF4 (Intensive Support Framework Level 4) and therefore relocate RDs to other specialities or the BRI (Bristol Royal Infirmary) site.  In summary, 10 Foundation year 1 (F1), 3 Foundation year 2 (F2) and 2 Internal Medicine Training (IMT) posts were relocated to the Bristol Royal Infirmary site or into alternative specialities at WGH.

Following the visit on 29/3/23 most posts were approved to return to their original specialities from August 2023. Two F1 posts remained at the Bristol Royal Infirmary site, and one remained relocated in Intensive Care Medicine at Weston General Hospital. One F2 post remained relocated in gastroenterology at WGH. One IMT post was permanently relocated in rheumatology at WGH.

At the visit in November 2023, the review found evidence of further progress, but a further visit was recommended in June 2024.  Further requirements for improvement were set at the June 2024 visit and a follow up visit planned for 12 months after.  The requirements for improvement included; educational governance, ward level clinical supervision for foundation doctors, allocating appropriate learning opportunities in the acute medicine placement of the IMT programme and local teaching.  Further work was required on job planning for supervisors and development of adequate numbers of supervisors to support learners across the Trust.

Who we met with

Learners

• Foundation Year 1 RDs
• Internal Medicine Training Stage 1 RDs

Educators

• Consultants from the medical departments
• Clinical Director
• Clinical Chair

Senior Education and Management Teams

• Director of Medical Education
• Medical Education Manager (Bristol)
• Medical Education Manager (Weston)
• Joint Director of Learning and Development
• Hospital Director
• Deputy Director of Medical Education (Quality)

Review panel

• Associate Dean for Quality – Ilana Langdon
• Regional Postgraduate Dean – Geoff Smith
• Deputy Dean for Foundation – Clare Van Hamel
• Head of School (Foundation) – Jessica Daniel
• Head of School (Medicine) – Carolyn Mackinlay
• Education Programme Manager (GMC) – Emily Saldanha
• Patient and Public Representative – Jenny Hepworth
• Quality of Training and Education Officer – Laura Grieve

Review findings

Domain 1: Learning Environment and Culture

When asking for advice, the RDs have on occasions had professional concerns about advice given to them from senior colleagues and find it difficult to challenge or take further without damaging professional relationships.  There is a high turnover of locum consultants making it difficult to build relationships and form judgements on a colleague they have only just met.

Handovers have improved since the last visit.  RDs feel the handovers are structured and they take place in the same location with a clear leader making them effective.

Concerns were raised about post take ward rounds (out of hours).  An F1 should clerk and a consultant review the patient. It is common for consultants to not be present, making RDs uncomfortable seeing patients without senior support.  It can be 1-2 days before a patient is seen by a senior.

Domain 2: Educational Governance and Commitment to Quality

IMT RDs received Trust and Department inductions and had no issues with being allocated supervisors and meeting with them.

Foundation RDs received an induction at the beginning of the year.  However, if Foundation RDs move from BRI to WGH throughout the year, they are not provided with an adequate induction.  Foundation RDs were on call and given the crash bleep on their first day.  Without an induction, they did not know where to go, what time to start or where any of the wards were.  Any information they received was through word of mouth.

Domain 3: Developing and Supporting Learners

Previous visits have highlighted concerns around clinical supervision on wards.  The RDs were positive about clinical supervision during this visit.  They are well supported and know who to contact especially to whom they can escalate if they have concerns regarding a patient.  They know which consultant is on call and looking after the ward.

Encouraging RDs’ involvement in quality improvement projects at WGH has improved since the last visit.  The RDs are told of opportunities and encouraged to actively create these themselves and get good support for their ideas.

The previous report mentioned IMT3s being given a caseload of F1 level work to do, making them unable to assist their more junior colleagues with supervision, queries and other support.  This is still the case and is not giving the IMT3s an appropriate learning environment for their grade.

Domain 4: Developing and Supporting Supervisors

The DME felt they are still struggling with improving the number of supervisors.  One issue contributing towards this is an increase in less than full time training for RDs.

Electronic job planning is now up and running.  An audit is being undertaken to ensure payments match supervision. Progress is being made but is very slow.

Domain 5: Delivering Curricula and Assessments

Teaching is now happening regularly, is protected and at a good level.

Foundation teaching is shared between WGH and BRI; the majority being face to face on one site and streamed on MS Teams to the other site.  The RDs feel teaching on MS Teams is not as beneficial as it would be in person.  There has been a lot of teaching focusing on wellbeing, with little focused on clinical teaching.  The teaching is senior-led but not always by clinicians.

IMT teaching is similar to Foundation, but it is taught face to face in BRI and streamed to WGH.  The RDs often feel excluded when joining via MS Teams and their questions are not always noticed or answered.  They felt it would be beneficial to be released to attend teaching in BRI to get the same level of teaching BRI RDs receive but understand it is difficult due to staffing.

The IMT RDs miss out on IMT teaching relating to competencies.  Most of this is delivered at BRI by senior clinicians but not during protected teaching time so WGH RDs are unable to attend and are at a significant disadvantage.

The IMT teaching days held throughout the year were well received.

Domain 6: Developing a Sustainable Workforce

An FPD has now been appointed with primary responsibility for the Weston site and all Foundation administration has been centralised.

The IMG pastoral support role has been lost across UHBW due to requirement for significant savings.  The IMG lead tutor role remains in place and there are guides on SharePoint to support people.

There has been a huge improvement in medicine appointing permanent or longer fixed term consultants, resulting in fewer short-term locum consultants and RDs now wanting to go to WGH.

There is ongoing work on joint consultant appointments and cross-site working.  All job descriptions now state post holders can be required to work across any site at UHBW.

There is work in progress for more rotations of RDs between BRI and Weston General Hospital.

The DME asked for support with rotations of RDs and consultants, noting the issues that will need to be overcome as logistical, educational, financial, clinical and cultural.  Long term benefits for UHBW included smaller hospital time, remote exposure, QI opportunities, outpatient clinic / day case opportunities, leadership development, recruitment and retention, reduction in locum costs, rota resilience and quality of care/reduction in patient safety issues.  The challenges are travel time, cost of staff transport and complexities around rota organisation.

The long-term benefits for NHSE SW WT&E mentioned were development and utilisation of the Weston General Hospital site for the planned expansion of training placements, exposure to remote and rural curricula, better IMG support and development and LED workforce development. The Regional Postgraduate Dean and NHSE SW WT&E team are happy to meet with the DME outside of this visit to discuss.  Wide-ranging discussions with RDs and consultants will be needed and robust clinical supervision in place.

Transport

A shuttle bus is provided but it is not regular, and the timings do not fit in with the RDs shifts.  For example, the bus is at 4:10pm and the next one is 7pm, whereas most RD shifts finish at 5 or 6pm.

Public transport for out of hours shifts is challenging.  Some RDs have been left stranded and needed to ask for lifts.

Friends and family questions

There was a mixed response to this question and overall much more positive than at the previous visit.  Some of the RDs would recommend their friends or family being treated at WGH and recommend the post to other RDs.  Rheumatology received a special mention for being excellent and the best teaching opportunity they have had.

Some RDs would not recommend their relatives to be treated at WGH due to some patients only being seen by F1s sometimes several days in a row with no senior input.

Areas for improvement

Mandatory requirements

Recommendations

Report approval

Report completed by: Ilana Langdon, Associate Dean for Quality
Review lead: Ilana Langdon, Associate Dean for Quality
Date approved by review lead: 18 June 2025

NHS England authorised signature: Dr Geoff Smith, Regional Postgraduate Dean, SW
Date authorised: 18 June 2025

Final report submitted to organisation: 24 July 2025