F1 Supervision. Why isn't the system improving?

Blood Taking by an F1

I should thank a poster called Amy who informs me that F1 supervision is dire. She posted recently on Dr Crippen correcting my rather super mean diatribe on F1. Perhaps I had forgotten what it was like to be a junior so Amy was quite right in correcting me.

Amy's Post

I am an F1 in a busy teaching hospital.

I an F1's defence we are meant to be supervised and taught throughout our F1year, hence our "preregistration" label.

Unfortunately there is often no one to teach or supervise me and as i wonder round the hospital checking my patient's observations and listening to their chests I am often frightened at how compromised patient care actually is.

Everyone has to learn but how can we if there is no one there to teach us?

Amy

Appropriate supervision has been raised by me since 1998. Indeed, it was one of the issues raised on Ward 87. See point 2 here where Colin Campbell admits to poor supervison.

2002 CHI report into North Staffordshire NHS Trust stated as follows

"CHI was informed that junior doctors working in medicine were often inadequately supervised and often left alone on wards, particularly on the medical assessment unit (MAU). During an evening visit we found only two junior doctors covering MAU, which was full to capacity, with a further junior doctor covering MAU and emergency admissions; one junior doctor covered the medical wards and one covered medical outliers but these patients could be on wards on either site. CHI felt this situation posed a potential clinical risk to patients.”

The 2002 report went on to say, in Paragraph 5.78:

"There were a number of concerns raised regarding support and supervision for junior doctors working in medicine. We were told of a number of occasions when it was felt there was a lack of support both during the day and when problems arise whilst oncall. The Trust has acknowledged that medical staffing at all levels is under resourced in medicine".

When concerns were first raised in 1999 with the Evening Mail. the Postgraduate Dean, Professor John Temple decided to lie to the public. He stated as follows :-

This is what he told the Evening Mail

Professor John Temple, regional post graduate dean for the West Midlands NHS Executive, says extensive work is being carried out to ensure that junior doctors are properly supervised.

And he adds that while there was a shortage of doctors in the NHS the system was managing to cope "remarkably well".

"Over the last five years one of the things which has changed quite dramatically is that doctors are supervised properly," he says.

"All junior doctors should be supervised and they're required to know who they should contact and how in times of emergencies.

"The world has changed since the times these doctors were left on their own and we're keen to ensure there's a very clear chain of command. We expect them to work as teams, not as individuals."

That was nearly a decade ago. It is therefore quite disturbing to find that F1s even now remain unsupported. Indeed, I was so concerned that I raised with with Prof Catto who assured me that he would send my concerns to the appropriate people so that matters are improved for doctors like Amy. It is also extremely important to raise concerns about poor supervision because only then can it be sorted out. Of course, raising concerns is another issue but I am sure most of the bloggers would be able to help out and ensure the issue is raised in high places without disclosing the identity of the doctor[s]. I think the problem is widespread but we aren't aware of it because doctors are afraid to speak out. I suppose if they GMC were more approachable then that would be one option but they aren't.

My advice to any F1 would be this - never take whole responsibility for a patient. If you are unsure, bleep your senior right up to the consultant. And the whole idea is that no one must be afraid to ask questions. It is better to ask the question rather than be responsible for someone's death. If seniors do not respond, write the bleep number and the time you called in the notes. I suppose when I was a junior doctor, I got so fed up of crap seniors that I simply bleeped any senior oncall. In fact, I believe I even dragged a SHO Dermatologist to supervise my work and forced him to write in the notes before he left. As it happens, in the future the buck stopped with him and not with me as the F1. I think if something goes horribly wrong, seniors are very willing to blame very junior doctors and in some occasions scapegoat them. It is therefore always important to write your notes clearly so it tells the story of what happened that day. Writing in point form with the date/time/signature is fine.

Poor supervision was again raised at Mid Staffordshire NHS Trust.

So who is in charge of this nationally? And what are they doing about it?

Recommended Reading - Diary of a Junior Doctor.