In a damning report by the NHS Education for Scotland (NES) Deanery, which is responsible for managing medical training programmes, concerns were expressed about patient boarding, junior doctor rotas and handovers.
The Deanery panel, which visited the hospital in March, said there had been “little improvement” since a previous visit in January 2016 and NHS Fife was told the hospital would be visited again by the end of the year and could be subject to enhanced monitoring by the General Medical Council if the issues raised were not addressed.
The report said there were “serious concerns” about patient boarding – the practice of a patient being accommodated in a bed in a ward other than the one they should have been admitted to because of lack of capacity. Trainees highlighted occasions when the medical team have specifically written in patient notes, on handover sheets and on the ward white board that a patient must not be boarded only to discover the next day that the patient has been boarded,” said the NES Deanery in the quality management report. Examples were given when patients returned to the ward more unwell than when they left as they had not received the appropriate care on the boarded ward.”
The report went on to say that junior doctors had raised concerns that their on-call rota was “too much and feels unsafe”. “The trainees do a period of on-call over a one-month period and find the change from days to nights and vice versa too quick leaving them exhausted. Trainees have raised this with the consultants and there was discussion about making it the same as the senior rota but trainees have not had any updates.”
Concerns were also raised about handovers, particularly at weekends. “Trainees are given a list of patients, often 100 patients, and are unable to identify sick patients. The trainees spend the first hour of the shift deciding who to see first and it is a random selection usually based on geography.”
NHS Fife medical director Dr Chris McKenna said: “Patient safety is our number one priority and we are committed to providing the best possible care in the most appropriate environment. Since the publication of this report, NHS Fife has been working closely with our trainee doctors to inform a significant programme of work that will improve the areas that were highlighted. We look forward to demonstrating these improvements when the NHS Education for Scotland Deanery returns to the Victoria Hospital next month.”
A spokesperson for the Scottish Government said: “Junior doctors are our future medical leaders and we value their dedication and commitment to NHS Scotland. It’s important our junior doctors feel valued and listened to when they have concerns. We expect NHS boards to address concerns, provide an environment where junior doctors feel a valued part of the clinical team and have access to the support they need to deliver first class healthcare.”