ICM specialists (intensivists) are involved in all aspects of care of the critically ill, including providing organ support, investigation, diagnosis and treatment of critical illness, as well as involvement in patient safety, ethics, end-of-life care and support of patients and families.
The Faculty of Intensive Care Medicine (FICM) is the professional body responsible for the training, assessment, practice and continuing professional development of intensivists in the UK. Training and certification in ICM was previously only possible in the UK in conjunction with a primary ‘base’ complementary specialty (usually anaesthesia or respiratory medicine) as part of a joint training programme, however, a standalone training programme in intensive care medicine now exists. Trainees can enter ICM training through a number of routes, and although the standalone programme exists, the majority still elect to train in two complementary specialties (i.e. anaesthesia, emergency medicine, respiratory medicine etc) through a GMC-approved dual training programme. Details of training and examinations in ICM are found on the FICM website.
Obtaining recognition for non-FICM ICM training (in order to be entered on the GMC specialist register as an intensivist) presents some challenges. Unlike other specialties, there is no reciprocal agreement for specialist recognition in ICM training in other countries and therefore there is no automatic recognition of previous ICM training/experience. Here a doctor has to demonstrate written, certified evidence of equivalence of ICM training to the GMC through a formal, complex process (CESR). Doctors are best advised to seek support in their application for equivalence, and applications should be made directly through the GMC.
European Society of Intensive Care Medicine (ESICM): https://www.esicm.org European congress, Certification, Journal (Intensive Care Medicine)
Intensive Care Society (ICS): http://www.ics.ac.uk UK Intensivist Society: national training days, annual State of the Art meeting, Journal, (JICS)
Author: Dr Susanna Price, Consultant Cardiologist and Intensivist, Royal Brompton and Harefield NHS Foundation Trust
Paediatrics continues to offer varied career opportunities including subspecialisation in level 3 training (ST6-8) in 17 accredited subspecialties as well as Community Paediatrics and neonatology (subspecialty training). In addition, doctors with a predominant general Paediatric interest can develop special expertise by undertaking “SPIN” modules during training or in career grade posts. There are 16 such modules (SPIN modules).
Paediatrics had a new ePortfolio last year, “Kaizen”. After some teething problems, this is a helpful electronic resource which continues to be developed and new features added. It is available for use by nurse practitioners, trust grade and staff and associate specialist posts but of course there is a fee for doing so (Register for RCPCH ePortfolio).
The RCPCH offers very helpful advice for doctors who wish to apply via the CESR route to the specialist register and in my mind no one should apply without seeking RCPCH advice first as chances of success are greatly increased (RCPCH CESR).
In 2018, Paediatrics will have a new training curriculum which will be outcome based rather than a competency based curriculum (RCPCH new curriculum). After having a number of new assessments introduced in August 2016, there are no planned changes in the assessment strategy and of note is that there is no minimum number of mini-CEXs or CbDs with a strong emphasis on the formative nature of assessments. In the future, RCPCH will have entrustable professional activities (EPAs) which are currently in development.
As all Paediatricians hopefully like children, there are a number of training rota gaps due to parental leave at both junior (ST1-3) and senior (ST6-8) training levels for which locums are frequently needed or for which trust grade posts are established. It is important to be up to date with paediatric life support courses (NLS and either EPALS or APLS) and level 3 safeguarding.
Author: Dr Helen Goodyear, Consultant Paediatrician and Associate Postgraduate Dean, Health Education England (West Midlands)
As mentioned in my last blog, locum doctors deployed on a flexible basis by Trusts are a widely varied group of professionals working within different specialities, with varying levels of experience and across many geographical locations. So when a Trust is looking for locums, how can they be sure they select the right person for the role?
With locums moving from job to job and agency to agency up to date information about individuals is often difficult to access. So what are the current guidelines for recruitment – and how the process can be made more effective and efficient?
The NHS Guidelines
In August 2013 NHS Employers issued a Code of Practice for the appointment and employment of NHS locum doctors. It applies to all doctors including directly employed locum doctors, agency locum doctors and locums working through their own limited companies.
Principles for appointment and employment of locum doctors
All locums should:
Employment Check Standards required by the NHS cover: identity, right to work, professional registration and qualification, employment history and references disclosure and barring Service (DBS) and occupational health.
Framework agencies are contractually obliged to meet these standards, and their compliance is audited on an ongoing basis. ‘Off framework’ agencies are not covered by this audit.
The big questions are how well are these standards and checks currently being applied, and do they go far enough? Do they ensure that the right locum is appointed for each role, and that – as the headline of this blog questions, are they fit for purpose?
Our belief at Doctors Direct is that it may be far too easy to ‘sign a slip’ and appoint a locum doctor as long as the basic checks are met. Given the pressure on Trusts to deliver services, how does the Trust reassure itself that the locum has the appropriate compliance and, more importantly, competencies to fill a position? If the wrong locum is placed in the wrong role there could be considerable implications for, and potential impact on, patient care and safety.
That’s one of the reasons why we have established Medical Advisory Group (MAG) – a body made up of nine senior consultant clinicians from across England, covering all major specialities, advising Doctors Direct on clinical governance matters as they impact our locum doctor service. It’s a structure which doesn’t exist anywhere else and brings significant benefits for our Trusts and locums. For a doctor to be presented to a Medical Advisor for approval they will have completed all the NHS Employment Check standards including appropriate references.
The role of the Medical Advisory Group in locum recruitment:
The benefits of this system:
Through the MAG, Doctors Direct are able to assure itself that our locum doctors are working at the right grade in the right speciality – reassuring the Trusts that they are making the right appointments. It is not possible for anyone other than a MAG, or in exceptional circumstances the Medical Director, to approve a role for a locum doctor. The approval process ensures that locums have the right skills to match the role, and Trusts have the reassurance of knowing all checks have been thoroughly reviewed and signed off by a senior clinician.
Locum doctors also have the opportunity for promotion to higher grades following MAG review of work experience, backed by evidence of competency training and references for the proposed higher grade. In this way locums have the opportunity to work in a wider range of roles and Trusts have the reassurance that locum progress through the grades is being monitored by senior clinicians.
I believe that with the MAG, Doctors Direct has developed a support network of senior clinicians to support the clinical governance agenda of our locum doctors service which benefits both the locum doctors and the Trusts.
In my next blog I would like to consider pathways by which we can reach out to, engage with and support the cohort of doctors who may want to return to clinical practice but for whom this has proved difficult. I am talking here of doctors who have been out of clinical practice for some time for a whole variety of reasons and who may feel deskilled, out of touch and no longer up to date.
Helen McGill, Medical Director and Responsible Officer at NHS Professionals
In my last blog I looked at the challenges facing locums, agencies and ROs – and what implications they have for Trusts.
Now I’d like to look in more depth at how we can support locums and at the same time provide Trusts with the information and data which enables them to make informed decisions about which locums they engage with. Core to any consideration must be patient safety and processes need to demonstrate that locums meet compliance standards and have role specific competencies. At the same time there may be opportunity to develop and enhance pathways for locums to transit into substantive posts if that is a route they wish to take.
Locum doctors deployed on a flexible basis by Trusts are a widely varied group of professionals working within different specialities, with varying levels of experience and across many geographical locations.
Locum doctors must have a right to work, be licensed to practise by the GMC and engage in appraisal and revalidation process. Guided by GMC ‘Supporting Information for Appraisal and Revalidation’. To revalidate all doctors must carry out a multisource feedback (MSF) of patients and colleagues once in the five-year cycle.
Many locums have difficulty getting paid study leave, in gathering supporting information, colleague and patient feedback for MSF as well as performance feedback by senior or supervising clinicians on completed locum sessions. Many also experience deferral of their revalidation because ROs may have difficulty making a recommendation for someone for whom they have. Inadequate supporting information and only short term connections. In addition to all this, there is the cost of appraisals.
There is currently little or no support structure, and no clear path to career development or training in new competencies, for locum doctors. They have no permanent base, few role models, are often excluded from normal networking facilities and may feel isolated and unsupported.
Such a hub could serve as an access point for sharing information between Trusts and locums. All locums could be registered through one organisation and a single data base could cover, for instance….
I propose that this would be a permanent base where locums can be supported. They would have a facility where they would be able to update work experience, references and educational and training updates. This information would feed into compliance maintenance and act as a reassurance to Trusts on hub locums.
Bringing all this information together and providing a clear and solid structure for employment and career progression would solve many of the problems locums currently face.
A central data base would bring many benefits for Trusts too – not just by providing information to help them access the right locums with the right competencies and specialisations for the roles they are looking to fill.
It would also help Trusts reduce costs by streamlining processes, centralising back office functions relating to locum recruitment, overcome geographical problems and helping to flag up problems and conditions.
I believe that NHS Professionals are ideally qualified and positioned to create and deliver such a hub as part of the locum recruitment and quality assurance process (I’ll be covering that in my next blog). It would also provide a way of tackling the underlying need to enable the transition of those locums who wish to become substantive staff into full time roles by gaining the training and qualifications which are currently difficult for them to access.
Let the debate begin!
Helen McGill, Medical Director and Responsible Officer at NHS Professionals
Currently nearly 9000 doctors without substantive NHS contracts serve Trusts across the country through locum agencies. Many register with more than one agency at one time, or move between agencies on a frequent basis. Helen McGill, Medical Officer and Responsible Offer (RO) at Doctors Direct, considers this to be a practice which presents a significant challenge in terms of monitoring their compliance, performance and the levels of patient care they, and the Trusts they serve, are able to deliver.
‘All of these doctors working as locums are connected to a Responsible Officer (RO) wherever they are working through their agency, following the GMC algorithm. However, when they move from agency to agency and Trust to Trust these connections become complex. Despite the RO to RO network and established information flow systems developed by NHS England, the risk remains that transfer of the most up to date information may not be as efficient as best practice aspires to.
This raises important issues for all concerned: Trusts, agencies, ROs and the doctors themselves.
Concerns are increasingly being expressed about how effectively, efficiently, promptly and accurately information regarding locums and their status currently flows between agencies and other designated bodies. Where agency ROs have concerns about locums and incidents, how should they respond – and how can the locum’s activities be restricted if they are working with more than one agency, yet registered with just one designated body? Working this way, are there sufficient checks and levers to ensure that locums are engaging correctly with the appraisal and revalidation process? Can and do problems arise when one RO acts in an outsourced capacity for multiple agencies?’
These are of course key considerations if agencies are to work to the principles of ‘Maintaining High Professional Standards in the Modern NHS’. Helen has pointed out that the issues are double edged, impacting locum doctors too:
‘Locum doctors themselves may find themselves isolated and unable to make professional progress, as without a substantive contact they may lack access to sufficient support. For instance, how can they fund and find study time or leave to prepare for appraisal? What role models can they refer to when they are constantly on the move? What feedback will they receive on issues, concerns, complaints and completion of placements? During those placements they may –as temporary staff – find it difficult to access IT, appraisal and reporting systems, or to gather supporting evidence like feedback from colleagues and patients for appraisal and revalidation. Because there may be insufficient supporting information for the RO to make a positive recommendation. These are important issues if they are to remain compliant and advance their skills and careers.’
Taking these comments from a senior professional and Responsible Officer on board, it appears that the mobile nature of the locum workforce, the myriad of agencies with whom doctors make multiple arrangements, and the outsourcing of many functions of a designated body may be making good governance a challenge – and that’s a major factor for all parties concerned, including ourselves at Doctors Direct, part of the NHS Professionals family.
The question must surely now be: how do we address that challenge? How do we best support locum doctors and ensure that they have the right qualities and qualifications for their placements? We’ve gone back to Helen McGill and asked her for her thoughts…. watch this space for details.