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Helping trainee doctors manage winter pressures

Dr Michael FitzPatrick and Dr Matthew Roycroft, co-chairs of the RCP Trainees Committee alongside Dr Emma Vaux, RCP vice president (education and training) and senior censor, write about the importance of trainees and consultants working together to support each other during the increased pressures of winter.

The winter months are upon us, and with them the annual surge in acute hospital attendances that put such pressure on NHS services. The inexorable rise in demand in an underfunded, underdoctored, overstretched health service has put unprecedented strain on hospitals and GPs, and it is likely that this winter will prove just as challenging as those before it, if not more. We know that time and time again clinicians go above and beyond to do what they can, and this winter will be no different.

We all have a responsibility to consider how we can best support each other to deliver safe, high-quality patient care in a challenging environment. We must ensure doctors with the most appropriate skills are available to care for patients, insist trainees are appropriately supervised, and make sure training continues. Winter must not be an excuse to forget training needs.

The findings of our recent winter poll highlighted the worries that many of you have. The RCP has lobbied strongly for increased funding and medical workforce within the NHS, and we will continue to communicate your concerns to NHS England, NHS Improvement and the government. Ultimately, sustained action to increase our workforce is needed to avoid a year-long crisis.

[Trainees] should feel confident about asking for the working arrangements to be reviewed if they do not feel they are acceptable, and there should be local escalation policies for concerns put in place.

Dr Matthew Roycroft, co-chair of the RCP Trainees committee

If local systems are considerably stretched, medical trainees may be asked to work in another acute specialty, or trainees from other specialties may be asked to care for acute medical patients. Trainees should only work in areas where they feel competent to provide safe care. If working in other teams trainees must be provided with an appropriate induction and adequate clinical supervision. They should feel confident about asking for the working arrangements to be reviewed if they do not feel they are acceptable, and there should be local escalation policies for concerns put in place.

Such trainee transfers should be for a defined period of time and must not be allowed to compromise training. Wherever possible, trainees should continue to receive their expected teaching and training, and should speak to supervisors and use exception reporting if their training needs are not met. If trainees miss training due to winter pressures, employing organisations must ensure that there are clear plans to deliver training at another time.

Trusts should have preemptive plans in place, and consultants have a responsibility to find out about the winter plans where they work. In particular, they need to know what these mean for their own work as well as that of their trainees – both those they already work with and those who may move to shore up services. When a trainee does come to support a different area, consultants must make sure they have a thorough induction and ongoing  clinical supervision.

Core surgical trainees have a different skillset to core medical trainee and thus it is imperative that clinical supervisors are given extra time and support to provide enhanced clinical supervision. Trainees from non-physicianly specialties may need particular support, and there is guidance from the Royal College of Surgeons of England regarding surgical trainees. The Academy of Medical Royal Colleges has also released guidance.

We know that the increased pressures during winter will place considerable strain on the system as well as individuals. The more we can do to support one another, learn from each other, and raise concerns where they exist, the more likely it is that together we will meet the needs of patients through a challenging winter.