Training and training establishments as a source of safety information

Accepted.
The General Medical Council has made it clear that it agrees that this is a fundamentally important principle which is given prominence in its guidance for doctors. The General Medical Council is considering as part of its review of quality assurance in education how it can be assured of the adequacy and appropriateness of training environments. The General Medical Council will share its proposals in the first half of 2014.

The GMC continues to work with partners in healthcare to support and improve the working and training environments of medical professionals to allow doctors to practice safely and provide the highest standards of patient care, implementing the standards it sets. It has since made improvements to its quality assurance processes for medical education and training since its review in 2012, including enhanced monitoring of training institutions where concerns related to patient safety or quality of education are raised.

Issues that need enhanced monitoring are those that could affect patient safety, training progression or quality. Issues are usually referred to the GMC if they meet the following criteria:
• Persistent and serious patient safety concerns
• Doctors in training’s safety at risk
• Doctors in training are not getting the experience required
• Local quality management processes alone are insufficient to address the issue. Concerns may be referred to the enhanced monitoring process by postgraduate training organisations, royal colleges and faculties. The GMC can also escalate a concern to this process as a result of its own evidence or information from other sources (like patients and doctors in training). Where possible the GMC works with all organisations to address the concern and develop a sustainable solution. Sometimes it needs to work with other regulators and organisations to make improvements. When local processes fail to address serious concerns, it may decide to use its legal powers to place conditions on the approval of postgraduate training posts. It may attach conditions to any approval it has already given. If it becomes clear that it is unlikely the conditions will be met, it may decide to withdraw its approval for training. The GMC publish information about issues which are under enhanced monitoring. This promotes transparency, drives improvement and helps organisations to learn from one another. The GMC has a duty to show that concerns about quality and safety are being addressed.

Students and clinicians in training are the eyes and ears of the service today and the safety leaders of the future. As they move around during their training, they can spot where safety doesn’t seem to be a priority, there is poor communication, and the concerns of patients and staff are not being listened to. As the future stars of a stronger safety culture, they need to be trained not only in safe care of the patient in front of them – already central to training – but in all the elements crucial to creating safer clinical systems: understanding human factors, measurement and audit, effective multidisciplinary team working, safe handovers of care, learning from error and near misses, and the tools of improvement science. Through the Health Education England Commission on Education and Training for Patient Safety, the General Medical Council will bring together comprehensive proposals for enhancing safety training for all health and care professionals, including producing a film to help staff and learners in the NHS to raise concerns if they experience or witness practice which puts patients at risk. The General Medical Council , Medical Schools Council, Foundation Programme and Royal Colleges are working across the UK to ensure that medical students and doctors in training are supported to become the leading lights of excellence in safety, with students starting this autumn seen as patient safety champions from day one. The General Medical Council will showcase current best practice at its conference in March and publish a report. The 5000 new Health Foundation NHS Improvement ‘fellows’ will work with medical educators to bring the most up-to-date knowledge on improving safety to the heart of training. The General Medical Council has focused on safety throughout its revised standards for education and training, published for consultation in January 2015, and expanded the questions on safety in its annual survey of all trainees. Through its visits to check the quality of medical education and training, it will work with providers to improve standards and tackle safety concerns, and its regional liaison service will expand its work with students and doctors in training on raising concerns and improving safety. It is very hard for staff to raise concerns where senior clinicians are dismissive, unsympathetic or worse. Doctors will be expected when they revalidate to demonstrate how they act on concerns raised with them, how they are reflecting on their practice and feedback from patients and colleagues, how they are fulfilling their professional duty of candour and supporting colleagues to do so too, and how their leadership skills and behaviours are contributing to creating an open safety culture that puts patients first.

This recommendation was accepted by the Government.

In its February 2015 Culture Change report, the Government said that the General Medical Council, the Medical Schools Council, Foundation Programme and Royal Colleges were working to ensure that medical students and doctors in training were to become patient safety champions.

The General Medical Council published new standards for medical education and training in July 2015, which came into effect in January 2016. They begin by stating that “Patient safety is at the core of these standards.”