Venue : Mclean Room, the Lister, Edinburgh

Foundation Programme Board (FPB) Date : Wednesday 20 June 2012 Time : 2pm Venue : McLean room, The Lister, Edinburgh

MINUTES

Item Action 1. Welcome and Attendees: South East: 1. Dr Duncan Henderson (DH) – Chair FPB, South-East FP Lead 2. Ms Marlene Anderson (MA) – Lay representative 3. Ms Anne Dickson (AD) –General Manager, South-East 4. Prof Anthea Lints (AL ) – GP Director, South-East 5. Dr David McQueen (DMcQ) - Director of Medical Education, NHS Forth Valley 6. Prof Gary Mires (GM) – Scottish Deans Medical Education Group 7. Dr Rob O’Donnell (RO’D) – BMA Scotland Trainee representative (FY1) 8. Prof Bill Reid (WR) – Liaison Dean West (Monklands): 9. Dr Andrew Todd (AT) – Chair of FP Curriculum & Assessment Group, West FP Lead East: 10. Dr Andrew Russell (AR)– SAMD representative North (Aberdeen): 11. Dr Kim Walker (KAW) – Foundation School Director, Chair of FP Operations Group, North FP Lead 12. Mr Mark McInerney (MMcI) – Chair of BMA Scottish Medical School Students Committee, depute on behalf of Leila Platt North (Inverness): 13. Mrs Kath Deans (KD) – Foundation School Manager

In attendance: Mrs Eliza Raeburn (ER)

DH welcomed all members to the FPB.

2. Apologies:  Dr David Bruce (DB) – GP Director, East FP Lead  Dr Mairi Finlay (MF) – Academic trainee representative (FY2)  Dr Greg Jones (GJ) – Chair of FP Academic Group, Academic Lead  Dr Jason Long (JL) – BMA Senior Doctor representative  Prof Paul Padfield (PP) – Scottish Government  Leila Platt (LP) – BMA Scottish Medical School Committee medical student representative

of 12 3. Minutes of the previous meeting: 2pm Tuesday 20 March 2012 The following amendments were requested: p. 5, para 4 3.7 Matters Arising: Psychiatry Foundation posts and tasters (DH) West (AT) …. It must be acknowledged that the underlying difficulty with allocating new Psychiatry posts in Foundation is that these posts are not new, additional posts, but redistributed Foundation posts. This will mean a potential decrease in Foundation posts elsewhere. There may be leeway to modify rotations (as has been done to include HDU in Foundation).

AT had considered the possibility that some rather less popular and poorly performing Surgical posts could be “re-badged” as Psychiatry, but this would be dependent upon response to Deanery visits etc. AT highlighted his concern that Psychiatry was not alone in having a shortage of Foundation posts and potentially a related dearth of application to higher training posts. Specialties such as Medical microbiology and O&G already fall into this category. He was concerned that Foundation should not be forced into loss of its generic nature for potential specialty career related issues.

Subject to the above amendment, the minutes of the meeting held 2pm Tuesday 20 March 2012 were accepted. 4. Matters Arising 4.1. LTFT Policy (KAW) The LTFT Policy has been updated and presented to the LTFT Associate Deans. Final amendments have been approved and the approved LTFT Policy for Foundation trainees can now be cascaded by FP Leads to the FPDs in their Deanery. DH thanked AT and KAW for their extensive work in the drafting of the LTFT Policy. Action: . FP Leads to cascade approved LTFT Policy to FPDs accordingly. FP Leads 4.2. Psychiatry Foundation posts and tasters (DH) Recruitment to the Psychiatry specialty is challenging in the UK, with Scotland slightly better. There is evidence that doctors who are exposed to Psychiatry early in their career are more likely to pursue this specialty and a formal mandate has been issued by the UKFPO, after discussion with the RCPsych, to introduce more Psychiatry posts in Foundation across the UK. However, Scotland already has a better provision of Foundation Psychiatry posts compared to the rest of the

of 12 UK. All were requested to update on current status: North (KAW): No plan to increase posts in Psychiatry, as North already has good provision. There is a possible option to move FY2 posts to FY1 in August 2013. West (AT): Currently exploring options in Liaison Psychiatry posts, Taster programmes, opportunities in FY2/FY1 and combination with Acute posts. It should be noted creation of Psychiatry posts requires removal of other posts; Surgery posts had been initially investigated, but would not be pursued. East: DB will update outwith the FPB meeting. South East (DH): Consultation underway with local Psychiatry leads. Initially exploring options in formal tasters and potential swap of F2 posts to F1. F1 posts in liaison Psychiatry already exist and are popular. An additional F2 Psychiatry post has been established after hospital reconfiguration. Agreed: DH will update Chair of the Mental Health Specialty Training Board (STB), Dr Susan Miller, on progress and confirm that the FPB has duly explored options for providing additional Psychiatry posts in the FP across Scotland. DMcQ noted that discussions at the Regional Work-force group had highlighted there will be recruitment difficulties for all specialty areas. Repercussions on Service can be expected. DH advised application rates have decreased across the Specialties and it is anticipated the results of the FY2 destination survey will be a good indicator of current trainee perceptions. MMcI indicated the Royal College of Psychiatry has taken a proactive approach to generate interest amongst students, with dedicated communications and promotion of the specialty at Careers Day. It will be interesting to gauge the effect of this and review against Psychiatry numbers in the coming years. RO’D recommended that trainees who were interested in Psychiatry in FY2 should have scope to review the block they do Psychiatry in eg best in 1st Block F2 to allow experience before Psychiatry Specialty application process. All supported this approach. 4.3. Business Case for Additional FY2 GP posts In England, F2 posts in General Practice were funded when the Foundation Programme was created. In Scotland, there was no additional funding and the number of posts created reflected this limitation. There is significantly less opportunity to undertake an F2 GP post in Scotland compared to the rest of the UK. Dr Stewart Irvine, Director of Medicine, has requested that the FPB produce a business case for the proposed expansion of F2 GP post provision in Scotland. The situation has become more complicated. KAW has received notice from COPMed that proposals for the four year GP training programme remain under discussion with the Scottish Government. No update is

of 12 currently available regarding funding and additional resources, which will be essential for successful programme expansion. WR advised his understanding from Programme Board was that it is a 2 years in GP plus 2 years in hospital split. Any changes to training programme length would be phased in over a number of years. Scotland already had some 4 year programmes in the intake for August 2012. There was discussion of the challenges a new GP programme would face. The creation of an educational structure without appropriate funding would lead to subsequent Service issues in Secondary Care. This is on a background of existing concerns around trainee numbers and the provision of support to the Acute Service. West (AT): Exploring options. South East (DH): There are a number of practices willing to take FY2. Any progression towards additional posts is limited by the lack of funding to pay the practices and the difficulty of moving F2 posts from Secondary care. East: No update. GP Specialty Recruitment had been reported to DH as challenging. Action: . DH will compile a formal report on current status in response to DH the recommendations for Additional FY2 GP posts. . Business Case for Additional FY2 GP posts is to be tabled for Agenda further consideration at the next FPB meeting. AL advised that very few FP trainees had requested GP tasters in 2012, therefore options had been limited. The North had offered tasters, but received no applications. There may scope to explore Community places. WR cautioned against reliance on non-recurrent funding to support programmes; programmes cannot be offered one year and not the next. RO’D queried if there were risks related to offering places trainees wouldn’t fill. WR advised that programmes need to be designed around a trainee’s original choices and trainees should be targeted early in their career, especially while still at university, to ensure they recognise the options available to them. AL explained that offering GP posts in Foundation was not intended to provide a lead in to a GP career, but had been intended to improve the profile of GP, especially to those who had no prior interest in GP. KAW noted that focus tends to concentrate on the quality of programme where trainees are and the education trainees receive. The importance of FP is it exposes the trainee to different roles and specialties, rather than just different locations. AR had observed that trainees who gained the most from FY2 posts in GP tended to be those who did not initially wanted to practice in that particular area. DH highlighted that this was a benefit of the broad experience base the FP provides. 5. Scottish Medical School Graduate Numbers (DH)

of 12 The UK FP has been oversubscribed by UK and non-Uk graduates for the last two years. The oversubscription is likely to progressively increase over the next few years as England is increasing it’s medical school output by 1,000 over 5 years. In the two years of oversubscription, the FP has always managed to find posts for UK graduates due to applicants not taking up post the following August (Finals fails, pregnancy, leaving medicine, leaving the UK, ill health). Approximately 400 candidates are lost each year in the UK in this way. For Scotland, we have 804 posts and lose around 40 Scottish grads each year. This means around 850 medical graduates are required to fill the Scottish Programme. All predictions are for increasing oversupply of UK graduates over the next few years. It was noted that in response to the oversupply Undergraduate intake numbers in Scotland will be decreasing by 50 in the near future. The four UK Health Departments are in ongoing discussion around the issue of unemployed UK graduates. A potential solution (one of a number that have been put forward) is to fund a one year F1 post for these individuals such that they can get Full GMC registration and then apply for F2 gaps. Each UK country would fund posts pro rata related to the oversupply of their own graduates. Two additional complications exist. Firstly, there is currently a case whereby a Czech student is taking the UKFPO to a UK Employment Tribunal. The majority of European Medical Schools have a six year degree, the last year of which is a hospital internship. As these graduates are eligible for Full GMC registration, they cannot apply to the 2 year UK Foundation programme which is designed for pre- registration doctors. The case will proceed in the autumn and further updates will be supplied. The outcome will have significant implications for the number of EU graduates that can apply for two year UK Foundation training. Secondly, UCAS (UK University admissions system) has distributed advertising to unsuccessful applicants to UK Medical Schools this year. It supplies information from the University of Buckingham, a privately run University, and how it can aid access to UK medical schools and also access to six European medical schools. It has no information around the likely chance of UK employment for UK citizens gaining a European medical degree. DH has contacted Prof Tony Weetman, Chair, Medical Schools Council, to seek his opinion and also ask that he contact UCAS about this matter. It should also be noted that the University of Buckingham is hoping to start the UK’s first private medical school.

Action: . DH will follow up current status of Scottish Medical School DH Graduate numbers and key issues with UKFPO and UCAS, with update at September FPB meeting. . GM will discuss Scottish Medical School Graduate numbers with

of 12 Scottish Deans Medical group, with update at September FPB GM meeting. RO’D indicated his understanding was that the reduction of 50 undergraduate places was an initial figure only and that this may be further increased. WR highlighted his concerns regarding an under supply of future graduates. This will impact upon both the immediate future and into the next 30 years; changes in manpower supply need to be very carefully considered. 6. August 2012 Recruitment (DH) The Scottish School is fully recruited for the 2013 FY1 programme. As at the date of the FP meeting, there were 6 gaps in FY2 in Tayside. 7. Scottish Foundation Day – Thursday 31 May 2012 (KAW) A successful day with robust participant engagement. Key topics and discussion had included: . New recruitment system . New Curriculum (Dr Ed Neville presentation) . Supervisor training . Application and Implementation of New Curriculum . ePortfolio . Application and Implementation of Foundation ARCP . Roles of Educational and Clinical Supervisor It was confirmed that Scotland would be sticking to the 2010 Curriculum arrangement whereby the Educational and Clinical Supervisor would usually be the same person. This individual would complete the Clinical Supervisor report and the End of Placement Review (EoPR) form. It had been recommended an option be introduced that allowed a dual Educational/Clinical Supervisor to indicate their dual role via a Yes/No Tick Box, thus avoiding separate completion of two forms. This had been referred directly to UKFPO for further consideration. A formal request has also been made to ePortfolio to allow FPDs authorisation to perform Sign Off on the End of Year (EoY) form. 8. New Curriculum Most items relating to the New Curriculum had been discussed at the FP Curriculum and Assessment (FPC&A) group meeting held on the morning of 20 June 2012. It had been agreed there were no further issues to be resolved in advance of the August 2012 New Curriculum implementation. 8.1. Curriculum Mapping Curriculum Mapping tool has been updated to reflect the New Curriculum. This will be completed by Educational Supervisors and trainees at the end of the first block. Results will be compiled and reviewed to confirm individual programmes met New Curriculum

of 12 requirements. 8.2. Minimum requirements for Foundation Teaching programme The FPC&A had agreed a recommendation to significantly alter the minimum Teaching Programme assessment requirements, moving away from a rigid prescribed programme of teaching towards more complementary training and an understanding between trainees and trainers that completion of training is an essential FP requirement, which the trainee will self manage. There is currently an issue where some trainees are not achieving the required 70% teaching attendance. The FPC&A has requested the following: . The minimum requirement for TAB (two per year in both F1 and F2 during the first two blocks with the option of additional TABs as needed) be formalised as a Scottish school requirement.

. The absolute requirement for clinical and educational supervisors reports remain as detailed in Appendix I.

. Any recommendations regarding ARCP timing and outcomes are pending the final version of the Foundation programme reference guide (2012)

. A positive approach to be taken to Supervised Learning Events (SLEs). It will be pointed out trainees that SLE's are formative and can be used as evidence that different curriculum domains have been actively explored and covered. Whilst the Scottish FP recognise that the Curriculum makes recommendations regarding "minimum" numbers that need to be completed over a year, the Scottish FP would like to suggest that in Scotland it is formally recognised that Scottish FP should not be counting SLE's but encouraging the maximum use of them by trainees to ensure curriculum coverage.

. A caveat would apply that if no SLE's were undertaken by a trainee then they cannot and will not be signed off. Whilst some trainees and trainers may wish to recognise the published recommended minimum numbers as a guide the Scottish FP will not stipulate such minimums across Scotland. This also enhances the FPD and educational / clinical supervisors responsibility to collate holistic evidence about the trainees performance as a doctor rather than 'tick boxes' as to completion of tasks.

The FPB discussed the issues of such a significant change. It was noted there was a degree of risk associated with a move towards a self managed assessment and removal of a tick box structure. The structure established an agreed bottom line for trainers and trainees to follow. KAW and AT highlighted that the recommendations had been made in direct consultation with Foundation Programme Directors (FPDs), who had indicated the current assessment was based on tick boxes and scored lists, with little scope to illustrate “trainer judgement”.

of 12 RO’D cautioned against a void of guidance, whereby minimum requirements were not set out. AT confirmed that there was indeed sufficient guidance available for trainees to confirm assessment and responsibility would fall on the trainees to make sure they completed the Curriculum to guarantee final Sign Off. RO’D indicated his concern that there may be trainees in the first year of implementation who will not be Signed Off, as it has not been clear what they should have achieved during the year. DH requested a suitable sign off apply to SLEs at the ends of blocks 1 and 2; this would prevent 8 months of no Sign Off at all. WR indicated his very strong support for the FPC&A proposal, noting it was well overdue. Since its 2004 inception, the aim of the FP has been to provide an education that was professional and “trainee driven”, rather than a replication of university. DH indicated that feedback from the Collins and Cook reports had been supportive of a reduction in the number of assessments. Agreed: The FPB supports the introduction of a self managed assessment structure for the Scottish Foundation School Teaching Programme. Action: . AT and KAW to compile full report on a self managed assessment AT / KAW approach to the Scottish Foundation School Teaching Programme, including: – Guidelines – Minimum data set – Treatment of Doctors in Difficulty (DiD) – Link in to proposals for an Annual Review of Competence Progression (ARCP) for Foundation – Support and resources options (link in with FPOG) 9. Foundation Research Surveys KAW has confirmed with the Medical Directorate Executive Team (MDET) that all Foundation Research Surveys be declined as a default measure, unless they are deemed of significant importance to the FP. KD noted this was consistent with the UKFPO arrangements. The UKFPO has declined Foundation Research surveys for a number of years; KD has the UKFPO’s generic response wording. 10. Foundation Programme Groups 10. Academic – Minutes 12 April 2012 1. Noted.

10. Curriculum & Assessment – Minutes 25 April 2012 2. Noted. AT alerted the group that FPC&A decisions noted in the 25 April 2012 minutes had been superseded at the FPC&A meeting held 10am 20 June 2012. Minutes of the 20 June 2012 FPC&A would be available for reference at the September FPB meeting.

of 12 10. Operations – Minutes 7 March 2012 3. Noted.

11. Papers for information 11. Foundation School Directors Committee – Minutes 7 March 2012 1. Noted.

11. Foundation School Managers Forum – Minutes 20 March 2012 2. Noted.

12. Any Other Business 12. Trainee application – No On-Call for FY1 (DH) 1. An F2 application had been received from a trainee on an English Academic Foundation training programme. The main reason for the application was that within their proposed 2 year training programme, they would have 1 supernumerary research block and no overnight on- call in the remaining 5 blocks. The trainee felt that this would not provide adequate training. DH agreed and would not sign off an individual that had not undertaken night shifts. The proposed programme didn’t meet the outcomes of the UK Foundation Programme. It was noted a number of English Deaneries have moved to no On-Call for FY1. DH is taking the information to the UK Foundation Board. Action: . DH will report after discussion at UK Board. DH 12. CMO Letter – Shadowing arrangements confirmed (DH) 2. Sir Harry Burns, Chief Medical Officer for Scotland, has issued a formal letter confirming payment for the four days of Shadowing. DH and the Board noted that the length of negotiation with involved parties had been frustrating but all were relieved that agreement had finally been reached. Shadowing, which has been run on a basis of voluntary attendance in Scotland, is a very positive step in assisting the transition from medical student to FY1 doctor. In Scotland, FY trainees will receive payment for four days of Shadowing week. Action: . KAW to issue formal notice to FP Leads and FP teams as KAW confirmation that four days of Shadowing will be paid. 13. Date of next meeting: . 2pm Thursday 13 September – McLean room, The Lister, Edinburgh

of 12 APPENDIX 1 : Scottish Foundation School minimum assessments for satisfactory completion of Foundation programme

2012 2011 Requirement Requirements MiniCex Formative Minimum of 3 per block of which 2 DOPS SLE with direct patient MUST be MiniCex interaction CbD Formative Minimum of 2 per block Developing the clinical teacher SLE without direct patient Minimum of 1 per year interaction TAB Multi source feedback Minimum of 2 per year completed in the first 2 blocks annually# Clinical supervisor report Competency assessment 3 per year, one at the end of each block* Educational supervisor report Summative assessment 3 per year, one at the end of each block* Core procedures As per list in “The trainee Must have completed this by end of F1 doctor” p 51 and be shown competent to both perform and be able to teach these to undergraduates ARCP group make up To be confirmed with final ARCP timing F1 version Foundation ARCP timing F2 programme ref. guide 2012. * These must all be completed but provision is present for failure in blocks one or two but still allowing pass in year as whole final assessor must comment and consider TOI to next post (ARCP should confirm decision) # Ed Supervisor, Clin Supervisor or FPD may request additional TABS. TAB assessors must include at least 2 from the following groups:  Doctors more senior than F2 including at least one consultant or GP principal  Senior nurses (band 5 or above)  Allied health professionals  Other team members e.g.ward clerks, secretaries, auxillary staff and peers in foundation(no more than two) Refs: The UK Foundation Programme curriculum (July 2012) pp 55-62 The UK Foundation Programme Reference guide 2012 pp 42-62

of 12 The Trainee Doctor (GMC) 2011 p 5

of 12 Page 12 of 12