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Foundation Charter (2020)

Undertaken in collaboration with Royal Colleges, the Medical Schools Council, the General Medical Council (GMC), the British Medical Association (BMA) and trainees, HEE's Foundation training review reinforces the commitment to enhancing the experience of doctors in training and, in turn, their health and wellbeing.

As part of the Review, a quality charter has been developed to define how Local Education Providers (LEPs) can support foundation training.

The Charter sets out standards covering the following:

1. High quality induction

It is important that LEPs try and ensure that a thorough clinical induction is provided every time a foundation doctor rotates into a new clinical area. This is particularly so when the FD is rotating between different hospital sites or other providers part way through the training year, for example when moving from a community placement back into an acute trust. Methods to consider are to roster the induction into the foundation doctor's work schedule and to aim for it to take place before the doctor starts clinical work in the new area.

2. All staff will be familiar with the level of competence of Foundation doctors

LEPs must ensure that staff working with foundation doctors are aware of their limited experience and do not ask them to carry out tasks that are above their level of competence.

3. Workplace supervision

Foundation doctors need to be made aware of who is available within the workplace to provide them with advice and, if required, hands-on support. This support should always be readily available and easily accessible.

4. Out of hours working

It is a good practice to have a handover at the start and end of every shift and that, where appropriate, that handover is multi-disciplinary and confirms the workplace supervision arrangements for the shift. Where possible, LEPs should promote the use of a mid-shift 'huddle' - a pre-arranged time for foundation doctors to meet and touch base with their supervising seniors to discuss workload and any concerns, including arrangements for bleep-free breaks. The promotion of hospital-wide coordination and fair distribution of out-of-hours workload is also beneficial, for example using 'Hospital at Night' arrangements for evenings and weekend daytimes as well.

5. Adequate support for tasks

It is important that LEPs ensure that the availability of support staff (eg. phlebotomists and physician's assistants) is matched to clinical need during the main working week and out-of-hours.

6. Standardisation of equipment

All relevant clinical areas should have an adequate stock of equipment used for simple procedures such as urethral catheterisation, venous cannulation, and blood-taking. Solutions such as the use of pre-made packs or easily accessible, clearly organised, and well-stocked trolleys should be considered for specific common procedures. The location where this equipment is stored on wards should be standardised across the hospital.

7. Appropriate electronic resources to support working

Whenever possible LEPs should use electronic resources to support the efficient working of foundation doctors, particularly out-of-hours. Examples include use of electronic prescribing and electronic systems, such as smartphone-based task allocation systems, to allocate work out-of-hours.

8. Facilitation of rest periods when working out of hours

Coordination of the out-of-hours workload should also ensure protected time is identified for foundation doctors to rest, with their bleep being taken by another team member during this time.

9. Adequate facilities for food and drink available on site 24 hours a day

Access to hot and cold food and drink should always be available.

10. Dedicated quiet areas for rest when working overnight

11. Trusts should facilitate the development of peer to near peer support networks for Foundation Doctors

12. Educational and named clinical supervisors to be trained for the role, proactive and readily available (and they need job-planned time for these roles)

13. Self-development time

Factoring self-development time (SDT) into foundation doctors' work schedules is important. SDT is formally rostered time for carrying out non-clinical activities that are essential curricula requirements. It is advised that foundation year 2 doctors should receive on average two hours per week and, where possible, foundation year 1 doctors should be allocated one hour per week.

14. Repetitive tasks

Good practice dictates that foundation doctors are not expected to perform inappropriate or excessively repetitive tasks of little educational value. For example, all FDs expect to write discharge summaries, but it would not be appropriate for them to regularly write large numbers of discharge summaries for day-case patients in whose care they have not been involved.

15. Educational programmes for Foundation Doctors

Wherever possible, foundation doctors should be involved in the development and annual review of their trust-based foundation teaching programmes. Teaching programmes should cover the breadth of medical practice, not just hospital-based medicine. Community-based doctors and mental health specialists should contribute to the development and delivery of the programme. All formal foundation teaching sessions should be bleep-free and where possible departments should endeavour to ensure routine work is suspended at times of departmental educational meetings to allow FDs to benefit from these.

16. Simulation based training

Foundation doctors should receive simulation-based training at least three times per year. This should have learning outcomes based on the foundation programme curriculum, could encompass both in-situ and simulation centre-based learning and ideally will be part of multi-disciplinary learning.

Full details and guidance can be found in the document below.