Chief registrar: making a difference on the shop floor

Dr Ananthakrishnan Raghuram, consultant chest physician and Linacre Fellow at the Royal College of Physicians (RCP), supervises two chief registrars –Emily Bowen and Zoe Jones – at the Gloucester Hospitals NHS Foundation Trust (GHFT). Here he reflects on the chief registrar scheme and its impact 10 months on.

I was introduced to the chief registrar scheme by Dr Gerrard Phillips, RCP senior censor and vice president of education and training. GHFT was already involved in a project to develop support for registrars, however joining the Future Hospital Programme chief registrar scheme, provided us with expert training and support from the RCP. It enabled us to also progress and champion existing local innovations.

Supporting the trainee workforce

As chief registrars, Emily and Zoe have established themselves an accessible point of contact for our trainee workforce when seeking guidance, timely feedback and formative and summative assessments. They have increased attendance at breakfast clubs, which now also serve as a registrar forum, facilitating valuable discussions about the topics covered by the General Internal Medicine (GIM) curriculum.

Another notable achievement is their work with the rota coordinators. By identifying gaps and rewriting the rota, this has helped to:

  • balance out the intensity of on-call rotas
  • support registrars who work across the county
  • address the huge locum spend
  • rationalise cover arrangements.

Previously, the induction of the core medical trainees and GIM registrars was also patchy, but the chief registrars have helped manage and support the August changeover and induction of the junior team.

The NHS is a slow ship to turn, but the voice of the trainee is powerful and change is easier with the input of our chief registrars

Dr Ananthakrishnan Raghuram, consultant chest physician and Linacre Fellow

Uniting local education and improvement initiatives

GHFT prides itself as a centre of medical education. Although initiatives including educational fellows and post foundation educational posts were already in place, the chief registrars channelled these disparate groups into a more cohesive unit, supporting education and other quality improvement (QI) projects via the trust's QI team.

Emily and Zoe are an integral part of the medical education board. From a management perspective, the director of medical education (DME) and educational team are able to utilise the chief registrars to support the development and progression of the educational agenda.

They also have been involved in several other transformational projects, including looking at the delivery of unscheduled care and the reconfiguration of services. Interface with the emergency department has been an ongoing challenge in our trust, but the involvement of chief registrars in pathway design has significantly improved the management of this issue.

Partnerships for the future

Having two chief registrars has given the divisional board access to the expertise of senior trainees with dedicated time for management. The NHS is a slow ship to turn, but the voice of the trainee is powerful and change is easier with the input of our chief registrars.

Our chief registrars have been very well supported by the senior trust management, including the medical director and associate medical director. Both trainees and managers have really improved their understanding of each other’s roles and established lasting and valuable partnerships for the future. At a time when the NHS faces critical financial challenges, strengthened relationships between trainees and trainers is essential.

At a time when the NHS faces critical financial challenges, strengthened relationships between trainees and trainers is essential

Dr Ananthakrishnan Raghuram, consultant chest physician and Linacre Fellow

The road to sustainable change

It has not been an easy project; change management takes time and our trust found itself in unexpected financial difficulty. Chief registrars are in post for 12 months so it is important for them to consider how their projects can be sustainable. Emily and Zoe remain positioned on the shop floor of the hospital, which is invaluable for the them in order to guide and support other trainees.

However, on some days it can be very challenging to not let day-to-day issues take over, particularly during clinical emergencies. While this remains important, it is also vital that the long term, strategic goals are not forgotten.

Although senior leadership engagement with the project was not a problem, identifying funding to support the posts was initially a challenge. We demonstrated  financial savings against the locum budget, as chief registrars are able to participate in the on-call medical rota, filling gaps that would otherwise require locums. This supported our DME in putting the case to our trust’s medical director help identify funding.

Future clinical leaders

Very few projects ever receive such sensationally positive feedback from trainees, trainers and managers alike; I am proud to say that Emily and Zoe have, in a very short period of time, achieved this. I am confident we will see them as two of our future leaders and a shining light at GHFT. They have set such a positive precedent for the chief registrar scheme here in Gloucester, and as a trust we are keen to continue to support the scheme and recruit their successors for next year. 

Dr Ananthakrishnan Raghuram, consultant chest physician and Linacre Fellow

Find out more about the scheme and how to recruit a chief registrar in your trust at the Future Hospital Programme. You can also read Raghu’s experience of appointing and funding the two roles in his blog post from earlier this year.

Follow @RCPLondon and @RCPFutureHosp on Twitter, and join the conversation using #FutureHospital.