Statements From NHS Education Scotland (NES) and NHS Highland Regarding Training Of Junior Doctors At Caithness General

3rd March 2015

Statement From NHS Education Scotland (NES)

NES quality management visit, Caithness General Hospital.

NHS Education Scotland (NES) is accountable to the General Medical Council (GMC) for assessing whether doctors in training are in an appropriate training environment. 
 
We carried out a quality management visit to Caithness General Hospital on Friday 13rd February to assess the quality of the learning experience and learning environment for postgraduate medical trainees in line with General Medical Council Standards. 

The visit was prompted by a shortage of substantive consultants in post and continued heavy reliance on locums and therefore the potential impact on the quality of training and supervision of doctors in training.
 
We were grateful for the co-operation and support of doctors in training, consultants and managers in NHS Highland throughout the visit.
 
The potential of Caithness General Hospital (CGH) as a training environment for Foundation Doctors and GP Specialty Trainees is real and is encapsulated by a quote from one of the trainees: "It's a good place to learn; I've never learned so much."

However, trainees also clearly described to us their concerns about the implications of the current position for their safe supervision.
We have therefore made a number of recommendations which we have also shared with the GMC.  These include:
 
1.   Escalation to ‘Enhanced Monitoring' status in partnership with the regulator (GMC)
2.   The construction of a robust implementation plan with clear actions, responsibilities and timescales once the full report is produced
3.   A named person from NES to work with NHS Highland/ Caithness General Hospital as new structures and service models are put in place to ensure that new arrangements are suitable to provide a high quality training environment for Foundation Doctors and GP Specialty Trainees.
4.    A follow-up visit from the NES North region Quality Management (QM) team by the end of March and a follow-up full QM visit within 6-12 months, or earlier should it be required.
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Statement From NHS Highland

Caithness General Hospital

Dr Paul Davidson, clinical director for NHS Highland's north and west operational unit, said: "It is no secret that the situation at Caithness General Hospital is very fragile with only five of the 12 substantive consultants currently in post. The only substantive physician, who tendered his resignation in December, has just left post. Adverts are currently out for a physician and an anaesthetist and we will be advertising soon for a range of other posts, including a surgeon. This will be without prejudice to the longer-term model but we need to get on and test the market to see what skills we can secure both in Caithness and as part of the wider Highland team, the surgeon being an example.

"As the visit by NHS Education for Scotland (NES) has illustrated, there is a pressing need to review the current model in Caithness General. We need to look at all viable options but senior clinicians continue to be of the firm view that the status quo is not a viable option.

“The next few months, however, do provide us with the opportunity to test out some different ways of providing the most safe and effective care and treatment.

“In the meantime, we have been working collaboratively with clinical colleagues in Raigmore and across Highland, as well as the Scottish Ambulance Service, to put contingency arrangements in place. These are significantly different from earlier proposals and will see enhanced cover during the out-of-hours period for some of the week. We intend that these will come into effect on 7th March 2015.

“In these arrangements we are looking to replace the majority of locum-consultant cover by using consultant surgeons, physicians and rural practitioners from Raigmore and Skye who will be based in the hospital, covering medical and surgical in-patients as well as A&E. They will work very closely with the hospital's permanent staff, as well as the out-of-hours medical cover and the Scottish Ambulance Service. This a period of significant change and I am satisfied that we have the senior support and leadership available on site as well as further back up from Raigmore and Belford Hospitals.

“Furthermore, additional on-site support for the junior doctors will be provided from NHS Highland's associate director of medical education, who is also an acute physician. There will also be support from by NHS Highland geriatricians who will work with local staff to review clinical pathways and identify what skills will best meet the needs of the population. They are very experienced at working across a range of clinical setting, including rural general jospitals.

“We have received excellent support from Raigmore colleagues as well as others who have committed to come north over the next few months and do what they can to help maintain our services. Both the immediate situation and the wider review will benefit significantly from their skills and expertise. It is a significant step forward to be working together in such a coherent and structured manner, hopefully building a model that is fit for the future and ending all the uncertainty of recent times.

“The seriousness of the situation was further illustrated last week when our only substantive surgeon was unable to be at work. That a surgeon from Raigmore should have travelled north to provide necessary cover at very short notice further illustrates both the support we are getting but that the current situation at Caithness General is simply not sustainable.

“In order to increase the presence of consultants in the hospital it may be necessary to reschedule some clinics in the short term but we will do everything we can to minimise any possible disruption. I do hope people will understand that in the short term it just might not be possible to keep everything going. We have listened very carefully to what people have told us and from this we understand that the main concerns are around making sure we provide safe and responsive care especially around emergencies and that is what our plan is based on.

Specifically on the NES visit, Dr Emma Watson, director of medical education for NHS Highland, said: “The concerns raised by NES about the training environment at Caithness General Hospital serve to highlight the challenges that exist with the current arrangements and model.

“We are grateful to NES for their visit and welcome their feedback. We look forward to working with them as well as with staff and wider community to ensure we continue to maintain Caithness General as a good place to learn as well as provide a service that meets the needs of local people.

“The enhanced monitoring announced by NES will mean more frequent on-site visits and will ensure that that any actions that are required, happen to their satisfaction. This is particularly important as we bring in any new changes and move away from our heavy and unsustainable reliance on locums.

“We anticipate that the interim arrangements we will put in place for the coming months will satisfy any requirements from NES."

Bob Silverwood, NHS Highland's area manager for Caithness and Sutherland, added that the work at Caithness General Hospital formed part of a much wider review of health and social care needs and provision that had been taking place over the past two years.

At a meeting on Wednesday 4th March in Pentland Hotel (Thurso), members of the overarching Reference Group - involving members of the public, service users, staff, partner agencies and local elected members - will get an update on the review, which has been looking at how to improve dementia services, palliative care, day care, community services as well as work within Caithness General.

Mr Silverwood said: “It is important to see the work in Caithness General as part of the wider system of care and there has been a lot of effort invested by all of the working groups. Those attending will hear how all of this fits together. We remain extremely grateful for the contribution of all members of the group, and the wider community, as we work towards our common goal of improving health and social care provision in the area fit for the future."