Welcome to UK Practice evaluation and implementation...The WtUKP film is designed to raise awareness...

1 April 2014

Strategy and Policy Board

7 To consider

Welcome to UK Practice evaluation and implementation Issue

1 We have successfully completed the Welcome to UK Practice (WtUKP) pilot programme of events and products for doctors new to practice in the UK. This paper seeks the Board’s endorsement of the evaluation report and of next steps towards implementing the programme for all doctors entering UK practice.

Recommendations

2 The Strategy and Policy Board is asked to:

a Consider the recommendations as described in the WtUKP phase two evaluation report at Annex A.

b Endorse the direction of travel set out in the evaluation report as the basis for WtUKP work in 2014.

c Endorse the activities identified in the high level WtUKP transition plan for 2014 at Annex B.

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Welcome to UK Practice evaluation and implementation Issue

3 In The state of medical education and practice in the UK Report 2011, we identified that an induction programme would help all doctors new to UK practice understand the ethical and professional standards they are expected to meet. We started to develop this programme in early 2012.

4 We began by seeking the views of key interest groups through a Call for Evidence (March to April 2012). We invited over 200 organisations to participate and 78 organisations responded. The responses indicated a need for an induction programme for doctors new to UK practice. A summary of the call for evidence is available upon request.

5 We tested the concept of induction with a range of key interest groups including trusts, deaneries and medical schools. Using the information and feedback gathered, we identified ten themes (based on Good medical practice) to form the WtUKP programme’s content.

6 At its meeting on 16 May 2013, the Board considered options and an evaluation report. This set out the work we had carried out in the first phase of the programme, and on this basis the Board agreed to continue piloting the WtUKP programme until the end of 2013.

7 In phase one, we focused on designing an accessible programme that could be adjusted to meet the needs of different doctors. We designed a range of components for doctors to access some or all of, according to their level of need.

8 In phase two, we focused on identifying how the greatest impact could be delivered to the largest number of doctors, while making best use of our resources. This involved developing our offering further, to include cost-effective products that were interactive, could be used in different forums by a wide range of users with the flexibility to be used on a large scale.

Product development and piloting

9 We have developed a suite of products which can be used either by individual doctors, by GMC staff delivering training, or by external trainers.

Self-assessment tool

10 The WtUKP self-assessment tool is an interactive online resource containing 16 different case studies (grouped under five themes) that explore ethical challenges in a variety of clinical scenarios. It is designed to help doctors assess their knowledge and application of Good medical practice and to direct doctors to further information and advice.

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11 The tool is available via the WtUKP page on our web site (http://www.gmc-uk.org/doctors/WelcomeUK.asp) and can be used by any doctor, regardless of where they have trained or how long they have been practising. Further information and feedback from users is at Annex A.

Welcome to UK Practice film

12 The WtUKP film is designed to raise awareness of the GMC’s role and the standards expected of doctors entering practice in the UK. The short film includes footage of established registered doctors talking about the importance of applying our standards to practice.

13 The film’s objective is to engage with doctors on a larger scale. It is currently being shown to all doctors who attend ID checks at the London and Manchester offices. A link to the film will be included on the Professional and Linguistic Assessments Board (PLAB) guidance pages and in the Welcome to the Register correspondence to all new doctors.

Things I wish I’d known when I started in UK practice film

14 The Things I wish I’d known when I started in UK practice film shows doctors sharing their experiences of starting practice in the UK. It features a diverse range of doctors at different stages in their career and emphasises the importance of adhering to the principles of Good medical practice.

15 The film is designed to facilitate discussion amongst doctors about personal challenges and how to overcome them. It has been used by GMC and external trainers. Accompanying guidance is available to assist delivery.

Filmed ethical scenarios

16 The seven filmed ethical scenarios are short two-part films presenting doctors in a range of ethical dilemmas. The films are designed to bring to life some of the common challenges doctors face. The trainer uses the films to prompt discussion about the possible outcomes of each scenario in order to demonstrate how to apply our guidance to achieve the best outcome. These films are currently being used by our Regional Liaison Advisors (RLAs).

Communications session

17 The importance of effective communication training session uses theory and practical exercises to raise awareness of how important communication is to good medical practice. We developed this session in response to feedback and evidence gathered in phase one that highlighted understanding effective communication as key to enabling a doctor to effectively transition into UK practice.

http://www.gmc-uk.org/doctors/WelcomeUK.asp


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Welcome to UK Practice event

18 During the pilot phases this was a one day event and the aim was to improve awareness and understanding of Good medical practice among doctors who are new to practice in the UK and help them to practise safely and effectively.

19 In 2013 we ran 11 pilot events across the UK. The events were made available to licensed doctors new to UK practice, whether they had trained in the UK or overseas. We tested some of the products described above to understand how they could be used with a range of audiences.

20 Delegate and observer feedback showed that the WtUKP events positively impacted on delegates’ perceptions of the GMC and increased their knowledge and awareness of our guidance. The opportunity to discuss ethical issues with GMC staff, established doctors and other doctors new to UK practice was also highlighted as a benefit. The event agenda and feedback is set out on pages 35 to 37 of Annex A.

Implementation

21 The Strategy and Communication directorate will lead the implementation of the WtUKP programme through the Regional Liaison Service (RLS) in England and Devolved Office teams in Scotland, Northern Ireland and Wales. The 2014 transition plan is at Annex B.

22 The transition plan describes actions we can take relatively quickly to further embed WtUKP as a GMC programme. It also outlines the need for continued piloting in 2014 to evaluate delivery and content with the teams now responsible.

23 Both the RLS and Devolved Office teams already have established mechanisms for delivering similar activities. To reduce the administrative and financial costs of the programme, time is needed in 2014 to understand how healthcare/education partners can help to deliver WtUKP. For example, by using partner facilities and standing meetings, rather than organising standalone events. This exercise will also help us further understand demand from partners and the profession.

24 In 2014, we will also need time to decide on the continued scope of the programme and whether we should seek to promote components to other doctors new to practice, for example FY1/FY2 doctors. We will add our findings to the 2015 indicative Strategy and Communication Directorate operational plans. The scope for including other doctor cohorts will be tested through evaluative pilots in 2014.

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Supporting information

How this issue relates to the corporate strategy and business plan

25 Strategic Aim 2 of the Corporate Strategy 2014-17 states that we will help raise standards in medical education and practice. Also Strategic aim 4 states that we will work more closely with doctors, medical students and patients on the frontline of care. This programme of work helps bring to life and raise awareness of the standards expected of doctors working in the UK.

What engagement approach has been used to inform the work (and what further communication and engagement is needed)

26 We continued to engage with those groups involved in the call for evidence throughout the project, and interest in work undertaken to date is high.

27 The phase two evaluation report details specific actions in terms of communications planning and stakeholder engagement. These are:

a Identify formal internal ownership of our relationship with the BMA and develop a joint working agreement, outlining how the relationship will be managed, developed and evaluated.

b Develop a communications plan that supports the programme over the next 12 months.

c Develop an implementation plan detailing how the programme will be rolled out in 2014, which will include an evaluation plan.

How the issues differ across the four UK countries

28 GMC standards and guidance apply to all doctors across the UK. In developing the programme we took country specific requirements into account and made adjustments where necessary. We piloted activities in all four countries.

What equality and diversity considerations relate to this issue

29 Throughout the project we have taken steps to ensure equal access to the WtUKP resources, and that the content is appropriate for different cohorts of doctors. In order to maintain the current levels of programme accessibility, the owners of the programme should also manage the actions as suggested in the WtUKP equality analysis at page 53 of the WtUKP phase two evaluation report at Annex A

If you have any questions about this paper please contact: Sunil Kapur, Head of Policy and Projects, [email protected], 0161 923 6654; or Dan Donaghy, Head of Regional Liaison Service, [email protected], 0207 189 6825.

mailto:[email protected]

mailto:[email protected]

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7 - Welcome to UK Practice evaluation and implementation

Annex A

Evaluation report of the second phase of the piloting of the Welcome to UK Practice events and resources

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Contents

Evaluation report of the second phase of the piloting of the Welcome to UK Practice events and resources ........................................................................................... 1

Contents ....................................................................................................... 2 Purpose of Paper ........................................................................................... 3 Background ................................................................................................... 3 Phase one content development and piloting ................................................... 3 Phase two content development approach ....................................................... 4 Development approach .................................................................................. 5 Self-assessment tool development and piloting ................................................ 5 Event contents and development .................................................................... 9 Resources required to deliver the event ........................................................ 15 Evaluation of feedback ................................................................................. 16 Recommendations following the completion of the WtUKP piloting .................. 19 Industrialisation and target audiences ........................................................... 26 Evaluation report of the second phase of the piloting of the Welcome to UK Practice events and resources ....................................................................... 28

Annex A ............................................................................................................ 28 Welcome to UK practice programme themes .................................................... 28

Annex B ............................................................................................................ 33 Self-assessment demographics ........................................................................ 33

Annex C ............................................................................................................ 36 WtUKP event agenda (London) ..................................................................... 36

Annex D ............................................................................................................ 38 WtUKP delegate feedback form..................................................................... 38

Annex E ............................................................................................................ 42 Delegate and observer feedback ...................................................................... 42

Summary .................................................................................................... 42 Phase two event delegate demographics ....................................................... 42 Phase two event delegate feedback .............................................................. 44 Phase two event observer feedback .............................................................. 49 Phase one delegate follow up questionnaire .................................................. 50

Annex F ............................................................................................................. 54 Welcome to UK Practice Equality Analysis ......................................................... 54

Background ................................................................................................. 55 Evidence ..................................................................................................... 56 Product development and delivery ................................................................ 57 Equality analysis .......................................................................................... 66 Reviewing and monitoring ............................................................................ 66

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Purpose of Paper

1 This paper provides details of the contents of the Welcome to UK Practice (WtUKP) programme, a summary of the phase two piloting activities, an evaluation of the work undertaken and recommendations for future roll out. The evaluation focuses on the delivery of the components of the programme and on feedback from delegates and observers.

Background

2 In The State of Medical Education and Practice in the UK 2011, we identified that an induction programme would help to make sure that all doctors new to UK practice understand the ethical and professional standards they are expected to meet. In early 2012, we started the development of the GMC induction programme for all doctors new to practice in the UK.

3 We started by seeking the views of key interest groups through a Call for Evidence (March to April 2012). This sought information, data and opinion from a variety of organisations to understand the current availability of induction, identify best practice and understand how the induction programme could best support doctors. In order to have a representative response, over 200 organisations were invited to participate and 78 organisations responded.

4 The responses we received varied in opinion and level of detail. However, the overall sense from the responses indicated that there is a perceived need. Many insightful and rich suggestions were provided on how such a programme could be approached.

5 In addition to the Call for Evidence, we were keen to engage with and test the concept of induction with a range of key interest groups including trusts, deaneries and medical schools. Having analysed the information and feedback from our key interest groups, we developed 10 induction themes (based on Good medical practice) that we used to form the basis of the programme’s content. These themes are designed to reinforce the professional and ethical standards expected of doctors in UK practice in line with the values and principles in Good medical practice (GMP). The themes can be found at Annex A.

Phase one content development and piloting

6 The contents of the WtUKP programme were developed to reflect the 10 themes which emerged from our engagement and are aligned to the principles within GMP.

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7 During phase one we developed:

a An online scenario-based self-assessment tool (providing doctors with insight into their knowledge of the application of GMP)

b Welcome to UK Practice (WtUKP) events (one day engagement/training events including interactive training designed to explore how to apply the values and principles of GMP in a doctor’s daily practice)

8 We started piloting the self-assessment tool with a small cohort of doctors and we received positive feedback regarding the contents and functionality of the system.

9 Four pilot events were held in the first quarter of 2013. The events included the following components:

a Role of the GMC

b Film of doctors sharing their experiences of starting practice in the UK

c Overview of Good medical practice

d Presentation by local educator or employer

e Forum theatre performance demonstrating some of the ten key themes

10 The events were successfully delivered and the feedback from delegates and observers was positive. An evaluation report of the first phase was presented to the Strategy and Policy Board on 16 May 2013.

11 The Board endorsed the proposal to continue to pilot and evaluate all components of the WtUKP programme and report on potential roll-out options.

12 Building on the lessons learnt in phase one, we set out to complete phase two by the end of 2013.

Phase two content development approach

13 The phase one piloting helped support the argument that doctors new to UK practice would benefit from induction into the ethical and professional standards expected of them. Evaluation of the phase one programme identified a number of improvement opportunities that, combined with the direction set by the Strategy and Policy board, helped form the basis of the phase two development approach.

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Development approach

14 A key requirement of phase two was to ‘industrialise’ the programme and identify how the greatest impact could be delivered to the largest number of doctors, whilst making best use of our resources. To achieve this, the following principles guided the phase two programme development and delivery phase:

a The components of the programme should be interactive and should ‘bring to life’ GMC guidance

b The components of the programme should also work as stand-alone products that could be delivered in other forums

c The skill and knowledge levels required to deliver the components should not prohibit usage by a wide range of users

d The cost of delivering any components, especially an event, should be minimised

e The components should have the potential to be delivered on a larger scale

Self-assessment tool development and piloting

Background

15 The online scenario based tool is designed to help doctors assess their knowledge and application of our core guidance Good medical practice and to provide signposting to further information and advice.

16 The tool contains 16 different case studies (grouped under five themes) that explore ethical challenges in a variety of clinical scenarios. As a result of feedback from the user testing carried out in March 2013 the following changes have been made to the system:

a A short instructional ‘how to get started’ film has been developed. The film is accessible on the tool home page and through a footer link on every subsequent web page

b The suggested theme completion time has been increased to 35 minutes (originally 20 - 25 minutes)

c The explanation regarding the purpose of the self-reflection box has been reworded, and the reflection box now contains an example of the type of information that doctors can include.

https://www.gmc-uk.org/doctors/welcomeuklogin/Default.aspx?WT.ac=WBWT130624

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Promoting the self-assessment tool

17 Although designed as part of the WtUKP programme, there is no restriction on who can use the tool. The content is such that it can be used by any doctor, regardless of where they have trained or how long they have been practising (those practising for longer may find it a useful way of refreshing their knowledge of GMC guidance).

18 The tool has had a ‘soft launch’ with the link provided to groups of doctors in the following ways:

a 120 doctors who attended the first phase of pilot events in Birmingham, Cambridge, Swindon and Manchester (link sent as follow up after the events)

b 274 doctors who confirmed attendance at the second phase of pilot events (link sent as suggested preparation for the event and again as follow up after the events)

c Since late September 2013 the tool has also been accessible through the WtUKP page on the GMC’s website: http://www.gmc-uk.org/doctors/WelcomeUK.asp

d Since late October 2013 the tool has been promoted to doctors via an email footer in correspondence from the Contact Centre, International Applications and Clinical Assessment Centre teams.

User demographics

19 Since July 2013, 158 people have used the system.

20 As outlined in the previous report, the tool is anonymous and does not collect any personal information that would lead us to identify participating doctors. Doctors are required to enter their nationality and country of primary medical qualification when logging in to the system, but this is for reporting purposes only and there is no compulsion on users to enter their true details.

21 However, when looking at the correlation between nationality and PMQ the numbers largely concur and also reflect the mix of doctors attending the events. A full breakdown can be found at Annex B but in brief: 33 doctors are categorised as British; 41 as EEA nationals; and 84 as nationals of countries outside of the EEA. In relation to PMQs, nine doctors indicated they hold UK PMQ; 38 hold an EEA PMQ; and 111 hold a PMQ gained outside of the EEA.



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Usage rates

22 The table below outlines how many times each theme has been started and completed, and the overall average score.

23 Overall, the completion rate for each theme is high, which indicates that no one topic is considered too long or too difficult. In addition, the number of unique users also broadly correlates with the number of times a theme is completed. Confidentiality emerges as the theme started most frequently, which may either be because it is the area most users are interested in, or because it appears first on the theme selection list.

24 The average scores are encouraging and reflect the varying levels of difficulty between the themes (this was also identified by the user testing group in March 2013).

Table 1 Theme title No of times

started No of times completed

No of unique users completed

Average overall score %

Confidentiality 159 125 123 72

Professional knowledge & skills

85 80 76 59

Raising concerns 59 55 51 69

Respect for patients

42 39 39 78

Team working 48 44 44 92

User feedback

25 At the end of each theme, users can complete a short feedback questionnaire. Questionnaires are automatically returned to the WtUKP inbox. This was not a mandatory requirement and 33 Your Comments forms have been received.

26 The results from the questionnaire were extremely positive. All responses indicate that doctors consider the tool to be useful and relevant to their needs; those completing a theme would recommend the tool to a friend or colleague; the language and explanations are clear; results and explanations would be

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used by the majority to inform further learning or share with an educational supervisor; and importantly, doctors find the system is easy to use.

27 Users have also left a number of positive comments about the tool including:

a “Please send similar tools often”

b “Quite a good tool - hope different case studies will be added”

c “A brilliant tool in better understanding ‘Good Medical Practice’ in action”

d “It has been a very informative experience going through all the themes”

28 We also received very positive feedback from doctors who completed the tool before attending the second series of pilot events. Below is a selection of their comments:

a “Yes, I was told of the event at the last moment as I started work only last week. This was quite useful.”

b “Very helpful. It helped me identify my weaknesses regarding GMC guidance.

c “Yes, after the training programme today I understand the importance of the online tool and I would like to use it to further enhance my skills to deal with ethical issues.”

d “I did, partially but still it again has helped me a lot. I think through scenario based questions have led me to learn more.”

e “The online tool was fantastic prepared and were precise and understandable.”

f “Yes I've completed just two modules so far but I like the fact that I can download and give my feedback.”

Stakeholder feedback

29 Educators (including medical schools), employers , the BMA and Health Education London’s Profession Support Unit have also reacted positively to the self-assessment tool and highlighted uses for it, including as part of wider training on ethical issues or as pre-work to appraisals.

30 Encouragingly, both the BMA and the Professional Support Unit have requested permission to include a link to the tool on their websites. We are exploring further opportunities to promote and disseminate the tool through discussions with the GMC’s Medical Staffing Reference group and observers who attended the second phase of pilot events.

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Summary

31 The staged piloting of the self-assessment tool has given us a detailed understanding of how the system works, and how it may be used by doctors and those who employ, train or teach them.

32 It has been received positively by all those who have used it and we know that both doctors and organisations understand its value in improving understanding of GMC guidance.

33 The WtUKP team has liaised with the Regional Liaison Service (RLS) and Devolved Offices (DOs) to build awareness of the self-assessment tool and promote it to the student/ doctor groups and organisations they engage with.

Event contents and development

Event purpose

34 The purpose of the event in phase two, as in phase one, was to drive better awareness and understanding of GMP among doctors who are new to practice in the UK and help improve their ability to practise safely and effectively.

35 Evaluation of phase one events highlighted the need to allow more time in the day to explore ethical and professional issues. Feedback from doctors showed that they gained most from these discussions but the original event timings meant that many important areas were not covered.

36 We had also concluded that the forum theatre sessions, although highly interactive and engaging, were resource intensive and potentially difficult to roll out on a larger scale.

Event agenda

37 We developed the phase two event as a day-long training event. We did consider delivering a number of half day events, but given the required content we did not feel the objective of raising awareness of our standards could be as effectively met within such a format. In addition, feedback from the first phase did not raise the length of the day as an issue for delegates.

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38 The agenda for the day was as follows:

a Welcome and introductions

b Role of the GMC

c Things I wish I’d known when I started in UK practice film and discussion

d Exploring Good medical practice – ethical scenarios

e Presentation by the Professional Support Unit (London only)

f The importance of effective communication

39 An example agenda from the London WtUKP events can be found at Annex C.

Welcome and introductions

40 Although a relatively standard process, the welcome and introductions section helped to bring out the diversity of the delegates attending. This also helped doctors to make connections with others from their home countries and was used as a reference point by the facilitators as they discussed the ethical differences around the world. Delegates from over 40 different countries attended the seven pilot events.

Role of the GMC

41 Feedback from phase one highlighted a general lack of awareness of the role of the GMC and how we support doctors throughout their career amongst delegates.

42 The purpose of this session remained making delegates more aware of the role and responsibilities of the GMC and in particular highlighting our role in developing and promoting guidance.

43 We had created an interesting and participative session using true and false statements about the GMC’s role and functions. These statements were used to prompt discussion amongst and with delegates.

44 Learning from phase one, we reduced the time spent on this part of the event. We identified that we could deliver the same quality of message and also allow more time to be spent on GMP and the supporting guidance.

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Things I wish I’d known when I started in UK practice film and discussion

45 During phase one of the WtUKP pilot we developed a short film of doctors sharing their experiences of starting practice in the UK, called Things I wish I had known when I started practice in the UK. At the phase one events the film worked well in generating discussion regarding the personal challenges faced by delegates when starting practice in the UK. We used the same format in phase two, but this time, where required we played a more active role in facilitating the table discussions. This helped to ensure that all delegates had the opportunity to share their experiences. It also provided an opportunity for observers to engage with the doctors.

46 As part of the exercise we set each table the task of identifying their ‘top tips’ to share with other delegates. This acted as a useful conduit for discussion.

47 Following the completion of the phase one events we attended a number of conferences to talk about our work on the WtUKP programme and presented the film to attendees. The film has received extremely positive feedback and a number of educators expressed interested in using the film as part of their internal induction events.

48 In order to deliver the maximum benefits from our available resources and maintain a reasonable level of control over usage we have developed guidance for third parties who wish to use the film. We also request that third parties complete a feedback form detailing how the film was used, audience demographics and information on its effectiveness as a learning tool.

49 To date we have received useful feedback from a number of external educators on how they have used the film. A sample of this feedback can be found at Annex E.

Exploring Good medical practice – ethical scenarios and discussion

50 Feedback from phase one showed that, as expected, this was deemed by the delegates as the most informative part of the day. The original session was split into a review of GMP and discussions around several ethical based case studies.

51 During the four pilots we continuously developed the sessions to shift the balance from talking about the guidance to spending more time discussing its practical application through issues raised in a number of ethical case studies.

52 During the phase one sessions we provided doctors with a written description of each of the case studies. Although a relatively standard way of delivering this type of training, we recognised the limitations of this medium. In co-operation with the Standards team we agreed that the programme would benefit from the development of a range of filmed ethical scenarios and the development of a more engaging way of understanding GMP.

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53 As part of the film development process we identified seven ethical scenarios which covered a number of our induction themes and developed the accompanying scripts.

54 The scripts were reviewed and approved from an ethical, clinical and communication perspective. Casting for the films was completed with oversight from our Equality and Diversity team and the filming took place over two days at Kingston University Hospital. We involved a GMC clinical fellow in the filming process to help maintain clinical realism.

55 The new, longer and more interactive session worked well at all of the events and we again received positive feedback from delegates and observers. The films allowed a greater flexibility in how the sessions were delivered and overall, provided a better learning experience for delegates.

56 The final change we made to this session was providing copies of our guidance to each delegate. Although each of the doctors would have received a full set of guidance documents at the point of registration, we wanted to emphasise the importance of reading and referring to the guidance. The facilitators directed doctors to relevant sections of the guidance to reinforce the points being made and the delegates were encouraged to make their own notes for future reference.

Presentation by local educator or employer

57 During phase one these local presentations varied in terms of quality of content and delivery. To allow more time in the day we decided that as a default local presentations would not be included in the phase two events. This was the case in Belfast, Cardiff and Edinburgh. However, in London the Professional Support Unit from Health Education London requested to deliver a 15 minute presentation on the support available to London based doctors.

The importance of effective communication

58 This session was specifically developed for the phase two events. The initial Call for Evidence and feedback from the phase one events highlighted that understanding effective communication was key to enabling a doctor to effectively transition into UK practice. We also identified a gap following the removal of the forum theatre section of the day, which had enabled doctors to explore practical communication issues.

59 The session, developed by a third party comprised two 45 minute sessions that mixed theoretical and practical exercises. This was designed to raise awareness of the importance of effective communication and to provide doctors with the opportunity to engage in one to one communication activities.

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60 The session received positive feedback from the delegates and observers. A number of doctors highlighted that they had not considered the importance of communication and had mainly focussed on the clinical aspect of their roles.

61 However, a number of observers also identified areas for improvement and some useful suggestions have been made about incorporating communication exercises into the ethical scenarios session.

Event delivery

Piloting approach

62 The first phase of piloting was facilitated by a third party and the forum theatre component delivered by an external theatre group. In order to maintain better control over the quality of the event delivery and to reduce costs we aimed to deliver the phase two events, where possible, utilising GMC resources.

63 The first four pilot events were held only in England, and so also didn’t test delivery across all four countries. Therefore in phase two pilot events were held in Northern Ireland, Wales and Scotland. This also gave us the opportunity to test how the events worked with varying numbers of delegates.

64 The pilots also tested if all of the components of the day could be delivered together, independently or as part of other induction events.

Pilot event locations

65 The first phase two pilot events were delivered in Cardiff, Belfast and Edinburgh with delegate numbers between 10 and 30. We recognised that the numbers in Belfast would be particularly low as there are only a small number of recently registered overseas doctors based in Northern Ireland.

66 A further four events were held in central London. Up to 60 delegates were booked to attend each event. These larger numbers allowed us to identify the most effective event size and test if all components of the day would work on a larger scale.

Pilot event target audience

67 As with phase one, the events were made available to doctors new to practice in the UK, whether they undertook training in the UK or overseas. For the purposes of the piloting we targeted, but did not restrict ourselves to, licensed doctors who had been on the List of Registered Medical Practitioners for less than two years.

68 We contacted doctors directly, based on their registered address and also worked with local employers to recruit doctors. In phase one we learnt that trusts and deaneries struggled to recruit doctors for the events directly, so we

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provided promotional materials for these organisations. We tried to ensure that we had a good mix of both employed and unemployed doctors. Colleagues in the DOs and RLS also contacted stakeholders within their networks to attract delegates.

Delegate demographics and invitation response rates

69 We considered the following when selecting the doctors to invite to the events:

a Country of PMQ

b Registered address

c Time since first registered

d Employed or unemployed

70 We knew from the phase one piloting that doctors were more likely to take up an invitation to attend an event if they were unemployed, therefore we phased the invitation process so that employed doctors had more time to respond.

71 Table 2 shows the response rates for the invitations sent out to doctors.

Table 2 Location No of

doctors contacted

No of doctors expressing interest

Invitation response rate %

No of doctors confirming attendance

Confirmation rate %

Belfast 44 11 25% 8 73%

Cardiff 295 37 13% 27 73%

Edinburgh 451 29 6% 26 90%

London 1621 237 15% 213 89%

Event drop-out rates

72 To try and minimize drop-out numbers on the day, delegates were sent three reminder emails prior to the day of the event. Regardless of this prompting a number of doctors didn’t show up on the day. As with any training course this was expected.

73 Table 3 shows the drop-out rates for the four countries. The overall drop-out rates for phase two (18%) was slightly lower than for phase one (21%).

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Table 3 Location No of doctors

confirming attendance

No of doctors not attending on the day

% non- attendance

Belfast 8 1 13%

Cardiff 27 6 22%

Edinburgh 26 6 23%

London 213 36 17%

Total 274 49 18%

Resources required to deliver the event

74 As one of the aims of phase two was to identify how we could industrialise the programme, we aimed where possible, to deliver the events utilising GMC resources.

Facilitation

75 Rather than use an external facilitator, each event was facilitated by either a DO representative, a regional liaison advisor or a member of the WtUKP project team. This approach worked well and added more of a GMC feel to the event. Specifically, as the regional liaison team and DO representatives have significant “generalist” GMC knowledge, they were excellent resources for answering a wide range of questions.

76 For some events we used two facilitators. This approach helped to keep the audience engaged.

77 Overall, the facilitators received very positive feedback from delegates and the observers. They presented a professional and approachable face of the GMC. As with the first phase of events, we received valuable feedback from delegates that the events gave them a very positive view of the GMC and its staff.

Exploring Good medical practice – ethical scenarios

78 In the first phase of piloting this session was delivered by Standards colleagues. It was identified early in phase two that the Standards team’s availability to support these events would be limited, so we again sought support from the DOs and the RLS. Colleagues from these areas have been trained to provide standards advice and are well equipped to deliver this section of the day.

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79 Where the groups were bigger we used two people to deliver the sessions. This improved the levels of delegate engagement and also allowed those delivering the session more time to access the relevant part of the guidance and share this with the group.

Event organisation and logistical support

80 The WtUKP project team, with assistance from a temporary employee, organised the events. This process is relatively labour intensive and should future events be organised we may wish to utilise an online booking system, such as the event management system currently used by the GMC events team.

81 As with the first phase of pilots, a lot of time was also spent ensuring we identified the right venues. In supporting the events on the day, project team members and other GMC resources were required to undertake the following activities:

a Set up the rooms and test the audio visual equipment

b Liaise with the venue staff to coordinate breaks and onsite facilities

c Greet the delegates as they arrive and hand out name badges

d Check attendance of late delegates

e Interact with delegates during the breaks and answer questions about the programme.

f Support the facilitators during the role of the GMC exercise

g Support the facilitator during end of day wrap up

Evaluation of feedback

82 The phase two pilot events enabled us to evaluate our ability to deliver to varying audience sizes, from a logistics point of view, and to gather feedback from the delegates and observers.

83 The seven pilot events also allowed us to assess how components of the day could be delivered as part of external induction programmes or other events.

Delegate feedback

84 Overall, delegate feedback was positive. A total of 225 delegates attended the events and 223 feedback forms were submitted. A copy of the feedback form can be found at Annex D.

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85 Delegates were asked to rate each part of the day and to also provide a rating for the day as a whole. When asked how they would rate this event as a whole they could choose between poor, satisfactory, good or excellent.

a 79% of delegates rated the event as excellent

b 21% of delegates rated the event as good

86 When breaking down each section of the day delegates rated the Things I wish I’d known when I started UK practice film and the Exploring Good medical practice sessions the highest.

87 A breakdown of the feedback can be found in Annex E.

88 Many delegates provided free text comments, including the following:

a “It was very, very helpful. I had some prejudices against the GMC and now they are all gone. I feel more confident in my interactions with the GMC that I used to perceive was hostility” (Cardiff)

b “A great way to meet other doctors and learn from their experiences. Despite being a new UK graduate I found this a really useful and thought-provoking course and though it covers no new material for me you can never be too familiar with GMP. Nice lunch too - thank you” (London 1)

c “I think the GMC should continue offering this day. It has been one of the most interesting courses/educational days I have ever attended “ (London 2)

d “I have learnt that effective communication is the key to good medical practice” (Edinburgh)

e “I will ask my seniors for help and advice if I am unsure” (Edinburgh)

f “I will use the GMC resources if I have questions regarding the topics presented today”. (Belfast)

89 The comprehensive feedback we received from the phase two events mirrors that received during phase one and re-enforces the importance of raising awareness of the ethical standards required of doctors starting practice in the UK.

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Observer feedback

90 All of the events were observed by GMC staff and external stakeholders. External stakeholders included deanery representatives, senior doctors in supervisory or training roles, representatives from the BMA and the Royal College of Physicians and Surgeons. We were keen to capture their views on the relevance of the event contents, how effectively it was delivered and how they may utilise the event resources as part of their role in supporting doctors.

91 The majority of observers completed feedback forms and their ratings of the day largely mirrored that of the delegates.

92 Observers were asked to rate the event using the same options as delegates - poor, satisfactory, good or excellent.

a 80% of external observers rated the event as excellent

b 20% of external observers rated the event as good

c 100% of internal observers rated the event as excellent

93 Additionally, we undertook 1-2-1 briefings with the majority of the observers, taking the opportunity to talk through their ratings and comments.

94 Observer feedback was also a useful way of obtaining ideas and suggestions for how we may use components of the day in other forums and what extra information we could provide to this cohort of doctors. These suggestions included:

a Wider promotion of the self-assessment tool

b The inclusion of information on the structure of the NHS

c Inviting other professional organisations to appear at lunch and breaks to share information relevant to the doctors in attendance

d Joint working between the GMC and the BMA in the delivery of the programme

e Running the ethical scenarios session as part of a local induction day at a trust / board

95 Although highly rated by the delegates, some observers felt that the effective communications session should be adapted to fit in with the ethical scenarios. Others commented that they did not feel communications training was within the remit of the GMC.

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Perceptions of the GMC

96 During the phase two events, we received written and verbal feedback from many of the delegates that they left the day with a more positive opinion of the GMC and a far greater awareness of the role the GMC plays in supporting doctors.

97 We believe that this change in perception is key to doctors’ willingness to positively engage with the GMC and access our supporting resources.

Recommendations following the completion of the WtUKP piloting

98 The first phase of piloting established the validity of the original products developed. The second phase has enabled us to test out our new concepts and identify how we can maximise the impact of the products we have developed with the greatest number of doctors.

99 The recommendations made in this report cover the following areas for each of the products developed as part of the WtUKP programme:

a Maintenance, development and governance

b GMC led delivery

c Non-GMC delivery

d Promotion and communications

100 Each recommendation is based on our evaluation of the two phases of the project and seek to achieve the goal, where applicable, of ‘industrialising’ the WtUKP programme.

101 During the two pilots the following products were developed:

a Role of the GMC exercise

b Things I wish I had known when I started in UK practice film

c Seven filmed ethical scenarios

d Effective communications workshop

e Online self-assessment tool

f Welcome to UK practice film

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102 For the purposes of this report, when we make recommendations relating to GMC delivery we are referring to the RLS, the DOs and the Standards team. Other GMC teams maybe also be specifically identified.

103 When we make recommendations relating to non-GMC delivery we are referring to doctor’s employers, educators and support organisations. Other non-GMC organisations may also be specifically identified.

104 With regards to ownership of delivery for the recommendations, we have not identified specific owners in this report, but we expect agreement to be made following a review of our recommendations.

Role of the GMC exercise

105 There are no priority changes identified for this exercise. However, it would be sensible to periodically review the contents of the exercise against the current GMC processes. For example, as Revalidation rolls out we may want to include more relevant information. We also need to ensure that any facts and figures quoted in the exercise remain up-to-date.

106 Supporting facilitator notes should be formalised and this exercise should be made available to GMC teams. Simplified notes should also be developed and made available to non-GMC teams

107 This component should be used as part of a GMC led events, stand alone or as part of a non-GMC event.

Things I wish I’d known when I started in UK practice film

108 There are also no priority changes identified for this film. This has been identified as a valuable resource and has already been used by a number of non-GMC organisations.

109 Supporting documentation has already been produced and is used when the film is shared with non-GMC organisations. Following on from the pilots we should revisit and where required, update the documentation.

110 The film should be made available to all GMC teams across the organisation. Over six hours of filming was produced as part of developing the film. We have utilised some of this in the new Welcome to UK Practice film and we should maintain awareness of the footage as a useful future resource.

Seven filmed ethical scenarios

111 These films were viewed by delegates and observers as a very useful and professional resource. No changes are required to the existing films.

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112 We had prepared notes around each of the ethical scenarios and identified potential delegate questions. The RLS and DO team members who delivered sessions also ‘marked up’ the relevant guidance with key points to discuss and share with the delegates. This ‘hands-on’ approach to using the guidance was very effective. We recommend that the support notes are updated, including an identification of the relevant sections of the guidance documents.

113 To assure consistency, further ‘train the trainer’ sessions may be provided to internal GMC staff. Resources permitted, we may also wish to provide training to selected external providers.

114 The films should be made available to GMC teams and to selected external organisations.

115 We recommend that following a period of further use we should evaluate the delivery of the existing ethical films, and we should identify if there are further ethical scenarios that would benefit from being developed into this format.

Effective communications workshop

116 The communications workshops received positive feedback from the delegates and from many of the observers. However, we believe that further development work is required to develop a product that better fits into our portfolio of resources.

117 As an organisation we recognise the importance of doctors being able to communicate effectively and recent analysis of the fitness to practice data shows that many doctors fail because of difficulties with communication. This view was echoed by many of the employers who attended the events and reinforced by comments from some of the doctors in attendance. One option would be to incorporate communications skills into the delivery of the ethical scenarios or develop a more interactive communications module for delivery by GMC teams or as an online resource.

Online self-assessment tool

118 The self-assessment tool has received positive feedback from doctors, educators and employers. A number of users have also enquired about us adding additional content.

119 Over the last six months we have increased our communications regarding the availability of the tool, but we believe that it still lacks the appropriate profile and we recommend that awareness of the tool is increased within the GMC and with our stakeholders.

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120 A review should be undertaken into how it fits into our portfolio of resources to support doctors and a development timetable should be set-up to maintain and add to its contents.

121 We should also continue to work with external stakeholders to understand how this and our other resources can be most effectively utilised. For example, some employers have suggested doctors undertake the self-assessment and talk through the questions and answers as part of their recruitment process or appraisal.

Welcome to UK Practice film

122 As part of the programme we have aimed to engage with the greatest number of doctors new to UK practice, but we recognise the logistical and resource challenges in providing our messages to this cohort. Working with the Registration Services team we have identified an opportunity to engage with all doctors who attend an ID check at either the London or Manchester offices.

123 During the ID process the doctor has between five and ten minutes where they wait for the GMC colleague to process their paperwork. We are using this opportunity to show the doctors a film welcoming them to UK practice. The film highlights the role of the GMC and includes footage of established registered doctors talking about the importance of understanding our standards.

124 We plan to include a link to this film in the Welcome to the Register email and letter to all new doctors. In the future it could also be made available on the GMC’s website.

GMC led events

125 We recommend that the GMC deliver a small number of one day events throughout the year. This would serve a number of purposes, including:

a Providing an opportunity to trial new or updated products

b A forum for showcasing our products and support services to key employers and educators

c An event to demonstrate the delivery of our products, quasi train the trainer

d Providing support to a number of doctors who fall out of current support networks, including unemployed doctors and locum doctors

e Provide an opportunity for GMC employers to engage with doctors new to the register and gain insight into the challenges they face when transitioning into UK practice

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126 The organisation and support for these events would have to be appropriately resourced and when locations are decided, consideration should be given to the four countries and doctor demographics.

Non-GMC led events

127 The GMC already provides support at non-GMC led events through a number of functions including the RLS, DO and Standards team. Therefore, our recommendation is to continue to utilise WtUKP products as required at non-GMC led events. We believe that this process could be improved by a centralised recording process, a review of the delivery of the products and collated feedback from participants.

128 We also recommend that we promote the use of our products by third parties. This would require setting up an appropriate governance framework to capture information about product delivery including:

a Organisation delivering the training

b Reason for use

c Audience demographics

d Feedback from delegates

129 We have started to build momentum behind the programme and it is key that this is maintained and built upon.

Key partners

130 As part of our goal of ‘industrialising’ the programme we have liaised with the BMA’s Ethics team during both pilot phases. Members of the team attended events during both phases and have also trialled the self-assessment tool. Their feedback on the products is extremely positive and we are keen to work together to maximise the impact of the WtUKP programme. There is therefore a need to agree a formal arrangement to work with the BMA and to plan how this relationship can be managed, developed and evaluated.

Communications and stakeholder management

131 During the two phases of the project we have raised awareness of the programme through a number of channels including: our Call for Evidence, meeting with key stakeholders, presenting at conferences, attendance at WtUKP events and through our website.

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132 The GMC has received considerable praise for our work on recognising a need to support doctors new to UK practice and proactively engaging with these doctors to highlight the importance of the UK’s medical ethical standards. We therefore believe that it is important to maintain appropriate communication with key stakeholders and to develop a communications strategy for the next 12 months that reflects on and supports our roll out plan.

133 We recommend that a communications owner is identified and a 12 month plan is developed.

Equality

134 The WtUKP programme has been developed to accommodate an individual doctor’s needs as they transition in practice in the UK regardless of where they qualified. In order to maintain the currently levels of accessibility of the programme, whoever takes ownership of the programme should also manage the actions as suggested in the WtUKP equality analysis at Annex F.

Summary of recommendations

135 Table 4 summarises all of the recommendations from the previous section.

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Table 4 # Summary of Recommendations Event products 1 The Things I wish I’d known film should be made available to all GMC

teams across the organisation and to selected external organisations. 2 The seven ethical scenario films support notes should be updated to

reference the relevant sections of our guidance documents. 3 The seven ethical scenario films should be made available to GMC teams

and to selected external partners. 4 Following a period of further use we should undertake a detailed

evaluation of the delivery of the existing ethical films and identify if there are further scenarios that could be developed in this format,

5 Supporting facilitator notes for the “Role of the GMC” exercise should be formalised and this exercise should then be made available to GMC teams. Simplified notes should also be developed and made available to non-GMC organisations.

6 Explore how the current communications session could be incorporated into the delivery of the ethical scenarios, or look into developing a more interactive communications module for delivery by GMC teams or as an online resource.

7 Roll out the Welcome to UK Practice film in 2014 as part of ID check process at Manchester and London offices.

8 Promote availability of our products to third party stakeholders Event delivery 9 The GMC should deliver a small number of one day events throughout

2014. 10 Continue to utilise the WtUKP products as required at non-GMC led events. Self-Assessment tool 11 Raise awareness of the tool within the GMC and with our stakeholders. 12 Undertake a review to establish how the self-assessment tool fits into our

portfolio of resources to support doctors. A timetable should be set-up for the maintenance and development of the tool and its contents.

13 Continue to work with external stakeholders, including the BMA, to understand how the self-assessment tool and our other resources can be most effectively utilised.

Communications, stakeholder management and planning 14 Identify formal internal ownership of our relationship with the BMA and

develop a joint working agreement, outlining how the relationship will be managed, developed and evaluated.

15 Develop a communications plan that supports the programme over the next 12 months.

16 Develop an implementation plan detailing how the programme will be rolled out in 2014.

17 Continue to monitor the protected characteristics of participants of the programme in line with the general equality duty.

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Industrialisation and target audiences

136 The aim of phase 2 has been to understand how we can industrialise the programme, delivering our messages to the greatest number of doctors new to UK practice whilst utilising the minimal resources.

137 This report has set out our recommendations for utilising each of our products and how we undertake GMC and non-GMC led engagement. This section summarises the various target audiences and our expected penetration levels.

Target audiences

138 The programme has always been targeted at doctors new to UK practice, wherever they have trained. The programme has always been needs based and engagement with any of the WtUKP activities have not been mandated.

139 We recognise that doctors with UK PMQs will be familiar with many of the topics covered in the programme. Their needs are therefore, probably less than a doctor trained overseas in a country with markedly different medical ethical standards.

140 However, we have been careful not to ‘label’ any doctors by particular demographics and have been mindful to design products that can meet the requirements of all doctors entering UK practice.

141 Table 5 provides a summary of the programme’s products and expected audiences.

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Table 5 Product Available on GMC

website Delivered face to face

Self-assessment tool Yes

All doctors and applicants

N/A

Welcome to UK practice film

Yes

All doctors and applicants

IMG – all at ID check

EEA – all at ID check

UK – not at ID check Things I wish I had

known when I started in UK practice film

Available to authorised 3rd parties

Through GMC & non-GMC led events.

Available for use in medical schools


Available to authorised 3rd parties



Ethical scenario films Available to authorised 3rd parties



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Annex A

Welcome to UK practice programme themes

1 This document contains the 10 induction themes (based on Good Medical Practice) that form the basis of the Welcome to UK practice programme content. The themes are designed to reinforce the professional and ethical standards expected of doctors in UK practice in line with the values and principles in Good Medical Practice.

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Theme Theme description Sub-theme

Raising Concerns

Doctors will protect patients from risk of harm by raising concerns about colleagues' conduct or practice

Dealing with errors and serious incidents

Challenging authority

Fear of Punishment

Team Relationships

Doctors establish and maintain positive, professional relationships with multi-disciplinary colleagues in order to provide good clinical care

Role of other healthcare professionals/Defining responsibilities

Accountability and doctor as manager; doctors in non-clinical roles

Change in the status of the doctor

Professional expectations and pressures

Doctors must provide a good standard of practice and care by keeping their professional knowledge up to date. Doctors must also recognise and work within the limits of their competence. Doctors understand that what they do in their private lives is as important as their professional conduct in ensuring the public's trust in the profession.

Managing health

Keeping up to date

Managing workload; managing information overload

Awareness that a doctor’s status can be affected by actions in their personal lives. Importance of maintaining patient and public trust in the profession.

Understanding the wider health system

Doctors should be well informed about the high level pathways of care between primary and secondary care. Doctors need to be aware of the organisations that are available to provide them with support

Key drivers in the NHS and the link with GMC obligations e.g. Constitution, Patient's Rights Act, incentive schemes, prioritisation, pathways and referral management

UK regulatory framework (including research good practice); quality assurance systems; openness

Ongoing learning and maintaining professional performance

Doctors understand the importance of CPD and revalidation, and their associated responsibilities

Culture of life long learning; evidence about transition challenges and what works to improve practice

Applying knowledge and experience to practising as a doctor in the UK

Doctors demonstrate the knowledge and skills to cope with ethical and legal issues that occur during the management of patients

Dealing with others expectations of their knowledge; managing uncertainty

Ethically and legally complex treatment decisions - end of life care, mental health

Probity

Supporting patients who have impaired decision making capacity

Understanding patient autonomy when developing treatment plans

Regulatory requirements; GMP and the link with

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fitness to practise

Paperwork and documentation; continuity and safety of care; information overload

Ensuring equal access to non-discriminatory care

Doctors have a responsibility to ensure that all patients, without discrimination, are provided with high quality care and treated with respect

Access to care and health inequalities in the UK

Culturally acceptable forms of illness presentation

Diversity duties in healthcare - maybe merge into access to care issue?

Meeting specific patient communication needs e.g. non-English speakers, sensory impairments

understanding the role of personal beliefs in decision making

Understanding disease profiles in ethnically diverse communities

Respect for patients

Doctors should treat patients as individuals, with dignity and respect.

Impose own values or preferences on patients

Relationships with patients

Informed consent; and the role of family

Cultural perceptions of health -same as above - remove?

Involving adults, children and young people in decisions

Safeguarding responsibilities for vulnerable adults or children

Dealing with knowledgeable patients

Issues of confidentiality

Doctors understand their responsibility to protect patient information, handle it sensitively and share appropriately

Confidentiality

Understanding when disclosure is permitted or required

Disclosure and safeguarding vulnerable people - links to above - move into safeguarding

Role of the family and handling different cultural attitudes to confidentiality

Understanding how to communicate effectively as a doctor in the UK

Doctors have a responsibility to ensure that they can communicate clearly and effectively with patients and colleagues

Non-verbal cues, communicating beyond language

Managing your own and patient/family emotional responses

Breaking bad news; supporting dying patients and their family

Not violating patient/Dr boundaries

Terminology; communication support tools and strategies - explaining things in straight forward ways

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Nationality Number of users Country of PMQ Number of users British 33 UK 9 Austrian 1 Austria 0 Bulgarian 4 Bulgarian 4 Czech 1 Czech Republic 1 Danish 1 Denmark 0 Dutch 1 Netherlands 0 French 3 France 2 German 6 Germany 6 Greek 5 Greece 6 Hungarian 1 Hungary 1 Irish 2 Ireland 1 Italian 5 Italy 4 Lithuanian 1 Lithuania 1 Polish 2 Poland 1 Portuguese 2 Portugal 2 Romanian 3 Romania 4 Spanish 5 Spain 4 Sub-total EEA 43 Sub-total EEA 38

Afghan 2 Afghanistan 1 Albanian 0 Albania 1 Algerian 0 Algeria 1 American 2 United States 1 Australian 4 Australia 3 Bangladeshi 3 Bangladesh 3 Barbadian 0 Barbados 1 Bhutanes* 9 Bhutan 0 Brazilian 0 Brazil 1 Canadian 1 Canada 2 Caymanian 0 Cayman Islands 9 Chinese 0 China 4 Congolese 1 Congo 1 Croatian 1 Croatia 1 Cuban 0 Cuba 1 Cypriot 2 Cyprus 0 Egyptian 2 Egypt 11 Grenadian~ 0 Grenada 1 Indian 16 India 17 Iranian 1 Iran 2 Iraqi 2 Iraq 2 Jamaican 0 Jamaican 1 Malaysian 1 Malaysia 1 Nepalese 3 Nepal 2 New Zealander 0 New Zealand 1 Nigerian 7 Nigeria 10 Pakistani 11 Pakistan 18 Philippino 1 Philippines 1 Russian 3 Russian Federation 5 Sri Lankan 3 Sri Lanka 1 Sudanese 3 Sudan 4 Tanzanian 1 Tanzania 0

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Nationality Number of users Country of PMQ Number of users Turkey 1 Turkey 2 Ukrainian 0 Ukraine 1 Venezuelan 1 Venezuela 0 Vincentian~ 1 Zimbabwean 0 Zimbabwe 1 Sub-total IMG 82 Sub-total IMG 111 TOTAL 158 TOTAL 158

*Stakeholders using the tool were asked to input their nationality / PMQ combination as Bhutanes/ Cayman Islands in order distinguish them from doctors using the tool.

~ Vincentian is a nationality option for citizens of St Vincent and the Grenadines. One used has also indicated they hold a Grenadian PMQ and it is reasonable to assume that this is the same person.

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Annex B

Self-assessment demographics

1 This document contains the demographics for the unique users who have accessed the self-assessment tool.

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Nationality Number of users Country of PMQ Number of users British 33 UK 9 Austrian 1 Austria 0 Bulgarian 4 Bulgarian 4 Czech 1 Czech Republic 1 Danish 1 Denmark 0 Dutch 1 Netherlands 0 French 3 France 2 German 6 Germany 6 Greek 5 Greece 6 Hungarian 1 Hungary 1 Irish 2 Ireland 1 Italian 5 Italy 4 Lithuanian 1 Lithuania 1 Polish 2 Poland 1 Portuguese 2 Portugal 2 Romanian 3 Romania 4 Spanish 5 Spain 4 Sub-total EEA 43 Sub-total EEA 38

Afghan 2 Afghanistan 1 Albanian 0 Albania 1 Algerian 0 Algeria 1 American 2 United States 1 Australian 4 Australia 3 Bangladeshi 3 Bangladesh 3 Barbadian 0 Barbados 1 Bhutanes* 9 Bhutan 0 Brazilian 0 Brazil 1 Canadian 1 Canada 2 Caymanian 0 Cayman Islands 9 Chinese 0 China 4 Congolese 1 Congo 1 Croatian 1 Croatia 1 Cuban 0 Cuba 1 Cypriot 2 Cyprus 0 Egyptian 2 Egypt 11 Grenadian~ 0 Grenada 1 Indian 16 India 17 Iranian 1 Iran 2 Iraqi 2 Iraq 2 Jamaican 0 Jamaican 1 Malaysian 1 Malaysia 1 Nepalese 3 Nepal 2 New Zealander 0 New Zealand 1 Nigerian 7 Nigeria 10 Pakistani 11 Pakistan 18 Philippino 1 Philippines 1 Russian 3 Russian Federation 5 Sri Lankan 3 Sri Lanka 1 Sudanese 3 Sudan 4 Tanzanian 1 Tanzania 0

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Nationality Number of users Country of PMQ Number of users Turkey 1 Turkey 2 Ukrainian 0 Ukraine 1 Venezuelan 1 Venezuela 0 Vincentian~ 1 Zimbabwean 0 Zimbabwe 1 Sub-total IMG 82 Sub-total IMG 111 TOTAL 158 TOTAL 158

*Stakeholders using the tool were asked to input their nationality / PMQ combination as Bhutanes/ Cayman Islands in order distinguish them from doctors using the tool.

~ Vincentian is a nationality option for citizens of St Vincent and the Grenadines. One used has also indicated they hold a Grenadian PMQ and it is reasonable to assume that this is the same person.

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Evaluation report of phase two piloting of the Welcome to UK Practice Programme

Annex C

WtUKP event agenda (London) 1 This document contains the agenda for Phase two Welcome to UK Practice

events which were held in London in November 2013.

Even

t ag

enda Welcome to UK practice

30 Euston Square London NW1 2FB

November 201308:30 – 17:00

8:30 Registration

9:00 Welcome and introductions

10:00 Role of the GMC

10:50 Break

11:05 Things I wish I’d known when I started in UK practice

12:00 Presentation from the Professional Support Unit, Shared Services on behalf of HE North Central and East London, HE North West London and HE South London

12:15 Exploring Good medical practice (part 1)

13:00 Lunch

13:50 Exploring Good medical practice (part 2)

14:45 The importance of effective communication (part 1)

15:30 Break

15:45 The importance of effective communication (part 2)

16:30 Overview and evaluation of the day

17:00 Close

The GMC is a charity registered in England and Wales (1089278) and Scotland (SC037750)

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Evaluation report of phase two piloting of the Welcome to UK Practice Programme

Annex D

WtUKP delegate feedback form

1 This document contains the delegate feedback form for Phase two Welcome to UK Practice events which were held in November 2013.

Event evaluation

Strongly agree

AgreeNeither agree nor disagree

DisagreeStrongly disagree

Welcome and introduction

Clearly explained the aims and objectives of the day


Was clear

Was relevant

‘Things I wish I’d known’ film and discussion

Was clear

Was relevant

Helped me to reflect on my own practice

Helped me to reflect on my development needs

Presentation from the Professional Support Unit, Shared Services on behalf of HE North Central and East London, HE North West London and HE South London

Was clear

Was relevant

Exploring Good medical practice

Was clear

Was relevant

Improved my awareness of issues relating to the GMC’s ethical guidance



Welcome to UK Practice

Please complete this form, ticking to indicate whether you agree or disagree with each of the following statements.

Name GMC Number

Strongly agree

AgreeNeither agree nor disagree

DisagreeStrongly disagree

The importance of effective communication

Was clear

Was relevant

Improved my awareness of issues relating to effective communication

Helped me to reflect on my own practice


The facilitator (s)

Was well prepared

Was knowledgeable

Was responsive to questions

Communicated effectively

Created a comfortable learning environment

Overall

The event met the stated aims and objectives of the day

Improved my awareness of issues relating to the GMC's ethical guidance

Excellent Good Satisfactory Poor

I would rate this event

How did you hear about the event?Please tick as appropriate:

a. Invite from the GMC b. Promotional poster

c. Promotional flyer d. Colleague

e. Employer

f. Other, please state ___________________________________________________________________________________________________________

Written comments

1. What were the most useful parts of the event for you?

The GMC is a charity registered in England and Wales (1089278) and Scotland (SC037750)

3. What, if anything, would you like adding to the event?

4. Would you recommend the Welcome to UK Practice event to a friend or colleague?

5. Did you complete the online self-assessment tool before attending the event?

YES If YES did you find the online tool useful in helping you to understand some of the ethical issues covered during the event? Please explain.

NO If NO, would you now use the online tool to help you further understand some of the ethical issues covered during the event? Please explain.

6. Please use this section for any further comments you would like to make about this event.

2. What have you learned from the event that you think might make you more effective in your practice?

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Annex E

Delegate and observer feedback

Summary

1 This annex contains:

a A breakdown of the demographics of the delegates who attend the seven Welcome to UK Practice (WtUKP) events held in quarter four of 2013 (paragraphs 3-7).

b A summary of the feedback received by delegates and observers of those events (paragraphs 8-15).

c A summary of earlier feedback from other piloting activities; the phase one events and Things I wish I’d known when I started in UK practice film (paragraphs 16-23).

Phase two event delegate demographics

Delegate booking

2 During phase one piloting in quarter one 2013, we found that it was more effective to invite doctors to WtUKP events directly using information from the List of Registered Medical Practitioners rather than through a third party.

3 Our phase two invite strategy was primarily driven by emailing invitations to doctors with registered addresses within the same geographical area of the events. We distributed promotional material to trusts and LETBs within the area of each event. Information on how to book a place was also included on the Welcome to UK Practice webpage. Additionally, the regional liaison advisors in London promoted the events with their stakeholders.

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4 The event feedback form included a question about how delegates had heard about the event. The data shown in chart one reflects our invite strategy:

Chart 1

5 For the seven events in Belfast, Cardiff, Edinburgh and London:

a we contacted 2411 doctors from the register

b we received expressions of interest from 314 doctors

c 274 doctors confirmed their attendance at an event

Attendance

6 Across the seven events:

a 225 delegates attended, meaning we had an 18% drop-out rate. This was slightly lower than the 21% rate we experienced for the phase one events.

b 44% of the doctors who attended were employed and 56% were unemployed*

c four doctors had graduated in the UK, 89 graduated in the EEA and 132 graduated outside of Europe.

d 45 nationalities were represented by the doctors who attended; after British (10%) the most common were Italian (9%), Pakistani (9%) and Nigerian (8%).

78.6%

0.5% 0.0%

8.6% 4.8% 7.6%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

How did you hear about the event?

Invite from the GMC

Promotinal poster

Promotional flyer

Colleague

Employer

Other

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* These figures are taken from Siebel, however we know that the reliability of employment data is not consistent across the UK.

Phase two event delegate feedback

7 We collected delegate feedback forms from 223 of the 225 doctors who attended an event. Their overall feedback was as follows:

a 78.5% of delegates rated the event as ‘excellent’

b 21% of delegates rated the event as ’good’

c 0.5% (one) delegate rated the event as ’satisfactory’

8 The phase two pilot events allowed us to test WtUKP products with different sized audiences. Our first event in Belfast had seven attendees, whilst our largest event in London, had 51 attendees. In comparing the feedback for these two events, the overall rating is similar (84% Excellent, 16% good for Belfast and 78% excellent, 20% good, 2% satisfactory for the largest London event) which supports the aim that the products are suitable for large or small audiences.

9 We asked whether the event achieved what it set out to, and received the response shown in chart two (across all seven events)

Chart 2

69.3% 74.1%

29.8% 25.0%

0.9% 0.9% 0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

The event met the statedaims and objectives of the

day

The event improved myawareness of the issues

relating to the GMC'sethical guidance

Overall

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

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10 Collectively delegates at all seven events provided overwhelmingly positive responses to all questions on the feedback form. The most positive was in relation to event facilitation, with over 80% of delegates strongly agreeing with all statements about the facilitator(s) (see chart three). This demonstrates a strong pairing between WtUKP programme content and delivery by the Regional Liaison Service and Devolved Offices.

Chart 3

11 We also asked delegates for their views on the clarity and relevance of each section of the day and received the following responses:

a Welcome and introductions

Chart 4

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d Role of the GMC exercise

Chart 5

e Things I wish I’d known film and discussion

Chart 6

68.7% 67.0%

31.3% 30.7%

0% 2.4% 0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Was clear Was relevant


Strongly agree

Agree

Neither agree nordisagree

Disagree

Strongly disagree

71.3% 70.2% 64.6% 63.3%

28.7% 28.4% 30.0% 32.6%

0%

0.9% 5.4% 3.6% 0% 0.5% 0% 0.5%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Was clear Was relevant Helped me toreflect on myown practice

Helped me toreflect on mydevelopment

needs

Things I wish I'd known film and discussion

Strongly agree

Agree


Disagree

Strongly disagree

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f Presentation from London PSU: the professional support unit, shared services HE North Central and East London, HE North West London and HE South London (London events only)

Chart 7

g Exploring Good medical practice

Chart 8

45.2% 52.4%

41.8% 38.1%

12.3% 8.2%

0% 0.7% 0.7% 0.7% 0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Was clear was relevant

presentation from the professional support unit

Strongly agree

Agree

Neither agree nordisagree

Disagree

Strongly disagree

70.1% 78.7%

69.1% 60.8%

28.5% 20.4%

28.7% 34.7%

0.9% 0.5% 1.8% 4.1% 0.5% 0.5% 0.4% 0.5%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Was clear Was relevant Improved myawareness of

issuesrelating tothe GMC's

ethicalguidance

Helped me toreflect on mydevelopment

needs

Exploring good medical practice

Strongly agree

Agree


Disagree

Strongly disagree

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h The importance of effective communication

Chart 9

12 The feedback for each section of the event agenda is more or less consistent across the whole day, with the exception of the presentation from London PSU. This element of the London events was delivered by a third party, with a different presenter on each occasion. As such there was a variation in the content and delivery.

13 A sample of the free text comments from delegates who attended the events are shown below:

a The most useful parts of the event were “…understanding more thoroughly the role of the GMC hence encouraged to spend more time with the guidance.”

b ”It is very important for me to know that someone (in this case the programme facilitators) understands the difficulties that an overseas doctor can have on his/her arrival in the UK, without challenging the doctor's competencies.”

c “I have learnt that effective communication is the key to good medical practice.”

d “[I learnt] how to be a professional; how to find the relevant resources and how to use them. Very effective way of learning. You transformed

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something that could be extremely boring to a pleasant interactive constructive process.”

e “[The event ]…was very, very helpful. I had some prejudices against the GMC and now they are all gone. I feel more confident in my interactions with the GMC that I used to perceive was hostility.”

f “I think the GMC should continue offering this day. It has been one of the most interesting courses/educational days I have ever attended.”

g “[The event is] great for encouragement, networking not feeling like 'the only one' with a problem to work in the NHS.”

Phase two event observer feedback

14 We invited external stakeholders and senior colleagues from the GMC to attend the events and sought their feedback afterwards. These observers provided useful and constructive feedback. We received ten feedback forms from external stakeholders and seven forms from GMC colleagues. In summary:

a 80% of external observers and 100% of GMC observers rated the event as excellent. 20% of external observers rated the event as good.

b Feedback from both external and GMC observers indicate that the most relevant and useful sessions were Things I wish I’d known when I started in UK practice film and discussion, and exploring Good medical practice.

c In line with delegate feedback, the facilitators received very positive feedback.

d External and GMC observers frequently commented that a significant benefit of the event is the opportunity for delegates to create new networks, enabling them to share similar experiences and support each other in overcoming challenges.

e Suggestions for improvements include more structure to the communications session or combining the communications session with the ethical scenario discussions. It was also suggested that it would be beneficial to include a topic on the structure of the NHS and invite other professional bodies to appear at the lunch break.

15 A selection of observer comments are below:

a “This was very well run and I would recommend that IMG doctors attend where possible. It will be useful to have access to materials to use locally” (Edinburgh: External observer).

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b “The videos on the ethical scenarios were good and lead to open discussion about the different issues involved” (London: External observer)

c “Really impressive event and excellent way of bringing the role of the GMC, our guidance and standards to life” (London: GMC observer).

Phase one delegate follow up questionnaire

16 In June 2013, we distributed a follow up questionnaire to the 122 attendees of the four phase one events. In line with the Kirkpatrick model of learning evaluation1, the aim of the questionnaire was to give us an additional level of insight into the delegates’ learning. This is in addition to the feedback collected on the day of the event.

17 We received 45 responses to the survey, a rate of 33%. Given the passage of time since the events this was no lower than expected. We asked 15 questions, charts 10-13 show the responses received to some of the questions which are most relevant to this report:

Chart 10

1 Donald Kirkpatrick’s four level training evaluation model is a commonly used method for meaningful evaluation of training (reaction, learning, behaviour and results)

89%

60%

42%

56%

18%

33%

16% 7%

0%10%20%30%40%50%60%70%80%90%

100%

In what way did you use the learning from the event? (Tick all that apply)

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Chart 11

Chart 12

91%

67% 64%

33% 29% 36%

44%

31%

0.00% 0%

10%20%30%40%50%60%70%80%90%

100%

Since attending a Welcome to UK Practice event, have you referred to any of the following GMC guidance? (Tick all that apply)

87%

51%

27% 31%

13% 13% 11% 0%

0%10%20%30%40%50%60%70%80%90%

100%

What did you use the guidance for? (Tick all that apply)

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18 It is promising to see that 91% of respondents have referred to Good medical practice (GMP) since attending an event and interesting to see the reasons for the guidance/learning materials being used. We know that when asked, many of the doctors who attend WtUKP events indicate they have not read GMP beforehand.

19 Although a subjective question, it is positive to see that 63% delegates agree or strongly agree with the statement below:

Chart 13

20 To carry on this approach to evaluate the effectiveness of the WtUKP events, it is recommended that a similar follow up questionnaire to the phase two events is distributed between four to six months after the first event, in April/May 2014.

Things I w ish I ’d known when I started in UK practice film feedback

21 During the WtUKP pilot, we collected feedback from third parties who used the Things I wish I’d known when I started in UK practice film as part of their internal induction events. Ten external contacts requested the film and we received five feedback forms. We know that some people used the film more than once but didn’t provide feedback for each occasion. The audience was generally trainee doctors of different levels and groups varied in size from 13 to 80.

22 The feedback received was positive from the educators who describe the film as a useful, easily accessible resource. The educators also fed back their observations of the doctors’ reactions to the film which were largely positive with some constructive suggestions. The comments show that the film achieves its aim to be a catalyst for discussions about overcoming difficulties such as adapting to new systems, language and cultural barriers, the importance of clinical documentation and asking for help.

34%

46%

17%

3%

The event has increased my confidence in dealing with the challenges I have faced or expect to face in my practice

Strongly Agree

Agree

Neither agree ordisagree

Disagree

Strongly disagree

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23 This activity is a good example of how third parties can make use of WtUKP resources and has shown that there is a strong demand for such products from educators.

24 A sample of the written feedback is shown below:

a “The film generated active discussion by both IMG and UKMGs with shared experiences and new insights” (David Byres, TPD, West of Scotland Deanery)

b “My personal view is that I hope that on reflection, trainees will think more about cultural issues, communication, professionalism and teamwork.” (Peter Hockey, Deputy Postgraduate Dean, Health Education Wessex).

c “It provided a valuable 'warm-up' resource for stimulating discussion as a group… the content was clear and the doctors who appeared on the film represented an appropriate spectrum for the target audience.” (Steve Walter, Health Education West Midlands)

d Doctor feedback included comments such as:

i “This is so much better than the booklets that the GMC send out”

ii “Could have focused more on cultural impacts on patients”

iii “It was good because it offered solutions as well as describing problems”

iv “Should help us understand our colleagues better”

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Annex F

Welcome to UK Practice Equality Analysis

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Background

1 In The State of Medical Education and Practice in the UK 2011, we identified that an induction programme would help to ensure that all doctors new to UK practice understand the ethical and professional standards they are expected to meet. In early 2012, we started the development of the GMC induction programme for all doctors new to practice in the UK.

2 This equality analysis covers the project to develop the induction programme, which is now known as the Welcome to UK practice (WtUKP) programme. This document should be read in conjunction with the December 2013 WtUKP phase two evaluation report.

3 The project was delivered in several stages:

a Evidence gathering and engagement

b Phase one content development and piloting

c Phase one evaluation

d Phase two content development and piloting

e Overall evaluation

4 For more detail about the work we undertook at each stage, please refer to the Welcome to UK Practice phase two evaluation report.

5 In the evidence gathering and consultation phase of the project we analysed information and feedback from our key interest groups. This enabled us to develop 10 induction themes (based on Good medical practice) which informed the programme’s content. These themes reinforce the professional and ethical standards expected of doctors in UK practice in line with the values and principles in Good medical practice (GMP). The themes can be found at Annex A of the WtUKP phase two evaluation report.

6 During the development phases of the project, we developed a number of products that formed the basis of the WtUKP programme. These are:

a An online scenario-based self-assessment tool (providing doctors with insight into their knowledge of the application of Good medical practice).

b WtUKP events (one day engagement/training events including interactive training sessions designed to explore how to apply the values and principles of Good medical practice in daily practice).

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c A short film of doctors sharing their experience of starting practice in the UK entitled Things I wish I had known when I started practice in the UK.

d A short film highlighting the role of the GMC and the importance of using our standards, called Welcome to UK Practice.

e Seven filmed ethical scenarios for use in interactive training sessions.

Evidence

Pre-project commencement evidence gathering

Literature review

7 Prior to commencing the project we undertook a literature review of relevant GMC commissioned and independent research to explore the challenges faced by doctors who are new to UK practice. For instance The Warwick report (2009)2, found that while UK and non-UK trained doctors experience similar issues when they transition into practice, providing an introduction to GMP and the ethical context for practising in the UK is likely to be of particular benefit to overseas qualified doctors.

Call for evidence

8 At the start of the project we undertook a Call for Evidence (March to April 2012) to understand the views of our key interest groups. This sought information, data and opinion from a variety of organisations to understand the current availability of induction programmes, how they support doctors and to identify best practice. In order to have a representative response, over 200 organisations were invited to participate and 78 organisations responded.

9 Organisations representing views from different protected characteristics were contacted:

a Disability – Association of Disabled Professionals, Long term conditions alliance Northern Ireland

b Race or ethnicity –British International Doctors Association (BIDA), British Association of Physicians of Indian Origin (BAPIO), Refugee Healthcare Professionals Programme, Refugee Council, Refugee and Asylum Seekers Centre for Healthcare Professionals Education (REACHE) North West, Indian

2 Slowther, A., Hundt, G. L.; Taylor, R., Purkis, J. (2009) Non UK qualified doctors and Good Medical Practice: The experience of working within a different professional framework. London: GMC

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Medical Association, Medical Association of Nigerian Specialists and General Practitioners,

c Sex and Sexual Orientation – Medical Women’s Federation, Gay and Lesbian Association of Doctors and Dentists, Rainbow Project

d Religion or belief – Progressive Muslim Forum

e Age – Northern Ireland Commissioner for Children and Young People, Northern Ireland Older Person’s Commissioner, Age Sector Platform

10 The responses we received varied in opinion and level of detail. However, the overall sense was that there is a perceived need for a nationwide induction programme. Many insightful and rich suggestions were provided on how such a programme could be approached.

Face to face engagement

11 In addition to the Call for Evidence, we were keen to engage face to face with a range of key interest groups in order to test the concept of induction. We held meetings with trusts, deaneries, medical schools and other groups such as REACHE North West, BIDA, BAPIO, and the Black and Minority Ethnic (BME) Doctors forum.

Product development and delivery

12 Throughout the product development activities we used the evidence gathered in the earlier stages of the project to inform the content. This helped us to ensure that we developed products which addressed the needs of our intended audiences, who are diverse in terms of the protected characteristics of gender, ethnicity, disability, age, religion or belief and sexual orientation.

Target audiences

13 The WtUKP programme is targeted at doctors new to UK practice, wherever they have trained. The programme is needs-based and therefore any registered doctor can participate if they feel they need support in any of the areas addressed by the programme.

14 The WtUKP programme has been designed to address the issues that doctors face as they transition into practice; however a doctor can complete the induction programme at any stage of their career.

15 We recognise that doctors with UK PMQs will be familiar with many of the topics covered in the programme. Their needs are therefore, probably less than a doctor trained overseas in a country with markedly different medical ethical

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standards. Whilst all WtUKP products are designed to meet the requirements of doctors entering UK practice, it is important to acknowledge that those trained overseas may benefit more from the support offered by the WtUKP programme.

Self-assessment tool

16 The online scenario based self-assessment tool is designed to help doctors assess their knowledge and application of our core guidance Good medical practice and to provide signposting to further information and advice.

17 Although designed as part of the WtUKP programme, there is no restriction on who can use the tool. The content is such that it can be used by any doctor regardless of where they have trained or how long they have been practising (those practising for longer may find it a useful way of refreshing their knowledge of GMC guidance). A doctor can also access the tool prior to seeking registration with the GMC, providing them with an opportunity to understand some of the ethical and professional challenges they will face when working in the UK.

18 This online element to the WtUKP programme means that where a doctor identifies a need to engage with the programme, they have the opportunity to outside of the WtUKP events where places are limited.

19 The tool was designed in consultation with members of our web team to ensure it conforms to web accessibility guidelines.

20 The tool is anonymous and does not collect any personal information that would lead us to identify participating doctors. For this reason, we do not hold information on the protected characteristics for users of the tool. Doctors are required to enter their nationality and country of primary medical qualification when logging in to the system. We use this information for reporting purposes but it is important to recognise that there is no compulsion on users to enter their true details.

21 A full breakdown of the demographics of users of the tool can be found at Annex B to the WtUKP evaluation report but in brief: 33 doctors are categorised as British; 41 as EEA nationals; and 84 as nationals of countries outside of the EEA. In relation to PMQs, nine doctors indicated they hold UK PMQ; 38 hold an EEA PMQ; and 111 hold a PMQ gained outside of the EEA.

22 These demographics reflect our assumption that whilst the WtUKP programme is suitable for all doctors new to practice in the UK, it may be most helpful to those who have trained overseas. The demographics may change once the tool is marketed more widely.

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Things I wish I’d known film and Welcome to UK practice film

23 During our initial evidence gathering, we identified that many new doctors wished to hear about and learn from the experiences of doctors who have previously been in the same position. Both the Things I wish I’d known film and the Welcome to UK practice film feature doctors from diverse geographical and medical backgrounds who are at different stages of their careers in the UK.

24 To produce the interview footage we contacted hundreds of doctors asking for volunteers and secured the participation of 13 doctors. We monitored the responses from volunteers to make sure we had a diverse range of doctors to include in the film. We felt we needed more representation from female and junior doctors and so approached the Medical Women’s Federation and the British Medical Association’s Junior Members Forum.

25 The original interviews contained over eleven hours of footage which was edited down, selecting the most appropriate quotes to highlight the principles and values required of doctors practising in UK.

26 The Welcome to UK Practice film outlines the role of the GMC and raises awareness of GMP principles, emphasising the importance of adhering to ethics in UK practice. To ensure that all doctors have had an opportunity to see the film at the point of registration, we will show it to doctors during ID checks in the registration process and through a link in the ‘welcome to the register’ email. We also plan to include the film on the PLAB guidance webpages.

Ethical scenario films

27 As part of the film development process we identified seven ethical scenarios which covered a number of our induction themes and developed the accompanying scripts. The scripts were reviewed and approved from an ethical, clinical and communication perspective. Casting for the films was completed with oversight from our Equality and Diversity team to ensure realistic and fair profiling of characters in each scenario. The filming took place over two days at Kingston University Hospital and we involved a GMC clinical fellow in the filming process to help maintain clinical realism.

WtUKP pilot events

28 The WtUKP pilot events were made available to doctors new to practice in the UK, whether they undertook medical training in the UK or overseas. For the purposes of the piloting we targeted, but did not restrict ourselves to, licensed doctors who had been on the List of Registered Medical Practitioners for less than two years.

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29 We considered the following criteria when selecting the key characteristics of doctors who would benefit most from attending events:

a Country of PMQ

b Registered address

c Time since first registered

d Employed or unemployed

30 We contacted doctors directly, based on their registered address and also worked with local employers to recruit doctors. In phase one we learnt that trusts and deaneries struggled to recruit doctors for the events directly, so we provided promotional materials for these organisations. We tried to ensure that we had a good mix of both employed and unemployed doctors, however places were offered on a first come first served basis. Colleagues and the DOs and RLS also contacted stakeholders within their networks to attract delegates.

31 We knew from the phase one piloting that doctors were more likely to take up an invitation to attend an event if they were unemployed, therefore we phased the invitation process in phase two to give employed doctors more time to respond.

Diversity monitoring of attendees at the pilot events

32 We hold two types of data which has helped us to monitor the diversity of attendees of the WtUKP events; data available from the register; and data collected through diversity monitoring forms filled in anonymously at events.

33 Both sets of data include age, gender and ethnic origin. However there is more data available for events two to four of phase one (Cambridge, Swindon and Manchester) including information on religion, sexual orientation and disability. This is because we took a decision to monitor a wider range of protected characteristics after the first event of phase one had been held in Birmingham.

34 During phase two of the pilot we decided to revert to the original approach by using pre-existing data available from the register rather than collecting additional data at events. This approach reflects the shift in phase two to developing a more industrialised programme that can be delivered in other forums; recognising that data which is readily available will be more accessible to those delivering WtUKP after the conclusion of the pilot.

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38.79%

61.21%

Gender

Man

Woman

Gender

35 Of the 348 attendees of the 11 WtUKP events, 213(61%) were female and 135 (39%) were male.

36 When compared to the gender breakdown of the whole register, it is not unusual that there were more female attendees. In December 2013, 56% of the whole register was female and 44% male.

Figure 1

37 A breakdown of gender across each of the event locations is as follows:

a Belfast: 3 female and 4 male

b Birmingham: 18 female and 13 male

c Cambridge: 18 female and 9 male

d Cardiff: 14 female and 7 male

e Edinburgh: 11 female and 9 male

f London (four events): 109 female and 69 male

g Manchester: 17 female and 15 male

h Swindon: 23 female and 9 male

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22.70%

50.29%

21.84%

4.31% 0.86%

Age of attendees

20-29

30-39

40-49

50-59

60-69

Age

38 The age breakdown of the total attendees of the phase one and two pilot events is shown in figure two.

a In total (of the 348 attendees of the 11 WtUKP events) 79 doctors were in the 20-29 age bracket. One in Belfast, 11 in Birmingham, two in Cambridge, three in Cardiff, four in Edinburgh, 43 in London, nine in Manchester, six in Swindon. Figure two shows the percentage breakdown of each group.

b In total 175 doctors were in the 30-39 age bracket. Three in Belfast, 11 in Birmingham, 20 in Cambridge, 12 in Cardiff, nine in Edinburgh, 92 in London, 16 in Manchester, 12 in Swindon. This was the most popular age bracket, reflective of that of the whole register (30% in December 2013).

c In total 76 doctors were in the 40-49 age bracket. Three in Belfast, eight in Birmingham, five in Cambridge, six in Edinburgh, three in Cardiff, 33 in London, seven in Manchester, 11 in Swindon.

d In total 15 doctors were in the 50-59 age bracket. One in Birmingham, three in Cardiff, one in Edinburgh, seven in London, three in Swindon.

e In total three doctors were in the 60-69 age bracket, all three attended London events.

Figure 2

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39.37%

29.31%

11.49% 9.20%

6.61% 2.87% 1.15%

0%5%

10%15%20%25%30%35%40%45%50%

White Asian orAsianBritish

Black orBlack

British

OtherEthnicGroups

Unspecified Not stated Mixed

Ethnicity

Total

39 The age breakdown of attendees reflects our expectations given that:

a 61% of doctors registered within the last two years (as at 1 December 2013) were in the 20-29 age bracket

b The programme may be of most benefit to doctors who have qualified in a different country, gained some experience and then come to the UK to work. Those doctors are most likely to be in the 20-39 age bracket.

40 However it is important to note that the programme is designed to be relevant for all doctors regardless of age, ethnicity, gender or any other characteristic.

Ethnicity

41 We hold ethnicity data for 315 of the 348 attendees of the WtUKP events. 33 doctors have either ‘unspecified’ or ‘not stated’ against the ethnicity field in their Seibel record.

a Of the 348 event attendees we hold ethnicity data for, 102 identify themselves as Asian or Asian British

b 40 identify themselves as Black or Black British

c Four identify themselves as mixed

d 137 identify themselves as White

e 32 identify themselves as belonging to other ethnic groups

Figure 3

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Country of PMQ

42 Figure four shows the ten most common countries of Primary Medical Qualification (PMQ) across all 11 WtUKP events in phases one and two.

Figure 4 – Top ten most common coutries of Primary Medical Qualification across all WtUKP events

Country of PMQ %

Pakistan 11.49%

Nigeria 9.20%

India 9.20%

Romania 6.61%

Italy 6.32%

Greece 4.60%

Egypt 4.02%

Bangladesh 3.74%

Iraq 2.87%

Germany 2.59%

43 According to the State of Medical Education and Practice report (SOMEP) 2013, in 2012 10% of registered doctors graduated in the European Economic Area (EEA), and 27% were international medical graduates (IMGs)3. Figure four reflects this trend as the top three countries of PMQ are classified as IMG locations. Over the last few years there has been a rise in the number of EEA graduates joining the register and a drop in the number of IMG doctors joining the register. SOMEP 2013 aligns this to changes in UK immigration policy, which helps explain the number of doctors from countries such as Romania, Italy and Greece participating in the WtUKP programme

44 Additionally, a number of doctors with UK (1.15%) and Irish (1.44%) PMQs attended the events. Feedback from these doctors was positive, showing that the events were well received and relevant although some material is a revision of that taught at medical schools. This shows that whilst UK and Irish medical

3 SOMEP 2013, pg 24

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graduates may be less likely to engage with the WtUKP programme, the material is useful for them.

Religion

45 For the three events (Cambridge, Manchester and Swindon) where we gathered data on the religion of attendees, 82 out of 91 doctors volunteered this information. Five identified as Buddhist, 20 Christian, eight Hindu, one Jewish, 34 Muslim, one preferred not to say, nine ticked the Other box and wrote Orthodox Christian (presumably as this was not specified in the Christian category).

Figure 5

46 Recognising that some attendees may hold religious beliefs, we made sure a prayer room was available at each of the event venues.

Sexual orientation

47 For the three events (Cambridge, Manchester and Swindon) where we gathered data on the sexual orientation of attendees 76 of the 91 attendees identified as heterosexual/straight, one as bisexual, one gay man and four people preferred not to say.

Disability

48 For the three events (Cambridge, Manchester and Swindon) where we gathered data on the disability status of attendees no doctors identified themselves as disabled according to the definition in the Equality Act 2010. However one person indicated they had a physical impairment.

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49 We took care to ensure that all event venues were accessible, for example making sure that lifts were available for event attendees.

Equality analysis

50 As demonstrated in the evidence section of this report, we have delivered a programme which is accessible to a diverse range of doctors. The WtUKP programme has enabled doctors spanning the protected characteristics to engage with Good medical practice on a meaningful level with the aim of helping to improve their ability to practise safely and effectively.

51 This equality analysis has uncovered no equality and diversity issues. Furthermore the programme has been well received by all groups of doctors who have engaged with it, as reflected in participant and observer feedback collected as part of evaluation.

Reviewing and monitoring

52 This equality analysis should be read in conjunction with the WtUKP phase two evaluation report. Any further actions identified below will be passed on to the owners of the WtUKP programme after project closure.

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Action plan

Issue Action Timeframe Person responsible Relevant protected characteristic

Status

The induction programme may not be relevant to all doctors new to practice in the UK

Continue to engage widely with key interest groups to make sure the induction programme is developed to suit all learning needs and address the most pertinent issues.

May-Dec 12 RB/SK Age, Race, Ethnicity, Disability

Complete

Participation in the induction programme by protected characteristic groups may be low

Promote the programme pilot widely to ensure that all protected characteristic groups have equal opportunity to attend

May-Dec 12 Comms W/S All Complete

The induction programme may not meet the needs of doctors in all protected characteristic groups

Collect diversity data on participants to inform evaluation and ensure the programme is addressing the needs of all groups

Nov 12-Jan 13 WS leads All Complete

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Issue Action Timeframe Person responsible Relevant protected characteristic

Status

The induction programme must be accessible to all doctors new to practice

Provide events in locations that are accessible to the majority of participants, provide information in accessible formats e.g. different languages, large print

Nov 12-Jan 13 WS leads All Complete

Third party vendors may not be addressing the equality duty

Ensure the equality duty is included in any contract with contractors or third parties

May–Dec 12 WS leads All Complete

After the project has finished the WtUKP programme may not continue to reach all target audiences

Those with responsibility for taking WtUKP forward to ensure that a communications plan is in place to market the products effectively. Data should continue to be collected to evidence that the programme is successfully reaching the target audience

Feb 2014 onwards WtUKP owner (post-project)

All Ongoing

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Sign off

Assistant Director/Director

Ben Whur

E&D Team member Aishnine Benjamin

B1

7 – Welcome to UK Practice evaluation and implementation

Annex B

Welcome to UK Practice Transition Planning 1 These slides set out the high level implementation plan for the Welcome to UK Practice Programme.

1

WtUKP Transition Planning 2014 quick wins and ongoing activities

INTERNAL USE ONLY - CONFIDENTIAL

2

Contents

1 “Quick Wins” for 2014

2 High-level activities for 2014

3 Proposed Governance Model [post handover]

4 Detailed Transition Plan – TBA when complete

3

Suggested “Quick Wins” within 2014

To keep momentum and embed the project within the GMC in 2014 the following 9 Quick Wins should be considered. We will also utilise existing corporate communications channels to drive awareness

Quick Win Advantages Disadvantages

1

“Things I wish I’d known” film and Self-Assessment Tool sent to partner organisations and “Welcome to UK Practice” film embedded on GMC WtUKP website / or main GMC doctors landing page [for example Locum Agencies, Postgraduate Education Centres, overseas PLAB partners, etc.]

• Already produced • To show joint working with other

orgs and partners • To widen usage and uptake • General messaging and promotion

– not giving away potential GMC Intellectual Property [IP] that can be used in facilitated sessions later on

• None foreseen

2 Use “Welcome to UK Practice” film within formal ID Checks for Year 5 Med Students

• As above • To be agreed with UK apps team

as part of wider changes to format of ID check events

• None foreseen

3 “Welcome to UK Practice” film shown to all newly registered doctors who attend ID checks at the GMC offices.

• Already produced • In use at Manchester and London

offices, [consider rolling out to DO offices]

• To promote guidance and understanding of role of GMC

• None foreseen

4 Link to Self-Assessment Tool and “Welcome to UK Practice” film inserted into PLAB guidance pages and “Welcome to the register email”

• Already in use • Positive reinforcement of

registration • Easy to implement • To widen usage and uptake • Active demonstration of impact of

the programme on operational aspect of the business

• We would need to clear on comms to ensure there isn’t confusion about this being compulsory [but this is something we could think about in future]

4

Suggested “Quick Wins” within 2014

Quick Win Advantages Disadvantages

5 Self-Assessment Tool to be used as part of pre-preparation for PLAB

• Positive reinforcement of registration • To widen usage and uptake • Active demonstration of impact of the

programme on operational aspect of the business

• Need to be clear on non-mandatory communication of this

• Would need to get sign-off from Registration/PLAB teams to initiate this change

• May be held up with PLAB Review

6

Link to Self-Assessment Tool mentioned / signposted in low-level FtP issues [Stream 2 for example – ROs might want to remind docs of this tool as a support mechanism]

• Shows GMC helping doctors to understand issues with practice even if this doesn’t meet our threshold for action [upstream correction of FtP…]

• Active demonstration of impact of the programme on operational aspect of the business

• Would have to be agreed with FtP directorate

7

Internal Communications activities to inform staff about success of the programme so far and how it will develop in 2014 and beyond

• Raise internal awareness • Create a positive internal narrative for WtUKP • Communicate a successful cross-directorate

project to the business

• Dependent on available internal comms support

8 Further Evaluative Piloting in England and Devolved Nations – number TBD

• Continued momentum • Would allow delivery teams to flex content

and delivery method before deciding on post 2014 roll-out options

• Gives opportunity to involve the Chief Executive in delivery / attendance

• Additive to RLS and DO work plans for 2014 so this would need to be agreed with Director of Strategy and Communication, and added to S&C Operational Plan [including resourcing options]

9 Demand survey / analysis to understand potential uptake post 2014 and indicative resource needed

• Would help us determine how large this programme of work could be

• Would enable a data driven decision on delivery resourcing for RLS and DOs

• Would frame GMC appetite for the Programme at SMT level

• Would need resourcing [possible to do this through external / internal teams but it would be additive work to current Operational Plan]

5

Q1 Q2 Q3 Q4

High-level activities for 2014

Transition planning

S&P Board Paper

Handover Workshop

S&P Board Director Sign Off

Evaluative Piloting [RLS and DO]

Demand Analysis

Post 2014 resource modelling

Director Sign Off

Implement Quick Wins 1-6

S&P Board - Sign off size of programme post 2014 - Sign of required Resource

Additional Tool Production

Ongoing Tool Maintenance

Internal Communications and profile building about WtUKP [TBD]

6

Proposed Governance Model

Shane Carmichael

Sponsoring AD

Sign off of budget decisions and key deliverables / tools

Paul Buckley

Sponsoring Director

Accountable for delivery of programme at SMT and Council

Dan Donaghy

Programme Lead

Responsible for overall project delivery and co-ordination

Elizabeth McGrath

Tools Maintenance & Development Lead

Responsible for maintenance of

existing WtUKP toolset and design and delivery of new tools through

Corp Comms channels

Sharon Burton / Nominee

Standards and Ethics SME

Subject Matter Expert input for tool development

Gareth Williams

DO Programme Lead

Responsible for project delivery and co-ordination in Devolved

countries

Tracey Melbourne

Programme Manager

Responsible for day-to-day project co-ordination across UK

Welcome to UK Practice evaluation and implementation...The WtUKP film is designed to raise awareness...

Documents

Transcript of Welcome to UK Practice evaluation and implementation...The WtUKP film is designed to raise awareness...