This Policy supplements the Lead Employer guidance on attendance: Lead Employer policy for Handling Concerns in respect of Medical and Dental Staff in Training.

Last Updated: 24/07/2022 by Sebastian Pillon

Structured Teaching Programme (STP)

The STP forms part of the educational aspect of the GP Training Programme and is designed to supplement “on-the-job” learning whilst on hospital and community placements.

Education sessions are organised and often delivered by the Primary Medical Educator Team.

In ST1, 18 sessions are provided over a rolling 12 month period, restarting each August.
In ST2, 26 sessions are provided over a rolling 12 month period, restarting each August.
- 10 sessions per 6-month semester are provided as Structured Education
- An additional 6 sessions are provided as a Consultation Skills Course
In ST3, 50 sessions are provided over a rolling 12 month period, restarting each August.

The teaching sessions form part of the educational time in GP Training Contracts, and attendance is expected as part of the job plan and contract with the Lead Employer.

There be optional educational opportunities separate from the STP which trainees can use study leave or other time to attend.

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Personnel

The Primary Care Medical Educators (PCMEs) co-ordinate and deliver the teaching programmes:

ST1 is coordinated by Dr Kat Rothwell
ST2 is coordinated by Dr Seb Pillon
ST3A is coordinated by Dr Seb Pillon
ST3B is coordinated Dr Kat Rothwell
The ST2 Consultations Skills Course is coordinated Dr Julian Tomkinson

As of August 2022, the teaching staff are supported by Carole Kennedy (Programme Manager) and Dr Reuben Pratheepan (Training Programme Director). The HEE NW Associate Dean for Bolton is currently Dr Nick Walton.

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Aims of the STP

The STP in each of the GP training years is designed to support the “on-the-job” learning gained in hospital and GP placements, as well as in speciality-specific tutorials and self-directed learning. The STP cannot and should not be considered sufficient alone to provide full coverage of the curriculum required to gain MRCGP. We therefore try to focus on areas where experience may be harder to come by for some or all trainees.

We use principles of adult learning in the design of our programme given that by its very nature, all attendees are postgraduates with at least one university degree. Trainees are expected to be active participants and engineers of their education, and cannot rely on the passive gains of facts to be sufficient to gain MRCP.

What do we mean by attendance?

Attendance means more than simply showing up or logging in to a planned STP session. All of our sessions require interactivity between the presenter(s) and audience. Even sessions that appear to mimic lecture-based sessions are greatly enhanced by audience participation and questions, and we encourage this to ensure the teaching delivered is meeting the known and unknown needs of trainees in attendance.

In addition, professional attitudes are gauged based on attitudes to teaching attendance and engagement.

To be clear, we expect trainees to treat educational session with the same respect they would show to a clinical session. Specifically, we expect trainees to:

Arrive in advance of the advertised start time of sessions, so that they can start as planned.
Remain in a session until it has either ended, or the advertised end time has passed
- Some sessions may go on longer than advertised for beneficial reasons (such as questions) but we would not expect trainees to stay if they had other responsibilities.
Have a working camera and microphone on their device for remote sessions. Cameras should be on during an entire session.
Inform their educational supervisor of non-attendance; in advance where this is planned (i.e. annual leave), and as soon as possible when not possible to plan (i.e. illness)

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Remote Learning

Developed in necessity during the COVID-19 pandemic, educational time used online video conferencing technology to continue to deliver the STP.

Remote sessions will typically use the Zoom or Microsoft Teams platforms and we encourage all trainees to download the authorised applications for these programs onto their intended device to ensure they work as intended. Where possible, we recommend using a desktop or laptop computer, or a tablet-sized device as these allow for trainees to better see their colleagues and any slide presentations. Use of mobile phone apps results in a suboptimal experience; whilst their use may be a necessity, we would advise against it being the default option.

We do not record sessions and nor do we authorise any trainee to record without the express permission of all those in attendance. Any unauthorised recording and/or distribution of a teaching session would be considered a probity issue and may also fall foul of the law surrounding GDPR

Remote learning can be a useful tool that allows for otherwise-unavailable opportunities and will continue to part of how we learn in future. A key part of GP education is interactivity, and trainees are expected to engage with sessions, whether in-person or remote.

Remote learning should not thus be seen as a background activity to passively whilst completing other tasks. These include, but are not limited to:

Driving
Attending appointments
Completing clinical administration work
Checking emails or other computer-based work/leisure activity
Primary caring responsibilities where attention is not focussed on the teaching session
Housework

To ensure all attendees are part of the sessions it is mandatory to:

Have cameras turned on throughout the session unless otherwise directed
Have a working speaker and microphone
Attend sessions in a location where distractions are minimal

Any trainees with temporary/longer-term difficulties (personal or technical) should make the PCMEs aware as soon as issues arise so that alternative solutions can be considered.

Trainees who are not felt to be engaging with this guidance may be marked as not-attending even if apparently logged into a session.

Caring Responsibilities

We recognise that unforeseen illness in a dependant may limit the ability of a trainee to attend a session. Whilst we are keen to promote attendance through novel means where possible, it is important to recognise the principle that “attendance” means more than simply being present as a passive observer.

We would not normally invite non-trainees to sessions, but if having someone else present is a necessity as a result of an unplanned caring need, please inform the PCME leading the session as soon as possible to ensure that any confidentiality or content issues can be raised at the start of a session.

If the caring responsibility means a trainee is unable to engage meaningfully with a session, then we would recommend leave entitlement be used. The PCME leading the session reserves the right to determine what constitutes meaningful engagement.

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Less Than Full Time Training

Less than full time trainees (LTFTs) may not necessarily attend all teaching sessions in the same order as their full-time colleagues.

As the weekly job-plan with specify education time on a pro-rata basis, LTFTs will “over-attend” by staying for the full duration of a teaching session, and so must at some later time claim that time back. If a trainee has attended greater than their allocated time in educational sessions at the expense of clinical sessions, then they should ensure to “pay-back” the missed clinical time.

PCMEs recognise that trainees who are less-than-full-time will not attend every session. This means that the attendance register may record an absence that is perfectly justified as part of the overall attendance. Trainees and Educational Supervisors should take care to interpret attendance registers with the Trainee’s LTFT status in mind.

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Alternative Educational Time

Trainees may wish to take advantage of other educational opportunities that coincide with the STP. This may include use of study leave. As these opportunities are likely to be infrequent, absence from the STP is permissible as long as the alternative activity has been agreed with the Educational Supervisor.

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Exam Preparation

Preparation for the Applied Knowledge Test or Recorded Consultation Assessment examinations is NOT considered an acceptable alternative use of the time allocated to the STP.

In particular, Trainees and Educational Supervisors in ST3 should not use the STP time for RCA case-gathering when a session is scheduled. The STP is designed thoughtfully with the examination dates in mind. It is designed to support and supplement to the clinical time, and as RCA cases involve real clinical interactions, they form part of the trainee’s clinical time.

Trainees may of course choose to use annual or other approved leave to attend examinations or for time to prepare, but failure to attend the STP would be considered an unauthorised absence unless this was granted in advance, with the consent of the Education Supervisor an din accordance with this policy.

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Recording Attendance

The best form of attendance log is a reflective entry in the Trainee Portfolio, demonstrating attendance and any learning from the session.

There is some benefit to Education staff keeping a register of attendance, in that it can identify trainees or systems in difficulty. It also provides objective evidence in the case of uncertainty.

Trainees are therefore expected to log their attendance with the register kept by the PCMEs. This forms both a back-up to a trainee’s own portfolio record, but also a way for Education staff to identify trainees, placements or other circumstances that may require attention.

If trainees fail to mark their attendance on the approved register, they will be marked as absent, even they are seen at a training session.

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Authorised Absence

Wherever possible, trainees should inform their Education Supervisor and the PCMEs as soon as they are aware they will not be able to attend a session. This is ideally before a session but should still be done after an unlogged absence when next possible to do so.

Educational Supervisors need to consider absences as part of the ES Report, and it is useful for PCMEs to know who is likely to be attending sessions to plan group work based on number of anticipated attendees.

Trainees should consider that attendance at education sessions is evaluated as part of the demonstration of competencies to progress through training and gain CCT. Educational Supervisors often ask for reports on attendance and engagement within teaching sessions.

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Procedure for reporting absence

For all absence, please follow the following guidance. Failure to do this may result in incorrect recording of attendance/absence

Send an email to the Educational Supervisor and copy in the gpeducatorsbolton@gmail.com address
- Please note that it is insufficient to inform only the PCME/Education Centre staff of absence – the ES must be included in all correspondence.
Include the date and time of the session (due to be) missed and include a brief description of the reason, for example:
- Annual Leave
- Zero Day/Rest Day
- Sick Leave
- Caring Responsibility
- Professional Leave (meeting with TPD or other HEE/Deanery staff)

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Unauthorised Absence

Trainees need to be aware that non-attendance may fall under misconduct and as such may potentially lead to a MHPS (Maintaining High Professional Standards) investigation in line with the St Helen’s & Knowsley Lead Employer (StHK LE) Handling Concerns Policy. Concerns include, but are not limited to

Unauthorised leave from work.
Poor time keeping, irregular attendance at work, late arrival, early leaving and extended breaks when not part of authorised flexible working nor previously agreed with a line manager.
Unauthorised absence or failure to comply with StHK LE’s or a Host Trust’s notification requirements for sickness absence, holiday booking, or any other type of absence.

In many cases, repeated unauthorised absence signifies a trainee with additional needs, or a hospital/GP system in need of attention. The goal of recording and classifying absence is to look at these causes and work with whomever necessary to improve things.

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Raising Concerns

Regarding Trainees

Poor attendance or engagement at the STP may be a sign of a Trainee in Difficulty and PCMEs have a duty to ensure such trainees are identified and offered appropriate support.

Trainees should be encouraged to inform educational staff any difficulties that may be affecting their training to allow for the opportunity for appropriate support and consideration to take place.

The PCMEs and their delegated officials (i.e. other allied tutor staff and educational administrative staff) reserve the right to discuss concerns regarding trainees with each other and the local Bolton GP training programme staff, including the area Associate Dean. The goal of this information sharing is to promote the early identification of trainees in difficulty. Concerns raised remain confidential within the education team.

These concerns may be escalated via the Educational Supervisor or other HEE NW staff as appropriate, but it would be expected that in most cases the trainee should be aware of this in advance of any disclosure.

There may be situation-specific occasions where disclosure of information sharing does not take place, but this should be considered unusual and exceptional, and would be subject to a robust assessment of why a trainee was not involved.

Where there is immediate concern regarding the safety of a trainee, they may contact appropriate emergency services, Host Trust or GP surgery, the GMC or other agency without first raising with the trainee.

Regarding Educators

Trainees should expect to receive high quality teaching, planned in advance and in support of their overall training programme.

Trainees should feel supported with their educational needs, and should be treated with respect and dignity.

The education team maintains training with regards to the Disability Discrimination Act, and trainees should expect to receive education in a discrimination-free environment.

Feedback is sought following teaching to identify strengths and weaknesses of the current programme and ensure it changes and develops as the needs of trainees evolve.

Where there are concerns about a member of the Education Staff or the Education Programme we would encourage trainees to raise this with someone they feel comfortable with.

This could include any of the PCME/TPD staff, the administrative staff, their own Clinical or Education Supervisor.

Where this isn’t appropriate, trainees could also consider the Associate Dean or other HEE NW staff. Alternatively, they can also utilise the Freedom to Speak Up Guardian at their Host Trust.

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Useful Contacts

Associate Dean	Dr Nick Walton	HEE NW	nick.walton@hee.nhs.uk
Training Programme Director	Dr Reuben Pratheepan	HEE NW (Bolton)	reuban.pratheepan@nhs.net
PCME (ST1, ST3B)	Dr Kat Rothwell	HEE NW (Bolton)	katherinerothwell@doctors.org.uk
PCME (ST2, ST3A)	Dr Seb Pillon	HEE NW (Bolton)	seb.pillon@hee.nhs.uk
Differential Attainment Champion	Dr Sadiyah Kauser	HEE NW (Bolton)	sadiyah.kauser1@nhs.net
Programme Manager	Carole Kennedy	Bolton NHS FT	Carole.Kennedy@boltonft.nhs.uk
Postgraduate Education Manager	Joanne Warburton	Bolton NHS FT	Joanne.Warburton@boltonft.nhs.uk
Freedom to Speak Up Guardian	Tracey Garde	Bolton NHS FT	Tracey.Garde@boltonft.nhs.uk
Freedom to Speak Up Guardian	–	GMMH NHS FT	freedomtospeakup@gmmh.nhs.uk

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Glossary of Terms

Annual Leave Planned leave as requested in accordance with local (Trust/GP) and Lead Employer Policy
Bolton FT Bolton NHS Foundation Trust
CS Clinical Supervisor, responsible for clinical supervision during a placement
ES Educational Supervisor, responsible for overseeing training of a GPST
GDPR General Data Protection Regulation
GMC General Medical Council
GM ICS Greater Manchester Integrated Care System
GMMH Greater Manchester Mental Health NHS Foundation Trust
GMP Good Medical Practice
GP General Practitioner or General Practice
GPST General Practice Speciality Trainee
HEE (NW) Health Education England (North West)
Host Trust The NHS Trust currently hosting a trainee (i.e. Bolton NHS Foundation Trust)
Lead Employer Organisation providing the administrative functions for speciality trainees (St Helen’s & Knowsley in our case)
NHSE NHS England
PCME Primary Care Medical Educator
StHK St Helen’s & Knowsley Teaching Hospitals NHS Trust
STP Structured Teaching Programme
TPD Training Program Director
Trust NHS Organisation providing patient services
Zero Day Rostered day off given to ensure compliance with working hours directives

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Structured Teaching Programme Attendance Policy

Contents

Structured Teaching Programme (STP)

Personnel

Aims of the STP

What do we mean by attendance?

Remote Learning

Caring Responsibilities

Less Than Full Time Training

Alternative Educational Time

Exam Preparation

Recording Attendance

Authorised Absence

Procedure for reporting absence

Unauthorised Absence

Raising Concerns

Regarding Trainees

Regarding Educators

Useful Contacts

Glossary of Terms

Links