• Trainee clinical oncologists left to make “critical” decisions around patient care without senior support at GSTT, report finds
  • Trainees say they would not recommend treatment at the trust for some subspecialties
  • HEE report finds trainees red-rating the cancer centre for teamwork, workload and clinical supervision

Trainee oncologists at a major cancer centre covered clinics and made “critical” decisions without senior supervision, including for cancers they were not trained for, HSJ  can reveal.

An Health Education England review, obtained by HSJ under the Freedom of Information Act, said: “The review team was concerned to hear that trainees were still expected to cover clinics where no consultant was present, including clinics relating to tumour sites that they were unfamiliar with.”

Guy’s and St Thomas’ Foundation Trust’s trainee clinical oncologists felt “they could only approach 50–75 per cent of the consultants for critical decision-making”, the document said.

GSTT is a major cancer centre for London and south east England. Through its new facilities, opened in 2016, it treats roughly 6,500 patients a year, along with 80,000 radiotherapy treatments.

However, the trust is under significant pressure, with just 76.7 per cent of patients meeting the 62 days to first treatment standard, against the 85 per cent target.

The HEE “urgent concern review” report said: “The trainees also reported that there was a continued lack of clear consultant supervision for inpatient areas in clinical oncology, which meant that they were not able to access senior support for decision-making.”

The report indicated some trainees had been involved in serious incidents — stating that while most of them had not been, where they had “it was reported the individuals involved did not receive one-to-one acknowledgement or feedback from the relevant senior staff”.

Asked how many serious incidents had occurred as a result of the lack of senior supervision, the trust said there were no cases where it had “been the root cause”. HSJ  has asked how many serious incidents listed it as a factor, but the trust had not responded at the time of publication.

A trust spokesman said: “We recognise that senior support to the clinical team is a vital part of keeping our patients safe.”

HEE conducted the review in July 2019 after the General Medical Council national training survey showed the clinical oncology service was given the lowest rating — the “red” rating — in 14 areas. These included teamwork, workload and clinical supervision.

At a follow-up meeting with the trust’s acting chief executive Ian Abbs, chief people officer Julie Screaton and the clinical director of oncology one month later, trainees reported “there was still no consultant supervision in clinics, some of which included new radiotherapy patients and required trainees to take formal consent for these treatments for the first time”.

The patient safety section of the HEE report said: “The clinical oncology trainees who met with the review team reported that, overall, they would feel comfortable to have family or friends treated at the hospital, but this would be highly dependent on which subspecialty team was treating them.”

The trust did not say what subspecialties were referred to.

A GSTT spokesman said that since the summer HEE had revisited the trust and that “progress includes considerable improvement in senior support for decision-making, for example ongoing management review of outpatient oncology clinic lists, a new ‘registrar of the week’ rota, and better processes for sharing information about consultant ward rounds with trainee doctors based on the ward”.

He added that feedback from the trainees had improved.

HEE’s report said: “When asked whether the trainees would recommend their roles to colleagues, the review team was disappointed to hear the trainees would not feel comfortable doing so due to the cultural issues within the department.”

It added: “Although some trainees felt there had been improvements, it was reported that some consultants were defensive and emphasised to trainees that there was not a cultural problem within the department, but rather a problem with the current cohort of trainees.

“The trainees still felt that feedback from some consultants was not given in a constructive and balanced way in a private environment and were concerned that their feedback to the consultants was not kept confidential. The trainees stated that they had avoided attending patient planning meetings after hearing several consultants talk negatively about trainees in this forum.”

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