• Trainees at Isle of Wight Trust unable to “do their job effectively” due to “significant stress” 
  • Trust at risk of losing trainees in acute medical services due to workforce gaps 
  • Inspectors uncovered “poor working relationships” between the emergency department and acute medicine

“Challenging behaviour” among senior clinicians and “disconnected” working between departments has been uncovered at a “special measures” trust at risk of losing some of its trainee doctors.

An inspection report by Health Education England said “significant stress” was being put on trainees at Isle of Wight Trust and they were “not able to do their job effectively” as a result.

During the inspection, in October, trainees in acute medicine at St Mary’s Hospital said they were “overwhelmed, felt unsafe and were being asked to work beyond their abilities”, according to the HEE report.

The trust was placed in special measures in April 2017 after it was rated “inadequate” by the Care Quality Commission due to “significant” concerns over patient safety. It was upgraded to “requires improvement” in September 2019, but remains in special measures. 

The HEE report, recently released to HSJ under the Freedom of Information Act, said there continued to be a “risk to the safety and provision of learning” in acute internal medicine specialty training at the trust.

“Challenging behaviour” from senior staff was “impacting on trainee safety, wellbeing and learning” while “poor working relationships” are leading to “conflicts” between the emergency department at the rest of the hospital.

HEE added that the emergency department and other teams, particularly acute medicine, “feel the other is not pulling its weight” however the reality is “both are under resourced for the work required”.

Trainees also reported that while there was always a senior presence in the emergency department they “felt alone due to workload”.

The report says: “ED is described as being very busy and feels like service provision with little time for training…

“We heard concerns that trainees feel some referrals from ED are made before patients have been fully assessed and a view that the medical team is being asked to do the role of ED around the decision to admit.

“There was also a feeling that the ED team leave medicine to deal with medical patients with little collaborative working between clinical teams. Concerns raised to senior colleagues about this were reported to have not resulted in any action.

“Out of hours, some medicine trainees reported that they were overwhelmed, felt unsafe and [were] being asked to work beyond their abilities.”

The trust’s latest accident and emergency performance against the four hour target was 70.9 per cent, compared to the national target of 95 per cent.

Trainees also raised concerns that in some cases on-call doctors showed a “lack of interest or reluctance” to provide support, while repeated calls had to be made made “to drag some individuals in”.

Despite the concerns the regulators said many trainees “described a good experience” working at the trust – which was “in general” seen as a friendly place to work.

Last month HSJ reported that Isle of Wight Trust could lose its trainee doctors in acute medical services this month if urgent action was not taken to provide additional out of hours doctors.

General Medical Council and HEE have monitored acute medicine training at the trust since 2018, after serious concerns were raised about the safety of learning environments for patients and doctors.

A series of requirements were placed on the trust by the regulators to address issues around bed management, gaps in the workforce, effective and efficient handover and doctor training.

A spokesman for the GMC confirmed this week that conditions around supervision and handover continue to be monitored at the trust and said progress would be reviewed during the next joint visit with HEE.

The spokesman added that removing trainees was a “last resort” and none had been removed from Isle of Wight to date.

A spokesman for Isle of Wight Trust said: “We are taking urgent action to address the concerns raised and to improve the experience of our trainee doctors.

“We have brought in new leadership, welcomed additional senior clinicians and benefited from the support of our partner agencies to help us improve the culture across our acute services, but particularly in the Emergency Department and Medical Assessment Unit. We continue to recruit and will soon have the extra out-of-hours medical cover needed.

“Our trainee doctors are an important and valued part of our workforce and we will do absolutely everything we can to make sure that they are supported, can learn and ultimately thrive during their time at our trust.”