Congratulations on your appointment to the training programme. This document summarises the core components of the training programme. The nature of training programmes is not fixed and can change. If you have any questions about training, please discuss this with your educational supervisor or training programme director (TPD).

For guidance about Stage 2 Internal Medicine (IM) training, please refer to your induction with the IM TPD.

Key Links

Employer - Lead Employer - STHK

Deanery – NHS England North West

2010 Curriculum - Palliative medicine training (2010, with 2014 amendments)

2015 ARCP Decision Aid - Palliative Medicine ARCP Decision Aid (September 2015).pdf (jrcptb.org.uk)

2022 Curriculum - Palliative medicine training (2022)

2022 ARCP Decision Aid - Palliative Medicine ARCP Decision Aid (2022 curriculum) 2023 update.pdf (jrcptb.org.uk)

2022 Rough Guide to Training – due to be published 2022, check https://www.jrcptb.org.uk/specialties/palliative-medicine

Gold Guide – Postgraduate Training Manual

ePortfolio – JRCPTB Guides, further help Barbara.coe@hee.nhs.uk

Training

Training Programme Length

The duration of Higher Medical Training is four years for a full-time Postgraduate Doctor in Training (PgDiT) and pro-rata for those working less than full time.

The length of training can be longer if Postgraduate Doctors in Training take time out of programme or if training extension is needed to achieve capabilities of practice.

At the end of the programme, Postgraduate Doctors in Training achieve a certificate of completion of training (CCT). The expected date of CCT is reviewed at each ARCP.

Training Year Map

Palliative Medicine & Internal Medicine Regional Teaching

PM = Palliative Medicine IM = Internal Medicine

Non-PM outpatient clinic – minimum 20 during training

Curriculum

All Postgraduate Doctors in Training are required to complete the following curricula:

Palliative Medicine Curriculum
Internal Medicine Curriculum
Generic Capabilities in Practice which covers all postgraduate curricula.

The bulk of information for this can be found on the ePortfolio, however you should also read and refer to the curricula which have additional explanatory details, on the JRCPTB website.

Plan your year based on the decision aids – these form the basis for ARCP review. A well organised personal library organised by training year and decision aid heading makes recording evidence much easier.

Supervision

Supervision is in line with the Enhancing Supervision model from Health Education England. PgDiTs will have an educational supervisor over the course of the training programme to provide continuity relating to the learning experience. Within clinical placements, you will have a named clinical supervisor in addition to the ES if they do not work there. For each clinical activity that you have, you should be clear about who is providing workplace support.

Most annual reviews of competency progression (ARCP) occur in June of every year with additional ARCPs for non-standard outcomes, three months prior to the completion of training or on an individual basis based on trainee need.

You will need an educational supervisor report at the end of each training year, regardless of whether an ARCP is due.

The ARCP also acts as a stage post for your revalidation with the GMC. The Form R is an official document consisting of two parts, A & B, which is used to formally register doctors in training with the Postgraduate Dean. All PgDiTs are required to fill out a Form R when starting a new training programme. Return of the Form R to HEE initiates the ARCP process and triggers the release of a National Training Number, which is used to identify you as a trainee in an approved training programme within the NHS. You then need to submit an updated Form R at each ARCP.

As part of Good Medical Practice, doctors should also record reflections relating to their scope of practice. This is uploaded to the ePortfolio. The following is recommended for completion in a training year:

Palliative Record of Reflective Practice mandatory two per training year
Attendance at organised teaching log after each attendance (still need to do this as a consultant)
Audit optional if details are submitted in personal library of protocols, results and outputs
Generic Reflection Form optional depending on your preference for form structures/anything not covered in the other pre-populated forms
Reflection on Clinical Event log four to six per training year
Reflection on Learning during an Attachment optional
Reflection on Learning Event optional
Reflection on Management and Leadership Experience at least one a year helpful to log learning from events as there are requirements for this in each year's decision aid

Types of Services and Placements:

A number of hospices, associated community specialist palliative care teams and hospital palliative care teams are accredited for Higher Medical training by the Royal College of Physicians and NHS England North West. The curriculum for palliative medicine is capability based and assessment is recorded on the e-portfolio, through regular appraisal and annual assessment.

The current training posts in Mersey are based at:

Marie Curie Centre, Liverpool (Integrated Mersey Palliative Care team (IMPaCT) South services, Inpatient Unit)
Royal Liverpool University Hospital (Hospital Specialist Palliative Care Team and Palliative Care Inpatient Unit) with On Call at Marie Curie Hospice
Aintree University Hospital (IMPaCT North Services, Hospital Specialist Palliative Care Team, Woodlands Hospice)
St Helens and Knowsley (Willowbrook Hospice, Community Services and Whiston Hospital)
Wirral (Wirral Hospice St John’s, Community Services and Arrowe Park Hospital including Supportive Care Unit)

The current training posts in NW are based at:

St Catherine’s Hospice, Preston
St Ann’s Hospice, Little Hulton
St Ann’s Hospice, Heald Green
Trinity Hospice, Blackpool
Wigan and Leigh Hospice, Wigan
Salford Royal NHS Foundation Trust
Lancashire Teaching Hospitals NHS Foundation Trust
Christie Hospital NHS Foundation Trust
East Lancashire Hospital NHS Foundation Trust
Manchester University Foundation Trust
St Catherine’s Hospice, Preston (Community)
St Ann’s Hospice, Little Hulton (Community)
Bolton NHS Foundation Trust (Community)

Training rotations happen in August and February depending on the Postgraduate Doctor in Training’s needs. Placements are decided after the annual training needs analysis and intermediate education review at the rotation date nearest to the start of your training year.

Hospital Palliative Care Team

Usually consists of clinical nurse specialists with medical support from a consultant in Palliative Medicine. The primary role of the team is to advise other clinical staff in the Hospital on the control of pain and other symptoms, taking account of the psychosocial needs of the patients and their family. The Hospital Palliative Care Team usually works alongside the admitting team who retain named clinical responsibility. Levels of intervention may vary from telephone advice to a single visit or multiple visits to the patient.

Other roles consist of information and advice to the patient regarding their illness and treatment, liaison with family and carers including emotional support and advice, emotional support for staff caring for patients with advanced disease, education in palliative care to other staff members and linking inpatient to community based palliative care services.

Some NHS Hospitals have designated palliative care beds which are run by the Palliative Care Team, or the ongoing medical care may remain the responsibility of the original admitting Hospital team.

Hospice

This is usually a free standing unit with inpatient facilities, staffed by a multi-professional team specially trained in palliative care. The majority have consultant input and other medical staff, with specialist nursing staff and a range of other professionals such as physiotherapist, OT, pharmacist, chaplain, social worker and dietitian. Patients are usually admitted for short-term assessment for symptom control, rehabilitation, terminal care and, in some units, respite care. The hospice may be funded by local or national charities or by the NHS or in combination.

Day Therapy & Wellbeing Services

Many hospices have a day therapy service attached to an inpatient unit. There are also some free-standing units. Day Therapy services offer rehabilitation, symptom control advice, psychological support and access to complementary therapies.

Outpatient Palliative Medicine Clinics

These may be held either in a hospice, hospital or community base, led by a Consultant in Palliative Medicine. The major emphasis is on pain and symptom control but clinics also give the opportunity to introduce other palliative care services such as day therapy, inpatient facility and community specialist palliative care teams.

Other Outpatient Services available in some areas include:

Lymphoedema
Breathlessness Clinics
Complementary Therapies

Specialist Community Palliative Care Teams

These usually consist of a team of clinical nurse specialists with consultant support. They work closely with primary care teams to support patients with symptom control, psychological support, advance care planning and end of life care.

Oncology, Pain and Children & Young People Transition Placements

Alongside palliative medicine and internal medicine placements, the training programme includes dedicated placements in oncology, pain and transition to offer specific experience alongside that which is obtained through the rest of the training programme. The timetable would be agreed for each trainee following discussion with their Educational Supervisor.

Oncology

Attachment will be based at Clatterbridge Cancer Centre (CCC) for Mersey Trainees, and either The Christie Hospital or Lancashire Teaching Hospitals for NW trainees. An individualised timetable would be agreed for each trainee following discussion with their Educational Supervisor. This formal placement would be complemented by oncology experience gained through palliative medicine and internal medicine training and evidence through a range of activities; working with acute oncology teams during HSPCT placements; acute oncology wards rounds at the trainee’s local acute trust to include management of oncological emergencies and treatment toxicity; logging interactions with oncology teams through IPU, HSPCT and CSCPT/Outpatient settings; CPD including updates in oncology/palliative medicine registrar teaching.

You will continue to undertake on call duties at hospices.

The attachment could include (but not limited to) the following:

Attendance at local oncology teaching sessions
Attendance at new patient clinics and MDTs to include the common cancers – breast, lung, colorectal, prostate
Inpatient wards rounds for both medical and clinical oncology
Sessions spent with on call StR (during working hours) gaining experience of managing oncological emergencies and prioritising admissions
Sessions spent with chemotherapy nurses
Sessions looking at radiotherapy planning plus a visit to the mould room
Attendance at Late Effects clinic
TYA MDT meeting
Meeting with members of Psychological services
Experience of range of systemic anti-cancer therapies

Pain

Attachment will be based at Aintree University Hospital for Mersey Trainees, and either Salford Royal NHS Foundation Trust or Lancashire Teaching Hospitals for NW trainees. You will continue to undertake on call duties at hospices.

The attachment could include (but not limited to) the following:

Attendance at local pain management teaching sessions
Attendance at chronic pain management clinics and MDTs
Inpatient acute pain wards rounds
Attendance at interventional pain sessions
Attendance at Walton Centre (observation of percutaneous cervical cordotomy)
Sessions spent with pain nurses
Meeting with members of the multi-professional team

Children & Young People and Transition (C&YP)

Attachment will be based at Claire House for Mersey Trainees, and Derian House NW trainees. You will continue to undertake on call duties at hospices.

The attachment could include (but not limited to) exposure to a children’s hospice and how differs from adult services.

Care planning and integrated working with hospital/ social care and schools.
Safeguarding issues and Child death panels awareness
MDT meetings
End of Life and car, ACP and parallel planning in this group.
Symptom management and prescribing in C&YP
Communication skills challenges with C&YP and parents/ families.
Children’s bereavement services/ bereavement suite/ making memories
Living well services/ various groups
Mental Capacity assessments in C&YP
Specific Learning disability awareness
Collaborative working with oncology, neonatal and children’s community services
Transition services including barriers to transition and so some experience of transition services (Claire House have a transition team trainees could spend time with)
Collaborative working with Special schools and other voluntary organisations
End-of life care in a children’s hospice

Specialty Curriculum Examination

Since 2011 there has been a mandatory Specialty Certificate Examination which must be passed prior to obtaining a CCT. This is held every nine months and Postgraduate Doctors in Training need to pass this to achieve their certificate of completion of training. There are no entry requirements for the SCE in Palliative Medicine, although trainees in UK training posts would normally take the SCE in their penultimate year of higher specialty training. Trainees who hold MRCP(UK), have gained the Certificate in Palliative Medicine and who are recommended for a CCT will be entitled to apply for the postnominal MRCP(UK) (Palliative Medicine).

Regional Teaching Programme

The teaching programme runs from February – December with a 4-year ‘rolling’ programme of topics relevant to the Palliative Medicine curriculum, particularly directed at those areas not easily covered in routine clinical placements. The sessions are on Thursday afternoons, once a month, organised jointly by Postgraduate Doctors in Training, and consultant / senior SAS leads from North West and Mersey training programmes.

The teaching programme will include an annual ‘Away Day’ in June. The Away Day is an opportunity to focus on more innovative and topical subjects, and to promote networking and sharing of service innovation between palliative medicine Postgraduate Doctors in Training, consultants and SAS doctors across North West and Mersey training programmes.

Study Leave

Postgraduate Doctors in Training have an allowance of 30 days of study leave per year, pro-rata based on full time training. For example, a Postgraduate Doctor in Training working LTFT at 60% would have an allowance of 18 days per year.

For up-to-date information on Study Leave, visit the NHS England North West website.

Employment

Throughout your training you will be employed by the Lead Employer, currently St Helens and Knowsley Teaching Hospitals NHS Trust.

The following organisations have these responsibilities:

Lead Employer – Overall employment responsibility including e.g. contracts of employment, employment checks, pay, restrictions/exclusions to clinical practice due to health needs and disciplinary matters.
Host Organisation – Provides day to day management, and day to day supervision of training by clinical & educational supervisors
NHS England – Responsible Officer, supervision of training & progress in training. HEE ensures consistency with the handling and resolution of concerns raised relating to capability and health matters.

You should contact the Lead Employer if you have any problems with pay or health.

You should contact your educational or clinical supervisor about issues relating to your day to day work programmes, on call and access to opportunities.

You should contact your training programme director if there are issues with training and achieving curriculum coverage that haven’t been able to be resolved locally. You should also contact your TPD if you are considering taking time out of programme, working less than full time or leaving the programme prior to completion of training.

Less Than Full Time Training

All Postgraduate Doctors in Training can apply for less than full-time training depending on eligibility criteria.

For up-to-date information on LTFT training visit the NHS England North West website.

Acting Up as a Consultant

Acting up allows Postgraduate doctors in training to gain experience of Consultancy whilst still maintaining the supervision afforded by their training programme. You must be within one year of your CCT date to act up as a Consultant (AUC). There is fixed maximum period of 3 months. LTFT postgraduate doctors in training may apply for a period of AUC on a pro rata basis.

Before commencing an AUC position, you must formally apply and request approval using the AUC form.

• Postgraduate doctors in training are responsible for arranging the completion of sections A-D and sending the completed form and supporting documentation to HEE.

• You are responsible for informing your current local education provider of your plans.

• Where you will be directly employed by a local education provider, you must also ensure the relevant gaining organisation complete section E of the form.

• Applications should normally be made a minimum of 16 weeks prior to the proposed start date of the acting up arrangement in order to meet code of practice requirements, however the notice period may be waived in exceptional circumstances.

Time Out of Programme

Absences from the training programme to undertake time out of programme for clinical training (OOPT), research (OOPR), clinical experience (OOPE) or career breaks (OOPC) must be approved by the Postgraduate Dean or her deputy on the advice of the relevant Specialty School. Applicants are therefore advised to discuss their proposals as early as possible with their Training Programme Director.

For up-to-date information on going out of programme, visit the NHS England North West website.

Training Programme Director (Mersey)

Dr Andrew Khodabukus

andrew.khodabukus@nhs.net

Training Programme Director (NW)

Dr Andrew Fletcher

Andrew.fletcher@stcatherines.co.uk

Dr Kirsten Baron (from 1^st September 2023)

Kirsten.baron@lthtr.nhs.uk

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Palliative medicine

Introduction