Health Protection Training Policy

Table of Contents

PART 1 – PHE South West Centre Health Protection Training – General Information

Introduction

Scope of Policy

Placement locations

Arranging phase 1 mandatory health protection placements

Arranging extended health protection training placements

Induction

Outline of responsibilities and expectations

Part 2 – Phase 1 Health Protection Placement – Detailed Outline

Aims and objectives of placement

Meeting learning outcomes

Working in the Acute Response Centre (ARC)

Partnership and proactive health protection work

Project work

Documenting learning experiences

Mid-placement review

Assessment of competence to participate in the PHE South West Centre out of hours on call rota

Continued development of health protection competence post-placement

Arrangements for registrars undertaking supervised on call

Placement evaluation and quality assurance

List of Figures

Figure 1 - Public Health Training Pathway Outlining Health Protection Training Opportunities

List of Appendices

APPENDIX 1 - Guidance for methods of assessment for core health protection competences

APPENDIX 2 - Assessment pro-forma for supervised on call

APPENDIX 3 - Examples of assessment scenarios for supervised on-call

APPENDIX 4 - Supervision pro-forma for Specialty Registrars on placement

APPENDIX 5 - ‘Knows-how’ and ‘shows-how’ checklist to support Specialty Registrars in Public Health to develop a wider knowledge of the system of health protection

APPENDIX 6 - Guide for PHE staff and registrars carrying out health protection duties out of hours: Storing and transporting PII and confidential information off site

APPENDIX 7 - Pre-mandatory placement meeting agenda/learning agreement

 

PART 1

PHE South West Centre Health Protection Training – General Information

PHE has a strong commitment to training and will make every effort to ensure that public health specialty registrars have the widest opportunities to make the most of their placement, feel part of the team and gain good quality health protection training overseen by the Deputy Director of Health Protection.

This policy document is in two parts. Part 1 outlines general information regarding health protection training offered to Specialty Registrars in Public Health attached to PHE South West Centre. Part 2 outlines in further detail the phase 1 health protection placement delivered by PHE South West centre.

The policy is based on the Faculty of Public Health Specialty Training Curriculum (2015).

Health protection is a fundamental tenet of public health delivery at local, national and international levels. Every educational /project supervisor has a role to play in supporting registrars to understand and improve their knowledge of the health protection system and relevant opportunities for them to show this understanding throughout their training. Therefore, health protection training should start at the beginning of training at induction into the programme, through induction to Local Authority placements, formal teaching through the MPH/MSc as well as Part A preparation.

Scope of policy 

This policy applies to: 

• Registrars at the beginning of their training who will be introduced to the wider system of health protection including the roles and responsibilities of their host organisation. The checklist in APPENDIX 5 outlines additional ‘knows how’ and ‘shows how’ areas for the StR to work through from the beginning of their training and should be completed by the end of Phase 2. Evidence of working through the checklist will inform sign-off of health protection competency 6.9 at the end of Phase 2.
• The phase 1 health protection training rotation for all registrars who must spend a minimum of three months whole time equivalent training after taking the Part A exam (Figure 1). This includes ongoing support and supervision following their placement to achieve all health protection competences including participation in the health protection out of hours on-call rota.
• Registrars in their final year of training who wish to develop further skills and knowledge in health protection can opt for an extended health protection pathway with PHE (Figure 1). Based on an assessment of learning needs, placements will be developed in partnership with several agencies which may include the PHE South West Centre Health Protection Team, the Field Service based in Bristol, Local Authority Public Health Teams and specialist PHE divisions including the National Infections Service, Centre for Radiation, Chemicals and Environmental Hazards (CRCE) or Emergency Preparedness, Resilience and Response (EPRR). These placements will be planned closely with the South West Public Health Training Programme Team to meet the training needs of the registrar.

This policy does not apply to placements outside of health protection provided by the PHE South West Centre or Field Services during Phases 1 and 2 of training.

Figure One - Public Health Training Pathway and Health Protection placements

Phase 1				Phase 2
ST 1	ST 2		ST 3		ST 4	ST 5
Knows	Knows how / shows		Shows how / does		Does
Developing knowledge of wider system of health protection through all phase 1 placements. (see Appendix 5)		3 month health protection placement and on call assessment#		Developing applying knowledge of wider system of health protection through all phase 2 placements. (see Appendix 5)		Extended health protection placement available following completion of phase 1 and 2 competences.
	ARCP		ARCP		ARCP	ARCP
	DFPH		MFPH

#mandatory for all registrars

Placement locations in the South West 

For their phase one 3-month rotation, registrars will be placed at Centre offices in either Bristol or Devon (Totnes). Registrars will be placed geographically according to their current training rotation as agreed with the South West Public Health Training Program Team. Registrars training in Devon, Cornwall and Somerset will be based at Totnes. Registrars training in Avon, Gloucestershire Wiltshire and Swindon will be based at Bristol. For registrars undertaking an extended health protection placement on completion of phase 1 and 2 competences, placement location will be determined based on identified training need, but the substantive base will normally be one of the PHE South West Centre bases (Totnes or Bristol).

Arranging phase 1 mandatory health protection placement

Registrars should start their health protection placement after successfully completing the Part A exam. It is a curriculum requirement that the Part A exam is passed prior to registrars commencing health protection on call. Additionally, due to time constraints, it is not recommended that registrars sit exams during the placement.

The South West Public Health Training Programme Team are responsible for producing a timetable outlining health protection training placements. This is to coordinate the flow of registrars required to do the placement and because there are limited placements within the health protection team. The list is updated following Part A exam results. The registrar should then contact the health protection PHE South West Centre Specialty Tutor (Mike Wade), to arrange a pre-placement meeting (no later than 4 weeks before the tabled commencement date. The registrar will be assigned a PHE placement supervisor (accredited to train through the Training Programme Team) who will be responsible for the duration of the placement working alongside the registrar and their Educational Supervisor.

The pre-placement meeting will discuss previous health protection experience, identify learning needs and agree a provisional learning contract (See Appendix 7). As well as a brief introduction to work undertaken in the Acute Response Centre, the meeting will provide an opportunity to discuss a health protection project to be completed whilst on placement. Ideally this will be a three-way meeting between the registrar, the placement supervisor and the educational supervisor.

At the pre-placement meeting the registrar should make their health protection placement supervisor aware of any special needs, e.g. disabilities, part-time work, or any annual leave or study leave they need to take during the placement. The duration of the placement may need to be extended to take account of this.

At the pre-placement meeting registrars will be provided with induction documentation and agree with their project/educational supervisor the relevant visits and key individuals/agencies they should meet during their placement. Registrars should commence planning for these visits prior to starting their placement.

Specialty Registrars in Public Health will have an honorary contract with PHE for the duration of their training. This is coordinated by the PHE admin team (swhpt@phe.gov.uk) This will be discussed at the pre-placement meeting and the process started as it can take some time to complete. Specialty Registrars in Public Health are CRB checked at the start of their training and records are held by the Training Programme Team.

Arranging extended health protection training placements  

On completion of all phase 1 and phase 2 competences, registrars may consider, with the Training Programme Team, an extended placement in health protection.

The placements will only be agreed for a minimum period of 6 calendar months. Following discussions with Training Programme Team, the registrar should arrange a meeting with the PHE Specialty Tutors for Health Protection at least 8 weeks prior to an anticipated placement start date. At this pre-placement meeting, a bespoke training programme and learning agreement will be developed to address learning needs identified by the registrar.

Based on identified learning needs, project supervisors may also be appointed to support the specialist placement from other specialist teams within PHE that support health protection delivery (e.g. Centre for Radiation, Chemicals and Environmental Hazards) and the Local Authority Public Health Teams.

Where there is a vacancy and in accordance with the South West Public Health Training Programme Team, registrars on an extended training placement may apply for an ‘Acting-Up’ post. Such posts will be discussed with the registrar during their placement. These posts are advertised to all registrars eligible for an ‘Acting-Up’ post and are not exclusive to those on the extended placement.

Induction

The aim of induction is to enable registrars to become acquainted with the training location, PHE organisational structures including the South West Centre, roles of team members and roles and responsibilities of external partners.

Registrars will have a structured induction overseen by their health protection placement supervisor using a PHE induction pack provided to them. Registrars with advice from their placement supervisor should familiarise themselves with local reference materials, resources and local tutorials they can access during this time.

Outline of responsibilities and expectations

PHE expect the following from registrars during all health protection placements: 

• to inform their health protection placement supervisor of any special requirements, ideally at the pre-placement meeting;
• to agree a learning contract with their health protection placement supervisor;
• to attend the work place as required and on time;
• to share their outlook/work diaries with PHE staff;
• to notify their health protection placement supervisor (or unit administrator if not available) when ill and unable to work;
• to act in accordance with the PHE policies and procedures, including health and safety;
• to agree tasks and projects with their health protection placement supervisor;
• to participate in one-to-one supervision sessions with their health protection placement supervisor;
• to attend weekly clinical meetings and other meetings to maximise learning as advised by the health protection placement supervisor;
• to work closely and collaboratively with all members of the PHE team;
• to inform their health protection placement supervisor of non-health protection pieces of work that have to be completed during the placement;
• to alert their health protection placement supervisor if deadlines on health protection work will not be met;
• to hand-over cases and significant events at work in a timely manner;
• to maintain high quality records in accordance with PHE policies (please refer to APPENDIX 6 for supplementary information);
• to inform the health protection placement supervisor of any difficulties straight away, including concerns about lack of opportunities to gain experience;
• to participate in local on-call training days and health protection training events;
• to reflect on learning experiences and document these in a log book;
• to provide mutual support to other registrars attached to the team;
• to work as engaged members of the health protection team and recognise the pressures on other team members and work collaboratively to balance personal needs and team need appropriately.

Registrars should expect the following from PHE during their health protection placements:

• to support the registrar to identify learning needs;
• to provide learning opportunities which contribute to meeting learning needs and competencies;
• provision of formal  and documented one-to-one supervision using the agreed supervision template (Appendix 5) on a frequency no less than fortnightly;
• to agree the learning agreement with the registrar;
• to regularly monitor the registrar’s performance considering feedback from other members of the team and relevant partners. 
• to formatively assess  the individual’s competence in health protection;
• to formatively assess the individual’s competence to commence supervised on call (see 14.4 and Appendix 3);
• to sign and return Activity Summary Sheets, Learning Outcomes Summary of Assessment Sheet and Annual Review of Competence Progression (ARCP) forms as required and in a timely manner;
• to liaise with the registrar’s educational supervisor as and when required.

PHE will provide the following resources for registrars on health protection placements: 

• access to desk-space, a computer, telephone, the internet, email and IT support;
• access to the PHE library resources and signposting to other key national and regional resources;
• all relevant information to support daily work;
• resources required for out of hours work;
• administrative support may be available by negotiation for specific activities.

 With regards to leave of absence:

• annual leave, study leave and other planned leave should be negotiated with the health protection placement supervisor in conjunction with the training programme team as appropriate; 
• registrars will be expected to report sickness absence to their health protection placement supervisor during their health protection placement, or when on call, which should subsequently be reported to the Training Programme Team by the supervisor.

PART 2

Phase 1 Health Protection Mandatory Placement – Detailed Outline 

Aims and objectives of mandatory phase 1 placement and supervised on-call

The placement and supervised on-call experience are designed to ensure that registrars meet core health protection competencies considering their background and existing knowledge and skills, with the aim of ensuring that they become familiar with the scope and practice of health protection. 

The main aims are to:

• ensure registrars successfully meet key area 6 competences outlined in the 2015 Faculty of Public Health training curriculum;
• provide registrars with an understanding of health protection practice and the system of health protection from within which the PHE health protection team operates;
• prepare registrars to take part in the PHE South West Centre supervised health protection on-call rota;
• enable registrars to further develop health protection skills following the placement through structured support and supervision. 

The placement has the following objectives. At the end of the placement, registrars should have a general understanding of:

• surveillance of communicable disease and environmental hazards;
• roles of various agencies in diagnosis, prevention and control of communicable diseases and environmental hazards;
• the legal basis of communicable disease control;
• delivery of infection control in the community;
• the role of immunisation including systems for monitoring vaccine uptake and adverse events and approaches to running immunisation programmes;
• the role of public health in emergency planning;
• environmental epidemiology and health risk assessment.

At the end of the placement, registrars should have developed skills in:

• investigation and follow up of single cases of common communicable diseases;
• using HPZone (case and incident management system) for day to day  health protection work;
• investigation of outbreaks/incidents including the application of appropriate epidemiological methods and production of written reports;
• advising professionals and the public on communicable diseases and potential health effects of environmental hazards;
• identification and management of clusters;
• communications and working with the media;
• risk assessment and risk communication;
• interpretation and presentation of data;
• advising professionals and the public.

By the end of the placement, registrars should have increased their knowledge of:

• major health protection issues/key policies and guidelines;
• how to keep up to date with health protection issues;
• sources of advice for health protection issues.

It is acknowledged that it may not always be possible to achieve all of the above in the initial 3 months full time placement and registrars may need to extend or pursue further short-term placements subject to Training Programme Team’s agreement.

Meeting learning outcomes

Registrars will participate in the investigation and management of single cases of communicable diseases and outbreaks/incidents including chemical incidents, as well as attend relevant meetings. Registrars will also be expected to complete a short health protection project during their placement which may contribute to meeting competes in other areas of the curriculum. This should not exceed more than 20% of the placement time (e.g. reviewing/developing a standard operating procedure/undertaking an audit). APPENDIX 1 outlines key area 6 learning outcomes and suitable assessment methods.

Where direct experience cannot be achieved in the 3 months (e.g. outbreak management) specific tutorials, exercises or discussion and opportunities for extra placement time will be arranged to address these needs. Registrars will be offered the opportunity to shadow key staff, such as Consultants in Health Protection, Health Protection Practitioners, Environmental Health Officers, epidemiologists, information staff and microbiologists. This will be identified through the learning agreement between the registrar and the health protection placement supervisor.

The formative assessment to support assessment of readiness for supervised on-call (Appendix 2 and 14.4) will be undertaken towards the end of the placement to contribute to the evidence for the faculty competences requiring sign-off before a registrar can join the rota.

Working in the Acute Response Centre (ARC)

The ARC is the central point for the PHE response to notifications of cases of infection, incidents and enquiries. Enquiries are received from other professionals and the public on a wide range of health protection issues.

The PHE South West Centre provides an acute response service over two offices in Bristol and Totnes managed by a senior health protection practitioner and staffed by a team of practitioners, administrators and a duty consultant on a rota basis.

Registrars will be briefed about local ARC arrangements. All registrars are expected to participate in acute response work at least three days per week (1.0wte) during their placement. The average registrar would need to spend between 50% and 75% (dependent on previous experience) of their placement working in acute response to gain the required competence. An equivalent period will be worked out for registrars working less than WTE on a pro rata basis.

During this period the registrar will be expected to respond to cases, incidents and enquiries working with the duty team. Registrars will never be expected to work alone, and appropriate support and supervision will be provided.  Registrars on their mandatory placement will always be considered as supernumerary capacity and not used to cover practitioners or consultants during their time in the ARC.

Registrars should recognise the limits of their competence and be prepared to ask for advice and assistance. Regardless of the site they are working, the duty consultant will be accessible to support and supervise the registrar and advice can also be sought from the health protection practitioners (e.g. in person or via Skype). When working in the ARC, registrars will also be expected to take part in daily Sit-rep meetings and other clinical review meetings as advised by their health protection placement supervisor.

At their base, registrars will be asked to review the in-hours ARC rota and self-select their ARC days. They will be encouraged to avoid days already taken by other visitors to the ARC AND when it is evident (although rare) that there will be nobody operating from their own base on any given day.

Registrars who need to travel long distances to attend the ARC should discuss with their educational supervisor and, if necessary, the South West Public Health Training Programme Director to identify available support.

Before working in the ARC registrars will have:

• completed PHE's mandatory training in fire safety, information governance and safeguarding;
• become adequately familiar with the health protection team and office environment;
• reviewed common previous enquiries with their health protection placement  supervisor or other nominated health protection specialist;
• received basic training on HPZone (the Centre’s case/situation management system);
• received information and instructions from their health protection placement supervisor or other members of the team on:
• confidentiality;
• documentation using HPZone;
• use of standard questionnaires, e.g. for gastrointestinal disease and chemical incidents;
• flow of information on notifications within the unit;
• how to access resources including local and national policies and guidance;
• how to access Standard Operating Procedures;
• access to telephone numbers of key contacts, e.g. infection control teams, and Local Authority Environmental Health Officers etc...

When rostered to work in the ARC registrars will:

• work under the supervision of the health protection duty manager;
• recognise and acknowledge limits to their competence;
• offer to ring the caller back if unsure of the response and then discuss the response with a member of the duty team for the day or the duty Consultant;
• follow PHE policy and standard operating procedures;
• record information accurately and contemporaneously on HPZone.

After each day in the ARC registrars will:

• review daily, the cases and enquiries with the duty Consultant or other nominated duty professional;
• ensure that any follow-up required is undertaken or passed on to appropriate colleagues or the duty Consultant.  This is particularly important if the registrar will not be available later or the following day;
• record in their training log the details and key learning points of cases, enquiries and issues dealt with;
• identify learning points and issues, which require further discussion on a one to one basis with the placement supervisor or at the weekly clinical team meeting.

To meet competences registrars will be expected to be involved in the event of major incidents/outbreaks anywhere in neighbouring localities and should be informed of and invited to take part in incidents requiring mutual aid, or the response to incidents that would provide a good training opportunity.

Partnership and proactive health protection work

Registrars will be offered the opportunity to attend scheduled meetings with local partners, together with a consultant in health protection or practitioner.  The main aims of attendance for registrars are to develop an understanding of key issues, the role of the PHE in these contexts, the roles of a range of partners and how the PHE works with partners to strengthen the health protection system. This will build on experience gained by the registrar in their other phase 1 placements and their progress against the checklist outlined in APPENDIX 5.

Examples of meetings may include routine partnership meetings such as Local Authority Health Protection Committees, Local Infection Control Committees, meetings with environmental health, local water companies and laboratories, port health, clinical strategy groups such as sexual health, blood-borne viruses; public health strategy groups such as immunisation and Emergency Planning such as Local Resilience Forum meetings.

Opportunities should be made with the placement supervisor to discuss these meetings, context and reflect on learning points.

Project work

Registrars will be expected to undertake a health protection project during their placement. The projects chosen will be negotiated between the registrar and their health protection placement supervisor (and where appropriate the educational supervisor of the registrar) and should address gaps in competence. The health protection placement supervisor will oversee their project. The project undertaken may contribute to meeting competences outside of key area 6 in the 2015 curriculum. It should not take more than 20% of time allocated for the placement and would normally involve reviewing / developing a Standard Operating Procedure/audit.

Documenting learning experiences

A health protection logbook and summary sheet (for reflections on at least 5 significant cases/enquiries/situations managed) should be completed omitting any personal identifiable infomation.

The log and summary sheet should be discussed at one to one supervision sessions. The registrar should submit documentation at least 48 hours before the meeting time.

Mid-placement review

As well as regular 1:1 supervision, a formally documented mid-placement review will be scheduled to review placement progress. This will normally include the registrar’s Educational Supervisor. The mid-year review will consider progress against competences outlined in the placement learning agreement. It will determine whether an extension might be required to ensure the registrar achieves sign-off for competence to join the out of hours rota. If an extension period is agreed, the project supervisor will notify the South West Public Health Training Programme Team as this might impact on the proposed start dates of other registrars.

Checkpoints for consideration at the mid-year in relation to acute response should include:

• demonstrable awareness of the ARC systems and processes; 
• ability to confidently use HPZone for case and incident management;
• demonstrable awareness of the available tools and guidance documents, including local SOPs;
• familiarity with the issues and approach required to respond to urgent cases;
• demonstrable evidence that registrar is working within their competency levels and is happy to consult colleagues as appropriate;
• all mandatory training completed in relation to information governance and takes consistently, clear and concise notes;
• awareness of and has commenced signing into the hunt group when on duty.

Assessment of competence to participate in the PHE South West Centre out of hours on call rota

Registrars seeking to start supervised out of hours on-call duties need to fulfil the following criteria before they can be assessed as competent for this role:

• have passed Diplomate of the Faculty of Public Health examination;
• have successfully completed their HPT placement and fully met competence against learning outcomes 1.2, 4.2, 6.1 - 6.6, and 9.2 (Note, 9.2 can be signed off following the health protection placement and this is supported by the SW Public Health Training Programme Team);
• have successfully completed the formative assessment for supervised on-call (APPENDIX 2) as evidence to underpin required competences 
• have maintained (and continue to maintain) a log-book documenting cases and incidents experienced and reflecting on the events as a learning experience regularly with their placement supervisor;
• have experienced, or received training in a range of common scenarios (APPENDIX 3).

Formative Assessment will be against performance criteria identified in the Faculty of Public Health Specialty Training Curriculum 2015 and the Skills for Health National Occupational Standards using the assessment pro-forma Appendix 1.

Methods of formative assessment will include:

• direct observation;
• case based discussion through log-book;
• review of case documentation;
• feed-back on performance including multi-source feedback.

The formative assessment for supervised on-call will be carried out by the assigned health protection placement supervisor and a senior health protection practitioner deemed by the Deputy Director of Health Protection as competent for this role and using the assessment pro-forma (Appendix 2).

The purpose of the formative assessment for supervised on-call is to assess that the trainee:

• understands the professional responsibilities of being on-call;
• understands the roles and responsibilities of key Out Of Hours players;
• has adequate theoretical knowledge of communicable diseases and environmental hazards to support the management of out of hours cases / incidents and undertake a risk assessment;
• knows where to find further resources and guidelines, and
• can discuss the issue with the consultant on call to agree necessary public health action.

The trainee is not expected to manage the scenario at consultant level but to assist the consultant on call in effectively gathering information, making a risk assessment and taking appropriate action required under the guidance of the consultant.

For the assessment for supervised on-call three health protection scenarios will be discussed. Examples of the cases/ incidents that will be used to inform scenarios are presented in Appendix 3. The candidate will be asked to outline their response for the ‘out of hours’ management of the 3 case/incident scenarios and be given 45 minutes on their own to prepare for this. After 45 minutes, the candidate will report each plan back to the assessors who may ask subsidiary questions to clarify information presented. The candidate will have access to HPZone, internet access and other support materials they would routinely be available to those on-call.

The outcome of this assessment will be provided by the assessors on the same day as the assessment. The pro-forma (Appendix 2) including feedback will be completed by the assessors and given to the registrar within three working days following assessment.

Should a registrar fail the assessment for supervised on-call, they will be supported to identify further learning needs over an agreed timeframe and arrangements will be made to re-assess with a different health protection placement supervisor and senior health protection practitioner.

Should they fail this second assessment, the health protection placement supervisor will meet with the registrar’s Educational Supervisor and specialty tutor to discuss this further and agree remedial action required where appropriate. This will be reported to the SW Public Health Training Programme Team for their agreement.

When the registrar has completed the requirements outlined in 14.1 and is ready to join the out of hours rota, the health protection placement supervisor must inform the South West Public Health Programme Team Training Programme Director in writing with a provisional start date. The health protection placement supervisor will ensure that registrars are not rostered for on-call duties until a start date has been agreed, otherwise there may be problems with payment.

Continued development of health protection competence post-placement

To achieve competence 6.9 (demonstrate competence to participate in an unsupervised out of hours on-call rota) and further develop health protection competence, registrars will have to meet the following:

• undertaken approximately 40 on-call sessions as first responder and demonstrate a breadth of out of hours health protection activity and appropriate response through their log-book. A 24-hour weekend shift counts as 2 sessions (e.g. 9 am Saturday to 9am Sunday). This is a guide and breadth of activity and reflection of learning points supersedes quantity of on-call undertaken;
• worked in the ARC to further develop competence and meet learning needs at least 3 days per quarter / 1 day per month (but preferably in a block of 3 days);
• demonstrated additional Continued Professional Development in health protection (e.g. attending on-call training days / relevant conferences / contributing to or appraising and reporting on relevant papers);
• maintained a reflective log-book and met with the health protection trainer at least twice per annum to review this over the period they are on-call.
• demonstrated a wider understanding of the health protection system with reference to how they have used the supplementary knows how and shows how check list whilst engaged in phase 1 and phase 2 placements (Appendix 5).

Arrangements for registrars undertaking supervised out of hours on call

Specialty Registrars in Public Health who have completed their Health Protection rotation and assessed as competent (as per 14.1) will be invited to join the rota to be the first point of contact alongside the health protection practitioner team. 1.0wte Specialty Registrars will be expected to complete 10 sessions of on-call every three months. 60% of the on-call allocation will be Saturday, Sunday or Bank Holidays as these are the days when they are most likely to handle calls to support learning. The remaining 40% will be allocated to week nights. One 24-hour period of on-call will count as two on-call sessions (e.g. 9am Saturday until 9am Sunday). For those working less than 1.0wte, the allocation will be proportionate to hours worked.

At these times, registrars on the rota will be the first point of contact for one of the three on call geographies:

• Devon and Cornwall;
• Somerset and Dorset
• Avon Gloucestershire and Wiltshire.

As the PHE South West Centre delivers one acute response service for the South West, a registrar may be required to support any one of these geographies whilst on-call regardless of their site of training.

For registrars who have not been provided with a mobile phone by their training location for work purposes, PHE will provide a mobile phone for the duration they are on the on-call rota. These are available through the Centres’ Business Management Team / Placement Supervisor.

Registrars will need to complete approximately 40 on-call sessions and demonstrate through their log-book a good breadth of health protection activity and response for competency 6.9 to be signed off (see 15.1).

Although the registrar will cover a geographic area of the South West when on-call, they are part of an on-call team and support will be available from the practitioners on the same on-call tier or the on-call consultant at any time.

Feedback and discussion of any learning points observed for activity undertaken by the registrar should be provided at the earliest opportunity (preferably within 24 hours of the shift).

Registrars will be expected to record, and report on-call activity undertaken to the health protection practitioner they are on-call with to support handovers.

Where registrars have been involved in cases/situations over their on-call shift, they will be expected to dial-in to the 9.30am health protection team Sit-Rep on the next working day to handover.

Registrars are responsible for checking their IT and access to HPZone prior to commencing an on-call shift. If there are known problems with IT and CITRIX, registrars should liaise with the health protection admin team to abtain a PHE laptop for their on-call shift. This will need to be returned once completing the shift.

Registrars on-call will be remunerated as per current arrangements with the South West Public Health Training Programme Team. Once the registrar has achieved their health protection learning outcomes including 6.9, they will no longer be required to undertake health protection on-call. Should they wish to remain on the on-call rota for professional / continued development purposes, this will need to be agreed by the health protection Specialty Tutor and South West Public Health Training Programme Director.

The following rules as outlined by the South West Public Health Training Programme Team following European Working Directives apply to registrars participating in the out of hours on call rota:

• participation must not include any continuous duty periods of more than 32 hours on weekdays and 56 hours at weekends;
• registrars will not be required to work more frequently than a 1:9 rota;
• activity must be consistent with registrars working within their contracted hours;
• in the case of a less than full time registrar their contribution must be proportionate to their hours of work i.e. if working 0.6 wte they must have on-call duties equivalent to 60% of whole-time registrars;
• registrars should also achieve a minimum of 5 hours continuous rest during the hours of 10 pm and 8 am.

Placement evaluation and quality assurance

As part of the pre-meeting, the health protection placement supervisor will advise the registrar that they are the first point of contact for discussions about the placement itself and will provide opportunities throughout the placement to discuss concerns or ways to improve the placement experience. This will normally be considered during formal one to one supervision sessions (see Appendix 4) and will involve the Specialty Tutor if required.

At the end of the Phase 1 placement, the registrar will be asked to provide feedback on the placement as part of an exit meeting (although it is acknowledged that support and supervision will continue whilst the registrar is on the out of hours on-call rota and to achieve remaining competences (namely 6.9).

The Specialty Tutor will also contact the registrar to ensure all relevant feedback is captured to inform future placements.

The Deputy Director of Health Protection will formally meet with members of the South West Public Health Training Team and registrar representative(s) quarterly to review health protection placements and ensure that the health protection training policy is being upheld and updated as required.

All health protection placement supervisors will remain fully accredited. Failure to do so will result in their being removed from the list of PHE accredited supervisors until such time that gaps in accreditation are met.

There will be a named PHE South West Centre Health Protection Specialty Tutor. This individual will participate in monthly Specialty Tutor meetings convened by the South West Public Health Training Programme Team.

The Deputy Director of Health Protection will attend quarterly Regional Specialty Committee meetings and report on health protection training activity for the quarter.

PHE South West Centre are required to participate in the South West Quality Panel process and following the annual review meeting will maintain an action plan to address matters raised through this process. This will be monitored by the Deputy Director of Health Protection.

 

APPENDIX 3: Examples of summative assessment scenarios

Examples of communicable disease scenarios, single cases of:	Examples of environmental incident scenarios:
Meningococcal disease or meningitis	Water incident, e.g. contaminated water supply
E coli O157	Fire involving asbestos
Legionella	Carbon Monoxide incident
Measles
Diphtheria
Hepatitis A
Acute Hepatitis B
Inoculation injury
Invasive Group A Strep
Contact with rash during pregnancy
Animal bite, e.g. dog or bat
Outbreak of diarrhoea and vomiting

 

APPENDIX 4: Supervision Pro-forma

 

Date:                          

Supervisee:                                                                                        

Supervisor:

 

Agenda

1)    General Placement Issues / observations

 

 

2)    Acute Response Work & Case/Enquiry/Situation Review

 

 

3)    Project update

 

 

4)    E-portfolio / sign off

 

 

5)    AOB

  

 

Signed: Supervisee: ___________________________/Date: _______                                                        

 

Signed Supervisor: ____________________________/Date: _______

 

 

APPENDIX 5: A "knows-how" and "shows-how" checklist to support Specialty Registrars in Public Health to develop a wider knowledge of the system of health protection (and show how this knowledge has been applied)

This checklist has been designed to aid Specialty Registrars in Public Health and their Educational Supervisors to maximise opportunities to understand (and demonstrate their understanding) of the system of health protection in the current health economy. It may provide further evidence of competence for Key Area 6 (and other relevant areas in the 2015 curriculum). This checklist should be completed before the end of Phase 2 and will be used to inform sign-off of competence 6.9 ‘demonstrate competence to participate in an unsupervised out of hours (OOH) on call rota’ It also outlines opportunities for how StRs can complete this checklist.

• Health protection is a fundamental tenet of public health delivery at local, national and international levels. Therefore every educational /activity supervisor has a role to play in supporting registrars to understand and improve their knowledge of the health protection system and relevant opportunities for them to show this understanding throughout their training.

• Health protection training should start at the beginning of training at induction into the programme, through induction to Local Authority placements, formal teaching through the MPH/MSc as well as DFPH preparation. Opportunities to understand the role of their host agencies in a system of health protection should be made at the earliest and where appropriate, specific project work agreed to enable StRs to apply knowledge acquired.

• Additional training in this area will further enhance the current PHE placement. The three to five month health protection placement and associated project work will remain protected time to cover placement specific outcomes of Key Area 6.

 

Know How Check list
Proposed Additional 'Knows How'	Achieved by .....
Civil Contingencies Act 2004 and duties of Category 1 and 2 organisations	Introduction to EPRR - PHE short  course/tutorial  Self-directed study Induction to placements

Role and functions of Public Protection/ Environmental Health Teams within  Local Authorities	Induction to placements Project work Self-directed study
Role and functions of Civil Protection Teams within Local Authorities	Induction to placements Project work Self-directed study
Role of Director of Public Health in  discharging their responsibilities under  the Health and Social Care Act 2012	Induction to placements
Functions/Terms of Reference of the  Local Resilience Forum and Local  Health Resilience Partnership	Self-directed learning Meeting attendance
Risk assessment process in relation to  emergencies including knowledge of the Community and National Risk Registers and hazard identification.	Introduction to EPRR - PHE short course/tutorial Self-directed learning
Range of emergency plans at LRF/Local Authority level and the 'planning cycle' in the context of EPRR.	Induction to placements Project work Self-directed study
Organisation Business Continuity Plans/ Planning including assessment and delivery  of business critical functions.	Induction to placements Project work Self-directed study
Risk communication in an EPRR context and wider communication strategies (eg. warn, inform and advise approaches).	Introduction to EPRR - PHE short course/tutorial Self-directed learning Exercise participation PHE Health Protection placement
Command and control arrangements including strategic, tactical and operational levels, their functions and how they are  coordinated.	Introduction to EPRR - PHE short course/tutorial Self-directed learning Exercise participation
Role/functions of the Scientific Technical  Advisory Cell (STAC)	STAC Members Training - PHE short course Self-directed learning Exercise participation
Role/functions of Local Authorities in leading the recovery arrangements following response.	Induction to placements Introduction to EPRR - PHE short course/tutorial Exercise participation Self-directed learning
Role/functions of agencies who will be involved in response and recovery following an incident eg. Environment Agency, Food Standards Agency, Animal & Plant Health Agency	Introduction to EPRR - PHE short course/tutorial STAC members training - PHE short course Health Protection placement induction/placement
Joint Emergency Services Interoperability Programme and Joint Decision Model.	Introduction to EPRR -  PHE short course/tutorial STAC members training - PHE short course Exercise participation
Incident declaration and escalation process	Introduction to EPRR - PHE short course/tutorial STAC members training - PHE short course Induction to placements
The functions of the air quality cell in support of an  incident and sampling of other materials (eg. water/food) to inform a risk assessment.	Local Authority/PHE induction and placements/project work Participation in exercises Self-directed learning/agency visits

Environmental health roles,  responsibilities, legislation, regulations, investigation, enforcement etc.	Local Authority/PHE induction and placements project work   Participation in exercises Self-directed learning/agency visits
Air quality and environmental protections, including  land contamination etc. and links to LA planning role	Local Authority/PHE induction and placements/project work  Participation in exercises  Self-directed learning/agency visits
Arrangements for commissioning and provision of  immunisation and vaccination programmes and  assurance that locally identified needs are met	Local Authority/PHE induction and placements;project work  Visit to SCRIMS team  Self-directed learning/agency visits
Health Overview and Scrutiny in relation to health protection	Local Authority Placement
Routine surveillance systems used in the context of health  protection	Local Authority Placement

 

Show How Check list
Proposed Additional 'Show How'	Achieved by .......	Example of Linked Learning Objectives
Contribute to the development of an  emergency or business continuity plan (eg. preparing, exercising or reviewing) within the Local Authority.	Local Authority placement. Core offer to CCG.	6.1 6.7 6.8
Participate and reflect on a live major  incident OR emergency planning exercise and debrief at either tactical/strategic level.	Local Authority or PHE placement	6.1 6.2 6.3 6.4 6.5 6.6 6.7
Attend a Local Resilience Forum/Local  Health Resilience Partnership meeting and  reflect through case based discussion/reflective summary	Local Authority or PHE placement	6.6
Complete a risk assessment / review an  existing risk assessment on the Community Risk Register ensuring local context for the  risk is clearly outlined.	Local Authority or PHE placement	6.2 6.3
Undertake dynamic risk assessment during incidents, emergencies and outbreaks to  guide appropriate public health action	Local Authority or PHE placement	6.2 6.3
Use routine surveillance systems in relation to answer a health protection query/question	Local Authority or PHE placement	1.1 1.3 1.5
Undertake at least one collaborative project with the Environmental Health/Public Protection team	Local Authority placement	4.8 6.6

 

Useful Supporting Reference Materials

Cabinet Office. 2013. HM Government Emergency Response and Recovery – Non statutory guidance accompanying the Civil Contingencies Act 2004. Cabinet Office.

Cabinet Office. 2013. Expectations and Indicators of Good Practice Set for Category 1 and 2 Responders. Cabinet Office.

Cabinet Office. 2013. The Role of Local Resilience Forums: A Reference Document. The Civil Contingencies Act (2004), its associated Regulations (2005) and guidance, the National Resilience Capabilities Programme and emergency response and recovery. Civil Contingences Secretariat.

Civil Contingencies Act 2004, Chapter 36. London: The Stationary Office.

Department of Health. 2010. Health Protection Legislation (England) Guidance 2010. Department of Health.

Health and Safety Executive. 2016. Health and Safety at Work etc. Act 1974 [Online]. Available at: http://www.hse.gov.uk/legislation/hswa.htm [Accessed 2 May 2016].

JESIP Website http://www.jesip.org.uk/home

NHS England. 2015. NHS England Emergency Preparedness, Resilience and Response Framework. NHS England National Emergency Preparedness, Resilience and Response Unit.

NHS England. 2015. NHS England Core Standards for Emergency Preparedness, Resilience and Response. NHS England
 

APPENDIX 6: Guide for PHE staff and registrars carrying out health protection duties out of hours: Storing and transporting PII and confidential information off site

Purpose

• to provide guidance on the storage and transport of confidential information or Person Identifiable Information (PII) for PHE staff and registrars working off-site and out-of-hours;
• to ensure the safety of confidential and person identifiable information.

Background

PHE Health Protection staff and registrars are required to undertake out-of-hours health protection duties, working away from the office. Information, including PII may need to be written down on paper, either at home or occasionally in transit before being transcribed into HPZone. There may also be occasions where IT systems fail, and transcribing into HPZone is not immediately possible.

Legal requirements

All employees have a legal duty of confidentiality to keep PII and confidential information private, and not to divulge information accidentally.

PHE’s Records Management Guidance states that all individuals who work for PHE are responsible for any records which they create or use in the performance of their duties. All records created by a member of PHE staff belong to PHE.

The Data Protection Act 1998 requires personal data to be protected against unauthorised or unlawful processing and accidental loss, destruction or damage. There are a number of other statutory provisions which limit or prohibit the use of confidential information, and which require information to be shared.

The Caldicott Principles set out the principles under which information should be shared:

• justify the purpose;
• don’t use PII unless absolutely necessary;
• use the minimum necessary PII;
• access to PII should be on a strict need to know basis;
• everyone should be aware of their responsibilities;
• understand and comply with the law.

Guidance

The following are guidelines, which should safeguard PII and confidential information in most circumstances. However, circumstances vary and may require different actions, but PHE staff and registrars should always follow the principles of safeguarding confidential and PII data.

Working outside PHE offices

PII and confidential information (both paper and electronic formats) should be kept under constant control, so that other people cannot see the content or have access to the information.

Storage

If paper records are generated during periods of on call they should be stored out of sight, preferably in a locked draw or filing cabinet. Other members of the household or friends/family must not be able to see the content or have access to the information. Completed paper questionnaires, or other paper notes should be entered onto HPZone as soon as possible, and then securely destroyed e.g. by securely transporting to the usual workplace and placing in confidential waste bins. This assumes that the place of work has sufficiently robust confidential waste disposal processes in place, if unsure ask your Educational Supervisor at the placement. Once information is transferred to HPZone these entries are considered the primary record and the paper notes can be destroyed.

Notebooks and paper used for in-office ARC days should be stored in a designated lockable cupboard. Notebooks and paper should therefore not need to be routinely transported.

Transporting PII or Confidential Information

If PHE staff and registrars need to travel with PII or confidential information they have personal responsibility to ensure the information is kept secure and confidential.

PII or confidential information must be kept out of sight whilst being transported. Paper records should be placed in a sealed non-transparent container e.g. windowless envelope marked ‘confidential’ prior to being transported.

Notebooks or paper records (securely packaged) should be kept under the constant control of the employee while in transit. When travelling by car paper records should always be locked in the boot. When travelling by public transport the records must be kept on the person at all times. No PII or confidential information must be left unattended.

Paper records should not be opened or reviewed while travelling on public transport or in public places.

Computers, laptops and phones

PHE laptops are password protected and encrypted. In general PHE staff and registrars must not store person identifiable or confidential information on a personal computer or device – if necessary it should be stored on a network drive.

If at all possible case information should be recorded directly onto HPZone. Only in exceptional circumstances should case information be recorded directly onto the local hard drive of a PHE or personal laptop or other device, if this does occur this information should be deleted immediately after it has been transferred onto HPZone. Where non-PHE laptops or devices are used to record case information, file destruction software such as ZDelete should be used to ensure this information is securely deleted. Any case information backed-up to a non-PHE Cloud service or removable storage device (such as a personal USB memory stick or external hard drive) must also be securely deleted.

When working on a laptop or other device PHE staff must ensure that the screen cannot be seen by anyone else. Personal information should never be viewed on a laptop or phone screen while travelling on public transport.

An unattended computer must be screen locked.

PHE staff and registrars must not send PII or confidential information to a personal e-mail account. PII or confidential information may be sent between PHE e mail accounts but not to nhs.net accounts from a PHE account. If it is necessary to send or receive PII from NHS colleagues (nhs.net to nhs.net accounts) enquire about using an nhs.net account that each health protection team may have access to. Separate local arrangements may be in place to transfer PII to local authority colleagues, please enquire about these arrangements if in doubt.

Accessing HPZone out of Hours

All directly employed PHE staff should be able to access PHE systems and HPZone via their encrypted PHE laptop out of hours using the Aruba Virtual Internet Access (VIA) application. Many on call registrars are not issued with a PHE laptop and therefore have to use their own personal computers. If this is the case then HPZone should be accessed using the secure remote access method called Citrix, where the user is authenticated by PHE systems with a unique randomised PIN number provided by PINsafe.

Staff who need a PINsafe & Citrix account to gain remote access to HPZone will require:

• an existing PHE email account authorised by a line manager using the normal ICT process;
• an approved HPZone account approved by the Centre Director or Deputy Director using the normal CIMS team process;
• complete the on-line application form provided by ICT and submit it to the remote access team through the ICT helpdesk. The application form and PINsafe guidance notes can be found on PHEnet using this link: http://phenet.phe.gov.uk/Resources/IT/Pages/Accessing-IT-systems-remotely.aspx.

Memory Sticks

Only memory sticks encrypted to the AES-256 standard should be used by all staff.

Only in exceptional circumstances should case information be recorded on a memory stick, if this does occur this information should be deleted immediately after it has been used or transferred onto HPZone. Suitable encrypted memory sticks are available from the HPT business support team.

Phone calls

If PHE staff or registrars receive an out-of-hours call in transit on public transport, they should assess the urgency of the call and take essential details without breaching confidentiality i.e. not mentioning people’s names etc. while on public transport. Based on this assessment a decision can be made regarding the urgency with which the call needs to be followed up. If necessary, it may be appropriate to pass the call to another member of the on call team who is in a more suitable position to deal with it or follow up may be delayed until the journey is complete and the member of staff is in a more suitable environment to deal with it.

Registrar Training Competencies

Confidentiality is covered under competencies 1.2 and 9.10 in the 2015 training curriculum for SpRs.  The full curriculum is available here: http://www.fph.org.uk/curriculum_2015

Registrar Log Books

Registrars are required to keep an On Call Logbook.

The Academy of Medical Royal Colleges provides the following advice on how logbooks and reflective notes should be anonymised:

Other practitioners, patients, parents and staff should not be named or be readily identifiable from the information you provide. For example, instead of referring to patient Jane Smith, refer to them as patient X. Never include the patient ID number or name. Avoid including date of birth (if necessary refer to the patient’s approximate age), addresses or any unique condition or circumstance of that patient which may allow someone to identify them when used in conjunction with other information they have access to. Occasionally it will be unavoidable as the condition of a particular patient will be unique, but try and minimise the patient identifiable information that you provide.
http://www.aomrc.org.uk/wp-content/uploads/2016/11/Academy_Guidance_on_e-Portfolios_201916-5.pdf

Educational Supervisors

Educational Supervisors should:

• ensure that registrars are aware of their obligations to keep PII and confidential information safe as outlined in this document;
• ensure that registrars have under taken the appropriate information governance training including their annual update;
• Check their registrar’s logbook to ensure information has been appropriately anonymised.

 

APPENDIX 7: Pre-mandatory training placement meeting agenda/learning agreement

Name:                                                                     Year:                                             Date:

Plan duration:

Placement supervisor:

Training Programme Director:

Items	Detail	Plan
Reasonable Adjustments Required to Support Placement/Learning (eg physical adaptations/support)
Honorary Contract (set-up prior to placement commencement and send to Diane Lloyd)
Previous health protection experience
Exam milestones for current phase
Phase-based learning outcomes to achieve
Generic skills to achieve
Anticipated study leave to support learning outcomes
Introduction to PHE induction document and Health Protection Training Policy

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 Signed (Registrar):                                                                                                 Date:

 

Signed (Placement Supervisor):                                                                                Date:

 

This page was last updated May 17th 2022 (1 year ago)