Wednesday, 17 April 2013

The Francis report and what it should mean for medical training - part 3

Now to part 3, in parts 1 and 2 I have highlighted Francis' key observations relating to training, that being the failing regulatory system.  The key recommendation is that routine visits to all local providers should be reinstated:

"The General Medical Council should set out a standard requirement for routine visits to each local education provider, and programme in accordance with the following principles:

- The Postgraduate Dean should be responsible for managing the process at the level of the Local Educational Training Board, as part of overall deanery functions.
- The Royal Colleges should be enlisted to support such visits and to provide the relevant specialist expertise
where required.
- There should be lay or patient representation on visits to ensure that patient interests are maintained as the
- Such visits should be informed by all other sources of information and, if relevant, coordinated with the work of the Care Quality Commission and other forms of review."

Francis also makes it clear that the DH must support this process and that the system must take these routine regulatory visits into account:

"- The Department of Health should provide appropriate resources to ensure that an effective programme of monitoring training by visits can be carried out.  All healthcare organisations must be required to release healthcare professionals to support the visits programme. It should also be recognised that the benefits in professional development and dissemination of good practice are of significant value.
- The system for approving and accrediting training placement providers and programmes should be configured to apply the principles set out above."

Francis also mentions that the role of routine visits in terms of patients safety:

"Training visits should make an important contribution to the protection of patients:
- Obtaining information directly from trainees should remain a valuable source of information – but it should not be the only method used.
- Visits to, and observation of, the actual training environment would enable visitors to detect poor practice from which both patients and trainees should be sheltered.
- The opportunity can be taken to share and disseminate good practice with trainers and management.
Visits of this nature will encourage the transparency that is so vital to the preservation of minimum standards."

Francis also adds that LETBS should have a medically qualified postgraduate dean:

"All Local Education and Training Boards should have a post of medically qualified postgraduate dean responsible for all aspects of postgraduate medical education."

Overall Francis' recommendations are good.  Routine regulatory visits have needed reinstating for some time.  It is utterly vital that the Colleges have a prominent role in this new regulatory structure.  The concern I have concerns the role of visits in terms of patients safety.  Of course if trainees mention things relating to concerns for patient safety then there must be mechanisms in place for ensuring that these are dealt with appropriately. However it is important that visits are primarily about training quality and training problems.

It is also vital that those  who are entrusted to take part in these visits are trusted by trainees and are properly independent.  I sorely hope the government act on these recommendations and do not ignore them as they did with John Tooke's excellent report.  It is a little worrying that there is no mention of medical training in the government's initial response to Francis.

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