The Thames Valley Quality Team has a responsibility for ensuring that clinical learning environments meet quality standards for education and training set by NHS England and the GMC. This process is managed under the Quality Strategy and Framework and is informed by the risk register. The risk register is multi-professional, but most of the risks are medical due to arrangements between Local Education Providers and the universities for managing quality concerns in non-medical education. Risks are graded using the Intensive Support Framework.
Over the past year (August 2022 to July 2023) 38 risks were managed on the risk register. Three of these were of a significant concern and were therefore reported to national and regional teams within NHSE-WTE and/or to the GMC. These were Trauma & Orthopaedics at Buckinghamshire Healthcare NHS Trust, Ophthalmology at Oxford University Hospitals NHS Foundation Trust, and Paediatrics at Milton Keynes University Hospital NHS Foundation Trust. As a result of actions taken to resolve concerns, 17 risks were closed. At the time of writing, 24 risks remained open on the Thames Valley risk register which include 11 new risks arising from the NTS 2023.
The list below comprises the main training issues that arose from the 2022 NTS or via other governance routes and the actions taken.
School of Histopathology
| Learning Environment | Source of concern | Summary of concern | Action taken/outcome |
| Histopathology – ST1 School | NTS and Head of school | The ST1 school for histopathology was relocated from Wycombe Hospital due to the significant pressures the department was under from an increase in workload, a shortage of consultants and difficulties in recruiting. It was no longer able to sustain high quality training for the number of learners on placement. ST1 training was relocated to the John Radcliffe Hospital in August 2022. | The move has been highly successful. Additional funds were provided for equipment and resources and there has been an increase in formal teaching and supervision. A former Thames Valley trainee took up a Consultant post at OUH and was appointed as the ST1 training lead. The ST1 school now has a dedicated teaching lead, pastoral support and mentorship support, including a buddy system where junior trainees are paired with senior trainees. The training provision for ST1s has been highly commended by trainees. The Thames Valley Histopathology programme was ranked 3rd out of 15 nationally for overall satisfaction and received no negative outliers on the GMC survey 2023 |
Buckinghamshire Healthcare NHS Trust
| Learning Environment | Source of concern | Summary of concern | Action taken/outcome |
| T&O – Foundation Training | NTS 2022 & direct feedback from foundation doctors in training in February 2023 | Concerns regarding supervision and support for the medical needs of surgical patients, rota issues, lack of educational opportunities and teaching, and overrunning of the morning handover/trauma meeting delaying release of doctors in training. | The Trust had a comprehensive action plan in place to address issues arising from the NTS 2022 feedback from foundation doctors. This included: A redesigned induction with new materials including a presentation and a handbook. Trainee/trainer feedback meetings. A newly appointed rota co-ordinator, rota redesign and rostering of self-development time. Increased medical workforce at all levels. Allocated consultant responsible for teaching programme, weekly protected teaching sessions. Due to ongoing concerns chiefly regarding supervision and support for junior tier doctors in training in relation to the medical needs of surgical patients, a quality visit to the Trust was arranged in October 2023. The review found that considerable progress had been made to improve the learning environment for foundation and core trainees and there was an excellent learning environment for higher specialty doctors. Workforce numbers had increased, and there was good clinical exposure and access to theatres. Teaching and training had increased for junior tier doctors. A mandatory requirement was set relating to the provision of senior medical cover on the wards and this will continue to be monitored. To reflect the improvement to training, the risk was downgraded and removed from the significant concerns register. |
| Histopathology | NTS 2021/ NTS 2022/ Head of School | Multiple red outliers in NTS 2022 and ongoing concerns regarding workload and supervision for the training that remained at Wycombe Hospital (following the move of the ST1 School). | Since the relocation of the ST1 School, training in Histopathology has improved. There has been good educational engagement, new educational leadership and two newly appointed locums who are involved in training. There is an improved ratio of consultants to trainees which has increased supervision and teaching opportunities. Trainees have reported much improvement. The risk was closed but the Head of School will continue to monitor progress and seek trainee feedback. |
Royal Berkshire NHS Foundation Trust
| Learning Environment | Source of concern | Summary of concern | Action taken/outcome |
| Haematology | NTS 2021 and 2022 | Multiple red outliers across the 2021 and 2022 survey. These included workload, supportive environment, handover, induction, feedback and local teaching Outside of the survey, concerns were also raised about the culture within the department. | First reported last year, the training issues in Haematology continued to improve following successful delivery of the Trust’s action plan. Educational governance meetings continue to take place which were managing training issues. Feedback from these meetings included: improved staffing levels with foundation year 3 in post; improved culture, and no concerns relating to local teaching or handover. The NTS 2023 results were much improved with one green positive outlier for Educational Governance. Subsequently, the risk was closed. |
Oxford University Hospitals NHS Foundation Trust
| Learning Environment | Source of concern | Summary of concern | Action taken/outcome |
| Paediatrics Neonatal Intensive Care Unit | Trainee Advisory Committee, Dec 2020 | Departmental culture including behaviours, multidisciplinary team working/ learning and reporting of concerns. support and supervision for learners to acquire essential skills. intensity of workload and the impact of this on education and training and learner wellbeing. | First reported last year, the Trust continued to engage with improving the education and training experience for doctors since the original quality review in Autumn 2021. Extensive work was undertaken to improve the cultural issues, a comprehensive teaching programme was introduced, changes were made to handover, there was improved access to wellbeing support, and mechanisms in place for identifying and responding to training issues. The improvement work was led and supported by a dedicated consultant over a 2-year period. Recent feedback from DiT was overwhelmingly positive and the risk was closed in December 2023. |
| Clinical Oncology Medical Oncology | NTS 2017 & subsequent NTS | Concerns focused around the heavy on-call rota arrangements impacting education and training. | In June 2023 a review confirmed there had been improvements made to education and training. Registrar-led palliative clinics had started; there was a consultant and registrar away day planned; and 3 TV trainees had been appointed as consultants. The risk was closed in August 2023 but a significant on-call element still exists and the Trust has been asked to continue to pursue ways to reduce this in order to sustain good quality training. |
| Ophthalmology | School of Ophthalmology July 2021 | Limited opportunities to access theatres for ophthalmology trainees for all sub-specialties but most concern about the amount of cataract surgery available for training purposes. | Since reporting this last year, most cataract surgery is now being done in the independent sector but case numbers can be small due to the way lists are organised. Access to other surgical specialties are also being monitored by the Head of School for Ophthalmology and remains on the risk register. |
| Renal Medicine | School of Medicine, Nov 2020 & NTS | Trainees moved to resident on-call reducing daytime training opportunities. | Following a period of monitoring by Head of School, training has continued to be achieved despite a requirement to be resident at night. NTS 2023 results were much improved with a positive outlier for clinical supervision out of hours and a pink flag for feedback. The risk was closed. |
Frimley Health NHS Foundation Trust
| Learning Environment | Source of concern | Summary of concern | Action taken/outcome |
| Anaesthetics | NTS 2022 | Several negative outliers in the GMC survey these included teaching and supportive environment, which appeared to be the main problem area. | The Trust identified an action plan to address concerns raised in NTS 2022. This included changes to the regional (involving the School of Anaesthetics) and local teaching provision. In May 2023 the Thames Valley quality team held a focus group with DiT to assess progress. Findings showed that education and training had improved with fewer occasions where DiT were moved from training lists and clinical supervision was good. However, there were concerns reported around incivility and the confidence to raise training concerns and mandatory requirements were made around these two issues. The risk continues to be monitored and will be formally reviewed again in Summer 2024. |
Milton Keynes University Hospitals NHS Foundation Trust
| Learning Environment | Source of concern | Summary of concern | Action taken/outcome |
| Paediatrics | NTS 2022 | Heavy workloads, staffing gaps and insufficient workforce numbers impacted capacity for training, chiefly access to teaching and learning opportunities. DiT unable to leave within rostered hours due to frequent overrunning of the morning handover. Rudeness and incivility. | A quality review was held at the Trust in January 2023 to assess progress made against the Trust’s action plan in response to GMC survey results. Considerable progress had been made to improve the culture and this was reflected in the feedback from DiT. However, increasing workloads and staffing gaps were affecting education and training including access to teaching sessions. Handover was also regularly overrunning. On subsequent reviews during 2023, while improvements to training continued including a new monthly teaching programme, instances of incivility were still occurring and a reluctance to report these. To reflect the improvement to training, the risk was downgraded and removed from the significant concerns register. Issues pertaining to incivility and reporting mechanisms will continue to be monitored on the risk register. |