BTFP Case Study Maidstone & TW

South Thames Foundation School www.stfs.org.uk

Broadening The Foundation Programme

The Experience of MTW

Dr Paul Reynolds Clinical Tutor&

Dr Alexander Brazier FY1 Trainee Rep


MTW NHS Trust

• Two main sites Maidstone Hospital (MGH) and Tunbridge Wells Hospital (TWH@P) with two separate but integrated Foundation Programme schemes

• Serves a population of over 500,000

• MGH - 27 FY1’s & 27 FY2’s• TWH@P - 30 FY1’s & 27 FY2’s

• Linked with a single Mental Health Trust - KMPT


MGH

• Of 27 FY1’s – 9 Gen Surgery, 3 Psychiatry, 2 ITU, 13 Medicine Only Surgical FY1’s do night shifts

• Of 27 FY2’s – 9 Emerg Medicine, 2 Psychiatry, 4 GP 4 T & O, 2 Paeds, 2 Ophalm, 4 Medicine

• Target to reduce 4 “surgical posts”


TWH@P

• Of 30 FY1’s – 10 Gen Surgery, 2 Psychiatry, 2 ITU, 2, T & O, 15 Medicine Only Surgical FY1’s do night shifts

• Of 27 FY2’s – 4 Emerg Medicine, 2 Psychiatry, 5 GP 6 T & O, 2 Paeds, 2 ENT, 2 O & G, 4 Medicine

• Target to reduce 9 “surgical posts” and to find an extra 1 Psychiatry FY1 and 2 extra Community posts across the schemes


Planning

• TWH@P trialled a 2 year rotation from 2013/2014 and early feedback was positive – so ? increase to a second rotation as it gives “you” control of linkage and so the community placements – (which means being unable to do both Psychiatry and GP in a FY2 year)

• A trial of 4 weeks in Old Age Psychiatry during a 4 month Care of the Elderly Rotation had received mixed feedback from the trainees, but Psychiatry felt that they could accommodate an extra FY1

• The Hospice were interested in a mixed acute and community Palliative Care Placement with the Trust

• The 9 Planned reduction in Surgical posts was actually 8 when we checked the figures


Planning

• Trust Service Reconfiguration meant we already rotated our FY1’s in Gen Surgery across both sites with a 19 week rotating cycle that gave a good mixture of emergency and elective care with opportunities for OPD and Theatres, and better Consultant Supervision (3rd design)

• Trust Service Reconfiguration meant we had already centralised T & O onto the TWH@P site, resulting in a very busy Orthopaedic site with largely Foundation Trainees and HST’s – In effect all 12 posts at Foundation level (10 FY2 and 2 FY1 were needed to be non-surgical)

• We had introduced an Ortho-Geriatric service, but feedback from our Foundation Faculty and our CQC preparation suggested that we needed to give them trainees to support the service


Planning

• Discussions with out-going Foundation Trainee Reps at Foundation Faculty June 2014 about possible changes led to an options list

• Discussions with Psychiatry, Gen Surgery Tutor, T & O Tutor, T & O Clinical Director, and Hospice and Trust Palliative Care colleagues led to some possible solutions

• Implications of these changes were discussed with CEO and Finance Director, DME to take account of the back-fill requirements and costs and Trust agreed to fund them and to commit to Physicians Assistants

• These initial plans were then taken to the respective Faculties in October 2014


Revision and Submission

• The Palliative Care & Hospice placement fell through

• Psychiatry were happy to take an additional TW FY1

• Discussions at the Surgical Faculty, with input from the trainees from FY1 TWH@P, FY2 MGH and FY2 TWH@P, raised concerns about the plans due to the high workload – which led to last minute changes

• These revised plans were then taken through the management cycles again with less than a week turn round – this Guillotine helped to focus the minds and reach a decision


Submission

• By 5pm 31st October we submitted our proposals

• Loss of a Surgical FY1 and Formation of Psychiatry FY1 for TWH@P

• Change of 2 FY1’s in T & O to Ortho-Geriatrics for TWH@P

• Change of 2 FY2’s in T & O to Ortho-Geriatrics for both MGH and TWH@P

• Request for a second 2 year Foundation Programme rotation in TW


Submission

• Disaggregation and Redesign of all FY2 programmes to limit to one Community placement per year

• Fulfilled all of the Psychiatry and Community Placement Targets for the Trust

• Led to a reduction in 7 rather than 12 “surgical posts”, all but one, in T & O with a change to Ortho-Geriatrics – any more would not fit with the current ward based system

• Failed Hospice plans may lead to two Community leaning posts in time


Submission

Anaesthetics Geriatrics and Stroke Medicine General SurgeryGeneral Surgery Anaesthetics Geriatrics and Stroke Medicine

Geriatrics and Stroke Medicine General Surgery AnaestheticsAnaesthetics Respiratory Medicine General Surgery

General Surgery Anaesthetics Respiratory MedicineRespiratory Medicine General Surgery Anaesthetics

Diabetes Ortho-Geriatrics General SurgeryGeneral Surgery Diabetes Ortho-GeriatricsOrtho-Geriatrics General Surgery DiabetesOrtho-Geriatrics Diabetes General SurgeryGeneral Surgery Ortho-Geriatrics Diabetes

Diabetes General Surgery Ortho-GeriatricsPsychiatry Respiratory Medicine Geriatric Medicine Obstetrics & Gynaecology Trauma and Orthopaedics Paediatrics

Geriatric Medicine Psychiatry Respiratory Medicine Paediatrics Obstetrics & Gynaecology Trauma and OrthopaedicsRespiratory Medicine Geriatric Medicine Psychiatry Trauma and Orthopaedics Paediatrics Obstetrics & Gynaecology

Psychiatry Gastroenterology General Surgery Otolaryngology (ENT) Ortho-Geriatrics Emergency MedicineGeneral Surgery Psychiatry Gastroenterology Emergency Medicine Otolaryngology (ENT) Ortho-GeriatricsGastroenterology General Surgery Psychiatry Ortho-Geriatrics Emergency Medicine Otolaryngology (ENT)

Cardiology General Surgery Geriatrics and Stroke MedicineGeneral Surgery Geriatrics and Stroke Medicine Cardiology

Geriatrics and Stroke Medicine Cardiology General SurgeryGeriatrics and Stroke Medicine Cardiology General Surgery

General Surgery Geriatrics and Stroke Medicine CardiologyCardiology General Surgery Geriatrics and Stroke Medicine

Geriatric Medicine Respiratory Medicine General SurgeryGeneral Surgery Geriatric Medicine Respiratory Medicine

Respiratory Medicine General Surgery Geriatric MedicineGastroenterology Geriatric Medicine General SurgeryGeneral Surgery Gastroenterology Geriatric Medicine

Geriatric Medicine General Surgery GastroenterologyEmergency Medicine Ortho-Geriatrics General Practice

General Practice Emergency Medicine Ortho-GeriatricsOrtho-Geriatrics General Practice Emergency Medicine

Emergency Medicine Psychiatry GastroenterologyGastroenterology Emergency Medicine Psychiatry

Psychiatry Gastroenterology Emergency MedicineEmergency Medicine General Practice Gastroenterology

Gastroenterology Emergency Medicine General PracticeGeneral Practice Gastroenterology Emergency Medicine

Trauma and Orthopaedics General Practice PaediatricsPaediatrics Trauma and Orthopaedics General Practice

General Practice Paediatrics Trauma and OrthopaedicsTrauma and Orthopaedics General Practice Otolaryngology (ENT)

Otolaryngology (ENT) Trauma and Orthopaedics General PracticeGeneral Practice Otolaryngology (ENT) Trauma and Orthopaedics

Trauma and Orthopaedics General Practice GastroenterologyGastroenterology Trauma and Orthopaedics General PracticeGeneral Practice Gastroenterology Trauma and Orthopaedics

Psychiatry Gastroenterology Obstetrics & GynaecologyObstetrics & Gynaecology Psychiatry Gastroenterology

Gastroenterology Obstetrics & Gynaecology Psychiatry

Acute Medicine General Surgery Intensive Care MedicineIntensive Care Medicine Acute Medicine General Surgery

General Surgery Intensive Care Medicine Acute MedicineAcute Medicine General Surgery Intensive Care Medicine

Intensive Care Medicine Acute Medicine General SurgeryGeneral Surgery Intensive Care Medicine Acute Medicine

Diabetes General Surgery Old Age PsychiatryOld Age Psychiatry Diabetes General Surgery

General Surgery Old Age Psychiatry DiabetesGastroenterology General Surgery Psychiatry

Psychiatry Gastroenterology General SurgeryGeneral Surgery Psychiatry GastroenterologyGastroenterology General Surgery Psychiatry

Psychiatry Gastroenterology General SurgeryGeneral Surgery Psychiatry Gastroenterology

Diabetes General Surgery CardiologyCardiology Diabetes General Surgery

General Surgery Cardiology DiabetesRespiratory Medicine General Surgery Acute Medicine

Acute Medicine Respiratory Medicine General SurgeryGeneral Surgery Acute Medicine Respiratory Medicine

Respiratory Medicine General Surgery Geriatrics and Stroke MedicineGeriatrics and Stroke Medicine Respiratory Medicine General Surgery

General Surgery Geriatrics and Stroke Medicine Respiratory MedicineAcute Medicine General Surgery Geriatrics and Stroke Medicine

Geriatrics and Stroke Medicine Acute Medicine General SurgeryGeneral Surgery Geriatrics and Stroke Medicine Acute Medicine

Emergency Medicine General Practice Trauma and OrthopaedicsTrauma and Orthopaedics Emergency Medicine General Practice

General Practice Trauma and Orthopaedics Emergency MedicineEmergency Medicine General Practice General Internal Medicine

General Internal Medicine Emergency Medicine General PracticeGeneral Practice General Internal Medicine Emergency Medicine

Emergency Medicine General Practice PaediatricsPaediatrics Emergency Medicine General Practice

General Practice Paediatrics Emergency MedicineEmergency Medicine General Practice Paediatrics

Paediatrics Emergency Medicine General PracticeGeneral Practice Paediatrics Emergency Medicine

Emergency Medicine Trauma and Orthopaedics HaematologyHaematology Emergency Medicine Trauma and Orthopaedics

Trauma and Orthopaedics Haematology Emergency MedicineEmergency Medicine Ortho-Geriatrics Ophthalmology

Ophthalmology Emergency Medicine Ortho-GeriatricsOrtho-Geriatrics Ophthalmology Emergency Medicine

Emergency Medicine Ortho-Geriatrics OphthalmologyOphthalmology Emergency Medicine Ortho-GeriatricsOrtho-Geriatrics Ophthalmology Emergency Medicine

Emergency Medicine Psychiatry General Internal MedicineGeneral Internal Medicine Emergency Medicine Psychiatry

Psychiatry General Internal Medicine Emergency MedicineEmergency Medicine Psychiatry General Internal Medicine

General Internal Medicine Emergency Medicine PsychiatryPsychiatry General Internal Medicine Emergency Medicine


Back Fill

• Gen Surgery feel that they can probably cope - and an 18 week rotating cycle might be fairer to trainees

• The Trust is considering that the 4 planned Physicians Assistants will be on the MAU’s and T & O wards

• T & O may have to switch back to a ward based system to help the new proposals and facilitate the back fill plans

• We have looked at the T & O rota template and there is the potential to change the rota design to allow a more efficient use of FY2’s


Any Questions?

Documents

BTFP Case Study Maidstone & TW