Seph : Special Circumstances and FPAS

[Several years on from this post and I have successfully applied for Special Circumstances to stay where I trained. For more up to date information please see www.foundationprogramme.nhs.uk]

Some more on the Foundation Programme! Don't ever say that we're not thorough... Here is another guest post by Seph which looks a little more closely at applying for special circumstances within the application process (specifically, reasons you need to stay in your 'home' - read medical school - deanery to work). Thanks Seph =)

In order to tie in with Flo's series on FPAS, I want to write a little bit about special circumstances. This is a process by which you can try to demonstrate that you have a particular need to have a job in a particular foundation school (and deanery). If you are successful, you are allocated to that school ahead of the general allocation process.

I should mention at this point that I did not get special circumstances, because I didn't apply in time, because I assumed I didn't qualify. I was then advised to apply on the basis that I would be more mentally stable if I didn't have to move across the country. Which I would have been. So: make no assumptions! If you think you might benefit from it and you can think of some justification, apply. At the least, email your med school's pastoral support person (particularly if they know you) and ask them what they think.

So, to qualify for special circumstances you need to a) have children, b) be a carer, c) have a medical condition (physical or psychological) or disability for which local follow up is an absolute requirement. There are also educational special circumstances which we will discuss in a minute.

Obviously point c is the more relevant here, and the one under which I tried to apply. Note that their idea of an absolute requirement varies – it may be that your area has a better speciality service than others, it may be that you are used to a psychiatrist or a therapist and would not benefit from being transferred, it may be that you have a surgeon who is taking an interest in your care. It doesn't matter what the reason is as long as you can justify it and get either an OH doctor, a specialist or (at a pinch) your GP to back you up. They have to write a report explaining about your condition, your ongoing treatment and follow up and – importantly – why said treatment has to be local. If you are going to apply, therefore, you need to discuss this with your chosen doctor well in advance and get them to write the letter well in advance so you've got it to hand in. Get your ducks in a row, as soon as you can. If you can get more than one letter backing you up, so much the better, and do it now. It is also worth noting that you can only do this is if you're applying to remain in your current deanery. You can't claim that you need local follow up somewhere else in the country.

Educational special circumstances is a slightly different deal. If you have special educational needs, your medical school will discuss with you what would be the best environment in which to carry out your foundation training. I should point out that the wording of this part suggests that this also includes an assessment as to whether you can “adapt to the working environment”. Make of that what you will. Anyway, your medical school can then put you forward for pre allocation to a particular foundation school.

Applying for special circumstances requires just a short form and the backup stuff. The form and the relevant guidance can be found on the Foundation Programme website at http://www.foundationprogramme.nhs.uk/pages/home/keydocs. The guidance document is pretty good, written in reasonably plain language and fairly straightforward. As these things go.

Special circs is not a certainty. Your application will be reviewed by a local and a national panel and your score still needs to meet the “national allocation criteria”, whatever that is. It won't guarantee you a job, either. You also can't link applications if you apply this way. However, it doesn't hurt (unless you're planning to link) and you might be eligible even if you don't strictly meet the above criteria. As I said above, if you can think of something that would medically justify your need to remain in your own deanery, give it a go.

Good luck!

Do you have experience of applying for special circumstances for the foundation programme? Would you like to write a guest post about any aspect of disability/chronic illness and medicine? Leave a comment or email disabledmedic[funny at thing]hotmail[dot]co[dot]uk

A and E : Compare and Contrast

This is a slightly different style of post. I know that for friends it will be a reminder of a difficult time, and that medics may find themselves acutely aware of the other side of these events. This is my perspective on two A and E visits, one a few years ago and the other a few days ago. This post may be triggering or difficult - please feel free to skip it, or come back later.

I walk into A & E. The waiting room is dark and intimidating. There are several loud, drunk men and I am frightened. Sophie goes to talk to the receptionist because I am too far away to find the words. She barks at her to speak up, and I am dimly aware of the room falling silent when Sophie says that I'm suicidal and not safe at home. Sophie asks if there is somewhere quiet where I can wait, and she is told that I can stay in the waiting room "like everyone else". We sit, and wait for over an hour.

This time I am going alone to a department that I've never been to before. I've been putting it off, because of all the times before, but the pain is too much. The receptionist asks lots of questions, and won't bring me a chair while we talk even though I ask her, I can't lift one myself. Again, my name, address, DOB and telephone number have to be shouted through a screen in a room full of strangers. I sit and wait for 15 minutes.

The triage nurse calls me through and tells Sophie she must wait outside. I freeze. I can't talk, I need my friend to be my voice. Sophie insists, and is eventually allowed in. I'm pretty sure the nurse assumes we've both been drinking. We haven't.

The triage nurse calls me in and smiles at me. When I tell her my diagnosis she writes it down and asks me to explain it to her. She tells me what will happen next. I am called up twice more - for ECG and chest Xray. Getting up and down is painful as is undressing. Both technicians are lovely, and help me to change into the best designed hospital gown I've seen. I return to the waiting room and wait another hour.

The triage nurse is aggressive, and brisk. I am under the "care" of crisis team, I should have called them. Sophie explains that after 2 hours of trying to get through, their advice was to do some washing up. Still, it is not her problem to deal with - "we're not going to admit you, we're not going to give you anything, you could wait to see the medic on call, but they're busy treating people who are actually sick". Apparently if I was really suicidal I wouldn't be seeking help. I can't find the words to tell her that depression this deep feels like and end-stage illness. Death hangs over my head, and I have no control. I'm frightened.

The doctor calls me in and takes a brief history. He knows about my condition, and agrees with my interpretation of the symptoms. He listens to my lungs, and tells me the rib is dislocating with every breath.

Before I know it, the nurse has pulled me to my feet, propelled me back to the waiting room and told me that "if I choose to stay" I'm in for a long night. I want to leave, and when Sophie doesn't try to stop me, I know it must have been as bad as it seemed. I feel small and helpless, and incredibly guilty for "wasting time" and upsetting Sophie. She stays at mine. My friends don't leave me alone for the next 2 weeks as service after service failed me. I am lucky to have friends like these - 20 year olds doing what the grown-ups can't seem to manage.

I get shown my Xray, and talked through the findings. They check my pain meds and I am given lidocaine patches, and told to come back if they don't work.

I have been on both sides of A and E. I know that people get frustrated, and I know it is difficult to feel helpless because you can't "fix" people. I also know that people feel frustrated by the thought of wasting time spent helping "sick people" on people who have "done something to themselves". If only life was that simple.

The difference was in the small things - being smiled at, being believed, receiving treatment. Not being told that as a medical student I should know better than to break a rib...

And if you think that feeling suicidal doesn't count as an accident or emergency, you might want the NHS online symptom checker to change their advice. Because according to them I should have phoned 999. Think how well that would have gone down.

Please also look at my friend Ali's blog here at her posts about A and E, especially this one called 'Getting it Right'

You are welcome to leave your comments, no matter your opinion. I would ask that you bear in mind both that this post leaves me feeling pretty vulnerable, and that I have other readers who have also had similar experiences.

I'm sorry that yesterday's post hasn't materialised. I'm tired, in a lot of pain, and trying not to think about the logistics of getting home.

Round Up

Today's post will cover a few bits and pieces - including Daisy's promised introduction to the NHS couch to 5k programme (she's going to keep us updated on her progress over the coming few weeks). There are also some news stories about disability or the NHS that I would like to highlight.

Hi, I'm Daisy and I'm Flo's fiancee. 4 weeks ago I started couch to 5k using the NHS choices podcast. I would thoroughly recommend couch to 5k to people who are interested in taking up running and don't know where to start. I can't believe I've been running for 4 weeks and I'm excited to tell you a little bit about why I decided to start running and to maybe review some running podcasts/apps for beginners. In my next post I'll explain how the c25k program works and why I started. I look forward to sharing this with you!

We've been asked to spread around this open letter to Iain Duncan Smith from the Broken of Britain, about how it feels to hear a life changing diagnosis, what it feels like to be ill, what it feels like to be a carer or to worry about a family member or friend and their health. It felt especially relevant yesterday, as we were getting our head around the fact that yet another thing has happened to make us feel vulnerable. Please consider sharing that link on your networks, to encourage people to remember that any of us could become ill at any time.

Today (I think) the Commons will release a negative report on ATOS "healthcare"(Guardian story here), the (IT) company who have been contracted to conduct "assessments" for DLA and ESA. There are some awful stories of bad practice out there, assessors are expected to deny people, and the huge number of individuals who are then granted at appeal shows how ridiculous the system is. Reports are almost always completely inaccurate, but it is hard to refute, as any form of recording is not allowed (without huge effort and expense as they require a trained engineer to examine the equipment beforehand). ATOS and the ridiculous system of computer assessment are the reason I have still not claimed for DLA (once I was aware of it), although I have been eligible at various rates for over 10 years now. And now everything's changing, to make these benefits harder to claim. I'm really scared about what will happen to some of my friends and patients, and to me - especially if the appropriate adaptations cannot be made to enable me to work.

Next, Bendy Girl has posted a great video showing what happened at the first 100 Voices conference (you should watch her keynote speech also, it was very well pitched)- a real first - the Brandon Trust (a Bristol based charity supporting those in SW England with learning disabilities) asked their clients with learning disabilities what they wanted their priority to be for the upcoming year. The video is a really inspiring example of facilitating people to make their own choices, rather than patronising them. It's made me think really hard about how I would try and facilitate an individual who was learning disabled to make decisions about their own care. Employment was the issue voted as most important (the variety of voting methods offered was really cool) and the Trust has committed to taking that forward.

This week, the government slipped out the first wave of privatisation of the NHS in the middle of the Murdoch enquiry. Luckily twitter is wise to that trick. Here Max Pemberton argues that this truly is the end of the NHS - because while any aspect is privatised, it is no longer a national, nationalised service. I'm worried, and mainly because any examples of private contracting of other services by the NHS, such as cleaning, seems to have been linked with a reduced quality, because people are treated like crap (but it's ok because it's not directly the NHS doing it...) and so it's not worth it and they're not motivated to do a good job.

I hope you find something to interest you in there. Following yesterday's A and E trip in my placement hospital, tomorrow I'm going to talk about different experiences of A and E. I also took part in my first twitter-based journal club on Sunday. I really enjoyed it, and will post about it later in the week. (Google for more info, their exact twitter name escapes me, but the tag is #twitjc)

Have you come across any stories this week you want to share?

Just Checking In

Hi,

Just a quick message to say that I'm sorry not to bring you the promised post tonight. I haven't forgotten you, but I've managed to have a fracture-dislocation of my rib today so spent the afternoon in A and E and the evening feeling a bit vulnerable and emotional. Tomorrow's post will be about starting to run, as promised, and also be a bit of a news round up of various disability and NHS stories that have caught my eye.

Foundation Programme : Applying for flexible training

[This post is now several years old. In fact, I am now working as a less than fulltime FY1 on a 50% pro rata basis. The first part of the application process is ranking your preferred foundation schools. When you find out which foundation school you have been matched to, you should contact them about working less than fulltime. They require at least 3 months notice before you would start work. In my foundation school the only official options now for the foundation programme are fulltime or 50%, although I know one doctor working on a supernumerary basis. You can be less than fulltime for reasons of childcare, health or for some professional reasons. I will write more about my experiences now I have the answers to a lot of my questions.]

Again, this is just my understanding, which is not a substitute for actual information being obtained from a proper grown-up, k?

This post has actually been several months in the brewing - that's how hard it is to get any straight answers on this topic. I still have plenty of questions left unanswered, as you'll see.

If you wish / need to complete the foundation programme on a less than fulltime basis, you go through the application process as normal, until you're allocated to a foundation school. Then it gets confusing, because you are then told to contact the Associate Dean for Flexible Training of the relevant deanery, even though you won't know which deanery you'll be in until you've got a job. The first area which needs further clarification.

As far as I understand from conversations with the med school, you wait until you have a job, and then you ask for flexible training. This is good in terms of anti-discrimination-ness, and would be fine if the NHS wasn't as it is. I'm just worried that they won't get anyone extra to cover the rest of 'my' hours, so other juniors will take up the slack, and everyone will hate me. Anyway...

My med school has already had a 'quiet word' with the relevant person in my deanery (with my consent, because it is for his ears only, and so that we can have conversations about the various options early - he is not part of the selection process). This is fine, as long as I get a job in the deanery I want to, otherwise I'll have a frantic few months trying to sort this all out, during my finals.

At this point you have to provide evidence to back up your reason - which are basically health or caring issues (although there are a variety of more unusual circumstances that can qualify). This then goes through the Associate Dean, and then to someone else (hospital, trust...?) who can approve or deny the application. (Apparently my letter of diagnosis from my consultant which the med school has a copy of is enough evidence. I hope this is true.)

That is the sum total of the information that I can find.

Flexible training during other stages is calculated on a pro rata basis (as in, if you're doing 0.6 of a fulltime job, you do 60% of the nights, 60% of the on calls and 60% of the hours. You also, as far as I can tell, get 60% of the pay, and 60% of the annual leave entitlement.), so I imagine this is true for foundation years.

However, there is no information about what would happen for those who cannot work night shifts, or who would need to work half days, for example. I personally need to know if I would be expected to work the same blocks of shifts as other folk (for example 12 days on) with just longer to recover, or if I could work shorter blocks, with more regular breaks.

There is also no information about how the programme works on a LTFT basis. Do I do 4 foundation years? And if so, do I get a 'normal' F1/F2 allocation, and then have to find locum jobs to bring up my hours, or do I get allocated to 4 years worth of job? When in those 4 years do I get my full GMC registration? After year 1, or after I've done a 'normal' 1 year's worth of hours?

There is so little information about this, which is really frustrating. Why should I, as a disabled applicant, have less of an idea of the application process I will go through than a non-disabled applicant? The long and short answer is that so few people do flexible training during foundation years that it's really dealt with on a case-by-case basis. Not helpful.

Yes, we are individuals, and a lot of applicants for flexible training will have different needs, but even a recognition of that would be useful. There is just no indication about how 'flexible' flexible training can be, if needed. This is a real flaw in the one-size-fits-all national application process. Obviously, I haven't been through the system that came before, so I don't know if it was any better...

There seems to be every chance of me pushing my way through the application process, only to get a job and not be able to take it, because the hours will be unworkable. There is also no way to factor in things like travel time or relative accessibility of different wards / hospitals into the process, but that is another conversation entirely.

It just feels very much like disabled applicants haven't been taken into account, or properly catered for at any stage of the planning process.

Does anyone have any more information about flexible training? I've never even met any F1/F2 who aren't training fulltime.

Foundation Programme : FPAS and disability

[This post is now several years old. For up to date information on FPAS, please see www.foundationprogramme.nhs.uk]

Here are some specific things to consider related to FPAS applications as a follow-up to yesterday's post, again with reference to the 2012 applicant's handbook :

- Some with evidence of a good reason they need to be placed in a specific foundation school (for example, school-aged children, staying with a certain healthcare team) can apply to do so. The application and evidence must be submitted by 29 Sept. However, this isn't a guarantee that you will get a job in this foundation school - you still have to have as high a score to be allocated a place as you would otherwise.

- The form does ask if you are disabled or have health problems. This will not affect your allocation to a foundation school (which is based purely on your score), but the foundation school will see it. Bear in mind that it takes time to put adaptations in place so it is probably wise to disclose at the time of application. You can tell them later in the process, but you don't want to give folk any excuse to not adequately deal with your needs.

*Edit : I am investigating this point further, in relation to a comment left below.*

- If you want to link your application to somehow - which may be extra important if, like me, your partner is also your carer to whatever degree - bear in mind two things :

1) You will both be assigned based according to the lower of the two scores

2) Linking applications will limit the number of posts you can apply for, because not all posts have a suitable 'sister' post that will work.

You need to talk this stuff out in advance, to avoid nasty surprises.

- Your referee will be asked if you have any health problems which will have an impact on your work. I think that this is really odd. To be frank, I don't think it is your referee's place to disclose personal information about you. For one, these referees are colleagues/supervisors - and my health, or lack of it, is none of their business to start with. I don't think it's appropriate, but maybe it's a standard questions for employers to ask referees, I don't know.

- The handbook points out that spelling and grammar mistakes can cause you to be marked down in the questions section. I would suggest that if this is likely to be an issue, you ask someone to proofread, which is allowed (and is probably a good idea anyway).