Minutes of the meeting of the Scottish Board for Training in Diagnostics Specialties held at 11.00 am on Wednesday 21March 2012 in the Boardroom, Lister Postgraduate Institute, 11 Hill Square, Edinburgh
Present: Dr Peter Johnston (PJ) (Chair), Dr Fiona Ewing (FE), Dr Paul Fineron (PF),Ms Morag Forbes (MF) from item 4, Dr Peter Galloway (PG) from item 4;Dr John Hood (JH), Dr Wilma Kincaid (WK), Dr Hamish McRitchie (HMcR), Mr Alan Orr (AO),Dr Louise Smart (LS),Mr Donald Smith (DS), Dr Tom Taylor (TT).
Apologies: Dr Celia Aitken (CA), Dr David Bruce (DB), Professor Philip Cachia (PC), Professor Graeme Houston (GH), Dr Shona Olsen (SO), Dr Shilpi Pal (SP), Professor Massimo Pignatelli (MP), Ms Jackie Sutherland (JS), Dr Jennifer Tolhurst (JT),Dr Emma Watson (EW), Dr Richard White(RW).
In attendance: Dr Stewart Irvine (DSI), Ms Helen McIntosh (HM).
1. / Welcome and apologiesDr Johnston welcomed all to the meeting and in particular Dr Stewart Irvine who was attending to discuss the specialty board’s quality remit. Dr Irvine has been appointed NES Medical Director, succeeding Dr Mike Watson, from 2 April 2012. Dr Johnston said he looked forward to working with Dr Irvine and congratulated him on behalf of the board on his new role.
Apologies were noted.
2. / Minutes of meeting held on 22 February 2012
Two amendments were noted:
To note that due to technical difficulties Dundee participants joined the meeting by videoconference from item 4.
Page 4, Item 5, second paragraph, second sentence to read ‘However the document defined trainers but not training …
With these amendments the minutes were accepted as a correct record of the meeting and will be posted on the website.
3. / Matters arising/actions from previous meeting
3.1 / Reshaping the Medical Workforce and regional workforce planning: discussion with Professor Padfield
PJ attended and produced a paper on balancing workload and workforce for the January Diagnostics Steering Group meeting. He subsequently produced a summary issues paper following which the Steering Group decided to establish a short term working group to discuss the issues and invited him to chair it. He has flagged up the need for wide representation on the working group from the specialty board, the Medicine specialty board and a range of NES directorates; details to be confirmed. The working group would meet on a couple of occasions in April and May and produce recommendations. PJ has contacted Iain Robertson to ensure he and the MDICN were aware of these developments.
It was noted there were strong views in the Radiology community regarding the ability of Radiographers to take onsome of the work currently performed by Radiologists. PJ said this was a generic issue; removing skilled people and deskilling workforce resulted in a reduced flexibility to cover work. HMcR felt the document produced (Improving Reporting Capacity within Diagnostic imaging in Scotland: Facing the Challenge) had been misunderstood. Assumed plain film and CT workload may well be underestimated given how much is sent out to third parties for reporting and the cost to the NHS in Scotland that this implies.
Professor Padfield has indicated that glidepaths may flatten to some degree as fewer trainees have CCT’d than expected and there has been no service redesign. DSI added the reshaping process in Scotland has paused for the moment and may also be overtaken by the Reshaping UK review.
PJ will keep the board informed on the working group developments.
Action:
- PJ to keep the board informed on the working group developments.
4. / Quality remit: discussion with Dr Stewart Irvine
4.1 / Comparison information/trends
DSI said he was keen to gain the board’s view on how to develop its quality remit. There was now a wealth of information on the quality of training:
- GMC trainee survey (established in 2006). This provided national benchmarkable data. The GMC was aware of the weaknesses of the survey and was making major changes eg there will be different questions and different reporting tools next year.
- Trainer survey; this will not happen next year. It was being rewritten and relaunched in 2013. In the interim NES planned to run its own trainer survey in 2012.
- NES performance appraisal questionnaire; this was collected 6 months out of phase with the GMC survey timetable and covered the same questions to allow mapping.
- GMC produces useful evidence based assessment: ARCP outcome data will be published next year on the GMC website.
- GMC was now receiving College exam data in a consistent format and this will allow better analysis.
- College annual specialty reports.
PJ felt the specialty board could provide externality on programme visits although this could be problematic for those specialties with only one or two programmes. As hospital visits involved a mixture of specialties it would be dependent on what was being inspected as to what would be relevant representation from the board. DSI noted GMC was still planning to establish a process for externality but until then NES was seeking to agree a process at a local level.
Board members discussed current arrangements. Externality for Virology was provided by Newcastle; Dr Pota Kalima provided externality for Medical Microbiology for ARCPs in the West and JH provided externality for the East so externality for Deanery visits would require someone from elsewhere in theUK.
Radiology ARCP panels were established and the system worked well. Externality was provided between Scotland and Northern England and although this gave just a ‘snapshot’ it was helpful to see differences in training. They could also be impartial as they had not been involved in recruiting the trainees. They did not participate but observed ARCPs and could be asked for their views; they were used for panels where trainees were struggling and for academics so this was not a random selection. The College provided guidance notes, a grid and a standard form to return. The same postholderwent to the same Deanery for 3 years.
Histopathology had an informal arrangement between regions. This does work and allows a degree of consistency although it could be seen as a ‘cosy’ arrangement. PF felt it would be good to be involved in Deanery visits but noted the difficulty in getting externality from the rest of the UK.
DSI said College externality was only necessary if there were concerns and acknowledged the general difficulty in sourcing College externality. WK noted the different types of reports from Deaneries and felt it would make interpretation easier if there was a Scottish standardised template. If adverse reports were received, DSI said the GMC view was that the PG Dean was responsible for the quality of training. However while there were many processes the only real sanction in such a case was to withdraw programmes from hospitals.
The Medicine STB model was to run arolling programme of quality reviews and 2 TPDs gave a presentation at each STB meeting. Diagnostics STB has done this for selection and recruitment which has been a standing item on the specialty board agenda for some time. The board has also done this for ARCP data and College exam results.
TT flagged up concern that they might create a climate where people did not want to give trainees Outcomes 2/3 as this information would be available on the GMC website and could affect the programmes ability to recruit; DSI confirmed GMC has taken some of these concerns on board.
It was agreed DSI and PJ will discuss outwith the meeting what data the specialty board would receive and its involvement in Deanery visits.
Action:
- DSI and PJ to discuss outwith the meeting what data the specialty board would receive/its involvement in Deanery visits.
4.2 / Questionnaire for CCT exiters: update
PJ felt this would be a relatively easy piece of work for the board as TPDs where people once they gained CCT. The plan would be to contact people between one and two years after completing CCT to ask how prepared they felt they were for taking up consultant posts and how they found the transition from trainee to consultant. Numbers each year would not be large at around 30. DSI said that although GMC was not considering this he felt it could be a valuable piece of work and he would be interested in taking it forward and will consider the feasibility of running this survey.
5. / Recruitment/HR update
5.1 / Recruitment 2012 update
All Radiology and Histopathology posts have been offered and accepted; one post in Medical Microbiology was being held and a decision will be made today. There were still sufficient appointable candidates.
PJ thanked MF and JS and colleagues for their efforts in ensuring a successful selection and recruitment process.
Interventional Radiology (IR) remained an issue. FE believed that funding for a post in SES was to come from a disestablished post but this has not been confirmed; meantime they will advertise the post. There was concern about what would happen year on year when posts became vacant. The College view was that unless trainees have undertaken IR subspecialty training they will not be able to undertake any work involving IR elements; therefore they had to plan ahead to train these people and prevent a time lag. PJ said he will continue to try to influence Scottish Government. Health Board Chief Executives would also have to be persuaded of the need for such training to further influence Scottish Government. PJ will raise the issue with the Diagnostics Steering Group.
Action:
- PJ to raise IR issue with Diagnostics Steering Group.
5.2 / Data analysis
PJ reported he has received the data as requested from JS and will produce analysis for the May meeting.
Action:
- PJ to produce analysis of data for May meeting.
5.3 / Recruitment 2013: decision re venues
TT reported that Radiology has always favoured rotating venues; he and FE will consider and inform JS and MF of the decision.
Action:
- TT and FE to consider venue for 2013 recruitment and inform JS and MF of the decision.
5.4 / Letter from COPMeD Chair and Amendment Order
MF asked how this would impact on specialty recruitment. PJ said the Forensic Pathology posts were funded by the Crown Office and have been recruited locally as ST3 posts. Funding was initially for 3 years but he considered this was likely to continue. Paediatric Pathology had 2 posts in WoS recruited as subspecialty posts. Neuropathology had one post in WoS and it was likely this would be a national programme. PF feltestablishment of these specialties was unlikely to impact on the recruitment process.
PJ will write to DSI confirming the board wanted to recruit to these specialties. NES will then formally request this from Scottish Government and seek approval for programmes and other arrangements.
Action:
- PJ to write to DSI confirming the board wanted to recruit to these specialties.
6. / GMC – recognising and approving trainers: a consultation – response
PJ has produced a draft response. He will circulate it to board members for comment by Friday of this week and copy the response to Professor Stephen Gillespie is the chair of the Scottish Regional Council of the RCPath. He will then submit the response from the board by the closing date. DSI noted a single Scottish response on behalf of Universities and NES has been made. This was co-ordinated by Professor Needham.
7. / CfWI: Shape of the Medical Workforce: discussion
This item was deferred to a future meeting.
Action:
- Agenda item for future meeting.
8. / Specialty tutors in Pathologies
The board discussed the email received from Dr Richard Cooke and agreed Scottish arrangements involving and local specialty leads worked well. PJ will respond to Dr Cooke to confirm this was not an issue for Scotland.
Action:
- PJ to respond to Dr Cooke.
9. / Update reports
9.1 / Histopathology
All posts have filled. The only concern for the specialty was the proposal to reduce the number of training posts. PJ noted the Scottish Government was aware its consultant establishment information was flawed and Professor Padfield has asked specialty boards to provide this information. DSI confirmed this should be done until ISD data improved.
It was agreed all specialty leads will provide this information by programme/centre for each of the specialties.
Actions:
- All specialty leads to send information for each specialty by programme/centre to PJ.
9.2 / Radiology
TT said Professor Padfield had requested data on CCT dates. Radiology has a fixed date in August so if individuals did not CCT then the result was a fallow post for a year. 42% of trainees CCT’d in August and a significant number get consultant posts and did not use the ‘period of grace’ hence there was little cost in terms of double running.
PJ said there was no significant pressure for recruitment at other times of the year and the specialty did not want a second round of recruitment; he felt as double running costs were not as great as in other specialties a degree of flexibility could be allowed. DSI confirmed that if objective data could be produced by the specialty this could be considered.
FE noted Dr Paul Allan has produced consultant establishment information for the College of Radiology as requested by Professor Padfield. She will send this information to PJ.
Action:
- FE to send consultant establishment compiled by Dr Paul Allan to PJ.
9.3 / Medical Microbiology
The SAC met in February and the CATT was due to meet later in the week. The latest proposal for ID training was for 2 years in core + 2 years + 2 years. JH will report on discussion after the CATT meeting.
Action:
- JH to report on discussion following the CATT meeting.
9.4 / Virology
No update report was received.
9.5 / Chemical Pathology and Metabolic Medicine
PG reported interviews were about to be held. He also noted the College has asked the specialty to look at numbers across the UK; there were some large centres and some small centres where trainees received little exposure.
9.6 / Trainees
No update report was received. To note a replacement representative for Dr Pal was being sought; update to be received at next meeting.
Action:
- Update on replacement representative for Dr Pal at next meeting.
9.7 / Academic issues
In MP’s absence, DSI said the reduction in MedicalSchool numbers has been applied evenly on a pro rata basis across Scotland. Next year’s process was due to begin and England was also giving consideration to reducing numbers.
9.8 / Service issues
HMcR reported that SAMD was seeking to rejuvenate its links with the board. He will attend meetings more frequently and noted Dr Alan Cook will replace Dr Mackenzie from 1 April as the second SAMD representative on the board.
9.9 / Lay representative
No update report was received.
10. / Report of meetings attended
10.1 / GP Selection Centre
PJ had recently attended the GP Selection Centre as an observer. He had found it an enjoyable experience and noted it was an open, transparent, fair and objective process. DSI noted that applicant numbers to GPST have fallen; PF said this was a general trend with many trainees wanting to go to programmes in the south of England. He felt that academic brilliance was not always a good indicator as to how well people will perform in programme.
10.2 / Joint Committee on Pathology Training – College of Pathologists
The meeting took place on 16 March. To highlight:
- audit was now termed quality improvement
- discussion on new programmes
- College exams – 4 attempts permitted plus 2 in special circumstances
- workplace based assessments – now called supervised learning events. There was a proposal to remove scoring in 2014; it was felt this should be done now
- LEPT – online system. A focus group will be set up to consider how it works; the College was seeking to improve the system.
- ID training
- Chemical Pathology numbers
- flexible leave – currently 3 months and discussion on whether to remove it. Discussion was taking place on all forms of leave.
11. / AOB
11.1 / Liaison Dean
PJ reported this was Professor Cachia’s last meeting as Liaison Dean on the specialty board. He recorded his personal thanks and the thanks of the specialty board for Professor Cachia’s continued input, his positive contributions and ability to find solutions. PJ noted that Professor Needham will replace Professor Cachia as Liaison Dean from the April meeting.
11.2 / Frequency of specialty board meetings
Following discussion it was agreed to retain the current number of meetings; individual meetings could be cancelled if there was no business to discuss.
11.3 / Shape of training review
DSI noted the review which was now being carried out on a four country basis.
11.4 / Health and Social Care Bill
To note the bill has been passed; there was likely to be considerable impact inEngland.
12. / Date and time of next meeting
The next meeting will take place at 10.30 am on Tuesday, 17 April 2012 in Forest Grove House, Foresterhill, Aberdeen with videoconference links.
Actions arising from the meeting