Working in the NHS

1. Working in the NHS Dhiraj Uchil RCOG MTI and Sponsorship Officer Consultant Obstetrician and Gynaecologist, University Hospital Lewisham, London

2. Outline Creation of the NHS NHS structure- funding and regulation Working in the NHS- models of care Working in the NHS- what it means for you

3. Creation of the NHS • NHS was created in 1948 • Central principle is to provide services that are free for all at the point of delivery

4. What do the public think?

5. Perception of the NHS

6. Challenges

11. NHS funding

13. NHS funding

14. What do you need to know and why?? • NHS is free at point of use, but not really “free” • There are great pressures on NHS funding and demand often outstrips supply • Like any other business, it needs to attract money and needs to save money • Centralization of specialist services • Merging units • Tertiary units vs Secondary units

15. What does it mean for you?? • Does the patient really need a follow up appointment? • Are these investigations/ scans really necessary? • Early discharge – eg postnatal women, ERAS/ EROS pathways • Do not refer to another consultant/ specialty, even in the same hospital • CS on maternal request, IVF funding • Tourism healthcare

16. The NHS structure

17. Current NHS structure

18. Trust • Fancy name for “hospital”!! • Describes a management Structure Foundation Trust • Financial & management freedom • Local community involvement • Freedom to re-shape services • Still accountable and regulated by the NHS

19. Funders Regulators

20. Funding of NHS services

21. Influencing commissioning

22. Funding of education in the NHS

23. Healthcare Regulators

24. Models of medical care

25. Paternalistic model of care • Doctor knows best model • Patients as passive recipients of care • Rarely encountered (or tolerated) in NHS practice

26. Informative model • Patients who do their own research with “Dr Google” and know what is wrong and what needs to be done • Clinicians as mere suppliers of information without offering opinions- allow patients to decide

27. Shared decision making in the NHS

28. Models of care

29. Hierarchies in the system Some of you may have worked in very hierarchical systems A flattened hierarchy as is often found in the NHS may be an unusual experience Dealing with questions/ challenges “Jump calls”

30. Multidisciplinary teams Working in a multidisciplinary team may be a new experience for some Working with midwives throughout the woman’s journey Working with other professionals- anaesthetists, physicians, physiotherapists Learning effective communication strategies Learning together- mutidisciplinary skills and drills

31. Your training in the NHS

32. Who is responsible for your training?? Hospital Royal College Deanery

33. Training responsibilities Trainee Deanery Clinical Supervisor Hospital (Trust) TPD (Training Prog Director) Educational supervisor DME (Director of Med Educ) Head of School College Tutor Postgraduate Dean Medical Director

34. What should you aim to gain out of working in the NHS?? • Technical skills • Not only surgical; FBS, colposcopy, scanning, etc… • Patient management skills • MDT, management planning, appropriate referrals, counseling, etc… • Communication skills • Patients, families, colleagues, GPs, nurses & midwives, documentation, etc… • Audit skills • Participate, understand concept, how to plan an audit, auditable standards • Organization & management skills • Book early annual & study leave, swap your on calls early, organize rota

35. What should you aim to gain out of working in the NHS?? • Presentation skills • Perinatal meeting, audit meeting, etc… • Teaching skills • Undergraduates, SHOs, even colleagues • Research skills • Look for opportunities • Writing skills • Reviewing and writing new local guidelines

36. Goals for MTI trainees

37. How to achieve your aims?? • Have clear realistic goals • Be enthusiastic and seek out educational opportunities • Don’t have a narrow focus (eg gynae surgery). Identify the areas that your previous training may have gaps • Be willing to learn….. Lots of people can teach you things, if you are willing to let them! • Understand service vs training dilemma • Speak to your educational supervisor and the College Tutor

38. Training Materials • Register as a trainee with RCOG • Curriculum • Core training, ATSM, SST • Log Book/ e-portfolio/ training matrix • ST1-ST7 • 19 modules • Assessment tools • Forms for induction and appraisal

39. Courses to attend RoBUST PROMPT EFM- K2/ RCOG EFM package Perineal trauma repair course Communication courses Part 2 exams course

40. Assessment Tools • Portfolio/Modular Log Book • Mini-CEX Minimal clinical evaluation exercise • CBDs Case base discussion • OSAT Objective structured assessment of technical skills • TO Team observation • ARCP Annual Review of Competency Progress

41. Annual Assessment TO1 forms • At least 10 observers • Midwives • Colleagues • Nurses • Secretaries • Usually chosen by trainee but should ideally be approved by the Educational Supervisor Educational Supervisor then produces a summary (TO2)

43. Any Questions ?