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Learn about NHS funding, care models, and training responsibilities for healthcare professionals. Gain insights on patient management, multidisciplinary teamwork, and essential skills development within the NHS infrastructure.
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Working in the NHS Dhiraj Uchil RCOG MTI and Sponsorship Officer Consultant Obstetrician and Gynaecologist, University Hospital Lewisham, London
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
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
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
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
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
Funders Regulators
Paternalistic model of care • Doctor knows best model • Patients as passive recipients of care • Rarely encountered (or tolerated) in NHS practice
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
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”
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
Who is responsible for your training?? Hospital Royal College Deanery
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
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
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
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
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
Courses to attend RoBUST PROMPT EFM- K2/ RCOG EFM package Perineal trauma repair course Communication courses Part 2 exams course
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
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)
