Wales
Deanery
Item
Number
WAL0112-07
WAL0112-19
Local Education Provider
Cardiff & Vale University Lhb
Deanery-Wide
Site
University Hospital of Wales
Domai
n
5; 6
All Sites
Programme code
WAL386
8 All
Programme curriculum
Core Surgical Training
All
Post Specialty
Cardio-thoracic surgery
All
Please list the level of
trainees affected
Foundation; Core
All
Item type
Concern
Concern
Description of item
Date item was
identified
(DD/MM/YY)
(TV007 & TP006)
Within the July 2011 update the Deanery advised that the concerns related to a heavy
workload which was exacerbated by rota gaps and had an adverse impact upon the ability
of the trainees to access teaching sessions and obtain exposure to clinics and theatre.
01/01/2011
(TV107)
Difficulties in ensuring the provision of access to the internet within all training
programmes across Wales.
01/01/2009
How was the item identified?
Other
Red
Deanery Survey; GMC NTS Outliers
Red
WAL0112-24
Betsi Cadwaladr University Lhb
Ysbyty Glan Clwyd
1; 2; 6
N/A
Foundation Programme
General surgery; Trauma and orthopaedic
surgery
Foundation
Concern
(TV183)
Below outliers reported in the GMC National Trainee Survey for induction and EWTD
during 2010 and Clinical Supervision and Consultant undermining in 2011
01/01/2010
GMC NTS Outliers
Red
(1-1UEK-235)
WAL0112-26
WAL0112-36
WAL0112-44
WAL0112-46
WAL0112-47
Betsi Cadwaladr University Lhb
Hywel Dda Lhb
Abertawe Bro Morgannwg University Lhb
Cardiff & Vale University Lhb
Cardiff & Vale University Lhb
Wrexham Maelor Hospital
West Wales General Hospital
Caswell Clinic, South Wales
Forensic & Psychiatric
University Hospital of Wales
University Hospital of Wales
1; 6
5; 6
1; 2
1; 5; 6
5; 6
WAL370
WAL370
WAL478
WAL461
WAL447
Anaesthetics
Anaesthetics
Core Psychiatry Training
Clinical radiology
Renal medicine
Anaesthetics
Anaesthetics
Forensic psychiatry
Clinical radiology
Renal medicine
All
ST1; ST2; ST3+
Core
ST1; ST2; ST3+
ST1; ST2; ST3+
Concern
Concern
Concern
Concern
Concern
WAL0112-48
Cardiff & Vale University Lhb
University Hospital Llandough
1; 6
WAL2239
Foundation Programme
Trauma and orthopaedic surgery
Foundation
Concern
WAL0413-03
Aneurin Bevan Lhb
Ysbyty Ystrad Fawr
1; 5; 6
WAL2239; WAL424; WAL377
Foundation Programme; General Practice; Core
Medical Training
General (internal) medicine
Foundation; Core;
Higher
Concern
WAL0413-04
WAL0413-06
Cwm Taf Lhb
Cardiff & Vale University Lhb
The Royal Glamorgan Hospital
University Hospital of Wales
1; 6
5; 6
WAL409
WAL401
Ophthalmology
Gastroenterology
Foundation Programme; Ophthalmology
Gastroenterology
Foundation; Higher
Core; Higher
Concern
Concern
(TV195)
The Deanery Visit during September 2011 identified the following concerns:1) Inadequate clinical supervision in obstetric anaesthesia.
2) Inadequate experience due to the organisation of out of hours working.
3) Inappropriate on-call frequency.
01/09/2011
(TV013)
Ongoing training concerns in the following three areas:- Training provision in obstetrics anaesthesia.
- Undermining.
- Inadequate critical care training.
01/01/2007
(TP050)
The results of the 2011 GMC National Trainee Survey report ongoing concerns in relation
to workload. In addition a Psychiatry trainee reported that they were working beyond
their level of competence and concern was also expressed about the rota arrangements.
01/01/2011
(TP077)
The concerns relate to a lack of consultants to deliver specific elements of the curriculum,
limited educational opportunities, inadequate clinical supervision when on-call and an
emphasis upon service provision which is partially attributable to rota gaps and an
increased departmental workload.
01/01/2011
(1-9NA-6)
(TP041)
Investigation into the training concerns has highlighted difficulties with the balance
between service provision and training provision within the Directorate. The specific
concerns reported by trainees are as follows:1) Inadequate training on how to undertake a Nephrology clinic when they commenced
their post.
2) The need for trainees to have a dedicated opportunity to discuss clinic cases to enhance
(TV159)
The original concerns in relation to Trauma & Orthopaedics training were raised in July
2010 and the issues raised related to undermining, inadequate supervision particularly out
of hours and concerns regarding workload. Local action planning has been undertaken by
the Health Board to address these. However, the initial concerns raised were complicated
by the fact that the specialty is split across two sites and the trainees based at Llandough
Hospital only have access to orthopaedics experience when they are expecting access to
The main concerns are:1) Difficulties in organising annual/study leave due to a vacancy and low numbers of
juniors.
2) Core trainees have difficulty accessing clinics.
3) Limited opportunity to carry out practical skills impacting on the ability of the trainees
to obtain the required level of experience.
4) The lack of HDU facilities or Anaesthetic support resulted in trainees feeling
The primary concerns were:1) Inadequate handover arrangements.
2) Inadequate supervision at foundation level with implications for patient safety i.e. a
Foundation trainee being responsible for triaging all emergencies within the Eye Casualty.
3) Emphasis upon service provision with trainees being pulled from theatre and clinics to
cover predictable rota gaps.
4) Perception of undermining.
workload, study leave, undermining, handover, feedback and local teaching, induction
Deanery Monitoring Visit
Amber
Job Evaluation Survey Tool
Amber
GMC NTS Outliers
WAL1013-03
WAL1013-04
WAL1013-05
WAL1013-06
WAL1013-08
Cardiff & Vale University Lhb
Cwm Taf Lhb
Hywel Dda Lhb
Abertawe Bro Morgannwg University Lhb
University Hospital of Wales
The Royal Glamorgan Hospital
Bronglais General Hospital
Princess of Wales Hospital
Deanery-Wide
Abertawe Bro Morgannwg University Lhb
1; 6
1; 6
1; 6
1; 6
1; 6
Princess of Wales Hospital
1; 6
WAL2239
WAL377
WAL2239
WAL424
N/A
WAL2239
Foundation Programme
Core Medical Training
Foundation Programme
General Practice
Foundation Programme
Foundation Programme
General surgery
N/A
Emergency Medicine
Obstetrics and gynaecology
Emergency Medicine
General surgery
Foundation
Core
Foundation
GP
Foundation
Foundation
Concern
Concern
Concern
Concern
Concern
Concern
TP104
- Clinical Supervision
- Educational Supervision
- Workload
(1-21G7-43)
(1-21F2-107)
TP090
- Clinical Supervision
- Workload
- Handover
- Study leave
TV201:- Low levels of staffing.
- Limited support out of hours.
- Workload
(1-222Y-237)
(1-1UCF-410)
TV198:- Study leave
- Workload
- Handover
- Clinical supervision
Training Programme Director visits
01/01/2011
Other
01/01/2010
01/08/2011
WAL1013-17
Cardiff & Vale University Lhb
Cardiff & Vale University Lhb
University Hospital of Wales
1; 6
University Hospital Llandough
WAL445
6 N/A
Emergency medicine; Foundation Programme
Foundation Programme
Emergency Medicine
General (internal) medicine
Foundation; Higher
Foundation
Concern
Concern
Trainees have raised concerns about a heavy workload, poor supervision overnight due to
the workload and working beyond their competence.
(1-1QFO-308)
(1-1UEK-650)
(1-AZ-3187)
(1-DW-1508)
TV162:-
Acting Deanery Specialty Lead
ARCP Feedback and the GMC National
Trainee Survey
Internal interviews
(TV170)
The concerns were identified through
trainee interviews which were arranged in
response to the findings of the 2012 GMC
Trainee Survey
Other
01/08/2012
GMC NTS Outliers
01/06/2011
GMC NTS Outliers
(TP078)
The initial concerns related to trainees
being pulled from clinics to cover service
and were identified by the Clinical Tutor
within the department. The other issues
highlighted within column I were identified
The concerns were identified initially
through the Local Faculty Lead's
investigation into the results of the 2012
Survey
GMC National Trainee Survey
Green
01/06/2011
GMC NTS Outliers
Amber
01/07/2012
Foundation End of Year Survey
The initial concerns regarding work
intensity were identified through the GMC
survey but at the time there was no
evidence of concerns regarding clinical
supervision or any other impact on training
provision. However, subsequent surveys
have identified further concerns which has
End of placement feedback
Amber
01/03/2012
Deanery Survey
Amber
GMC NTS Outliers
The initial concerns relating to study leave.
However, recent end of placement feedback
and GMC Surveys have also identified
concerns in relation to workload, handover,
working beyond competence and feeling
unsupervised on occasions although all
trainees reported that overall they were
Clinical supervision, handover and
workload reported as below outliers when
compared to other UK Foundation Schools.
Red
GMC NTS Outliers
GMC Survey and direct trainee feedback.
Amber
01/07/2013
GMC NTS Patient Safety Comments
GMC Survey free text comment
Amber
01/07/2012
GMC NTS Outliers
GMC Survey
Heavy workload, clinical supervision concerns due to low staffing levels.
Amber
(1-229D-329)
(1-21F2-274)
WAL1013-18
WAL1013-19
WAL1013-20
WAL1013-21
Abertawe Bro Morgannwg University Lhb
Abertawe Bro Morgannwg University Lhb
Aneurin Bevan Lhb
Cardiff & Vale University Lhb
Morriston Hospital
Singleton Hospital
1 N/A
2; 1
Royal Gwent Hospital
University Hospital Llandough
WAL376
6 N/A
5; 1
WAL448
Foundation Programme
Obstetrics and gynaecology
Foundation Programme
Respiratory medicine; Foundation Programme
Emergency Medicine
Obstetrics and gynaecology
Emergency Medicine
Respiratory Medicine
Foundation
Higher
Foundation
Foundation; Higher
Concern
Concern
Concern
Concern
TP164:Clinical supervision, handover and workload reported as below outliers in the 2013 GMC
Survey. In addition an individual trainee has reported that a GP trainee is the most senior
doctor at night which can lead to trainees making decisions beyond their level of
competence. However, the trainee did accept that consultants worked late and there was
someone they could contact for help.
01/07/2013
TP116:The initial concerns raised in 2012 was a below outlier for a below outlier for Regional
Teaching and the Specialty have identified a consultant to take on responsibility for this
role. In 2013 further concerns were raised within the free text comments of the survey
identify concerns about a lack of continuity of care and concerns that senior review of
patients was not routinely undertaken.
01/06/2012
TP022:Workload reported as a below outlier in 2013 GMC Survey. In addition, the free text
comments of the survey report that the trainees are excessively tired due to the rota
arrangements.
01/07/2013
(1-1UEK-25)
(1-21F2-16)
TV126:Concerns regarding workload and trainees reporting that they are undertaking work of
limited educational value. In addition, the foundation trainees have reported that there
have been occasions when they are the most senior doctor on the ward with Consultant
support being available by telephone.
(1-AK-2316)
GMC NTS Outliers
GMC Survey
Green
GMC NTS Outliers
GMC Survey
Amber
GMC NTS Outliers
GMC Survey
Amber
01/07/2013
GMC NTS Outliers; GMC NTS Patient Safety Comments
Amber
Local Faculty Lead trainee interviews 16th October
2012:
GMC Survey and free text comments.
Deanery Visit March 2012. Investigatory visit showed
problems lay in on call arrangements at Neath Port
Talbot Hospital rather than the daytime trainee
experience at Caswell.
September 2012:
Core Psychiatry Programme Director reports
• The Programme Director will handover the process
of ensuring trainees attend any required audit
functions to the new Audit Lead.
• The Quality Unit will investigate how the new GMC
Survey Results are calculated, in particular the
undermining score, and ensure guidance is issued
when results become publically available.
March 2012 :
-The transplant clinics have been changed to provide
opportunity for case discussion with Clinical
Supervisors following the clinic.
-The referral system has been reviewed, and a more
robust system of supervision is being put in place to
allow trainees to be supported during this time.
October 2012 update from STC Chair:
A review of progress to be undertaken by the Deanery Psychiatry
Specialty Lead December 2012
The Deanery has reviewed the results of the 2015 NTS and notes that induction has been
reported as an above outlier. However, there are ongoing concerns around workload which
we have continued to liaise with the Health Board over. The Health Board have confirmed
that there are proposals in place to establish a revised medical model which would
incorporate an expansion in nurse practitioner roles. However, we note the slow progress in
taking this forward and have therefore escalated this issue to Enhanced Monitoring. (Non
publishable)
The Deanery has reviewed the results of the 2015 GMC NTS and have noted a further
improvement in the results with 79.39% of respondents reporting the access to the internet
was either very good or good and 12.15% considered it to be neither good nor poor. The
GMC Survey scores for Wales have significantly improved for two consecutive years and the
results for Wales in comparison to other UK Deaneries/LETB's can no longer be considered
to be statistically inferior. In addition, we have confirmation from the majority of Training
Programme Directors through our Annual Specialty Reporting process that internet access
The Deanery undertook a Targeted Visit on 11th November 2014. Trainee feedback at the
visit was positive and in contrast to the results of the 2014 NTS. The trainees did not raise
concerns about the level of supervision and reported that they would recommend the post
to a colleague who was considering applying for it. The Deanery has reviewed the 2015 NTS
results and notes the below outliers. Therefore, the School of Surgery will be undertaking a
visit to all surgical sites within the Health Board at the end of October in order to try
understand the reason for the 2015 results. Further action planning or escalation to
The Denaery has continued to monitor progress and is satisfied that there has been a
continued improvement in the training experience due to the implementation of the revised
rotas. The 2015 NTS results demonstrate further imrprovements in satisfaction with no
results being reported in the lower quartile and an above outlier for induction being
reported in the programme report. The Deanery is satisfed that the improvements are
sustainable and has therefore requested closure from the DR. Routine monitoring will of
course be undertaken within the traininig programme.
The Deanery has continued to liaise with the Health Board regarding the concerns and
through this further measures have been introduced in order to improve the training
experience. The primary improvement is in relation to the staffing levels with the LEP
providing confirmation in July 2015 that an additonal three consultants have been
appointed. This has been particularly welcomed by the Welsh School of Anaesthesia and
will be key in addressing the clinical supervision concerns that have been reported in the
NTS. In addition new College Tutors are in place and this will ensure that there continues to
The Deanery has reviewed the results of the 2014 NTS and notes that the The Deanery has continued to monitor progress and given that clinical supervision and
results by post specialty do not highlight any concerns around clinical
workload were both reported in the interquartile range in the 2015 NTS and no other
supervision or workload. The Deanery has reduced the RAG rating from concerns were reported we would like to close this issue.
amber to green but would still like to monitor the training experience
during the next placement to ensure that these improvements are
sustained.
Concerns ONLY Deadline for
resolution
(DD/MM/YY)
07/01/2015
Foundation Programme Director Feedback
Green
01/07/2011
Current return update: October-2015
GMC National Trainee Survey & GMC QA
Regional Visit
Other
Red
TV020:- Heavy workload and difficulties accessing senior support.
Previous return update: October-2014
01/07/2015
Red
01/02/2013
01/01/2011
What further actions are planned?
An update meeting is planned in January 2013 to address the following The Deanery had a meeting with the AMD on 22nd July to discuss the
action points:
training concerns. At the meeting it was noted that the departments
commitment to the Hospital at Night system resulted in trainees being
1) The Assistant Medical Director will liaise with the departments and
pulled from theatre to cover ward work. In addition it was noted that
the Postgraduate Centre to investigate which trainees would require
the Deanery's concerns around the lack of an appropriate induction to
the combined induction course training and a process around training provided cross-cover to ENT and Urology had not been fully addressed.
them in August would be identified.
Therefore, the AMD has made arrangements for the department to be
The Deanery is working with Colleagues in Welsh Government, The
The Deanery has reviewed the results of the 2014 the percentage of
National Leadership and Innovation Agency for Healthcare and Welsh
people reporting IT access as poor or very poor has reduced from 17.42%
Centre for Pharmacy Professional Education, to provide a policy
in 2013 to 12.92% in 2014 which is encouraging. The Deanery has
statement for Technology Enhanced Learning, a business case,
continued to raise the concerns with Heatlh Boards and with NWIS and
operational plans and evaluation mechanism. The aim of this is to
also direct with the Health Boards. A number of Health Boards have
ensure all stakeholder organisations involved in the delivery of the
reported that they have taken pro-active steps to ensure internet access
multifaceted requirements for the effective provision of a technology
either through EduRoam or The Cloud following successful pilots in parts
1) Routine post assessment forms.
The Deanery has reviewed the results of the 2014 NTS and notes that
2) Monitoring to take place every four months to record when
both overall satisfaction and clinical supervision have been reported as
induction meetings are being held
below outliers. In addition, induction and adequate experience have
3) Programme Director to introduce "hot cases of the week" every week been reported in the lower quartile. The Deanery has asked for the
to trainees every week in an attempt to improve senior attendance
Health Board to provide the Deanery with an update and arrangements
4)Trainee questionnaire to be analysed and results shared with Wales have been made for a Targeted Visit which will be held on 11th
Deanery
November 2014. Given the ongoing nature of the concerns and the fact
The concerns were originally identified
08/02/2012: The Associate Dean (Quality) wrote to
Routine end of placement evaluation forms and a follow up visit will be The Health Boards proposals to change the rota as indicated within the
through a specialty visit during August
the Clinical Director confirming receipt of the letter
undertaken during March 2013
April DR have been implemented. The Deanery has reviewed the 2014
2010. Further information from end of
in December 2011 addressing issues raised in the
NTS and notes that there has been some improvement but the results
placement evaluation forms, the GMC
Deanery visit report of September 2011. An update March 2013 meeting to include trainee interviews.
are still not as positive as we would like them to be and therefore we
Survey and a follow up visit during
has been requested by May 2012.
have not de-escalated this issue. However, it should be noted that the
September 2011 have been utilised to
timings around the implementation of the new rota and the survey
establish the extent to which there are
The Health Board have submitted an action plan in
would have been similar and the Head of School considers that this
The concerns were identified through a
Following the May 2012 Visit, the agreed action were The Deanery will re-visit the department in March 2013
The Head of School of Anaesthetics has discussed the quality of training
combination of end of placement
as follows:
with the local consultant trainers. This discussion confirmed that the
evaluation data, GMC Surveys and Deanery
following are now in place:
Visits.
• There must be a clear undertaking that additional
consultant posts will have been advertised by the
1) Obstetric guidelines are now available and that guidelines are being
time of the next review meeting.
made for main theatre anaesthesia, and in intensive care.
Amber
TV200:Clinical supervision
Handover
Workload
List the actions taken
• No Core trainees attended the meeting so
questionnaire survey has been sent to them asking
for feedback.
• Higher trainees are very happy with training
The original concerns were raised following October 2012 Update:
an investigation into the results of the 2009 1) An increase in bandwidth took place in 1st quarter
National Trainee Survey.
2012. Recent surveys carried out by the Deanery with
its PG Centres and Libraries in September 2012
indicate that there have been some improvements in
some places, but in many places the circumstances
remain as challenging as they were previously. There
GMC National Trainee Survey Results
October 2012 update from Foundation programme
Director. A survey of Orthopaedic trainees is
currently taking place.
Amber
(1-21F2-188)
WAL1013-14
The Foundation training concerns were
identified through end of placement
evaluation forms and the Core Trainee
concerns were identified through a review
of the JCST's SPACE data reports.
Amber
Amber
WAL1013-02
How was the item identified? - NOTES
Concerns ONLY RAG when initially
identified
Progress in taking forward the Health Boards action plan will be
The Deanery has continued to monitor the situation with the Health
monitored by the Acting Deanery Specialty Lead.
Board and Head of School of Radiology. Whilst the overall training
Trainee feedback in November to provide more detail on concerns with experience has improved it has been recognised that August 2014 was
formal review meeting planned for January 2013.
likely to be a particularly challenging period due to rota concerns.
Therefore pro-active steps were taken to undertake the following to
mitigate against any deterioration:-
The Deanery was concerned to note the results of the 2015 NTS results and has engaged in
urgent talks with Health Board Managemetn at the highest level. At the most recent
meeting with the Health Board on 21st October 2015 the Deanery received a further
progress update which provided us with sufficient assurance that the action plan was back
on track. The following key points were noted at the meeting:
- A new Training Programme Director has recently been appointed.
- That the number of substantive consultants within the department has increased.
October 2012:
The Deanery has reviewed the results of the 2014 GMC Survey which
The Deanery has continued to engage with the Health Board over the concerns and the
-Educational Resources opportunities to be explained to trainees as
indicate that there may have been a deterioration in the training
following key points are being taken forward:
part of induction from now on
experience. The Deanery has raised their concerns with the Local
- An additional departmental teaching session was introduced on Friday's.
-Induction revised to contain more information on protocols and
Faculty team who are meeting with the department in order to identify
- A new departmental induction programme is being developed and a revised departmental
educational supervision and on-call arrangements
solutions to address the concerns. Given the apparent deterioration and induction pack has been produced to support this.
-Unit is investigating the possibility of monthly meetings with clinical
the fact that concerns regarding supervision have been reported in the
- Prospective cover to ensure that trainees can take study leave.
supervisors ; to be discussed among consultants
survey we have increased the RAG rating.
- Steps to ensure that trainees are working within their level of competence and take
1) Foundation Post Assessment Forms to be monitored.
The Deanery has reviewed the 2014 NTS results which do not report any Whilst within the last DR significant improvements in the quality of training were reported,
2) Out of hours ward referrals will be via the on-call service at UHW
below outliers in relation to the original concerns around supervision or we have noted a deterioration in the 2015 NTS results. We are liaising with the Health
1) Each F2 is part of an orthopaedic team comprising 3) Induction will be strengthened and a handbook is being developed
workload. However, the results do suggest that the handover process
Board over these concerns and trainee interviews are planned in the next few in order to
several named
4) With the move of West Wing to Llandough there will be more robust requires strengthening as this has been reported as a below outlier. The establish the extent to which additional action needs to be taken.
consultants, 2 SpRs, 2 Fellows, an F2 and a surgical
consultant orthogeriatric cover on a daily basis.
Local Faculty Team are currenty working with the department to review
care
5) Pre and post appraisals will be monitored for areas to be
this and a formal update on progress has been requested. Whilst overall
practitioner.
strengthened
there have been improvements we have not adjusted the RAG rating
The Deanery has written to the Health Board to
The Deanery is in the process of arranging a formal Targeted Visit to
With effect from August 2014 the CMT were removed from the out of
Please refer to issue QA5217 under the Enhanced Monitoring tab for an update on this item.
highlight the training concerns.
discuss the training concerns and ensure that an appropriate action
hours rota at Ysbyty Ystrad Fawr. The CMT trainees continue to access
plan is developed in response to this.
daytime experience at the site but out of hours experience is obtained at
either Nevill Hall Hospital or the Royal Gwent Hospital. The Deanery has
liaised with the Health Board to ensure that an appropriate induction
package has been put in place for for the site where the trainee will be
gaining their out of hours experience. The Deanery will continue to
The following actions have been taken:The Deanery has reviewed the results of the 2014 survey which reports
The Deanery has continued to monitor progress and the 2015 NTS results do not report any
1) The Specialty Training Committee has liaised with
below outliers for clinical supervision and access to educational
below outliers or lower quartile results. In addition, the scores for induction, workload and
the Health Board to try to resolve the concerns
resources. We have contacted the Health Board regarding the results
local teaching have been reported as above outliers.
informally.
and it has been noted that the clinical supervision concerns relate to
2) The Deanery has undertaken a formal Targeted
middle grade rota gaps at the time. As indicated in the April 2014
Visit due to lack of progress.
update the Health Board were in the process of recruiting at the time
3) The Health Board have submitted an action plan
that the trainees were completing the survey. The Health Board have
The Local Faculty Lead originally met with the
A formal Deanery Targeted Visit is being arranged which will include
The Deanery has reviewed the results of the 2014 NTS and has noted an Since the last reporting period the LEP has agreed to provide funding for a Clinical Fellow
department in order to try to identify action points senior Health Board Management so that an effective action plan can
overall improvement in the feedback. The Sub Dean (Quality &
which should further enhance the training experience. The postholder has recently
that would address the concerns highlighted within be developed to address the concerns
Governance) met with the AMD and Programme Director on 15th August commenced and will help address any residual concerns around workload. In relation to
the survey results. Progress was monitored through
2014 in order to consider the latest feedback. At the meeting it was
other general progress handover is no longer reported as a below outlier and and the
trainee interviews which highlighted that the
noted that the training experience could be further enhanced by the
improvement reported in the 2014 NTS results has been sustained. We will continue to
concerns were still ongoing. Whilst there has been
appointment of Clinical Fellows and the Health Board are taking forward monitor the impact of the addtional Clinical Fellow prior to final closure.
engagement from the department it is considered
these plans. The Deanery will continue to monitor the experience with
The following actions have been taken;Further action planning will be dependant upon the outcome of the
The Deanery has reviewed the 2014 NTS results which reports clinical
Within the October 2014 DR we indicated that improvements have been sustatined over an
1) F1 GS Trainee to be moved to Upper GI and
trainee interviews which will provide an indication on the extent to
supervision, workload and educational supervision within the
appropriate period of time and requested closure from the DR. The 2015 NTS results are
Hepatobiliary to help with the workload.
which the action plan has been implemented.
interquartile range. This feedback indicates that the improvements
generally positive with no below outliers being reported. We would therefore support our
2) Embed robust team working in order to share out
made have been sustained and the Deanery has therefore decided to
previous recommendation to close this issue and would be grateful for clarification on what
the workload
close this issue from the DR although monitoring will continue through
further information is required to do this.
3)Introduce a hands free communication system to
routine quality processes.
enable better real time communication between FT's
The following key actions have been put in place :
Arrangements have been made for the trainees to feed back locally
The Deanery has reviewed the results of the 2014 NTS and these indicate The Deanery has continued to monitor progress with the Local Faculty Lead. End of
- Remodelling of one of the wards to provide more
whilst the action plan is being implemented. Following this a more
that the action taken by the specialty has improved the situation with no placement feedback and the 2015 NTS results indicate that the issues have been resolved.
space and provide a better separation of ambulatory formal review will be undertaken to assess progress.
below outliers or results in the lower quartile being reported. Given the We have therefore closed this issue
care from the admissions stream.
improvements we have downgraded the RAG to green. However, the
- Review of tasks undertaken by the juniors to
Deanery will continue to monitor with the specialty lead to ensure that
establish whether there is any scope to review the
this improvement has been sustained prior to final closure.
allocation of duties.
A new area has been developed within the hospital Monitoring the implementation of the Health Boards action plan
The Deanery has reviewed the 2014 NTS results and the patient safety
The Head of School has undertaken a visit to the department in order to monitor the
which brings together all unscheduled care activity
through end of placement feedback
comments and notes that concerns regarding clinical supervision out of implementation of the Health Board's action plan. The findings of this visit indicate that the
i.e. medical admissions, emergency medicine, surgical
hours were raised. The Deanery requested an urgent action plan from
revised supervision arrangements reported in the last DR has addressed the training
admissions and critical care. This measure aims to
the Health Board who have reported that with effect from August 2014
concerns. 2015 GMC NTS results do not indicate ongoing concerns and the above outlier for
improve the experience of the foundation trainees
the foundation doctors have been withdrawn from out of hours activity. overall satisfaction has been noted and there are no concerns around clinical supervision.
and enhance the supervision arrangements.
During the daytime the trainees will have direct supervision from a more The Deanery has de-escalated the issue to amber and will consider closure once there is
senior member of staff in the department. The Head of School of
evidence that the improvements have been sustained.
The GP Programme Director will be undertaking an
Update on the GP Programme Directors investigation to be obtained.
The Deanery has reviewed the results of the 2014 NTS and these indicate The GP Programme Director has linked with the department in order to take forward the
investigation to review the concerns locally and in
that there may have been a deterioration in the overall quality of
concerns locally. Progress has been monitored through trainee feedback and the following
the event that further evidence validating the end of
training with below outliers being reported for clinical supervision,
points were noted through this:
placement concerns are identified and that local
handover, local teaching, and study leave. In addition induction was
solutions cannot be identified then the matter will
reported in the lower quartile. The latest end of placement feedback
- Teaching was reported to be in place two to three times a week and that study leave
be escalated to the Quality Unit.
results also indicates that new concerns have been raised. The Deanery available provided it is applied for in time.
has asked the GP Programme Director and the Local Faculty Lead to
- Supervision was reported to be adequate with seniors easy to reach.
The Deanery is bringing together common lessons
The Deanery will continue to manage the training concerns at specific
The Deanery has reviewed the 2014 NTS results which provide mixed
The Deanery has reviewed the results of the 2015 survey and notes that clinical supervision
from managing training concerns at specific sites,
sites and escalate the concerns to the Welsh Government.
feedback. The most persistent concerns relate to the Royal Glamorgan
and handover are no longer a below outlier on a Deanery wide perspective although there
(e.g. the Royal Glamorgan Hospital see DR ref
Hospital and these are reported separately under enhanced monitoring are still ongoing challenges relating to workload and feedback. The Deanery continues to
WAL0413-5). These will be brought together and fed
item 83. The Deanery has noted that in some areas a below outlier for
manage site specific issues and the recent withdrawal of foundation trainees from the Royal
into a meeting with the Head of Unscheduled Care
workload has been reported and has sought confirmation that there are Glamorgan Hospital is likely to result in an improvement in future results. In addition we
within Welsh Government.
appropriate structures in place for the trainees to ensure that they are
will take forward any concerns reported in the 2015 survey. Given the improvement in the
appropriately supported. A series of school visits to specific sites are
clinical supervision and handover scores we have downgraded the RAG rating.
The Health Board has reported that there are
Monitoring
The Deanery undertook a further Targeted Visit on 16th October 2014.
This issue was escalated to Enhanced Monitoring in the October 2014. However, since then
general challenges around the sustainability of
At the visit the following key points were noted:
significant progress has been made and this is no longer required. The Deanery undertook a
middle grade rotas in surgery with many locums
- Whilst there was resident on site supervision in place the lack of a
further Targeted Visit on 30th April and signigicant improvements in the quality of training
currently in place. The reconfiguration changes is
middle grade tier resulted in the potential for trainees to be working
were noted. The introduction of a middle grade tier through the appointment of addition
anticipated to address some of these issues. Local
beyond their level of competence.
clinical fellows had been a key factor in improving the support available to trainees. In
strategies looking at reduction in operating lists and
- Shift patterns were out of sync with that of the higher trainees resulting addition, the Health Board had taken steps to synchronised the shift patterns so that all
clinics have also been explored. Trainee interviews
in them being unable to participate in evening handover.
trainees could participate in the evening handover. Quality control mechanisims to
The Deanery has raised the concerns with the Health Ongoing monitoring.
The Deanery has reviewed the results of the GMC Survey which indicates The Deanery undertook a Targeted Visit on 1st June 2015 due to concerns over progress. At
Board who have reported that that the issues have
that there has been a deterioration in the training experience. Faculty
the visit the following key concerns were identified:
been discussed with the Clinical Director and the
Leads discussed with Training Programme Director on 11th June 2014 this - No concerns around undermining were raised. However, a need to enhance the lines of
General Paediatric Consultants and has confirmed
included the discussion on the training issues identified through the NTS communication between the Consultant body and the trainees was noted to ensure that
that the trainees are never expected to work outside
results and the undermining issues were discussed. Action plans are:
there are sufficient opportunities to engage in change management processes.
of their competence. There is always senior help
• Faculty lead is to present the trainee concerns on undermining at the
- A lack of leadership for education and training within the department although it should
available including consultant help. The ability to
trainers committee meeting in the ED. And training is available for
be noted that since the visit a College Tutor has been appointed.
The Deanery has raised the concerns with the Health The Foundation Programme Director is monitoring progress locally.
The Deanery has reviewed the results of the 2014 NTS which does not
The Deanery has continued to monitor progress and given the particualrly postive 2015 NTS
Board who have reported that the concerns have
report any below outliers or results in the lower quartile. The Deanery
feedbacck for GIM at the site we have closed this issue.
arisen due to unprecented gaps in the middle grade
would like to continue to monitor the training experience for a period of
rota due to sickness. The Health Board did make
time to ensure that this improvement is sustained.
attempts to obtain locum cover but this was not
always successful and therefore arrangements were
made for the consultants to be more accessible to
The Deanery has raised the concerns with the Health Monitoring the implementation of the Health Boards action plan
The Deanery has reviewed the survey results and liaised with the Health The Deanery has continued to monitor progress and notes that the results of the 2015 NTS
Board who have reported that the following actions through end of placement feedback
Board to address the concerns. As part of this process we have been
report an improvement in some areas with clinical supervision and handover being reported
are in place:advised that middle grade rotas were reconfigured during August 2014 to within the interquartile range. We note that workload has been reported as a below outlier
- An unscheduled care improvement plan has been
ensure that there was a middle grade presence in the department
and this is being reviewed locally in order to establish the extent to which this is impacting
developed and is to be ratified by the Executives.
overnight in order to improve the level of clinical supervision and
upon the training experience so that an action plan can be developed.
- Additional Consultant appointments have been
workload concerns. Consultant led board rounds are in place at least
sanctioned in order to extend the hours of
three times a day.
The Deanery has raised the concerns with the Health The Health Board plan on having a further meeting to discuss the
The Deanery has reviewed the results of the 2014 NTS which do not
The Deanery has continued to monitor progress and no further concerns regarding the
Board who have provided the following response:concerns.
report any below outliers and the score for regional teaching is within
senior review of patients have been identified.
the inter-quartile range. In addition, no further concerns regarding the
The Obstetrics & Gynaecology department is aware
senior review of patients have been noted. The Deanery has reduced
that senior review of emergency cases has not always
the RAG rating but would like to continue to monitor this issue through
been timely. Although a mechanism for senior review
epef's and the School of Obstetrics & Gynaecology for a period of time
has been in place for some time the Health Board
prior to considering final closure to ensure that the improvements are
The Deanery has shared the concerns with the
The Deanery has continued to monitor the concern and no further
The Deanery has reviewed the 2015 NTS which report above outliers in relation to Overall
Health Board who have provided the following
concerns have been identified. Given that the improvements have been Satisfaction, Handover and Access to Educational Resources. Whilst the foundation report
response:sustained the Deanery has closed this issue.
reports a below outlier for workload we are satisfied that generally the training
environment is supportive and that the trainees have access to appropriate supervision.
The Health Board has acknowledged the seriousness
We note the GMC's feedback in relation to the 2014 DR which referred us to a free text
of the patient safety concern, and has experienced
comment. This comment was classified by the Deanery as being a service issue which we
an unprecedented period of pressure on their
have no jurisdiction over and we have therefore asked the Health Board to feed into their
The Deanery has raised the concerns with the Health The Deanery will continue to liaise with the Health Board about the
The Deanery has continued to monitor the training experience and this
Issue closed no below outliers reported for two consecutive years in the NTS
Board who have provided the following response:plans for service reconfiguration and in particular the timelines
feedback confirms that the training experience is positive. This
associated with this.
supported by the findings of the 2014 NTS which does not report any
The Health Board has reported that the
below outliers and the results for clinical supervision are within the
development of respiratory services at the University The Health Board has also investigated concerns that foundation
interquartile range.
Hospital of Wales has resulted in a marked increase trainees are the only person on the ward and their investigation has
in workload for Respiratory Medicine due to
not substantiated this. The Health Board have assured the Deanery
Concerns ONLY - Date
item was resolved
(DD/MM/YY)
06/01/2015
Concerns ONLY - Status
Person responsible
Name and describe engagement with college/faculty/medical school or other
healthcare regulators (if any)
Sub Dean, Quality
None
BSSU Manager
None
Concerns ONLY - RAG
at the time of
current report
Stage 3c: Concerns over Progress - The
action plan has fallen behind or is likely to
fall behind.
Red*
01/07/2015
06/01/2015
01/07/2015
Stage 4: Closed – Solutions are verified,
evidence that there has been sustained
improvement over an appropriate time
period.
Green
Stage 3c: Concerns over Progress - The
action plan has fallen behind or is likely to
fall behind.
Foundation Programme The Deanery has made Cardiff Medical School aware of the concerns through
Director
sharing routine risk reports. As part of this process we have extended an
invitation to discuss any common concerns with us.
Red
01/07/2015
01/06/2015
07/01/2016
08/01/2015
30/07/2016
Stage 4: Closed – Solutions are verified,
evidence that there has been sustained
improvement over an appropriate time
period.
Green
Stage 3b: Monitoring Progress – Actions
are being implemented, and there is
evidence of improvement through
monitoring.
Amber
Stage 4: Closed – Solutions are verified,
evidence that there has been sustained
improvement over an appropriate time
period.
Green
Stage 2: Implementing Solutions – Action
plans/plans for improvement are in place,
but are yet to be fully implemented and
evaluated.
30/07/2016
Anaesthetics Head of
School
Royal College of Anaesthetists. The Royal College Regional Advisor was part
of the Deanery Visit panel and the Deanery met with the College Tutors
during the visit.
Deanery Anaesthetics
Specialty Lead
Royal College of Anaesthetists. The Royal College Deputy Regional Advisor
was part of the Deanery panel during the visit and the Deanery also met with
the College Tutor during the visit process.
Psychiatry Specialty
Lead
The Royal College of Psychiatrists Regional Advisor receives copies of the
Deanery's quarterly risk reports with an invitation to participate in action
planning process.
Sub Dean, (Quality &
Governance)
The Deanery has made Cardiff and Swansea Medical Schools aware of the
concerns through sharing routine risk reports. As part of this process we
have extended an invitation to discuss any common concerns with us.
The Royal College of Radiologist Regional Advisor has been involved in the
action planning process.
Red
Stage 3c: Concerns over Progress - The
action plan has fallen behind or is likely to
fall behind.
STC Chair
Royal College of Physicians. The Deanery provides the Royal College Regional
Advisor with a copy of its quarterly risk reports with an invitation to
participate in action planning on specific issues if they wish to do so.
Red
06/01/2016
Stage 3c: Concerns over Progress - The
action plan has fallen behind or is likely to
fall behind.
Sub Dean, (Quality &
Governance)
01/05/2015
Stage 3a: Progress not yet apparent –
there is no change as of yet, but there
continuing monitoring and evaluation of
actions.
Red*
Stage 4: Closed – Solutions are verified,
evidence that there has been sustained
improvement over an appropriate time
period.
Green
The Deanery has made Cardiff Medical School aware of the concerns through
sharing routine risk reports. As part of this process we have extended an
invitation to discuss any common concerns with us.
Not at this stage
Red
01/06/2015
Sub Dean, Quality &
Governance
http://crm/epublicsector_enu/start.swe?SWECmd=GotoView&SWEView=Acti
vity+Attachment+View&SWERF=1&SWEHo=crm&SWEBU=1&SWEApplet0=GM
C+Activity+Form+Applet+-+EDU&SWERowId0=1HPMKM5&SWEApplet1=Activity+Attachment+Applet&SWERowId1=1HPMKM7
Sub Dean, Quality &
Governance
The Deanery has made Cardiff Medical School aware of the concerns through
sharing routine risk reports. As part of this process we have extended an
invitation to discuss any common concerns with us.
The Royal College Regional Advisor was on the Deanery visit panel.
20/04/2015
01/08/2014
08/01/2014
30/04/2015
30/07/2015
30/07/2015
01/06/2015
30/04/2015
01/08/2015
01/06/2015
Stage 3b: Monitoring Progress – Actions
are being implemented, and there is
evidence of improvement through
monitoring.
Green
Stage 4: Closed – Solutions are verified,
evidence that there has been sustained
improvement over an appropriate time
period.
Green
Stage 4: Closed – Solutions are verified,
evidence that there has been sustained
improvement over an appropriate time
period.
Green
Stage 3b: Monitoring Progress – Actions
are being implemented, and there is
evidence of improvement through
monitoring.
Amber
Stage 4: Closed – Solutions are verified,
evidence that there has been sustained
improvement over an appropriate time
period.
Green
Stage 3b: Monitoring Progress – Actions
are being implemented, and there is
evidence of improvement through
monitoring.
Amber
Stage 3b: Monitoring Progress – Actions
are being implemented, and there is
evidence of improvement through
monitoring.
Amber
Sub Dean, Quality &
Governance
The Deanery has made Cardiff Medical School aware of the concerns through
sharing routine risk reports. As part of this process we have extended an
invitation to discuss any common concerns with us.
Sub Dean, Quality &
Governance
The Deanery has made Cardiff Medical School aware of the concerns through
sharing routine risk reports. As part of this process we have extended an
invitation to discuss any common concerns with us.
Sub Dean, Quality &
Governance
The Deanery has made Cardiff Medical School aware of the concerns through
sharing routine risk reports. As part of this process we have extended an
invitation to discuss any common concerns with us.
Sub Dean Quality &
Governance
None at this stage.
GP Programme Director
Stage 3c: Concerns over Progress - The
action plan has fallen behind or is likely to
fall behind.
Sub Dean, Quality &
Governance
The Deanery has made Cardiff Medical School aware of the concerns through
sharing routine risk reports. As part of this process we have extended an
invitation to discuss any common concerns with us.
Sub Dean, (Quality &
Governance)
None at this stage.
Sub Dean, (Quality &
Governance)
No
Red
01/07/2015
18/08/2015
07/01/2015
01/07/2015
01/08/2014
01/06/2014
Stage 4: Closed – Solutions are verified,
evidence that there has been sustained
improvement over an appropriate time
period.
Green
Foundation Programme No
Director
Stage 3b: Monitoring Progress – Actions
are being implemented, and there is
evidence of improvement through
monitoring.
Green
Stage 4: Closed – Solutions are verified,
evidence that there has been sustained
improvement over an appropriate time
period.
Green
Stage 4: Closed – Solutions are verified,
evidence that there has been sustained
improvement over an appropriate time
period.
Green
Stage 4: Closed – Solutions are verified,
evidence that there has been sustained
improvement over an appropriate time
period.
Green
Sub Dean, Quality &
Governance
No
Head of School of
Obstetrics &
Gynaecology
No
Sub Dean, (Quality &
Governance)
No
Sub
WAL1014-06
Velindre NHS Trust
Holme Tower Marie Curie Hospice
1 WAL398
Palliative medicine
Palliative medicine
Concern
As indicated in the October DR feedback letter, a triple red item has been found in the
area of handover and has been added as a new item for investigation.
06/01/2014
GMC NTS Outliers
Amber
WAL1014-07
Cardiff & Vale University Lhb
University Hospital of Wales
5; 2
WAL467
Paediatrics
Paediatrics
Higher
Concern
Concerns that longstanding rota gaps are impacting upon the overall training experience
and trainees requested to cover shifts at short notice. Patient safety feedback reported in
the free text comments of the survey.
13/12/2013
Trainee complaints
Trainee letter
Amber
WAL1014-08
Cardiff & Vale University Lhb
University Hospital of Wales
1; 6
WAL2239
Foundation Programme
Emergency Medicine
Foundation
Concern
Adverse NTS results with below outliers being reported for clinical supervision, handover,
workload, access to educational resources and study leave.
01/06/2014
GMC NTS Outliers
Red
WAL1014-09
Cardiff & Vale University Lhb
University Hospital of Wales
5 WAL2239; WAL377
Core Medical Training; Foundation Programme
Cardiology
Foundation; Core
Concern
Concerns around the lack of experience due to service pressures.
08/06/2013
Trainee complaints
Amber
WAL1014-10
Cardiff & Vale University Lhb
University Hospital of Wales
6 WAL409
Ophthalmology
Ophthalmology
Higher
Concern
The following issues have been identified though a training programme visit:
Deanery Monitoring Visit
• There is a need for developmental support in trainee interaction (and feedback in
particular).
• Difficulties in obtaining experience in specific areas due to service pressures.
• Variable levels of Consultant support in the eye casualty.
WAL1014-11
Betsi Cadwaladr University Lhb
Ysbyty Glan Clwyd
6 WAL376
Obstetrics and gynaecology
Obstetrics and gynaecology
Higher
Concern
Concerns that significant rota gaps are impacting upon the training experience.
Trainee feedback obtained through a
specialty visit.
Red
18/10/2013
Trainee complaints
Green
WAL1014-12
WAL1014-13
Betsi Cadwaladr University Lhb
Abertawe Bro Morgannwg University Lhb
Ysbyty Gwynedd
Princess of Wales Hospital
1; 6
1; 6
WAL434
WAL428
General Practice
General Practice
General psychiatry
Obstetrics and gynaecology
Higher
GP
Concern
Concern
(TP141)
Below outliers for overall satisfaction, clinical supervision and educational supervision
reported in the 2014 NTS. These concerns have been triangulated through end of
placement feedback.
07/01/2014
Below outliers for clinical supervision, handover, local teaching and study leave
01/06/2014
GMC NTS Outliers
Red
GMC NTS Outliers
Red
WAL1015-01
28/08/2014
(TP211)
NTS below outliers for Clinical Supervision
01/10/2014
Green
Stage 4: Closed – Solutions are verified,
evidence that there has been sustained
improvement over an appropriate time
period.
Green
Stage 4: Closed – Solutions are verified,
evidence that there has been sustained
improvement over an appropriate time
period.
Green
The Regional Advisor is aware of the concerns and is involved in the action
planning process. In addition, the local College Tutor has been key in
ensuring the resolution of concerns locally.
Associate Dean, Quality No
GP Programme Director
GP Programme Director None at this stage.
Not applicable
Not applicable.
WAL1015-14
Betsi Cadwaladr University Lhb
Health Board wide
6 All
All
All
All
Good
practice
The Health Board has recognised that the provision of a robust induction for out of sync
trainees is a particular challenge. In order to address this the LEP has taken steps to video
the main induction for out of sync trainees to review at a later dae. This measure helps to
ensure that trainees are being provided with consistent information regardless of when
they rotate. This initiative is being disseminated to other Health Boards across Wales.
01/10/2015
Other
Commissioning self reporting
Not applicable
Not applicable
Not applicable.
See column J
AMD (Education)
None
WAL1015-15
Cwm Taf Lhb
Health Board wide
6 All
All
All
All
Good
practice
The Health Board undertaken an annual consent audit in order to monitor comliance with
the consent policy. Following the review actions are identified in order to ensure that
consent is taken appropriately which ulitmately can only have a positive impact upon
patient safety.
10/01/2015
Other
Commissioning
Not applicable
Not applicable
Not applicable.
See column J
Medical Director
None
WAL1015-16
Hywel Dda Lhb
Health Board wide
6 All
All
All
All
Good
practice
The Health have significant geographic challenges in relation to service delivery but the proactive approach of Senior Health Board management in ensuring that training is built into
service reconfiguration is beneficial in the longer term recruitment challenges.
19/10/2015
Other
Commissioning
Not applicable
Not applicable
Not applicable.
See column J
Medical Director
None
WAL1015-17
Aneurin Bevan Lhb
Health Board wide
6 All
All
All
All
Good
practice
The Health Board have developed a comprehensive Trainer database which not only
records all Named Educational and Clinical Supervisors but also contains their cpd record
as well as other education related activity including involvement in ARCP & recruitment
processes. This development has recently been presented to other Health Board's at an All
Wales Local Faculty Meeting.
19/10/2015
Other
Local Faculty Meeting
Not applicable
Not applicable
Not applicable.
See column J
Local Faculty Lead
None
WAL1015-18
Velindre NHS Trust
Velindre Hospital
6 WAL377; WAL425; WAL433;
WAL398; WAL394; WAL461
Clinical oncology; Clinical radiology; Core
Medical Training; General Practice; Palliative
medicine; Medical oncology
Clinical oncology; Clinical radiology;
Medical oncology; Palliative medicine
All
Good
practice
The Trust has a Junior Medical Workforce Group which is chaired by the Clinical Director
and was established to address specific issues with CMT and GP training. The group is
attended by other groups including managerial and administrative staff, finance, and a
senior nurse. This ensure that training provision is appropriately prioritised and has
resulted in the swift resolution of trianing concerns.
10/01/2015
Other
Commissioning
Not applicable
Not applicable
Not applicable.
See column J
Medical Director
None
WAL1015-19
Betsi Cadwaladr University Lhb
Ysbyty Glan Clwyd
1 WAL2239; WAL430
Foundation Programme; General Practice
General surgery
Foundation; GP
Concern
(TV183)
Difficulties with ensuring effective handover due to communication challenges and
potential implications for patient safety as a result.
26/10/2015
Other
Head of School Visit
See October 2015 update.
See October 2015 update
Not applicable.
The Deanery has escalated the concerns to the Medical Director given the potential
implications for patient safety. In addition, the Local Faculty Team are liaising with the
department in order to take forward the concerns. The Deanery Quality Unit are also
currently arranging a Targeted Visit in order to monitor progress.
Sub Dean, (Quality &
Governance)
Feedback was sought from the College Tutor as part of the visit
Not applicable.
Amber
GMC NTS Outliers
See October 2015 update.
See October 2015 update.
Not applicable.
Red
GMC NTS Outliers; Deanery Monitoring Visit
See October 2015 update.
See October 2015 update.
Not applicable.
Amber
GMC NTS Outliers; Foundation School LEP Visit
GMC Survey and local trainee interviews.
See October 2015 update.
See October 2015 update.
Not applicable.
Amber
WAL1015-06
Betsi Cadwaladr University Lhb
Ysbyty Glan Clwyd
6; 1
WAL2239; WAL434
Foundation Programme; General Practice
Emergency Medicine
Foundation; GP
Concern
(TV114)
. Concern regarding the suitability of the training environment, lack of appropriate
supervision and an emphasis upon service provision due to gaps in the rota.
18/05/2009
Training Programme Director visits
See October 2015 update.
See October 2015 update.
Not applicable.
Red
WAL1015-07
WAL1015-08
WAL1015-09
WAL1015-10
Cardiff & Vale University Lhb
Cwm Taf Lhb
Hywel Dda Lhb
Hywel Dda Lhb
Whitchurch Hospital (Cardiff)
6 WAL460; WAL2239; WAL433;
WAL478
Prince Charles Hospital Site
West Wales General Hospital
6 WAL376
6; 5
West Wales General Hospital
WAL467; WAL2239; WAL431
1 WAL2239
General psychiatry; Core Psychiatry Training;
General Practice; Foundation Programme
Obstetrics and gynaecology
Paediatrics; Foundation Programme; General
Practice
Foundation Programme
General psychiatry
Obstetrics and gynaecology
Paediatrics
Trauma and orthopaedic surgery; General
surgery
Core
Higher
All
F2
Concern
Concern
Concern
Concern
(TP142)
- Free text comments ref: 1-1121515007, 1-1139599084, 1-1139598975, 1-1143659317, 11145200376, 1-1145200544, 1-1146448646, 1-1149977894, 1-1149978046, 1-1155142277, 11155142575
- 2015 GMC Survey Results: CPT shows below outliers for Handover, Supportive
Environment, Local Teaching and Regional Teaching as well as lower quartile for Overall
Satisfaction, Induction, Adequate Experience, Feedback and Study Leave.
(TP243)
-Below Outliers for Overall Satisfaction and Handover, lower quartile for Clinical
Supervision, Clinical Supervision Out of Hours, Induction, Adequate Experience, Suppotive
Environment and Feedback.
01/07/2013
(TP229)
- End of placement feedback highlighted organisational challenges related to training
recongiguration. Specific difficuties include a lack of team working, difficulties in ensure
trainees could obtain relevant experience.
01/10/2014
(TV179)
- NTS outliers for clinical supervision and overall satisfaction.
18/05/2009
Trainee complaints
Targeted visit took place on 2 April 2015. August
2015: LFL met with trainees on 24th July to discuss
concerns following Deanery Targeted Visit in April.
See October 2015 update
Not applicable.
Red
07/01/2014
GMC NTS Outliers
See October 2015 update.
See October 2015 update
Not applicable.
Amber
Deanery Survey
See October 2015 update.
See October 2015 update.
Not applicable.
Amber
GMC NTS Outliers
See October 2015 update.
See October 2015 update
Not applicable.
Red
WAL1015-11
WAL1015-12
Hywel Dda Lhb
Hywel Dda Lhb
St Davids Hospital
Withybush General Hospital
6; 1
WAL459
6 WAL377
General Practice
Core Medical Training
General psychiatry
General (internal) medicine;
Gastroenterology
GP
Core
Concern
Concern
(TP143) 2015 GMC Survey Results: Prog Report: Below Outliers for Overall Satisfaction,
Clinical Supervision, Handover, Adequate Experience, Workload and lower quartile for
Clinical Supervision Out of Hours and Access to Educational Resources.Post Speciality:
Below Outliers for Handover and Local Teaching and lower quartile for Overall Satisfaction,
Clinical Supervision, Clinical Supervision Out of Hours, Workload and Feedback.
01/10/2013
(TP034)
- Rota challenges impacting upon the availability of appropriate clinical supervision.
18/11/2010
GMC NTS Outliers
See October 2015 update.
See October 2015 update
Not applicable.
Red
Deanery Survey
See October 2015 update.
See October 2015 update
Not applicable.
Red
Red
01/07/2016
Stage 4: Closed – Solutions are verified,
evidence that there has been sustained
improvement over an appropriate time
period.
AMD (Education) &
Specialty Training
Committee Chair
Not applicable
Concern
(TP196)
2015 GMC survey showed below outliers for Overall Satisfaction, Clinical Supervision,
Adequate Experience, Supportive Environment and Educational Supervision. Lower
quartile for Clinical Supervision Out of Hours and Induction. Trainee feedback from other
sources has also identified challenges with limited exposure to Obstetrics and too much
Gynae experience.
See October 2015 update.
01/06/2015
21/09/2015
Green
None at this stage.
Commissioning self reporting
F1; F2
Concern
01/10/2014
School report
See October 2015 update.
Not applicable.
01/07/2015
01/08/2014
Stage 3b: Monitoring Progress – Actions
are being implemented, and there is
evidence of improvement through
monitoring.
Sub Dean Quality &
Governance
Other
General surgery
GP
(TP212)
NTS below outliers for Clinical Supervision Out of Hours and Handover. Lower Quartile for
Overall Satisfaction, Clinical Supervision, Induction, Supportive Environment, Feedback and
Local Teaching (CPT), Below Outlier for Handover and lower quartile for Clinical Supervision
Out of Hours (GP) and no indicators below average (Psychiatry F2).
20/02/2014
Targeted visit if no further improvement
01/04/2015
Green
No
10/01/2015
Foundation Programme
Obstetrics and gynaecology
Concern
Green
Trainees were moved away from Ward 19 while
improvements were made and reinstated once new
nurse based practitioner and Ward Based Registrar
were appointed to provide addiotnal support to
trainees.
Could this issue be closed as there appears to have been a duplication. The appropriate
update is reported under item WAL1013-05. Apologies for any confusion.
01/06/2015
Stage 3b: Monitoring Progress – Actions
are being implemented, and there is
evidence of improvement through
monitoring.
Sub Dean Quality &
Governance
The Trust has a Significant Clinical Incident Forum (SCIF) which is an award winning group
that examines incidents and near misses to identify and disseminate learning points in a
supportive way. The Deanery has noted that the Trust received an above outlier in the
2015 NTS under the 'Supportive Environment' indicator which indicates taht trainees feel
comfortable raising issues of concern.
6 WAL2239
General Practice
All
GMC NTS Outliers; Training Programme Director visits
The Deanery has continued to monitor progress and no further concerns have been
identified either through the NTS or local monitoring. We would therefore request closure
of this issue.
01/06/2015
Green
Good
practice
Royal Gwent Hospital
WAL426
General psychiatry
Concern
06/01/2013
The Deanery held a further Targeted Visit on 11th June 2015 which was informed by trainee
interviews on the day as well as other evidence sources. The following key points were
noted:
- That two additional Clinical Fellows had been introduced into the department and this has
resulted in a significant improvement in the training experience for both foundation and
core trainees. The trainees reported that the main benefit of the additional appointments
was a better balance between service and training provision and the Deanery noted that the
The Deanery have continued to monitor progress and notes the positive results of the 2015
NTS. In addition the Local Faculty Lead has undertaken interviews with the trainees in
order to monitor progress and the following key points were noted:
- That the trainees had access to a wide range of experience at the site.
- No undermining concerns were reported.
- That the induction programme had been improved and was considered by the trainees to
be comprehensive.
The trainees were withdrawn from Ysbyty Glan Clwyd in August 2014. We would therefore
like to close this issue. Any concerns regarding Obstetrics & Gynaecology training at other
sites within the Health Board will be reported as separate issues.
Stage 4: Closed – Solutions are verified,
evidence that there has been sustained
improvement over an appropriate time
period.
Sub Dean Quality &
Governance
All
1; 6
General psychiatry
Core
(TP125):
• A heavy workload which had an emphasis upon service provision to the detriment of
training provision.
• Patient safety concerns with reports that the trainees are making decisions beyond their
level of competence.
• Difficulties in releasing the trainees to attend teaching.
• Limited ward based teaching and a general lack of educational value within the post.
(TP184)
- Concerns regarding the balance of out of hours experience and inadequate access to
obstetric anaesthesia out of hours.
- 2015 GMC Survey Results: Programme ST Report: lower quartile for Clinical Supervision
Out of Hours. Core Anaesthetics Specialty Report: Below Outliers for Clinical Supervision
and Clinical Supervision Out of Hours.
The Deanery held a Targeted Visit on 19th May and the following key
points were noted:
- That the induction arrangements to ensure that they incorporated
guidance on how, where and when to contact consultants.
- That lines of communication would be strengthened and processes
introduced to ensure that there was a common awareness of patient
management plans.
The Deanery have liaised with the Health Board and the following
actions are being taken forward.
• The Health Board agree that there is a need for developmental
support in trainee interaction (and feedback in particular).
o (LFL for Trainers) will deliver an extensive session to all consultants on
“improving feedback to trainees with difficulties”: This will be delivered
on 7th November 2014.
The Deanery has undertaken a series of meetings with the Health Board
through its Targeted Process. Through this it has been noted that there
are major gaps in the rota which is impacting upon the training
experience. The trainees have reported that last minute rota changes to
cover service are common and there are difficulties in gaining any
meaningful clinic experience due to long travelling times. During the
process the Health Board have advised the Deanery of their intention to
The Deanery has raised the issue with the Health Board who have
reported that GP trainees will not be on call for the first two weeks to
enable them to gain an awareness of the way the Psychiatric service
operates. There is a tier of consultants covering psychiatric services
across the Health Board out of hours to provide trainees with advice. In
addition, the trainees have a weekly opportunity to discuss on call
experiences and additional nursing staff are being appointed and a 24
The Deanery has triangulated the survey results with end of placement
feedback which highlight difficulties with access to bleep free teaching
and some supervision concerns. The GP Programme Director is currently
liaising with the department in order to investigate the survey results
and work to identify solutions.
Green
Clinical oncology; Clinical radiology;
Medical oncology; Palliative medicine
Royal Gwent Hospital
6 WAL460
Anaesthetics
Concern
30/06/2016
Stage 3b: Monitoring Progress – Actions
are being implemented, and there is
evidence of improvement through
monitoring.
No
Clinical oncology; Clinical radiology; Core
Medical Training; General Practice; Palliative
medicine; Medical oncology
St Cadocs Hospital
Core Anaesthetics Training
GP
Duplicate entry, please refer to issue WAL1013-14 for update as the same issues apply
across all grades of trainees. We would be grateful if this issue could be closed and all
further DR updates provided under WAL1013-14.
Sub Dean (Quality &
Governance)
6 WAL377; WAL425; WAL433;
WAL398; WAL394; WAL461
Aneurin Bevan Lhb
5 WAL370
Geriatric medicine
30/06/2015
Amber
Trust-wide
WAL1015-05
Aneurin Bevan Lhb
Princess of Wales Hospital
General Practice
The Deanery met with the Health Board on 27th January 2015 in order to review progress.
The following key points were noted at this meeting:
- Significant progress in ensuring a fully staffed rota has been made with Tier 1 and " rota
having a full compliment of staff.
- Trainee feedback undertaken by the Local Faculty Team indicated that the undermining
concerns had been addressed.
Stage 2: Implementing Solutions – Action
plans/plans for improvement are in place,
but are yet to be fully implemented and
evaluated.
Velindre NHS Trust
WAL1015-04
Aneurin Bevan Lhb
6 WAL428
07/01/2016
WAL1015-13
WAL1015-03
Abertawe Bro Morgannwg University Lhb
Princess of Wales Hospital
The Deanery has continued to liaise with the Trust regarding the handover concerns
emphasising the need to address this. As a consequence the Trust has recently undertaken
a review of the handover process with support from the Information Governance Lead.
Following this review the Trust has introduced written guidance around handover. The
Deanery will continue to monitor progress and will raise the issue at a senior level through
the forcoming Commissioning Visit.
The Deanery's initial concerns related a below outlier for local teaching and following our
investigation into this we subsequently received assurance that all trainees were able to
attend. However, a deterioration was reported which raised concerns over the level of
clinical supervision and an emphasis upon service provision. The Deanery has raised these
concerns with the Health Board and the LEP has confirmed that the supervision
arrangements have been changed and the trainees have confirmed that there has been an
improvement noted. We will continue to monitor progress on the educational value of the
The Deanery has reviewed the concerns with the LEP and steps have been taken to amend
the rota. The revised rota would involve be to rotating the core trainees to cover 1 extra
evening ITU shift in 8 weeks and receive a half day back as compensation. They would still
be on a 1:8 rota, have one half day daytime session less in 8 weeks. In relation to the
concerns raised through the GMC NTS meetings have taken place between the ITU Lead and
trainees to identify areas for improvement. A weekly ITU teaching session and forum to
discuss case management is being implemented and options to improve the out of hours
The Local Faculty Team have met with the trainees to discuss the survey results and an
action plan has been submitted in response to the concerns. The following key points have
been noted:
- Need for clarity on who was providing daytime supervision. The Health Board are taking
steps to enhance the transparency around the chains of supervision.
- Whilst handover was reported to take place during the weekend there was some concern
around the weekend arrangements.
The Local Faculty team has met with the trainees in order to discuss the survey results and
the following concerns were noted:
- Inadequate exposure for GP trainees.
- Diffuculties completing WPBA's
- Difficulties in accessing clinics and teaching sessions.
- Variable middle grade supervision.
The Health Board have outlined processes for the trainees to access clinics and the rota has
The Local Faculty Team have met with the trainees to discuss the survey results and
expressed concern that as theatre lists started early and finished late trainees had to work
longer hours in order to ensure that there was a senior review of patients. Trainees also
raised concern around rota gaps and late notification of shift patterns as well as expressing
concern that the teaching programme was not directly relevant to the trainees. The
following actions have been put in place:
- Teaching programme is being reviewed in order to ensure that it is relevant to foundation
The Head of School undertook a visit to the site on 13th March 2015 and the following key
concerns were identified at this:
- Lack of appropriate supervision due to rota gaps.
- Empahsis upon service provision.
Since the visit the LEP has submitted an action plan to address the concerns with the
following key points being noted:
- Improvements in supervision have been reported with dedicated Consultant slots
The Deanery undertook an initial Targeted Visit on 2nd April 2015 in order to investigate the
concerns. Trainee and trainer interviews were undertaken as part of this and a follow up
visit was undertaken on 7th October 2015 in order to monitor progress. The following key
points should be noted following these meetings:
- That a review of the working relationships within the department had been undertaken
since the initial Targeted Visit with an improvement in this area being noted on 7th October
2015. However, it was recommended that there was scope to further improve the training
The Deanery has liaised with the Health Board over the concerns reported in the NTS.
Through this we have established that the primary cause for the concerns were rota gaps
arising from maternity leave and difficulties with recruitment. The Health Board has taken
steps to engage the trainees in the rota arrangements to ensure that training opportunities
can be maximised and has been regularly monitoring the training experience. The Health
Board have confirmed that the rota gaps have been resolved and since the concerns were
identified rotas have been centralised on a single site, (Prince Charles Hospital). The
End of placement feedback from highlighted organisational challenges following
reconfiguration. The Deanery met with the LEP on 7th July and 15th October and the main
points arising from these meetings are outlined below:
- The trainees reported difficulties in accessing a consultant to undertake formal
assessments. The LEP has taken steps to introduce a Consultant of the week who is always
avaialble to the trainees.
- The trainees reported that they were working a 13 week rota and it was therefore difficult
The has identified a trend of below outliers reported in the NTS for foundation surgical
trainees and a Deanery Targeted Visit was undertaken to investigate this in November 2014
and the key points from this and progress since the visit are outlined below:
- Whilst the trainees had access to support from five seniors there was a lack of clarity
around the reporting arrangements. The Health Board have provided confirmation that the
chains of supervision are clarified at induction.
- Insufficient induction to provide cross cover for surgical sub specialties at night. The
The Local Faculty Team have investigated the survey results and the results of this highlights
that whilst the majority of trainees were satisfied there were difficulties with a particular
post. The LEP have made changes to the timetable for the particular post and it has been
split into Community and Ward commitments. The revised arrangement for the post are
being monitored by the GP Programme Director. In addition, a Junior Doctors
Representative has been identified and a supervision recording system has been put into
place to ensure that this is occuring and to monitor the quality of supervision.
The Deanery has identified concerns with the availability of appropriate clinical supervision
for the core trainees in March 2015 due to recrutiment challenges. The Deanery took urgent
steps to liaise with the Medical Director of the LEP to ensure that a temporary solution was
implemented to address the immediate challenge thereby addressing any patient safety
concerns. However, the identification of a longer term solution is part of an ongoing
discussion with the LEP and will be raised at the forthcoming Commissioning Visit. However,
it should be noted that as a result of a particualry challenging CMT recruitment round this
See column J
WAL1015-02
Abertawe Bro Morgannwg University Lhb
The Deanery is liaising with the specialty and the Health Board to ensure
that wherever possible greater formality is embedded in the handover
process whilst recognising the non resident nature of handover within
the specialty. Phone and email handover will remain central to this
process but steps will be taken to ensure that there is a formal nature to
it. In addition, the Deanery has reviewed the scores for the handover in
the survey results for the last three years and notes that they are
The Deanery held a meeting with the Directorate on 14th October 2014
and the following key points were noted:
- That with effect from 8th October 2014 the rotas were full. However, it
was noted that there was a need to develop contingency plans to ensure
that predictable gaps based upon historical trend could be pro-actively
filled instead of adopting a crisis management approach. This is being
taken forward by the AMD and the Clinical Director.
The Deanery has been in discussion with the Health Board about the
results and the Local Faculty Team are meeting with the Department in
order to develop solutions to the concerns raised. The Deanery have
requested an update on progress and the content of this will inform
decisions around the need for a formal Targeted Visit.
01/06/2016
01/06/2016
01/06/2016
01/06/2015
01/06/2016
01/07/2016
01/07/2016
01/07/2016
01/07/2016
01/07/2016
01/08/2016
06/10/2016
Stage 2: Implementing Solutions – Action
plans/plans for improvement are in place,
but are yet to be fully implemented and
evaluated.
Red
Stage 2: Implementing Solutions – Action
plans/plans for improvement are in place,
but are yet to be fully implemented and
evaluated.
Amber
Stage 2: Implementing Solutions – Action
plans/plans for improvement are in place,
but are yet to be fully implemented and
evaluated.
Red
Stage 2: Implementing Solutions – Action
plans/plans for improvement are in place,
but are yet to be fully implemented and
evaluated.
Red
Stage 2: Implementing Solutions – Action
plans/plans for improvement are in place,
but are yet to be fully implemented and
evaluated.
Red
Stage 2: Implementing Solutions – Action
plans/plans for improvement are in place,
but are yet to be fully implemented and
evaluated.
Red
None
Head of School of
Anaesthetics
The College Tutor has been involved in taking forward the concerns locally.
Sub Dean (Quality &
Governance)
None at this stage.
Local Faculty Lead,
None at this stage.
(Quality & Governance)
Local Faculty Lead,
None at this stage.
(Quality & Governance)
Associate Dean, Quality None
Stage 3b: Monitoring Progress – Actions
are being implemented, and there is
evidence of improvement through
monitoring.
Amber
Stage 2: Implementing Solutions – Action
plans/plans for improvement are in place,
but are yet to be fully implemented and
evaluated.
Amber
Stage 3b: Monitoring Progress – Actions
are being implemented, and there is
evidence of improvement through
monitoring.
Amber
Associate Dean, Quality A Royal College Representative has been present at all Targeted Visits.
Stage 2: Implementing Solutions – Action
plans/plans for improvement are in place,
but are yet to be fully implemented and
evaluated.
Red
Stage 2: Implementing Solutions – Action
plans/plans for improvement are in place,
but are yet to be fully implemented and
evaluated.
Amber
Stage 2: Implementing Solutions – Action
plans/plans for improvement are in place,
but are yet to be fully implemented and
evaluated.
Red
Stage 2: Implementing Solutions – Action
plans/plans for improvement are in place,
but are yet to be fully implemented and
evaluated.
Sub Dean, (Quality &
Governance)
Red
Sub Dean, (Quality &
Governance)
College Tutors have been involved in the aciton planning process.
Sub Dean, (Quality &
Governance)
The recently appoinited College Tutor is involved in taking the concerns
forward locally.
Sub Dean, (Quality &
Governance)
None
Local Faculty Lead
None
Sub Dean, (Quality &
Governance)
None
Medical Director
None