The chief registrar Clinical leaders for today and tomorrow

Transcription

1 The chief registrar Clinical leaders for today and tomorrow

2 Foreword In 2013, the Future Hospital Commission (FHC) report put forward an ambitious vision for how hospitals of the future should operate, and emphasised the need to advance care of patients. A key finding of the FHC report was that the NHS would benefit from enhanced input by trainees. As part of its recommendations, the report highlighted the need for two senior posts at trust level chief registrar and chief of medicine aimed at improving the coordination and delivery of care. In the midst of the difficulties faced by the NHS, it is essential that our trainees not only are valued, but also have their voices heard by the organisations that they serve. The chief registrar scheme provides a platform from which positive change can be effected by people who experience life on the medical front line every day. By remaining clinically active, chief registrars can help to develop practical solutions to local problems that are specific to their trusts. The scheme galvanises future clinical leaders to be the innovators and improvers within their organisations. Chief registrars oversee projects relating to service redesign, workforce transformation, quality improvement, patient safety, and education and training. The Future Hospital chief registrar scheme is testament to the Royal College of Physicians (RCP s) continuing commitment to valuing, supporting and motivating trainees. Chief registrars will bridge the gap between trainees and senior clinical decision makers, as well as positively influencing patient outcomes, staff fulfilment and motivation, and organisational performance. With an initial intake of 23 chief registrars from England, Wales and Northern Ireland, the scheme has really started to come to life, gaining support from a number of key national organisations. The RCP Education Department and the Faculty of Medical Leadership and Management (FMLM) have designed a dedicated development and training programme to support the exciting evolution of chief registrars from doctors in training into clinical leaders. The programme will equip them with the skills to navigate a challenging health and social care system. We aspire to facilitate the evolution of an NHS that supports effective delivery of high-quality patient-centred care, with a valued, supported and motivated workforce. Dr Gerrard Phillips, RCP senior censor and education and training vice president

3 The chief registrar role an overview > A recognised local leader and manager. Chief registrars will attend and sometimes lead departmental and divisional management meetings to gain an understanding of the organisation, and the wider social, political and economic influences on healthcare delivery. Where possible and appropriate, they should attend trust board meetings and present to the board on their work, particularly in relation to quality improvement and service redesign. Chief registrars should have access to senior leaders within the trust, particularly their medical director. > Quality improvement and service redesign. With dedicated time in the role, chief registrars will lead change within their organisation that benefits both patients and their colleagues. We envisage that trusts will work with chief registrars to determine the areas most in need of improvement and will support them to deliver the principles of the future hospital. The chief registrars clinical background ensures that the changes will be clinically intuitive, while their new skills will enable them to manage change systematically and sustainably. > Future leaders. With access to high-quality leadership and management training, innovative ideas and national leaders, the chief registrar experience prepares trainees for a future in a variety of leadership roles. Chief registrar: The role at a glance - The chief registrar will be in post for 12 months % of a chief registrar s time will be spent on clinical work - 40% of their time (minimum) will be protected for chief registrar work This leadership development post would have a key role in planning the workload of medical staff in training, medical education programmes and quality improvement initiatives. Future Hospital Commission, 2013 > Workforce transformation. Chief registrars will have oversight of current planning of service delivery in relation to junior medical staff deployment. They will develop an understanding of patterns of out-of-hours working, shift working, safe cover, handover and hospital at night. They will work with senior colleagues and teams to ensure that medical skills are deployed where and when they are needed, designing changes where required, and ensuring that plans meet current and future patient needs. > Education and training. Chief registrars will be in an ideal position to influence the training and education of junior doctors, ensuring that the skills being developed are fit for the modern medical environment and for future developments such as integrated care, digital technologies and the changing patient demographic.

4 Training and education Successful chief registrars will require greater leadership skills than are normally expected of doctors in training. They will need to be trusted, confident, emotionally resilient, self-aware and able to inspire and motivate, all in the context of striving to deliver safe and improving care for patients in challenging times. A chief registrar will need to be able to reflect objectively upon their own performance and that of the team around them, and handle difficult conversations. They will need to be able to hold their own in executive and board-level discussions, as well as successfully lead their colleagues. These are executive and strategic roles, not representative. Effectiveness will therefore demand sophisticated leadership, management skills and a good understanding of the local and national context, including the political context. The training programme The chief registrar training programme has been designed to cover the following core capabilities: > detailed self-awareness, with knowledge of personal strengths and areas for development > understanding of personal impact and how to build effective, diverse teams > understanding of leadership theory and practice relevant to the individual > mentoring and/or coaching > identification of further development needs, eg handling conflict and negotiating skills > the opportunity to learn from each other, eg through action learning sets > development of management skills > understanding of the local and national context in which their trust operates. Training and education are delivered by the FMLM and the RCP Education Department. The costs of the training and education package are, at present, covered by the RCP, a major benefit of involvement with the scheme. Accreditation Chief registrars will have the opportunity to work towards a recognised accreditation from the FMLM. The RCP Future Hospital Programme (FHP) will guide chief registrars on what they should be adding to their portfolio during their tenure.

5 Benefits For patient care and the organisation There is growing evidence that effective medical leadership and management have a positive influence on: > patient outcomes > quality of care and innovation > staff fulfilment, motivation and morale > organisational performance. Using their position, clinical judgement, knowledge of the clinical environment and new skills, chief registrars will lead work that tackles their hospital s critical challenges. With access to quality improvement and service redesign experts at the RCP, chief registrars will deliver measurable improvements to patient care, to be sustained long after their tenure. I believe that moving decision making closer to the shop floor is one of the most important ways to make genuine service improvement and deliver effective patient-centred care. The chief registrar role will go some way towards beginning this journey, with benefits to patients, staff and managers. Dr Emily Bowen, chief registrar, Gloucester Hospitals NHS Trust For the trainee workforce Trainee doctors are a precious commodity in any hospital, but a cohort under considerable strain. The RCP 2013 report The medical registrar: Empowering the unsung heroes of patient care found low morale and disenchantment among trainees, especially with regard to internal medicine and particularly the acute medical take. This was due to a combination of increasing workload, lack of control over workload, increasingly complex and multiply comorbid patients, heightened patient expectation, increased litigation and lack of support. The chief registrar is a tangible demonstration by any NHS organisation of its commitment to trainee development. While the chief registrar is not a representative role, postholders provide a conduit between their trainee peers and trust leaders and managers. The improvement work carried out should be sensitive to the needs of the whole clinical workforce and undertaken in consultation with, and involvement by, clinical teams. A more effective workforce will have a beneficial effect on patient care. In my role as chief registrar, I hope that I can improve the issues faced by junior doctors, such as lack of support and education. This will improve their morale and hopefully improve their ability to work within the confines of what is largely accepted as an NHS under strain. Dr Zoe Jones, chief registrar, Gloucester Hospitals NHS Trust For the individual The benefits to the chief registrar are multiple: the individual will develop effective leadership and management skills, and will have the opportunity to initiate and deliver high-impact quality improvement projects. Unlike anything in their clinical training, they will have direct experience of management at senior trust level and gain an understanding of the wider NHS and care system. Through the RCP, they will have access to a high-quality management and leadership education package, as well as national meetings and stakeholders. Their time in post as a chief registrar is excellent preparation for any future leadership or management role within their trust or nationally. The experience will prepare them to be exceptional consultants. I am delighted to have this privilege. I have dedicated time to facilitate service improvement, and I can act as a voice for junior doctors, playing a part in improving their morale. Dr Christopher Parokkaren, chief registrar, Kent & Canterbury Hospital These anticipated benefits are being examined during the current pilot of the chief registrar scheme. There is a formal external assessment process, which should start to realise some outputs by spring 2017 and will report formally in the summer of 2017.

6 Costs Cost of post The chief registrar > The cost of a chief registrar appointment will vary from trust to trust, depending on: - the trainee s decision to complete the post in programme (IP) or out of programme (OOP) - the grade of the trainee - the percentage of hours out of usual work for chief registrar duties. Backfill Backfill arrangements will vary depending on a number of factors that must be decided in advance by the participating trust. We recommend that those looking to appoint a chief registrar start negotiation and planning as early as possible, in discussion with the trust s medical director (and/or CEO), human resources (HR) team and clinical directors. Cost of training The chief registrar scheme is in its formative stages. As such, the RCP will cover the costs of the training and education package for chief registrars in 2017/18. Many trusts involved in the first cohort noted how instrumental this was to the successful appointment of their chief registrar. Expenses policy Chief registrars or their employing organisations are responsible for covering all travel, accommodation and subsistence required to carry out the post of chief registrar and attend training. The RCP does not cover expenses related to events, conferences or speaking engagements to which chief registrars may be invited during their tenure. Guidance on training status The chief registrar must be based at a site approved by the General Medical Council (GMC) for training in the applicant s specialty. Permission must be sought from the training programme director (TPD) in advance of an application. Our guidance remains that chief registrars should be ST5 or above. The chief registrar post may be undertaken as either an IP or OOP opportunity, dependent upon local workforce requirements and individual training needs. In programme: As the chief registrar role fulfils a number of curriculum requirements, trainees may wish to remain IP. Requests must be agreed prospectively with formal approval of the TPD. At least 40% of the trainee s time must be available for chief registrar activities. Trainees should continue to satisfy the requirements for the Annual Review of Competence Progression (ARCP). Out of programme: Requests for OOP applications must be agreed prospectively with formal approval of the postgraduate dean. The decision to pursue out-of-programme experience (OOPE) or out-of-programme training (OOPT) is made at local level, in conjunction with the educational supervisor and TPD. It is recognised that the skills developed within the chief registrar role align with several training curriculum requirements. In light of the fact that curriculum competencies will be obtained from this opportunity, the Certificate of Completion of Training (CCT) date may or may not need to be extended. The RCP can offer guidance on effective logging of skills developed during the time as a chief registrar within the current eportfolio forms.

7 Recruitment Appointment to the post of chief registrar should be done through an open and competitive process. Trust responsibilities > Trusts should use the standard chief registrar job description to form the basis for an advert via NHS Jobs or other recruitment sites used by the trust. > Applications should follow trust procedures. > An interview date should be set and the interview should be attended by a panel made up of (at a minimum) a trust senior medical manager, a representative from the deanery and a lay/patient representative. Trainees responsibilities > The trainee should give their postgraduate dean and their employer (current and/or next) as much notice as possible before commencing the chief registrar post. Three months is the minimum period of notice required. > Approval of the relevant specialist advisory committee will be required for candidates seeking OOPT. Trainees undertaking OOPT should continue to satisfy the requirements for the ARCP. > The candidate will need to notify the Joint Royal Colleges of Physicians Training Board (JRCPTB) with at least 3 months notice if they are undertaking the year OOP. This recruitment advice is available from November 2016 to assist NHS trusts in recruiting chief registrars for 2017/18. The timeline for recruitment is as follows. > November 2016: FHP recruitment advice available > December 2016 March 2017*: Trust advertisement, interviews and recruitment > Friday 28 April 2017: Deadline for notifying the FHP of names and details of successful candidates (download the candidate details form) > Thursday 8 June 2017: FHP showcase and introductory event for chief registrars > August/September 2017: Trust start date for chief registrar appointees > September 2017: First training module for chief registrars *Trusts should determine their own timeframes within the recruitment phase (December 2016 March 2017).

8 Frequently asked questions Which trainee doctors can apply for a chief registrar role? Applicants must be ST5 or above, hold a National Training Number (NTN) and be enrolled in a medical specialty training programme or on the Certificate of Eligibility for Specialist Registration (Combined Programmes) (CESR-CP). Applications should be open to both full-time and less-than-fulltime trainees. Ideally, the trainee will be working towards dual accreditation in both a specialty and general internal medicine. Who leads the training programme and what does it involve? The training programme in leadership and development is delivered jointly by the FMLM and the RCP Education Department. Through a series of four modules, chief registrars will be exposed to the latest international thinking in leadership, learn about the wider healthcare system and how to influence it, develop skills in change management and quality improvement, and explore their role in developing the future hospital. For those looking to appoint a chief registrar How is the position funded and how much does it cost? The cost of a chief registrar appointment will vary from trust to trust. If a trainee remains in programme (IP), their salary will be paid in the usual way, with contributions from their trust and Health Education England / Northern Ireland Medical and Dental Training Agency / Wales Deanery (as appropriate). If the post is undertaken out of programme (OOP), the employing trust will fund the trainee s salary during their time as a chief registrar. If the post is being undertaken IP, the trust will be required to provide backfill to cover the clinical time when a chief registrar is carrying out their leadership and management duties (40% minimum). The need to provide backfill for chief registrars undertaking the year OOP will vary. It is important that those looking to appoint a chief registrar should hold early conversations with trust management (including medical HR) to explore funding. How should I set about recruiting a chief registrar? Once you have agreed funding with your trust, you should review the standard job description for the chief registrar role. Trusts appointing a chief registrar may make moderate changes or additions to the job description, based on local requirements. We advise all trusts to advertise the job on NHS Jobs: Advertisement, interviews and recruitment should take place between December 2016 and March What is expected of my trust/department when we appoint a chief registrar? You should ensure that the trainee has sought permission from the TPD and education supervisor. Your recruitment of a chief registrar must also be agreed by the deanery/local education and training board. You will be expected to appoint a senior clinical leader as mentor to the chief registrar, who will offer guidance and support during their placement. The chief registrar should have access to senior medical managers, particularly the medical director, to support them during their tenure. There will be infrequent invitations for mentors and senior managers to join the chief registrar at RCP events. For trainees Will my training status change during my time as a chief registrar? The chief registrar post may be undertaken as either an IP or OOP opportunity, dependent upon local workforce requirements and individual training needs. OOP requests must be agreed with the local deanery and TPD. Approval from the relevant specialist advisory committee must also be gained by candidates seeking OOP training. The candidates will need to notify the JRCPTB with at least 3 months notice if they are intending to undertake the year OOP.

9 What is expected of me during the post? The chief registrar programme is a 12-month post. A minimum of 40% of the chief registrar s time will be required for leadership and development work. The remaining 50 60% of a chief registrar s time will be spent on clinical work. I would like to be a chief registrar; how should I apply? Chief registrars are appointed by their trust through application and interview. The RCP advises all trusts to advertise the role and application details on NHS Jobs: I have not seen an advert for a chief registrar position at my hospital. Who should I approach at the trust about this position? You should speak to your educational supervisor and the trust s director of medical education in the first instance. They should have insight into whether the trust has agreed to appoint a chief registrar. Will this opportunity continue to be available in the future? The RCP has committed to the ongoing development of the chief registrar scheme. We are still learning from the pilot and its evaluation, so there will be some adaptation to ensure that the scheme and role description meet the current and future needs of the NHS. Chief registrar appointment is at the discretion of local trusts. Trusts that have previously appointed a chief registrar are likely to continue to do so. During 2017/18, we hope to expand to more organisations. Is there a job description for the role of chief registrar? The standard job description and person specification for the role of chief registrar can be found on the RCP website. Trusts appointing a chief registrar may make moderate changes or additions to the job description based on local requirements. We advise all trusts to advertise the job on NHS Jobs: How much travel is involved? Chief registrars will be based at their hospital, as they would during their clinical training. Education and training cover approximately 10 days over 6 months and will be held mostly in London. Other opportunities for events or speaking engagements around the UK will be offered to chief registrars, but are not mandatory.

10 Candidate details Following the successful appointment of a candidate to the position of chief registrar, the trust recruiter will need to send the following information to the RCP. The form below is available online. Please return it to the FHP (futurehospital@ rcplondon.ac.uk) by 5pm on Friday 28 April Full name Trust Hospital Medical specialty Training status (OOPT, OOPE or IP) Grade (eg ST5) National training number Start date as a chief registrar Mobile number address Twitter handle Local mentor s details: - name - job title - address Dietary requirements Is the appointed chief registrar able to attend the chief registrars showcase event at the RCP on Thursday 8 June 2017? Yes No Is the appointed chief registrar happy for their contact details to be shared with other chief registrars? Yes No

11 For further information Visit: or contact Future Hospital Programme Royal College of Physicians 11 St Andrews Place Regent s Park London NW1 4LE rcplondon.ac.uk/projects/ future-hospital-programme