General surgery Morriston Hospital

This is what you told us:

The 2017 General Medical Council (GMC) national trainee survey highlighted a significant deterioration in the feedback for trainees in general surgery posts at Morriston Hospital. There were four below outliers (for workload, handover, induction and educational governance) and a lower quartile for regional teaching. 2018 survey results also showed below outliers for workload and induction as well as rota design and lower quartiles for educational governance and educational supervision.

This is how your feedback was used:

After reviewing trainee feedback in 2017 we asked the Faculty team to look into the results and provide us with a response. The local team met with trainees and trainers in order to obtain more context around concerns and following this a local action plan was developed in order to address the concerns. The local team introduced a range of improvements such as:

• recruited a physician associate (PA) to support the pancreatic team from October 2017
• undertook a thorough review of the induction process in Morriston Hospital
• agreed to adopt a more formalised, robust paper-based handover to complement the current set up for on-call
• consultants were reminded that ALL trainees must be released for teaching sessions
• five physician assistants would be appointed and two consultants would be on call. One to cover post take ward round issues and the other to cover issues in theatre.

Whilst the Health Board were implementing the action plan the Quality Unit continued to seek updates from the local team on progress through the risk process. In addition, we used trainee feedback through end of placement reports so that we could obtain the trainees’ perspective on the extent to which progress was being made. In July 2018 Health Education and Improvement Wales (HEIW) undertook a targeted visit in order to collaborate with the Health Board to secure further improvements. Recommendations were agreed with the board relating to induction, on-call arrangements, surgical trainee forum, ward rounds, patient management, non-medical support, transfer of patients, and the split-site service. Progress in addressing the recommendations was regularly monitored in conjunction with the local team. A review visit took place on 16 January 2019 and there was evidence of improvement in most areas. It was agreed that this risk would be de-escalated. Further recommendations were also made in relation to access to clinics and theatre and monitoring of the trainee experience. Continued monitoring via the risk process took place over the next year and a big improvement was seen in trainee feedback via the 2019 survey where no below outliers were recorded and only one lower quartile.

What changed?

You can see from table one below that the results of the 2018 GMC national training survey reported that there had been a small improvement in most areas that had been reported in the lower quartile or as below outliers in 2017. In 2019 there was a greater improvement and there were no longer any below outliers for the first time in five years and only one lower quartile remained. Based upon all of the evidence the Quality Unit considered that the action that had been taken was sustainable and we have since closed this issue down. However, whilst this particular issue has been closed your feedback through end of placement reports is still being reviewed by your specialty leads and of course centrally in the Quality Unit we keep an oversight of training quality both in terms of good practice as well as concerns.

Table one: 2016 – 2019 GMC national trainee survey results