Higher Specialty Training
Health Education England school of psychiatry hosts well established Higher Training schemes in all psychiatric specialities. The schemes include placements across the region with the training co-ordinated from the main centres in Leeds, York, Wakefield, Bradford and Sheffield. It has developed innovative dual CCT training in General Adult combined with other specialities including Old Age and Medical Psychotherapy. There are many opportunities to develop teaching, leadership and management skills through participation in the educational programmes of the School and the work of the local provider organisations, including opportunities to take time in an OOPE placement as a Leadership Fellow.
During Core Training in Psychiatry there is an opportunity to spend 6 months training in Child and Adolescent Psychiatry. Trainees who want a career in this specialty enter the Higher Training Programme at the ST4 level after obtaining Membership of the Royal College of Psychiatrists.
North/East and West localities Scheme
South Yorkshire locality Scheme
The scheme has 6 National Training Numbers (NTN's). There are 11 approved trainers. There is a strong commitment to training within this friendly and welcoming scheme and 4 of the placements are within Sheffield, one in Rotherham and one in Chesterfield.
The scheme offers a full range of training experience and trainees will have no difficulty in meeting the Intended Learning Outcomes as stated in the Curriculum. Where a particular experience is not available within a placement, there is a commitment from trainers that trainees should gain the experience elsewhere within the scheme and all areas of the Curriculum are available. There is a full range of training opportunities including emergency, on call and all psychotherapeutic modalities.
Trainees can expect to spend one year in a Sheffield and one a district Tier 3 CAMHS placement. The inpatient experience is gained in Sheffield and trainees can choose to be placed in a 14-18, a 10-14 inpatient unit or a specialised children's day unit. Trainees can opt to spend a year in their Tier 4 post, or, to spend 6 months in general Tier 4, with 6 months in a Intellectual Disability team (community or inpatient are both possible) or 6 months in a community Forensic/Vulnerable Children CAMHS team if this suits their training requirements. Sheffield benefits from particularly strong interagency working and there is opportunity to become involved in training experiences in this area.
There is no academic department of Child and Adolescent Psychiatry within Sheffield but the scheme has close links with the Academic Department of Psychiatry and benefits from being hosted within Sheffield Children's Hospital NHS Foundation Trust hence trainees will become involved in teaching medical students and core trainees in psychiatry and in paediatrics.
There is a training management group for Child and Adoloscent Psychiatry combining the North, East, West and South Regions which will be meeting twice a year, including one meeting as an annual meeting. The committe consists of:
- A representative for each of the trusts
- TPD and deputy TPD
- Two trainee representatives
The group also take feedback from local trainer - trainee forums across the region.
More information is available in the Handbook
There are six NTN’s in forensic psychiatry and one NTN in forensic psychotherapy. There also occurs some opportunities to train for up to one year full time for ST4 to 6 trainees on other schemes such as general adult and learning disability. There are also opportunities for trainees to join the academic programme based at Newton Lodge, Wakefield, as well as participating in special interest sessions.
Higher training in forensic psychiatry takes place over a three year period in order to gain the CCT. Training is available in all parts of the region involving medium, low secure and high secure forensic services. The training programme is centred around Newton Lodge, Regional Centre for Forensic Psychiatry, which runs the academic programme.
The focus of training is on the assessment and management of mentally disordered offenders or those presenting risks to others. A wide variety of training opportunities exists including work in adult mental illness, gender specific services, forensic learning disability service, personality disorder services, and prisons.
There is a lively academic and audit programme run from Newton Lodge and opportunities to conduct and publish research.
The East, North and West Yorkshire Higher Training Scheme in General Adult Psychiatry
The West, North and East General Adult Higher Training rotation scheme aims to provide every higher trainee with exceptional quality training in a range of placements that both suits the interests of the individual and equips them for the demands of a consultant post in the future NHS. The rotation has clinical placements across a wide geographical areas covered by 5 NHS Foundation Trusts: Tees Esk and Wear Valleys, Leeds and York Partnership, Bradford and District Care, Humber Teaching, and South West Yorkshire. There are 35 funded 3-year posts with a choice of over 60 approved trainers covering essential inpatient and community competencies, as well as a range of options, based on trainee preference and identified needs, including Crisis Teams, Early Intervention and Assertive Outreach Teams, Psychiatric Intensive Care, Forensic services, Rehabilitation placements, Liaison services, Addictions Teams, Perinatal and Eating Disorder Services.
There are Dual Training programmes in General Adult and Old Age Psychiatry (4 years), and General Adult and Medical Psychotherapy (5 years), with close working between the Old Age Psychiatry and Medical Psychotherapy rotations, as well as opportunities for Academic Posts including Academic Clinical Fellows, Leadership Fellows and Lecturer Posts.
The trainees are appointed to the whole rotation, can apply to work Less Than Full Time, and are encouraged to take ownership of their own training needs, supported by their clinical and educational supervisors, their training programme director, mentoring by more senior trainee colleagues, local Trainee Forum and monthly Higher Training Committee chaired by higher trainees. They are expected to work across at least two different Trusts, but have some choice in the placements after their first year. During their training they do middle tier on-call and gain competencies in managing risks and complex mental health problems. HEEYH has well established psychotherapy tutors to support psychotherapy competencies.
The rotation places particular emphasis on adult learning, personal development plans and Outline Training Reviews, use of the College curriculum and ePortfolio, and extensive opportunities for clinical and non-clinical competencies in preparation for Consultant practice, based around 4 clinical 1 Special Interest day. Alongside educational progression, there is pastoral care and support as needed through the HEE SuppoRTT programme, opportunities for Acting Up, available bursaries and Out of Programme Scheme dependent on trainee needs. The overwhelming majority of our Higher Trainees take up substantive Consultant Posts in the training region and become much-valued Consultant colleagues.
The South Rotation, Yorkshire and Humber, Health Education England
Higher training is organised through the School of Psychiatry which is accountable for delivering the educational contract and to the Royal College of Psychiatrists and GMC for maintaining quality and standards.
In the scheme we have 23 GA and 7 in OA, 2 GAP/OA and 1 dual GA/Psychotherapy, 6 CAMHS and 1 CAMHS/LD National Training Numbers (NTN)s. Numbers are set by Health Education Yorkshire and the Humber (former Deanery) and are funded jointly from HEE tariff and the four linked Trusts. A wide range of placements are available in community, inpatient, liaison, substance misuse, rehabilitation, assertive outreach, early intervention, crisis and intensive home treatment. Trainees have in their time-table one day release for research and special interest in the region. The clinical posts are spread across 4 NHS trusts based at these sites:
Sheffield Health and Social Care Trust: Clinical bases include the Longley Centre in the North and Michael Carlisle centre with community bases in different parts of the city of Sheffield. As the lead employer the postgraduate department deals with both SHSC education as well as the rotation’s HR services for psychiatric trainees in the South rotation. The Director of Medical education is Dr Abhi Shetty
Rotherham, Doncaster and South Humber NHS FT. Higher training is divided equally across both centres in Rotherham and Doncaster. Each has its own local teaching programme and on-call rota. The base for Rotherham is Swallownest Court and the Doncaster base is Tickhill Road Hospital. The Director of Medical Education is Dr Sunil Mehta.
Derbyshire NHS FT: Chesterfield is a town situated 10 miles south of Sheffield based in North Derbyshire. The teaching base is located at the Hartington Unit in the grounds of the Chesterfield Royal Hospital. Community bases are located in communities that they serve. The Director of Medical Education is Dr Vishnu Gopal.
South West Yorkshire NHS Trust: This includes the town of Barnsley which is located to the North East of Sheffield and is within South Yorkshire. The Educational base is Kendray Hospital. The Director of Medical Education is Dr Subha Thiyagesh.
Sheffield Childrens’ Hospital NHS Foundation Trust. There are 4 CAMHs posts based in SCH, 1 at Centenary House and 3 at Becton.
All trainees are employed by SHSC but each of these Trusts work with the rotation in providing local induction, Local Negotiating Committee (LNC) for junior doctors and have their own on-call rotas and banding, providing governance structures for medical education and report directly to the Deanery as well as the south rotation through the TPDs. Each of the Trusts have their own medical education departments that share necessary information with SHSC.
There are seven NTNs in Psychiatry of Intellectual Disability across the whole of the Yorkshire and Humber region. There are more approved placements than funded posts which allows for some flexibility to give trainees a significant degree of choice. The size of the scheme ensures that training can be personalised to individual Trainee needs and Trainees are well supported with a strong emphasis on peer support and learning.
Clinically the posts cover a wide range of services and placements are chosen over the period of training to ensure that trainees are equipped with the skills and competancies to work as a consultant in modern specialist intellectual disability services. The actual clinical experience will be within multidisciplinary Community Intellectual Disability Teams, as well as in specialist teams and inpatient settings. Trainees will work with other statutory and non-statutory agencies, with an emphasis on service user involvement processes. There may also be the opportunity to do more specialised placements in the later years of training, in forensic intellectual disability and child intellectual disability.
As well as core clinical work there is a wide variety of clinical experience available in areas relevant to intellectual disability. Trainees have been involved in clinical genetics, community paediatrics, family therapy and neurology, as well as other psychiatric specilaities such as forensic psychiatry, liaison psychiatry and eating disorders. Trainees therefore benefit from the expertise available in the various regional centres in the Yorkshire and Humber area.
There is an active academic programme, integrated with the regional CPD programme but with specific sessions for trainees. This includes a Balint Group and some integrated training with other professional groups. The size of the scheme also allows for shared teaching with other neighbouring schemes and other higher training programmes such as that for CAMHS. There are three medical schools in Health Education England working across Yorkshire and the Humber and Trainees have opportunities to be involved in both undergraduate and postgraduate teaching throughout their training. There are also many opportunities to be involved in multidisciplinary training.
The Intellectual Disability Training committee meet twice a year, immediately before one of the monthly academic meetings. The Speciality Training Committee for Intellectual Disability Psychiatry is attended by:
- The chaired Training Programme Director
- Three other trainers
- Trainee representative
East, North and West localities
The Scheme has an establishment of eight-teen Higher Trainees with significantly more Trainers giving Trainees plenty of choice. The posts are spread across Bradford, Hull & East Riding, Leeds, North Yorkshire and York, Wakefield, Dewsbury, Halifax and Huddersfield. The Scheme provides a wide range of training experience of Old Age Psychiatry in city centre, rural and academic settings. A full range of training opportunities are available including emergency and on call work as well as community and hospital based settings. Relationships with partner agencies including acute trusts and Social Services are generally very good.
The general programme at ST4 – 6 levels involves three 12-month placements commencing in October. Trainees will be encouraged to work in a variety of settings and locations to broaden their training experience and trainees will be able to contribute to this decision.
The Scheme includes one day/week for personal development. A variety of opportunities are available for Trainees including Neurology, Neuroradiology, Forensic Psychiatry, Medicine for the Elderly, Psychotherapy, management training as well as many more. Opportunities to collaborate with colleagues on a variety of research projects are also available.
The higher psychotherapy training scheme covers the whole of Yorkshire and Humber. All the posts are dual CCTs, three with general adult and one with forensic psychiatry. Each lasts five years. Each week is split into a general adult part and a psychotherapy part so both trainings occur concurrently and the proportions vary from year of training but equal time is spent in each speciality over the training. We have been very fortunate that the Leeds consultants have supported this model and adapted their training to it.
Whilst onerous in that six years of training must be compressed into five years, dual training provides an integrated psychiatric and psychotherapeutic training that can be applied in a wider variety of settings.
Training placements are available in Leeds for psychoanalytic trainees. There is a possibility of other placements as trainers and educational supervisors become available but the presence of a cohort of trainees in one place has been found by trainees to be helpful for each other's learning and support. The current trainees have described their experience in the journal Psychoanalytic Psychotherapy.
The Forensic psychotherapy post has links with a national group of trainees and The Portman Clinic in London. It has been based at Newton Lodge and it is planned to continue it there. The cooperation of the Forensic consultants has ensured the scheme has worked well. The TPD for the forensic part is Dr Patrick Quinn.
At present all the Trainees are specialising in Psychoanalytic Psychotherapy (PAP), but there is the option of specialising in CBT as well. Trainees are expected to attain theoretical and therapeutic competence in the other two modalities that are not their main modality.
For the Psychoanalytic component:
- The core component is the training therapy or analysis with a psychoanalyst. We encourage the maximum frequency the trainee can manage and Health Education England working across Yorkshire and the Humber fund one session. The minimum recommended is three sessions at present as there is a strong psychoanalytic influence in this training.
- Psychoanalytic psychotherapy training to Masters level is available in Leeds (Foundation Course in Psychodynamic Psychotherapy; the D58L run in partnership between the Tavistock and Portman NHS Foundation Trust and Leeds Partnerships NHS Foundation Trust).
- The aim of this is to lead to application to the institute of Psychoanalysis for the northern training to become a psychoanalyst if the Trainee so wishes and is accepted as a candidate.
- There are two consultants who can oversee the training and one is approved as an educational supervisor. There is the possibility of placements in Leeds and / or Wakefield.
- The academic component of this training would be worked out through the Educational Supervisor and there are a number of options equivalent to the other modality available and which would be supprted.
The Psychotherapy Speciality Training Committee meets quarterly at Southfield House in Leeds, the main training centre. The Training Programme Director chairs the committee with administrative support from the east office of the Deanery.
The members of the committee are as follows:
- Training Programme Director (Chair)
- All medical psychotherapy consultants in the Yorkshire and Humber Deanery
- A trainee representative
- A representative from all local psychotherapy trainings used by the training programme e.g. D58 course at NSCAP in Leeds, CBT training course in Sheffield, Masters in Systemic Therapy (Leeds University)
- Non-medical trainers/supervisors