• GMC warns of issues with acute and internal medicine 
  • Trust believes concerns stem from supervision and education of trainees
  • Watchdog places trust in “enhanced monitoring”

The General Medical Council has raised serious concerns about the quality of training at a major London teaching trust.

The watchdog has raised several issues with Barking, Havering and Redbridge University Hospitals Trust’s acute and internal medicine department. These include leadership from consultants, and the assessment and triage of patients in the emergency department.

There are also concerns about how patients are handed over from one consultant to another during consultant changes over the course of the day, and how doctors in the ED and acute medicine work together when referring patients between the departments.

The General Medical Council has sent a written warning to BHRUT saying it is worried the trust is not meeting 10 of the requirements for teaching medicine that trusts must adhere to.

The warning comes after the GMC and Health Education England visited the trust in early April to talk with medical registrars about “the emergency referral and acute medicine admission process,” after concerns were voiced confidentially to HEE during a previous visit.

The trust has been put into “enhanced monitoring” by the GMC, meaning BHRUT’s efforts to improve its medical training will come under greater scrutiny from the regulator.

This is the first step in a regulatory process that could lead to the department being stripped of its trainees.

Relations between consultants and management have been fraught in the past. A 2018 review into governance failures found the then-medical director tried to tackle “inappropriate behaviours” among the consultants but his efforts left his position at the trust unsustainable. He has since left the trust on secondment to a think tank and the Royal College of Pathologists.

BHRUT moved out of quality special measures in 2017 after three years in the improvement regime. However, it was put in financial special measures in 2018, with NHS Improvement raising concerns about its “rapid and significant deterioration in its in-year finances”.

BHRUT has started work to resolve some of the issues highlighted by the GMC warning notice and voiced by its registrars, according to its May board papers. These include a process the trust hopes will mean all patients attending the ED are triaged, regardless of how they got there.

Its longer-term plans include ensuring all consultant job plans include “appropriate educational supervision” and agreed internal standards for emergency referrals.

Chris Bown, the trust’s interim chief executive, said: “Providing a supportive learning environment for our trainees is a responsibility we take very seriously so these findings are disappointing.”

He added: “On the specific points raised here, we have already made good progress with improving our support by being clearer about rotas, trying to reduce the numbers of gaps, and improving the visibility and access to consultants, particularly at change overs.

“However, there’s much more to be done. We will see this through, working with the GMC and our staff to improve.”