PMETB DEANERY-WIDE VISIT TO NORTH WESTERN DEANERY – FINAL DECISION

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					                                                               Postgraduate Medical Education
Professor Jacky Hayden                                         and Training Board (PMETB)
Dean of Postgraduate Medical Studies                           Hercules House
                                                               Hercules Road
Dept of Postgraduate Medicine & Dentistry                      London
Gateway House                                                  SE1 7DU
Piccadilly South
Manchester M60 7LP                                             Tel: +44 (0)20 7160 6100
                                                               Email: info@pmetb.org.uk
                                                               Web: www.pmetb.org.uk
31st August 2006


Dear Professor Hayden

  PMETB DEANERY-WIDE VISIT TO NORTH WESTERN DEANERY – FINAL
            DECISION AND CONDITIONS ON APPROVAL
PMETB reference:                      DV001
Date of visit:                        15th-17th March 2006

Specialties visited:                  Anaesthetics
                                      Intensive Care Medicine
                                      Emergency Medicine
                                      Trauma and Orthopaedic Surgery

Training providers visited:           Lancashire Teaching Hospitals NHS Trust – Royal
                                      Preston Hospital
                                      Pennine Acute Hospitals NHS Trust – North
                                      Manchester General Hospital
                                      South Manchester University Hospitals NHS Trust –
                                      Wythenshawe Hospital

The PMETB visited the North Western Deanery from 15th – 17th March 2006. The purpose of
the visit was to approve training across the North Western Deanery in the specialties of
Anaesthetics, Intensive Care Medicine, Emergency Medicine and Trauma and Orthopaedic
Surgery. The visiting team also evaluated the Deanery’s quality control processes.

PMETB’s Deanery Visit Approval Panel received and reviewed the North Western Deanery visit
report on 19th July 2006. The PMETB has agreed that training in Anaesthetics, Intensive Care
Medicine, Emergency Medicine and Trauma and Orthopaedic Surgery across the North
Western Deanery should be approved subject to the following conditions. The PMETB does not
impose time limits on its approvals:

CONDITION ONE (Anaesthetics)
PMETB supports the visit team’s conclusions that the shortage of ITU beds in Wythenshawe
Hospital means that ventilated patients are cared for in A&E Resuscitation and Theatre
Recovery and anaesthetics SpRs have, therefore, to remain with these patients for long
periods of time. This experience is not suitable training and is evidence of poor clinical
practice. PMETB notes that the Medical Director of the trust is aware of this situation and is
working to resolve it also and that the Deanery plans to visit the trust to review the situation
in the Autumn of 2006. The Deanery should submit a report on progress in this matter
following that visit.
PERSON RESPONSIBLE
North Western Deanery led by the Postgraduate Dean

TIMEFRAME FOR MEETING THIS CONDITION
A report to be submitted to PMETB from the North Western Deanery following the Autumn
2006 visit to this Trust.


CONDITION TWO (Emergency Medicine and Trauma & Orthopaedics)
PMETB supports the visit team’s findings that shifts at Oldham Hospital in Emergency
Medicine did not include a handover period; also the Hospital at Night handover in Trauma &
Orthopaedics at Rochdale Hospital was found to be less than satisfactory. PMETB concurs
that all shifts must allow handover for patient safety and recommends that the Deanery give
urgent attention to introducing a robust handover system. The Deanery should provide
PMETB with an update report on progress in this area.

PERSON RESPONSIBLE
North Western Deanery led by the Postgraduate Dean

TIMEFRAME FOR MEETING THIS CONDITION
A report to be submitted to PMETB from the North Western Deanery in 12 months, by 1
September 2007.


CONDITION THREE
PMETB endorses the visit team’s findings that the Deanery has good systems for quality
controlling SHO training, but does not currently have in place comprehensive quality control
processes for SpR training. The Deanery should therefore give urgent consideration to the
implementation of some interim quality control processes so that SpR training quality can be
adequately monitored in the period leading up to the publication of the new model (which will
be based on the work of PMETB and JACSTAG in formulating proposals on a new model of
quality assurance for PGME across the UK).

The Deanery has the option to trigger a PMETB visit if it has particular concerns about a
training provider and is not able to resolve those concerns to its satisfaction.

PERSON RESPONSIBLE
North Western Deanery led by the Postgraduate Dean

TIMEFRAME FOR MEETING THIS CONDITION
The Deanery should take action to implement this recommendation immediately and should
provide a written report to the PMETB by the end of September 2006 on the action taken.


CONDITION FOUR
PMETB supports the recommendation that the Deanery should give urgent attention to the
delivery of induction programmes in all the specialties inspected at the Pennine Acute Trust.
The Deanery should provide PMETB with an update on progress in this area

PERSON RESPONSIBLE
North Western Deanery led by the Postgraduate Dean

TIMEFRAME FOR MEETING THIS CONDITION
The progress report should be submitted to PMETB from the Deanery in 12 months, by 1
September 2007
CONDITION FIVE
PMETB supports the visiting team’s recommendation that a strategy on the delivery of
training at the Pennine Acute Trust was needed urgently. The action plan produced by the
Trust following the PMETB visit was welcomed by PMETB, and it is recommended that this
be the subject of continuing dialogue between the Deanery and Trust. PMETB also notes
that the Deanery plans to visit the Trust in the early part of 2007. A progress report should
be submitted to PMETB following that visit.
PERSON RESPONSIBLE
North Western Deanery led by the Postgraduate Dean

TIMEFRAME FOR MEETING THIS CONDITION
A progress report on this is to be submitted to PMETB by the Deanery following its visit to the
Pennine Acute Trust in 2007

In particular the PMETB wishes to congratulate the Deanery, and all others involved, on the
excellent training and supervision of trainees in Intensive Care Medicine across the board.

The PMETB also wishes to thank the North Western Deanery for the hard work and assistance
given towards planning and carrying out this visit.

This letter and the report are being sent for information to the Greater Manchester Strategic
Health Authority and the Cumbria and Lancashire Strategic Health Authority, the Royal College
of Surgeons, the College of Emergency Medicine, the Royal College of Anaesthetists and the
Intercollegiate Board for Training in Intensive Care Medicine as well as members of the PMETB
visiting team. This letter, supported by the report and the comments of the Deanery on the
report will be published on the PMETB website and shared with relevant members of the
Healthcare Commission Concordat.

The Deanery should share this approval letter and report widely and in particular with
representatives of the training providers visited and with deanery and royal college
representatives locally who were involved in planning and coordinating the visit.

Click on the links below to see:

 • PMETB’s Visit Report
 • Response from STC Chair Orthopaedics North Western Deanery (June 2006),
 • Response from STC Chair Intensive Care Medicine North Western Deanery (June 2006)
 • Response from Postgraduate Clinical Tutor, South Manchester University Hospitals NHS
   Trust (June 2006)
 • Response and Action Plan from Pennine Acute Trust
 • Overall Deanery comments

Yours sincerely,




Peter Rubin
Chair
Postgraduate Medical Education and Training Board

				
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