What local authorities can expect from becoming a training location within the South West Public Health Specialty Training Programme

 A Briefing for Local Authorities

The South West Public Health Specialty Training Programme is a regional training programme for future directors and consultants in public health.  Up to 40 registrars undertake 5 years of specialist training through placements at a range of training locations. 

 The Programme is regulated by the General Medical Council (GMC), as is the case for all medical specialty training programmes.  Public Health is unique in training future specialists from both clinical and non-clinical backgrounds.  The GMC sets standards that must be met by us and training locations.  The Programme is funded centrally via Severn Deanery. 

The SW School of Public Health can place high calibre registrars in local authorities as part of their PH specialist training

The registrars are employees of a single NHS employer.  This will continue to be the case after April 2013, when Gloucestershire Hospitals NHS Foundation Trust becomes our employer.  The lead employer takes responsibility for pay and employment matters, whilst training is provided in public health departments across the South West. 

At the training location, the registrar needs to be supervised by a Public Health educational supervisor meeting Severn Deanery accreditation standards.  The supervisor and registrar agree a learning agreement which can feature a range of work, provided that this will enable them to achieve learning outcomes set out in the Faculty of Public Health Curriculum. A local authority public health training location will need to provide work facilities for the registrar, but will not need to make any financial contribution towards their employment costs or usual expenses.

How registrars can contribute in a local authority placement

A typical placement in a local authority will be for about 2 years. Registrars work towards department and organisational objectives relevant to their training needs. They can lead innovative projects and develop partnerships with other organizations.  Two such local authority placements will be needed for a typical registrar 5 year training programme. During this time some registrars will be out-posted for shorter specialist placements or take time ‘out of programme’ e.g. to undertake research.  Some registrars pursue academic training involving additional time working in Universities. The last few months of training may involve acting up for consultant level work.  Registrars are already working with local authorities on projects in the South West  - please see appendix 1 for examples.

Standards and features of training locations

Our programme is quality assured by Severn Deanery on behalf of the GMC.  All training locations need to be approved and recognised by the GMC. 

In assessing training locations, we look for:

  • A strong multidisciplinary public health team, with two or more GMC or UKPHR registered specialists who have gained educational supervisor accreditation.
  • Leadership for specialty training provided by a designated specialty tutor, who participates in quality assurance e.g. ensuring that there are governance arrangements covering training.
  • Educational supervisors have time in their job plans to provide supervision.  A reasonable allocation would be one half day per fortnight.
  • A culture conducive to learning and development, with evidence of organisational commitment to training and continuing staff development, including support from the organisation’s leaders.
  • Availability of practical facilities for registrars including access to a desk, phone, a computer enabling report writing, statistical analysis, on-line information and search facilities and administrative support.

 How local authorities can become training locations

We hope that all local authority public health departments will wish to become training locations.  Public health departments moving to local authorities should ensure that their specialty tutor contacts us regarding how standards will be met in the new location, with a view to our progressing GMC recognition.

 How to contact us:

 Please visit our website for more information on our training programme and team

 Appendix A: examples of registrar work undertaken with local authorities in the South West

 

 

Modeling the impacts of physical inactivity at the local level; development of a tool to aid Joint Strategic Needs Assessments.

Dr Jon Roberts, Public Health Specialty Registrar, South West Public Health training Programme

In my training placements I have had the opportunity to continue a working theme based on the benefits of physical activity.  As part of the completion of the current Joint Strategic Needs Assessment (JSNA) the lack of available data to demonstrate the impacts that being inactive has at a local level has been recognised.  We therefore initiated a collaboration project with the Sustrans charity, South West public health observatory and council public health colleagues to develop a model which would address this need. We used information from the evidence base and merged this with routinely available data to provide estimates of the impact of inactivity across a number of diseases down to local authority level.

 The Health Impacts of Physical Inactivity (HIPI) tool will be launched in 2013 and available via the internet as a resource to help inform JSNAs.   We have gained support for this work nationally with recognition from the British Heart Foundation, Cancer Research UK and the Faculty of Public Health.  Specific skills such as the ability to find, appraise and utilise evidence, multi-agency working and project management have all been essential to this work and are assessed as part of the specialty training in public health curriculum.’ 

 Ensuring Bristol’s health and social care services are resilient to a future world of oil depletion

Dr Gemma Morgan, Public Health lecturer, South West Public Health training Programme.

I've have worked with Dr Angela Raffle, Consultant in Public Health to Bristol City Council and NHS Bristol, on a piece of work looking at how Bristol must prepare for ‘peak oil’ – a period of relative resource scarcity where prices rise and supply drops. Health and social care services in the NHS and wider community are dependent on a constant supply of cheap and readily available petroleum for transport to disposable gloves. The global community recognises that the era of cheap oil is ending and yet little work has been done to ensure that health and social care services are not negatively impacted. This work starts to address this by analysing routine and locally-collected data to summarise the care needs in Bristol including, for example, data estimating the number of vulnerable adults dependent upon social care services for their personal care daily living. Widespread disruption to these services could cause considerable harm to the Bristol population. This project has involved a literature review of the medical, social, political and engineering evidence on how peak oil is likely to affect health and social care; analysis of local data on population need and service use; and some qualitative work with a local charity who are themselves looking at ways to build ‘peak oil resilience’ into their work.

I am also preparing a factsheet on behalf of the Health and Transport Forum on “Why parking is a public health issue”, which addresses issues, concerns, and experiences around implementation of the Residents’ Parking Schemes in areas across Bristol.’

 Impacts of Drugs Policy and Audit of Services for Safer Bristol Partnership

Dr Georgie MacArthur, Public health lecturer, South West Public Health training Programme.

 I was involved in a scrutiny inquiry day held by Bristol City Council to consider the local impacts of drug policy. The specific question asked by the inquiry was 'Can we as a city identify the additional cost (human and financial) of criminalising use of illegal drugs and how can we address this?'

 My role in this debate involved reviewing the academic and grey literature; contacting experts in the field; preparation of a summary document with relevant information for councilors and attendees regarding the local, national and international policy context; the national legal framework around drugs; impacts of current drug policy; and details of key reports on the topic. 

 I have also undertaken an audit of provision of psychosocial interventions by drug treatment services on behalf of the Safer Bristol Partnership. The audit involved interviews with drug treatment agencies to identify the type of services they provide; analysis of data on the number of clients entering and exiting psychosocial interventions; and focus groups with the User Feedback Organisation to assess clients’ views on the psychosocial interventions, any gaps in provision, and areas for improvement.”

Appendix B:

PUBLIC HEALTH SPECIALTY TRAINING
COMPETENCES AND PROJECTS

1.      Surveillance and assessment of the population’s health and well-being

This area of practice focuses on the quantitative and qualitative assessment of the population’s health, including managing, analysing, interpreting, and communicating information that relates to the determinants and status of health and well-being. By the end of training Registrars will be expected to demonstrate that the work has been considered at a high level in a relevant organisation and action has taken place as a result of their assessment of health status and needs. 

Key Project Areas

  • Gathering, analysis and presentation of data for a health report.
  • Board reports.
  • Health needs assessment.
  • Geographic mapping of health indicators.
  • Health Impact Assessment
  • Health Equity Audit

 2.      Assessing the evidence of effectiveness of interventions, programmes and services intended to improve the health or wellbeing of individuals or populations

This area of practice focuses on the critical assessment of evidence relating to the effectiveness and cost-effectiveness of public health interventions, programmes and services including screening. It concerns the application of these skills to practice through planning, audit and evaluation. By the end of training Registrars would be expected proactively to seek out opportunities for using evidence to influence decisions. They would be working with highly complex issues and would be influencing the deliberations of senior decision-makers. 

Key Project Areas

  • Evidence-based policy briefings
  • Writing or appraising business cases.
  • Health Needs Assessment.
  • Press release.
  • Clinical or public health audit.
  • Development of clinical guidelines.
  • Commissioning plan.
  • Health improvement strategy/policy/programme.
  • Peer reviewed publication.

 3.      Policy and strategy development and implementation

This area of practice focuses on influencing the development of policies, implementing strategies to put the policies into effect and assessing the impact of policies on health. A policy is a principle adopted that governs and guides strategy. A strategy is a formally planned set of actions taken over a long term to address a particular issue. 

Key Project Areas

  • Preparing a health impact assessment.
  • Developing a local policy.
  • Writing a paper for a Board meeting or equivalent.
  • Leading the local implementation of a national policy.

  4.      Strategic leadership and collaborative working for health

This area of practice focuses on leading teams and individuals, building alliances, developing capacity and capability, working in partnership with other practitioners and agencies, and using the media effectively to improve health and well-being. By the end of training Registrars will manage more complex change management situations, understanding and managing the conflict involved and negotiating solutions. They will show appropriate leadership styles in different settings, including multi-agency settings. They will use appropriate communication and advocacy skills in a variety of public health settings, listening and responding appropriately. They will be expected to demonstrate the appropriate management of people and financial resources. 

Key Project Areas

  • Chairing a multi-disciplinary meeting.
  • Leading a public health project.
  • Successfully completing a change management project.
  • Identifying and engaging stakeholders in projects to improve the public’s health.
  • Working with the media.

 5.      Health improvement

This area of practice focuses on promoting the health of populations by influencing lifestyle and socio-economic, physical and cultural environment (including sustainable development) and health education directed towards populations, communities and individuals. It involves a theoretical and practical understanding of health improvement in order to work with, and possibly direct, health improvement specialists. By the end of training Registrars would be involved in increasingly complex health improvement activities, including community development activity, work with other professionals and understanding barriers to health improvement measures. 

Key Project Areas

  • Briefings for boards, committees, colleagues on health improvement issues.
  • Proposals (business cases) for health improvement activities.
  • Reports and evaluations of health improvement activities
  • Peer reviewed publications.

 6.      Health protection

This area of practice focuses on the protection of the public’s health from communicable and environmental hazards by the application of a range of methods including hazard identification, risk assessment and the promotion and implementation of appropriate interventions to reduce risk and promote health. By the end of training Registrars would be expected to be able to pull together different types of complex data to draw conclusions for disease control, environmental and chemical hazards control as well as health improvement in the health protection context. They will be able to demonstrate and integrate all public health skills in a health protection context including health intelligence, assessment of effectiveness, policy development, leadership and risk communication and have undertaken health improvement and health service quality work. Trainees will recognise and work within the limits of their professional competence in relation to out of hours emergency work. 

Key Project Areas

  • Scenario based exercises.
  • Reports (including Outbreak/incident reports) and peer reviewed publications.
  • Presentation of material at peer groups, internal peer audit or external meetings or conferences.

 7.      Health and social service quality

This area of practice covers commissioning, clinical governance, quality improvement, patient safety, equity of service provision and prioritisation of health and social care services. By the end of training Registrars should have implemented and led change in some of the areas above. They will also have proactively sought out opportunities to use evidence to influence decisions. They will have worked on highly complex issues and influenced the decisions of senior decision-makers both within and across organisations and outside it. 

Key Project Areas

  • Evidence briefings providing recommendations for policy (for boards, committees, public health colleagues, the public)
  • Writing or appraising business cases and service specifications
  • Health needs assessment
  • Press releases
  • Clinical or public health audit and governance reports
  • Development of clinical guidelines and quality standards
  • Calculation of population costings for new technologies
  • Reports on commissioning and delivery of clinical services
  • Quality improvement strategy/policy/programmes
  • Peer reviewed publication

 8.      Public health intelligence

This area of practice focuses on the systems and strategies that are essential for organisations to base practice and policy on sound intelligence. By the end of training Registrars will be skilled at working with senior management in understanding the intelligence systems required to develop interventions to address the needs of sub populations served. Registrars will be able to effectively use public health intelligence in the development, implementation and evaluation of policies and strategies.

Key Project Areas

  • Implementation of national surveillance policy.
  • Quality assurance activity.
  • Data flow analysis.
  • Development of systems to extract intelligence and decision support from data sets.
  • Production of a major data rich report (e.g. public health annual report).

 9.      Academic public health

This area of practice focuses on the teaching of and research into public health. By the end of training Registrars will have demonstrated their ability to teach reflectively and with enthusiasm, in class and individually, will have had experience of or observed prioritising, writing and presenting research findings. They will demonstrate an ability to write proposals, to critique research substantively and have used one or more research methodologies to support current service or academic work, disseminating findings appropriately. By the end of training Registrars will be expected to have undertaken some original research in association with an academic unit and taught public health to a range of audiences. 

Key Project Areas

  • Written research reports including literature reviews.
  • Published peer reviewed papers.
  • Articles in the media.
  • Research proposals submitted (possibly in collaboration).
  • Peer observation of teaching and student feedback.