All foundation doctors will have to undertake community placements, HEE says

Foundation doctors will have to undertake at least one community based placement during their training, Health Education England (HEE) has said.

In a report HEE said that by undertaking a community or integrated placement trainees would gain a wider experience of community settings and community care.1 It recommended that by August 2015 80% of foundation doctors should undertake a community or integrated placement and that by 2017 this should apply to all foundation doctors.

The placements are likely to be carried out during the second year of foundation training. The report said that foundation year 2 doctors were “more suited” to working in the community because they did not require the same level of supervision from a “critical mass of healthcare professionals” as foundation year 1 doctors did.

Community placements, the report said, could be four to six month placements based in a community setting, such as general practice, community paediatrics, palliative care, public health, or community psychiatry.

Integrated placements would also take place outside the hospital setting and would focus on integrated care models. For example, foundation doctors on an integrated placement could be placed in a community emergency multidisciplinary unit or a medical unit day assessment service, HEE said.

In terms of the redistribution of posts from specific specialties it was likely that posts would “move from surgery and, to a lesser extent, from medicine,” the report added. Rather than locum doctors filling posts that previously would have been filled by foundation doctors, the report said that organisation should be “innovative” and should look to other professionals such as physician associates, staff grade doctors, and nurse practitioners.

The report said that moving trainees into community based placements would require investment. It added that the current funding tariff would also change, so that from April 2014 all posts would receive 50% base salary funding, with an additional educational placement fee.

Chris Welsh, director of education and quality at HEE, said, “Changes are required in the current foundation programme to ensure that our newly qualified doctors are trained so that they can respond better to future changes in the country’s health and social care system. There are opportunities for services and doctors to become more patient centred, more integrated in approach, and more effective in meeting the needs of patients, now and in the future.

“Implementing the recommendations in this report will be challenging; however, we’ve worked closely with our local education and training boards, royal colleges, trusts, and partners to deliver these recommendations. We all agree that education and training must keep pace with changes in health and social care provision.”