HEE London, South East and East of England Repatriation Steering Group Meeting Thursday 11 th August 2016 1. In Attendance Professor Bill Irish (BI) Postgraduate Dean HEE, East of England Local Office Dr Sanjiv Ahluwalia (SA) Postgraduate Dean HEE, London & South Local Office Dr Julia Whiteman (JWn) Postgraduate Dean HEE, London & South Local Office Dr Alys Burns (AB) Head of Education & Quality (Secondary & Tertiary Care) Deputy HEE, East of England Local Office Postgraduate Dean Susan Knight (SK) Senior Project Manager HEE, East of England Local Office Thomas Gale (TG) Operations Manager (KSS and EoE separation projects) HEE, London & South Local Office Keith McKay(KM) Head of Trainee Development & Resolution Trainee & Applicant HEE, London & South Local Office Support Team Silvio Giannotta (SG) Head of Quality & Commissioning (Medical) North West London HEE, London & South Local Office Angela Fletcher (AF) Head of Education and Training HEE, London & South Local Office Emilie Hoogenboom (EH) Trainee Representative LSE Apologies Kate Read (KR), Deputy Dean for Education and Performance Dr Jonathan Waller (JW), Deputy Postgraduate Dean (Head of Education & Quality Medical Programmes) Paul Martin (PMtn), Senior Medical & Dental Commissioning Manager Suneetha Siddabattuni, Trainee Representative HEE, East of England Local Office HEE, East of England Local Office HEE, London & South Local Office EoE 2. Decision and Discussion Log Agenda Item Discussions / Decisions 1. Welcome and apologies SA, as chair, welcomed all to the meeting. Apologies KR, PMtn, JW and SS. 2. Terms of Reference BI - no further amendments, request to remove this from the agenda. 3. - 4. Minutes of previous meeting/matters Arising BI typo on page 3 Director of Medication to be corrected, should read as Director of Medical Education, SK to action. Action Log 5. now closed 6. to be discussed as agenda item 6 7. to be discussed as agenda item 7 8. separate column added to SOJF to confirm EIA has been actioned now closed PMtn attended EIA training - now closed Separate paper for Public Sector Equality Duty for Foundation training, AB to discuss with PMtn. 9. now closed 1
5. Review of Summary Sheet of Joint Feedback Discussion took place regarding the specialties flagged red. Red Dermatology LSE and EoE HoS/TPD joint meeting 21/07/2016. Discussion and agreements to repatriate 2 x posts within the timeframe of the project, SoJF updated and SG/PB requested this specialty is changed to green. Nephrology Meeting with EoE HoS took place 09/08/2016 to prepare a proposal for the phased return of the remaining 7 x posts. For the full curriculum delivery 4 x additional posts are required at CUHFT and 2 x NNUH. SK sent a spreadsheet with the suggested proposal from EoE HoS to LSE HoS and TPD for comments with a request for a response by 26/08/2016. Update: Recent email communication between LSE/EoE HoS/TPDs and SoJF updated. BI suggested nephrology is changed to amber. SA requested there is communication with the Royal Colleges and Lead Deans regarding repatriation. Discussion took place regarding the feasibility of HoS raising the concerns for the repatriation of Nephrology posts at SAC. Update; Lead Deans and Royal Colleges are included in the circulation list for the Briefing document. AF - GMC need to be made aware of any changes and written approval is required. SK to confirm with GMC. Update: SK contacted Quality team at GMC and response received, I can confirm that we do not currently approve posts and that they would be covered as long as the location is approved under the correct programme. Diabetes and Endocrinology Meeting with EoE HoS and TPD took place 09/08/2016, HoS suggested with the Shape of Training review there is an opportunity to re-map D & E into IM however this will take longer to implement and requested an extension to the timeline for the repatriation of these 14 posts. There is a requirement for additional tertiary posts, 5 x posts at CUHFT and 1 x post at NNUH. BI meeting with NNUH to agree the number of tertiary posts required. SG/PB discussed and agreed the proposal is a high risk and agreed this remains red. Haematology Still facing challenges for both LSE and EoE to confirm dates for HoS/TPD joint meeting. Risk of potential slippage if this is not managed. The request for an additional post at CUHFT has now been agreed. EoE HoS to meet with Dr Joanne Howard, Consultant Haematologist at BTUH to discuss what specific aspects of the curriculum could be delivered at the Trust, as part of the Essex Success Regime. EoE HoS suggested 3 x Essex posts to be repatriated first with a slower approach for 3 x posts at WHHT. SG/PB agreed to remain red flagged on SoJF. T & O To be discussed in agenda item 7 and to be changed to red. Amber TG liaising with Liam Coleman (EoE) to organise joint LSE/EoE HoS/TPD meetings for specialties flagged amber to agree dates, number and locations for the repatriation of remaining posts. ENT SK - EoE HoS/TPD requested the repatriation of 1 x SUHFT post in 2017/18 and 1 x E & NH post in 2018/19 which is essential for rotations following the repatriation of the BTUH post. LSE TPD has not agreed to this phased return and does not agree with the repatriation of the E & NH post. 2
6. Cost Neutrality Paper and Updates (Cardiology/ Diabetes and Endocrinology/Haem atology/histopatholo gy/ Plastic Surgery/ Renal Medicine/T & O Discussion took place suggesting the co-funding (EoE and LSE) of an additional post for 1 x year only as a temporary solution. E & NH appear keen for an additional post, LSE to investigate as there may be an opportunity to access a Trust funded post. Curriculum delivery is important but there is a need to maintain momentum and agree a solution soon. KM there is a need to reach a solution with the cooperation and agreement from LSE TPD. SA SG and TG to liaise with LSE TPD to find a solution. SK GP post at E & NH has been confirmed as a Trust funded post and LSE recruit to this post, initially identified as out of scope for repatriation, SG/PB to agree how to progress. SG/PB agreed to leave this post as it is with LSE to continue to recruit to this post. Orthodontics SK LSE to confirm the 40% funding arrangement of SUHFT posts, TG currently investigating. Trusts E & NH meeting date for EoE HoS/TPDs to be confirmed. WHHT still appears to be some confusion regarding 50% of posts out of scope for 2016 2018. BI confirmed 50% of posts per specialty out of scope for 2016 2018 with an annual review meeting and a further meeting in 2018 to discuss and agree the repatriation of the remaining posts. This will not affect specialties where agreement for repatriation has been agreed. Discussion took place regarding section 2 and the use of the word promise in 2.1 Is the requirement for the post as a result of a training rotation which had been promised to an existing trainee? There is a requirement to clarify promise and trainees to be made aware prior to and during recruitment that there are no guarantees and programmes may be subject to change. SG/PB requested changes to some of the wording: 2.1 change the word promised to confirmed in writing 2.2 change the word only in first sentence to normally 2.3 change wording to read to ensure that appropriate training to the required curricula is provided. 2.3 change wording to read matching trainees to places must comply with the requirements of the Code of Practice. EH requested the timeframe to change rotations is communicated earlier as this impacts on the trainees. SA agreed and reiterated the Code of Practice where the national benchmark requested 12 weeks notice to trainees. JWn queried if there is an existing documented rationale for the promise to trainees and reiterated IDTs and OOPTs are options available to trainees. AF there is a requirement to consider training needs and personal needs. Educational needs should be addressed as a priority. There is a need to ensure TPDs do not agree to changes at ARCPs. Also concerned with the timeframe of 12 months in 2.2 and suggested this is changed. SA requested PMtn and TG confirm the LSE process for any changes to rotations discussed at ARCP. Request for AF/PMtn/SG and KR to meet to review wording in the Cost Neutrality paper. SG requested clarification on proposed commissioning, will this result in an increase in the number of posts, John Stock and John Howes need to be made aware. Confirmation of status after recruitment is required and investment plan will need to include an explanation. BI KR/PMtn and SG will agree a timeline when HEE will be in a steady state, it is anticipated HEE will be at zero at the end of the repatriation process. AF there is a potential risk to double counting, therefore the recording of post numbers on Intrepid needs to be clear particularly with the 3
7. Specialties with potential repatriation challenges (T & O/Renal Medicine/ Diabetes and Endocrinology/Haema tology, Dermatology) 8. Equality Impact Assessment progress of TIS. KR and AF to agree a process. SA confirmed all the identified specialties with potential repatriation challenges are now progressing well towards agreement across both sets of local offices with the exception of T & O. Repatriation for 2016 plans are in place for T & 0, EoE and LSE have now allocated trainees to posts. BI - requested confirmation of the 5/6 T & O posts LSE had agreed to commission in the EoE, SA agreed to confirm details week commencing 22/08/2016. SA - LSE TPD raised significant concerns regarding the repatriation project for T & O and as a result meeting held recently (22/7/16) with HEE Chief Executive, LSE PGD, LSE DEQ and LSE TPDs. LSE TPDs presented their concerns to HEE Chief Executive. A review of T&O programmes is being organised to ensure that LSE T & O training fully delivers all curriculum requirements, maintains quality of education and no trainees are disadvantaged. It is anticipated the review will take approximately 3 months and will likely commence in September 2016. KM requested reassurance that this process is managed carefully, with clarification of the purpose so trainees in other specialties do not also request a review. Discussion took place referring to the lack of agreement from LSE T & O TPDs regarding the repatriation project and the SG/PB agreed the need for a robust process to ensure this does not set a precedent for other specialties. It was noted that T&O is the only outstanding specialty where there has been no agreement about the repatriation process hence the external review. SG/PB agreed the ToR must include a clear purpose for the review. SA there is a requirement for a review of LSE T & O programmes for DGH posts with a focus on the ability for LSE to create high quality training posts which fully meet the curriculum. PMtn will be involved in all discussions and the review meetings will require pragmatic issues to be discussed. BI/AB identified the confirmation of numbers for recruitment as a potential issue although this was acknowledged as indicative numbers only. TG joint LSE/EoE HoS/TPD surgery meetings have already been scheduled for September and requested confirmation of whether these should still be honoured. BI with the pending review there is a question of the value of the meetings and suggested both LSE/EoE agree a mechanism that is able to accommodate potential outcomes. SA the review will refer to a specified number and location of posts to be repatriated with a requirement for a confirmed number of LSE posts to be enhanced, all to be reviewed again in 3 months. BI requested a decision regarding the ENT posts to be confirmed as a priority as this may distract focus and present problems for EoE HoS/TPDs. SK PMtn has drafted a pro-forma EIA template and confirmed this will need to be completed for every specialty. Although the document is lengthy SK/PMtn and TG to populate with contribution from clinicians for the specific specialty and trainee representative to be involved in the process. Joint LSE/EoE Foundation EIA to be completed. SA queried what next steps are and requested PMtn draft an outline of the process for the September SG/PB meeting. Requested a disclaimer is added to the websites for trainees to understand the changes to training programmes. BI thanks passed to PMtn again for all his hard work to produce the PSED paper and EIA template. 4
9. Foundation Update AB no changes everything on track. 10. EoE Trusts with T & O Addressed in agenda item 7. placements (Harlow, BTUH, Mid Essex, Colchester, E & NH, SUHFT, WHHT) 11. AF asked if the slower approach to remove 50% of posts per specialty in 2016 2018 has been documented and suggested another letter to confirm the process is sent to WHHT to remove any confusion. BI requested KR drafts a letter to WHHT to confirm 50% of posts per specialty in 2016 2018 will be out of scope, an annual review to take place with a meeting in 2018 to identify successes and implement a plan for the repatriation of the remaining posts. EH confirmed the trainee experience at WHHT is positive. JWn agreed the location is attractive however there are some concerns trainees have identified in the GMC Trainee Survey. BI confirmed EoE will assess the success of repatriation and identify and action any concerns regarding the quality of training at WHHT. 12. Risk Registers SA risks have been considered and mitigated with due regard to the transparency of the process however the document is quite lengthy. JWn requested the T & O review is considered as a risk. SA once the ToR for the T & O review has been actioned then PMtn, SK and SG to review risks. JWn clear ownership of all risks needs to be confirmed with a second column for LSE/EoE. Each PGD to sign off prior to SG/PB meetings. 13. Communications SK there is an increase in visits to the web pages after each Briefing document is circulated. Thanks passed to EH for FAQs, email communication indicates individuals are reading the document. EH confirmed she is receiving an increase in queries. BI EoE Trainee Forum feedback was very positive and trainees are very appreciative of the communication. 14. AOB SK confirmed PMtn, TG, KM & SK to meet with Hugh Townsend, BMA Regional Coordinator 23/08/2016 to discuss the repatriation project. BI also meeting with BMA and need to ensure there is no confusion, SK to confirm details with RK. EH will attend the North West Thames BMA meeting. AF suggested a letter is sent to HoS and TPDs where repatriation has been actioned to confirm the agreed outcomes. AB will write to EoE Trusts to confirm reconfigured Foundation training programmes. SA a standardised letter to be drafted. EH requested there is less printing for SG/PB meetings due to the impact on the environment. Apologies for next SG/PB meeting, Thursday 15 th September 2016 received from AB. Actions 3. Actions Arising (and Carried Over) Discussions Discussion/Action log to reflect decisions. Owner (s) Date Added Due Date 2. Terms of Reference Agreed there are no further changes, remove ToR from the agenda. SK 11/08/2016 15/09/2016 3. - 4. Minutes of previous Separate paper for Public Sector Equality Duty for Foundation training, AB to discuss with AB/PMtn 11/08/2016 15/09/2016 meeting/matters Arising PMtn. 5. Review of Summary Sheet Haematology meeting date to be confirmed as a matter of urgency. PMtn/TG/SK/LC 11/08/2016 15/09/2016 5
of Joint Feedback GMC need to be made aware of any changes, written approval is required. SK 11/08/2016 15/09/2016 6. Cost Neutrality Paper and Updates (Cardiology/ Diabetes and Endocrinology/Haematol ogy/histopathology/ Plastic Surgery/ Renal Medicine/T & O Amber flagged specialties, joint LSE/EoE HoS/TPDs meetings to be confirmed. TG/SK/LC 11/08/2016 15/09/2016 SG and TG to liaise with LSE TPD for ENT to find a solution to agree repatriation of SG/TG 11/08/2016 15/09/2016 remaining posts and investigate feasibility of temporary additional funding for 1 x post at E & NH if required. Meeting with E & NH to be confirmed. SK/LC 11/08/2016 15/09/2016 AF/PMtn/SG and KR to meet to review wording in the Cost Neutrality paper. AF/PMtn/SG/KR 11/08/2016 15/09/2016 KR/PMtn and SG to agree a timeline when HEE will be in a steady state KR/PMtn/SG 11/08/2016 15/09/2016 Potential risk to double counting, and the recording of post numbers on Intrepid needs to KR/AF 11/08/2016 15/09/2016 be clear in readiness for TIS. KR and AF to agree a process. 7. Specialties with potential repatriation challenges (T & O/Renal Medicine/ Diabetes and Endocrinology/Haematolo gy, Dermatology) 8. Equality Impact Assessment Confirmation of the 5/6 T & O posts LSE had agreed to commission in the EoE, SA agreed to confirm details week commencing 22/08/2016. Review meetings to be arranged to ensure full curriculum for LSE T & O training in DGHs delivers requirements and no trainees are disadvantaged. SA/PMtn 11/08/2016 15/09/2016 SA/PMtn 11/08/2016 15/09/2016 EIA templates to be completed for each specialty including clinicians for specific specialty TG/PMtn/SK/AB 11/08/2016 15/09/2016 and trainee representative. Joint LSE/EoE EIA template for Foundation programmes. PMtn draft an outline of the EIA process for the September SG/PB meeting. PMtn 11/08/2016 15/09/2016 11.E & N H NHS Trust/ WHH KR to draft a letter to WHHT to confirm 50% of posts per specialty in 2016 2018 will be KR 11/08/2016 15/09/2016 NHS Trust Updates out of scope, an annual review to take place with a meeting in 2018 to identify successes and implement a plan for the repatriation of the remaining posts. 12. Risk Registers T & O review to be included as a risk and once the ToR for the T & O review has been PMtn/SK/SG 11/08/2016 26/10/2016 actioned then PMtn, SK and SG to review risks. Clear ownership of all risks needs to be confirmed with a second column for LSE/EoE. Each SK/PMtn/PGD 11/08/2016 15/09/2016 PGD to sign off prior to SG/PB meetings. 14. AOB SK to contact RK to confirm details of BI meeting with BMA. SK 11/08/2016 15/09/2016 Standardised letter to be drafted for HoS/TPDs to confirm the reconfiguration of SK/PMtn/AB 11/08/2016 15/09/2016 Foundation training programmes, higher specialty repatriation and agreed outcomes. Reduce printing of documents for SG/PB meetings. SK/TG 11/08/2016 15/09/2016 6