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SYNOPSIS OF COUNCIL MEETING
10th May 2005

Present:
Dr A Long Chairman
Dr PG Jackson Vic Chairman
Dr K Byatt Honorary Secretary
Dr J Lowes Hon. Assistant Secretary
Dr L Spencer PR Officer
Dr J Baker Yorkshire
Dr D Baldwin Northwest (West)
Dr S Bowles Mersey
Dr A Mackie Sth Humber
Miss A Carr Devon & Cornwall
Prof P Baker Northwest (East)
Dr P Harrison Eastern
Dr H Jones Oxford
Dr M O’Connor Wessex
Dr B Reid Scotland
Dr J Stroobant London SE Lewisham
Dr I Verber Northern
Miss J Wilson SW London
Dr J Young London NE
Mrs J Sharpe NAMEM


Welcome & Apologies
Chairman welcomed everyone to 122nd Council Meeting; especially Peter Baker (North West), Mike Cheshire’s replacement, Alison Carr (Devon & Cornwall), Nuala Campbell’s deputy, and Jane Young (London NE), Hilary Cass’ deputy. Apologies were received from: Drs A Jeffrey, H Cass, C Weir, N Campbell, G Caldwell, A Naftalin, E Hughes, D McQueen, Mr R Keenan and Prof P Hill.
Minutes of the last meeting
The minutes of the last meeting were accepted and duly signed.
Matters Arising
  1. 5th Joint Conference
    155 delegates had registered to date. This was approximately half of planned numbers. It was recorded that facilitators are required for the breakout sessions and that Clinical Tutors are welcome to volunteer. It was noted that the Conference web site is www.pgmde-conf.info Explicit arrangements will be made for NACT members who want to go to the NACT AGM without attending the conference (details will be sent out via e-mail cascade).
  2. Deanery Communications
    COPMeD has been trying to achieve as much parity between deaneries as possible. NACT have been asked to co-produce a paper for COPMeD to inform discussion on best practice.
  3. Professor Winyard has suggested that Deaneries undergo Multi-source feedback and that PMETB will quality assure the Deaneries. A quick poll of the deanery representatives present showed great variety in efficacy of communications between deaneries .
  4. The chairman requested that any further feedback re Communications between deaneries & CTs (via deanery reps) and the “Roles and Responsibilities of Deanery Reps” document be sent to him.
  5. Papers for approval
    “NACT Council Terms of Reference” – approved
    “NACT Good Practice Guidelines” – approved
    “Process for Officer appointment” and “CT induction”- feedback from council requested.
  6. Officer nominations for AGM
    A paper ballot was held for the nomination to the post of Hon. Assistant Secretary. Dr W Reid was successful and will be Council’s nomination at the AGM
Reports
  1. Deanery Representatives these were tabled
  2. COPMeD no representative present
  3. NAMEM tabled
  4. Chairman tabled
Hot Topics Discussion – (common issues from Deanery reports pulled from tabled reports)
  • Independent sector’s role in PGME is becoming of concern with the development of Independent Treatment Centres
  • There was concern about GP placements and F2 what will happen to orphan slots (not used this year because of funding withdrawal)
  • It was noted that at GMC meeting had been held on the previous day on training for future. A number of points arose from this .
    • The new version of “The New Doctor” will be delivered at a local level (i.e. via deaneries) during Foundation year 1(F1);
    • a list of competencies will be identified which maps on to MMC curriculum.
    • Satisfactory completion of F1 will satisfy GMC.
    • A licensing examination will not be instituted.
    • The GMC expect Clinical Tutors to quality assure this process at a local level. The chair of the GMC Education Committee (Peter Rubin) is engaged with NACT on this.
  • Communications
    Nationally CT meetings are very variable in quantity and quality; many focus on MMC, non-MMC topics valued in Scotland The operational framework probably released week after next – Legal opinion awaited. MMC includes FPs, but also specialty training Andrew Havers (MMC project lead) (AH) pointed out variability in implementation & understanding of MMC nationally and professed keenness to know where deaneries weren’t implementing MMC;
  • Study leave
    The approaches taken around different deaneries remain very heterogenous. The concept of an “Individual learning Account” has been suggested. It is thought likely that some of the Study leave budget will be required to deliver part of the F2 curriculum. Concerns were raised about the quality and quantity of information held about trainees study leave
  • Multiprofessional Deaneries – A number of Deaneries are developing models of multiprofessional deaneries. This will be discussed further at the 5th Joint Conference.
  • Early years surgical training programmes
    Pilots being carried out in Mersey and the South West. Andrew Havers commented that MMC is closely watching Mersey deanery’s interesting initiatives in this area. The feedback from the Peninsula was very positive about this development.
  • Doctors in difficulty
  • Oxford and Trent have clear procedures based largely on the West Midlands Deanery model.
  • Portfolios for Foundation Programme
    COPMeD have agreed that national portfolio should be implemented. Some deaneries beginning to express concern at the rumoured size of the portfolio (121 page document!)
    Questions remained about whether this was an assessment or a learning portfolio. Concern was expressed at potential harm to CTs’ credibility in delivering such a large piece of work and whether there was realistic time available for educational and clinical supervisors to support the process.
    GMC expect that competencies will have been delivered & documented as having been delivered (using assessment tools) to satisfy registration in law. There will be GMC transition process until end of Jul 07
    It was noted that some of the novel jobs did not deliver all the opportunities for the necessary assessments.
  • Clinical Negligence Scheme for Trusts
  • This posed a significant workload for some CTs. It was recognised that this was a bureaucratic process – discussion took place about where the boundary between clinical & educational responsibilities lay.
    • MMC Update – Andrew Havers
    This took the form of a brief resume of the background, a presentation of plans, recognition of the ”Language” of unforeseen consequences – small changes to complex systems can produce major unforeseen impacts.
    The NHS will remain dependent on trainees, rather than make mainstream training supernumerary.
    Resume of case for reform – free standing posts to be made into programmes local QA will be needed– a rotation per se is not necessarily a programme
    No agreed end point in specialist training inevitably leads to “repeating” training The service remains dependent on trainees (NB the people in queue are experienced trainees - which is service useful).
    Selection point procedures are often inefficient, expensive & lacking validity & capacity to withstand legal challenge.
    Supervision assessment & appraisal – no consistent mechanism of introducing assessment.
    Service- training tension – there has been no clarity about appropriateness of this and cross- cover potential between trainees has not yet been fully explored.
    Flexible training (Increasing numbers of flexible doctors in workforce).
    Meeting non UK graduates’ needs? (Numbers of Trust grade doctors have increased considerably in the last 1-2 yrs; European Working Time Directive will have yet further impacts on workforce).
    Workforce planning doesn’t currently happen at SHO level with respect to the long term needs of service.
    SHO numbers currently reflect medical school output & service pressures (NB 10K p.a. PLAB doctors registered )

    The role of Royal College exams inconsistent
    • what is the end point?- (broader less deeply specialise doctors delivering service)
    • Above issues written 2 yrs ago (“Unfinished Business”) - ? relevance/implemetation now
    • need to acknowledge new demands: Payment by Results; St Bo P, plurality of provision, foundation trusts unforeseen consequences
    • MMC timeline: 2005
      May operational framework
      Jun selection methods for specialty training.
      July “ Rough Guide” published
      Aug Foundation programme s begin
      Sep SAS grade restructuring plan agreed (re Article 14)
      Sep Specialty review conclusions
      Oct Workforce transition management arrangements agreed (to support current trainees in bulge)

      2006
      Aug application process for specialty selection agreed
      • moving from FP to specialty programme
        • explicit pathways
          sensitive to trainees’ & service needs
          flexibility
          • ST1 principles explored by strategic group
            • key achievement of FP is attainment of core competencies as set out in curriculum
            • after F2 will moved via selection process to broad based ST1 post counting towards CCT
            • selection processes mustn’t undermine key objective of FP nor threaten range of opportunities presented to trainees
            • no entry to Specilaty Training programme without successful attainment of F2 competencies.
            • all doctors on a Specialty Training level programme will be doctors in training
            • Doctors who fail to progress on an ST programme (or who choose not to progress to next level) may choose to work in service posts where they have the competencies necessary to do so.
          • Specialty training (NB 65 specialties)
            • Unfinished Business proposed 8 streams:
              Medicine, Surgery, Primary care, Child Health, Obstetrics & Gynaecology, Mental health, Anaesthetics, Pathology.
            • The BMA has proposed 5 streams
              Streams link specialties
              programmes within streams
            • Initial model for post-Foundation Programme:
              Acute care (reactive; hospital environment )
              Interventional (High level Practical skills)
              Community/continuing care (longitudinal relationships with pts)
            • Selection processes uncertain. It is uncertain how this will be organised.
              One of the key determinants to this will be the extent to which service can be sustained.
    Discussion followed this presentation with the following key points raised:-
    Educational Programme underpinning Foundation Years
    Needs to be a 2yr programme- not standard PRHO teaching
    There have been some useful lessons from pilots (but not disseminated enough)

    The GMC want change in how training occurs at local level
    CTs will need to take on management of this at local level – this will vary from one place to another
    NB role modelling (the problem is even worse in US c f UK – only 1/6 of establishments are educational providers)
    Main problem for CTs is taking consultants with them – many consultants don’t understand the changes. The explicit timeline provided was helpful
    If F1 goes well, in effect PRHOs will become better assessed
    F2 however will be a problem because GP & A&E – need data to allow further change (i.e. to run-through grade) It takes 3-4 months for psychiatric trainers to determine which (of psychiatric SHOs) will be suitable for a career in psychiatry.

    The chairman summarised the way forward:
    Good communications were essential – sharing good practice
    The process was only deliverable by those with the appropriate experience – CTs are clearly key in this.
    Dates of next Council Meetings
    16th September, Med Society of London, 7/8 Jan 06 – Horwood House, Little Horwood, Milton Keynes.
    AOB
    There being no other business the meeting closed at 1535

    Last modified: 8 Jun 2006