20 December 2021
Dear Trainee / Trainer,
As we move towards the end of 2021 and into winter, we continue to navigate our way through the COVID pandemic, and the profound disruption it has caused across society and our health and care system. The response and contribution of all health and care staff continues to be outstanding and supporting and caring for colleagues must be a central part of our response.
Winter always brings additional pressures to bear on the NHS, but all the signs are that this winter will be particularly difficult. The emergence of the omicron variant of the SARS-Cov-2 virus is an unwelcome additional challenge, and whilst there remains a great deal of uncertainty regarding the likely impact of this variant, the early signs are that it could be very disruptive.
As an education body, NES continues to make every effort to support the service and to mitigate the impact of the pandemic on all aspects of education and training, working closely with Directors of Medical Education in Boards, with the Scottish Government and with the other Statutory Education Bodies, Medical Royal Colleges and the GMC across the UK.
We recognise the stresses that doctors in training and their trainers have faced as they have navigated changed recruitment processes, and the challenges many have encountered in the acquisition of competencies and passing professional examinations to progress their training.
We are aware too that many of you are tired, and apprehensive as we face the winter. The Scotland Deanery and Health Board Directors of Medical Education remain in regular contact and above all, we wish to ensure that you consider your own wellbeing and that of your colleagues, and that we do what we can to support you in this. Resources are available if needed:
At the present time our clear intention is that the forthcoming February 2022 rotations will continue as planned. Many new doctors join our programmes in February, and many more move to new posts essential to their clinical progress. In very specific circumstances, local arrangements may be required but this will require approval of the Director of Medical Education, relevant Postgraduate Dean and any involved trainees.
Whilst most doctors in training have managed to progress normally through training, others have faced problems in gaining the necessary experience. This impact has affected some specialties more than others and has not been the same across the country.
NES continues to work closely with the Statutory Education Bodies in the other devolved nations (HEE, HEIW, NIMDTA), the General Medical Council (GMC) and the UK Academy of Medical Royal Colleges (UK AoMRC) to agree principles that have been used to make changes to curricula and assessments to adapt to the pandemic, and to support progression wherever possible[i]. All are agreed that patient safety remains paramount, and that we must maintain standards – the CCT standard remains unchanged. We are looking to assess competency not quantity and we need to maintain proportionality and support equity, diversity and inclusivity.
Following our annual review process (ARCP) we determined that about 87% of trainees were progressing normally, but about 13% were facing problems. Our December update suggests that the position has improved, but we are obviously keeping the position under frequent review, and continuing to invest in additional support, for example in simulation. We will continue to provide support on an individual basis and offer extensions to training where these might be required.
We recognise the importance of study leave to personal and professional development and will seek to protect this to the maximum extent possible, particularly where this is essential to progression along a training pathway. It is important to recognise however, that in the event of significant service pressures or staff absence, study leave may need to be paused, but would aim to minimise the period of impact as much as possible.
It is inevitable that the additional service pressures which might emerge could lead to a need to redeploy staff – including trainees. We would hope this would be within the same clinical department or directorate (but could under extreme circumstances be deployment to wider clinical areas). The Postgraduate Deans and Directors of Medical Education have co-produced a framework document setting out the principles for any redeployment. This has proved valuable in minimising the extent to which doctors in training have been redeployed to date and to mitigate the impact on trainee progression. Any decisions regarding redeployment will take into account the principles outlined in the agreed framework.
It is particularly important that trainees who received an outcome 10.1 at their most recent ARCP are not redeployed unless this is absolutely essential as they are at higher risk of requiring extensions to their training. The few trainees who received an outcome 3 or 10.2 at their most recent ARCP should also not be redeployed unless absolutely essential, as they already need extensions to training in educationally tailored placements.
While acknowledging the above, it is possible that unavoidable service disruption, for example restricting clinical activity in an area, may severely reduce training opportunities for some doctors. Under these circumstances, the service may seek to deploy doctors to other duties for short periods.
It is possible that local Boards may approach doctors currently out of programme (OOP) and ask them, on a voluntary basis, to offer to undertake occasional shifts to support unexpected absences of colleagues.
In the event of extreme service pressures, it is possible that some trainers who undertake educational roles in their workplace may find that their time is temporarily reallocated to clinical work – and we will work across NES and the Health Boards to monitor this and minimise any impact on our ability to offer support to trainees who need it most.
We would like to thank you all for your continued efforts, both to deliver the service patients need and to provide the training environments that ensure we continue to have a highly skilled and competent medical workforce.
We remain determined to ensure that every trainee and trainer feels supported and valued. Please make sure that, if you have any concerns or queries, that you discuss these with your Educational Supervisor or Training Programme Director, or alternatively contact your DME Office or the Deanery.
Most importantly, keep safe, keep well, and look out for each other. Together we will get through this, and we remain determined to ensure that all doctors in training will achieve everything they aspire to and more.
Finally, can we send you and yours all good wishes for the holiday season.
Professor Stewart Irvine
Professor Rowan Parks
NHS Education for Scotland
Dr Ian Hunter
Dr Helen Freeman
NHS Board Directors of Medical Education
This page was last updated on: 20.12.2021 at 15.52