Support and Counselling.
As part of its educational role, the GP School monitors the progress of all its General Practice Specialty Training Registrars (StRs). About 25% are tracked more closely when something has taken place that could be a possible indicator of potential difficulties ahead.
This monitoring ensures that both the local Training Programmes and GP School are aware of any potential indicators or problems, and that the subsequent appropriate support is given at the right time.
The extent of Health Education England working across Yorkshire and the Humber monitoring may include:
- meeting with the GPStR and their educators for a more focussed discussion about the support required
- providing targeted training to support the development of particular skills
- providing supernumerary funding for less than full time training
- providing supernumerary funding for an extension to training.
When meetings do take place the purpose is usually:
- To discuss the issues and obtain the GPStR’s and their educators' views
- To provide helpful constructive feedback to form the basis of an educational plan
- To identify the GPStRs needs in order to support them in the successful completion of their training programme
- To determine whether the StR will need a period of extended training
- To provide careers advice.
Indicators that lead to monitoring include:
In 2015, the GP School carried out a survey amongst trainees and trainers in several schemes which identified very high degrees of agreement about which areas indicate that there are more likely to be concerns in training progression. Out of this work can a RAG screening tool that is being taken up in full by some schemes and used as a guide by others.
The tool is available here and describes the reasons that a scheme or the GP school would normally want to review progress of a trainee.
In addition to these indicators the GP school and scheme would be concerned about StRs with a poor attendance record, or any revalidation concerns.
GPStRs who are identified as having problems will be monitored either at Training Programme or central School level depending on the individual concern. See the policies section to see information about the formal framework that is followed. There is however specific guidance for GP Trainees contained within the School policy.
The GP school has written a short summary of the courses available for those who may benefit from them.
The following resources may be helpful for those involved in writing a coroner’s report or attending an inquest.
An event in which there is an unexpected fatal or near fatal outcome or there is the potential for this is classified as a SE or significant event. These are investigated by the Trust in which they happened so that lessons can be learn organisationally and by individuals concerned from the event. As some events (e.g. palliative care) will inevitably cause death the definition and interpretation of the term is slightly complex and further information is available at http://www.england.nhs.uk/ourwork/patientsafety/serious-incident/
The national guidelines on how an event should be investigated are long and complex. The investigation however must follow a nationally defined process. This process will often involve several trusts and commissioners. Because of the number of organisations involved there have been issues with communication though work is going on to try to improve these.
It is normal for all those who are even peripherally involved in an event to be included as part of the SE investigation. This does mean that many trainees can be” involved in a SE” (and so be asked and be expected to reflect on their actions) when their part in the events has been to provide good and safe and appropriate care. This can be a difficult and painful period for trainees. Normally their GP TPDs will be happy to signpost support and their ES may also provide continuing input and support. The GP school would want to encourage all GPSTRs to inform their CS that there has been a SUI in which they have been involved and of their part in it.
Until the event is fully investigated (and the national guidance suggests 60 days should be normal though this is, it acknowledges not achieved regularly for appropriate reasons) all those named will have to declare on a Form R prior to any ARCP that the event is there and no outcome is available yet. (The principle that the priority is to protect the public is paramount.)
The GP School will contact the ES and Trainee when it becomes aware of a SE though it is possible that the trust will have contacted the trainee directly before this. The GP School will also review the progress of and monitor those who are involved in a SE to look for whether there is a pattern of problems. Some people who have been involved in a SE will be asked to come up for a meeting with a GP tutor to review their progress in a bit more detail but for most people the monitoring will be more indirect.
For more information on support and what happens next if you are involved in an SE please click here
The GP school has a team who support trainees and training programmes with issues related to difficulties in training:
Dr Caroline Mills SYLO Caroline.Mills@hee.nhs.uk
Dr Jayashree Mangipudi WYLO and NEYNL Mangipudi.Jayashree@yh.hee.nhs.uk
Dr Nick Whelan WYLO and NEYNL firstname.lastname@example.org
Dr Mike Tomson All School Lead Mike.Tomson@hee.nhs.uk