Broadening The Foundation Programme

Introduction

The Broadening the Foundation Programme report was published by Health Education England in February 2014 
It responds to the recommendations and aspirations of Collins’ 2010 Foundation for Excellence report, as well as recommendations within the Francis Report, Keogh Review and Berwick Review about the need for a more integrated approach to deliver patient-centred care. Broadeningalso includes previous targets for significant increases in foundation psychiatry placements, so that 45% of foundation doctors will experience a 4 month placement in psychiatry.

Recommendations

Recommendation 1
Educational supervisors should be assigned to foundation doctors for at least one year, so they can provide supervision for the whole of Foundation Stage 1 (F1), Foundation Stage 2 (F2) or both years

Recommendation 2
Foundation doctors should not rotate through a placement in the same specialty or specialty grouping more than once, unless this is required to enable them to meet the outcomes set out in the Curriculum.  Any placements repeated in F2 must include opportunities to learn outside the traditional hospital setting.

Recommendation 3
a) At least 80% of foundation doctors should undertake a community-based placement or an integrated placement from August 2015.
b) All foundation doctors should undertake community-based placement or an integrated placement from August 2017.  It should be noted that both community and integrated placements are based in a community setting, and that an acute-based community-facing placement is not a substitute.

Target Requirements

Previous Targets
By 2014, LETBs should have demonstrated credible progression towards existing targets for placements in general practice and psychiatry, in both F1 and F2.

  •  22.5% of F1 doctors in psychiatry
  •  22.5% of F2 doctors in psychiatry
  •  55% of F2 doctors in the community or primary care
  •  5% of doctors in an academic placement
  • 10% of F2 doctors in shortage specialties

Implementation of the report will therefore result in major reconfigurations in foundation doctor posts:

  •  Reductions in surgical foundation doctor (FD) posts
  •  Increase in community posts (such as general practice, community paediatrics, palliative care, public health or community psychiatry)
  •  Potential developments of integrated community placements, which must include a supervisor based in the community
  •  Increases in psychiatry posts (some of these are community based, so can contribute to both targets).STFS standards for psychiatry posts are available as a PDF download in the resources section
  •  Most medical posts will need to include community-facing experience