Better Training Better Care

Better Training Better Care aims to improve the quality of training and learning for the benefit of patient care by enabling the delivery of the key recommendations from Time for Training and Foundation for Excellence. DH Ministers commissioned both reports and Medical Education England (MEE) is taking forward the work.

Sir John Temple’s Time for Training called for better use of the expanded consultant workforce, not only to ensure improved training for junior doctors but also in terms both of efficiency savings for the service, as well as enhanced safety and higher quality care for patients.

Findings from Sir John’s review were echoed and built on in Professor John Collins’ Foundation for Excellence which evaluated the Foundation Programme in the context of the needs of patients, the needs of trainees and the changing healthcare environment. Professor Collins’ review identified Trusts that were doing well, having changed practices to cope with reduced working hours. However, it also highlighted concerns that in some cases some of the most junior trainees are asked to practice beyond their level of competence and without appropriate or adequate supervision.

Similar findings were also found in the 2009 Wilson report to the MMC Programme Board, the 2009 PMETB survey of Foundation doctors, in evidence collected by Lord Patel, and in recent PMETB / GMC training surveys. In part, similar concerns led to the development and implementation of the Calman reforms and Modernising Medical Careers (MMC).

In order to implement recommendations from both the Collins and Temple reviews the work programme for Better Training Better Care contains two overlapping components:

  • the identification, piloting, evaluation and dissemination of good education and training practice; and
  • improvements to curricula and the underpinning education and training frameworks to ensure training is fit for the purpose of providing safe, effective and improving patient care

A series of workstreams and activities has been developed with an emphasis both on the need for local and national activity. Outputs from BTBC will inform the developing of HEE commissioning decisions and work around the development of reliable and valid quality metrics.

BTBC seeks to deliver improved patient outcomes, safety and experience through better training and better systems of care. This will be achieved by:

  • Building on service redesign which will draw upon greater consultant involvement in the delivery of care
  • Improved and more immediate supervision of trainees
  • Enhanced multidisciplinary working which supports training
  • Trainees undertaking training on procedures and skills in simulation environments

Benefits to trainees will be sought through:

  • Improved mentoring and support
  • Improved and more accessible supervision
  • Opportunities to draw upon simulation, e-learning and other innovative techniques to develop their skills

Benefits to consultants will include:

  • Mentoring and support for newly appointed consultants
  • Recognition of education and training in job-plans
  • A framework for the training and accreditation of trainers

The Secretary of State for Health has asked that MEE take forward this programme as a priority. MEE agreed to remit responsibility to its Medical Programme Board (MPB) and a dedicated Taskforce reporting to the MPB has been established, chaired by Sir Jonathan Michael, Chief Executive, Oxford Radcliffe Hospitals NHS Trust.

Primary responsibility for delivering the recommendations will rest with local education providers (LEPs) supported by deaneries, Higher Education Institutions and medical Royal Colleges and Faculties. In addition to proposing changes to curricula, BTBC will provide evidence-based examples of good practice and refine the quality metrics that will be used for commissioning medical education and training by Health Education England. The recommendations also require action at national level. This will entail working with groups such as the GMC, Academy of Medical Royal Colleges, NHS Employers and BMA among others.

All of the leading partners have agreed to join the BTBC Taskforce to lead and co-ordinate the comprehensive plan of action required for implementation. There is already a great deal of interest from the service in this work and a number of NHS Trusts have expressed an interest in taking part.

Better Training Better Care provides the opportunity to embed within the NHS the changed practices and high quality medical training required to provide the necessary levels of patient care, including incremental improvements and safety while ensuring a more efficient and productive service.

Local Implementation and Pilots

Sixteen pilot NHS Trusts Have been selected to play a critical role in the delivery of the three key objectives of the BTBC Programme:

  • Appropriate supervision, and/or implementing a consultant present service
  • Service delivery that explicitly supports training
  • Making every moment count; ensuring training is planned and focused

Effective and energetic implementation of pilots will help achieve the desired changes outlined in both the Temple and Collins reports resulting in benefits to patients, trainees, consultants and providers. You can view the pilot sites and their projects here.

Helpful BTBC documents:

BTBC Thematic Analysis