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Health Protection Training

Training Policy for Speciality Registrars in Public Health

And other trainees seeking health protection placements

Including the assessment of competence for all professionals taking part in out of hours public health rotas

 

Acknowledgements

This training policy was developed by a subgroup of South West Health Protection training Committee consisting of:

Charlotte Chamberlain, Specialty Registrar

Linda Churm, Health Protection Nurse, SW Peninsula Health Protection Unit

Janet McCulloch, HPA South West, Regional Training Lead (Coordinator)

Sarah Lawson, Speciality Registrar

Gill Lewenden, Consultant in Communicable Disease Control, SW Pensinsula HPU

Kalyanaraman Kumaran, CCDC Dorset & Somerset Health Protection Unit

Bharat Pankhania, CCDC HPA SW (North) Unit

Mark Kealy, CCDC Dorset & Somerset Health Protection Unit

Rachel Campbell Health Protection Nurse, SW Peninsula Health Protection Unit

Faustina Montsho-Hammond, Health Protection Nurse, HPA SW (North) Unit

The document was based on similar policies developed in West Yorkshire and Yorkshire and Humber, and grateful thanks to the authors of those documents.

Thanks also to Dr Ada Bennett whose training paper has been incorporated into this policy and to the Avon, Gloucestershire and Wiltshire Health Protection Unit training group whose paper on expectations has also been incorporated and to Dr Toyin Ejidokun.

The section on on-call competence assessment was developed in collaboration with Dr Yvonne Young, CCDC London.

Feedback and suggestions from staff working for HPA South West and public health colleagues across the region is also gratefully acknowledged.

Table of contents

Introduction
Background
Health Protection Agency South West training locations
Timing and arranging health protection placements
Named Trainer (Health protection supervisor)
Aims of the training
Elements of the training
Pre-placement assessment meeting
Induction
Responsibilities of trainees during health protection placements
Responsibilities of the Health Protection Agency during placements
Meeting learning outcomes
Acute Response Centre experience (reactive work)
Partnership (proactive) work
Project work
Teaching/Training Sessions
Developing competence for out of hours work (on call rota)
Assessment of competence for supervised on call
Continuing professional development after the placement
Documenting learning experiences
Extended specialist training pathway in Health Protection
Other health protection attachments
Evaluation of placements
Trainee sickness and leave arrangements
Grievance procedure
Occupational health issues
Attachments for other trainees in public health roles

List of tables and figures

Figure One             Public health training pathway

Table One              Learning outcomes for key area six

Figure Two             Assessment proforma (for out of hours competence)

Figure Three           Examples of assessment scenarios

Appendices    

Appendix A             Summary of training locations within the HPA South West

  • HPA South West (North) HPU
  • HPA South West (South) HPU
    • Dorset and Somerset offices
    • Devon and Cornwall offices
  • HPA South West Regional Epidemiology and Regional Office

Appendix B           Example of a health protection placement

Appendix C           Learning contract

Appendix D           Learning contract review

Appendix E           Project proposal template

Appendix F           Examples of potential projects

Appendix G          Summary sheet for activity summaries

Appendix H          

  • Health Protection specialist attachments
  • Microbiology and hospital infection control
  • Environmental health
  • Community infection control
  • Tuberculosis services
  • Genito-urinary medicine services
  • Infectious diseases services
  • HPA Centre for radiation, chemicals and environment
  • HPA Colindale laboratory
  • HPA Centre for emergency preparedness & response

Appendix I            Courses and events in health protection

Appendix J            Health protection reactive work log book

Appendix K           Activity summary sheet

Appendix L           Evaluation of Health Protection attachment

Appendix M           Assessment of on call competence proforma

Annexe                 Induction pack

 

Introduction 

This policy is presented as a sub-section of the South West Public Health Training Policy and addresses the training programme offered to Specialty Registrars in Public Health (trainees) attached to the Health Protection Agency (HPA) South West.

Health Protection Agency South West recognises the changing patterns of recruitment and postgraduate training in Public Health, and aims to meet the needs of all public health trainees, including those who intend to specialise in health protection, and those who do not.

Many of the principles outlined in this policy will be relevant to others undertaking training in Health Protection Agency South West, including Foundation Year Two (FY2) doctors and health protection practitioners.

The policy should be used as guidance and adapted to suit individual training needs taking into account trainees’ previous experience and existing skills and competencies. The appendices provide tools and further information which may be used as required.

Background 

All trainees are required to have an initial three month whole time equivalent (WTE) placement (or equivalent if part-time) after taking the Part A exam. Trainees have the option of further placement or project work with the Health Protection Agency if they have outstanding competencies to meet.

Trainees wishing to specialise in health protection are offered individually tailored programmes with longer attachments to the Health Protection Agency of up to three years. These trainees will pursue more in-depth training in health protection and will be offered a training programme of placements with local Health Protection Units, Regional Epidemiology Unit, and specialist centres.

This policy describes arrangements for:

  • The initial three month placements, with opportunities for a further attachment if necessary,
  • Extended specialist training pathway.

The policy should be read in conjunction with the following on-line documents:

  • South West Public Health Specialty Training Programme Policy (2009)
  • Faculty of Public Health website:
  • Health Protection Training for generalists in public health, including Educational Requirements for on-call –2006
  • Public Health Training Programmes – Log Book of Health Protection Reactive Work, June 2006
  • FPH Standards and Guidance for Commencement of Supervised On-Call 2007

Figure One Public Health Training Pathway 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Health Protection Agency (South West) training locations 

Health Protection Agency (SW) has a strong commitment to training and will make every effort to ensure that trainees enjoy their attachment, feel part of the team and gain good quality health protection training. Appendix A provides a summary of health protection training locations in the South West.

Health Protection Agency (South West) is comprised of the following public health training locations:

  • Two local health protection units (HPUs):
    • HPA SW (North) Avon, Gloucester, Wiltshire offices
    • HPA SW (South) Dorset, Somerset, Devon and Cornwall Offices
  • Regional epidemiology unit (REU)
  • Regional laboratory in Bristol 

Timing and arranging health protection placements 

The timing of health protection placements should be consistent with the training pathway outlined in Figure One. The Health Protection Agency is not prescriptive regarding timing of placements, as it does depend to some extent on the individual’s previous training/experience. In general the placements work best if trainees have some knowledge of public health and the NHS and are not in the middle of exam preparation.

It is important that Specialty Registrars in Public Health spend a minimum of three months on a health protection placement (average 65 working days). If exam preparation, training courses, leave of absence or other work interferes with the placement an extension of the placement may be recommended.

All trainees seeking health protection placements should start thinking about their health protection placement early in their training. They should contact the relevant Health Protection Unit Specialty Tutor at least three months in advance to agree the timing and be assigned to a named trainer (health protection supervisor). Names of Speciality Tutors can be found in Appendix A. On occasions the Health Protection Unit training capacity may be full or may have staff shortages which may require the placement to be delayed. It is advised that trainees agree mutually convenient dates for their placement early so that the Unit can make effective arrangements.

Specialty Registrars will have an honorary contract with the Health Protection Agency for the duration of their training. This should be discussed with the Speciality Tutor.

Named Trainer (health protection supervisor) 

The named health protection supervisor should be contacted at least one month in advance of the placement to agree a date for a pre-placement meeting to assess learning needs.

Although a named health protection supervisor will be assigned for the duration of the health protection placement, registrars will also have access to all other Consultants in Communicable Disease Control (CsCDC), Health Protection Practitioners (HPPs) and information specialists working in the unit for advice and teaching, particularly with reference to their “lead” roles.

The health protection supervisor will be responsible for assessing the registrar’s competence against key area 6 learning outcomes and signing off the Activity Summary Sheets which may be e-portfolio or paper-based. If the registrar is using the e-portfolio the health protection supervisor must have an e-portfolio log-in from the Faculty of Public Health.

Registrars should ensure that the health protection supervisor is listed as the project supervisor on the activity summary sheets. This categorisation ensures that the health protection supervisor is able to assess and sign off a specific project (activity summary sheets) and associated evidence.

In signing off the activity summary sheets, the health protection supervisor will note in the supervisor reflection section whether there is insufficient evidence for the learning outcome to be signed off and make recommendations for further training needs.

In order for the learning outcomes to be signed off by a supervisor in the e-Portfolio, trainers must be listed as the registrar’s Educational Supervisor. The Registrar’s Educational Supervisor will use this evidence to formally sign off the learning outcomes on the e-portfolio.

Aims of the training 

The training provided by Health Protection Agency (SW) supports trainees in meeting key public health competencies taking into account their background and existing knowledge and skills, with the aim of ensuring that trainees become familiar with the scope and practice of health protection.

The main aims are to:

  • Provide trainees with an understanding of health protection practice
  • Prepare trainees to take part in the on-call rota as first-on call
  • Enable trainees to identify opportunities to develop health protection skills
  • Complete an essential element of specialist public health training

The health protection placement will provide trainees with an understanding of health protection issues, principles of surveillance, control and management of incidents and outbreaks of communicable diseases and the control and management of exposure to non-infectious environmental hazards. The training will focus on meeting key area 6 competencies relating to health protection, though a range of other competencies may also be met through a health protection placement.

At the end of the three month WTE placement, trainees should have:

An understanding of:

  • Surveillance of communicable disease and environmental hazards
  • Roles of various agencies in diagnosis, prevention and control of communicable diseases and environmental hazards
  • Legal basis of communicable disease control
  • Basis 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 public health role in emergency planning
  • Environmental epidemiology and health risk assessment

Developed skills in:

  • Investigation and follow up of single cases of common communicable diseases
  • Using HPZone 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
  • Decision making and time management
  • Dealing with the media
  • Risk assessment and risk communication
  • Interpretation and presentation of data
  • Policy development and implementation
  • Communications
  • Advising professionals and the public

Increased 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 fulltime Health Protection Unit placement and trainees have the option to pursue further placement.

Elements of the training 

Health protection placements can be broken down into three periods:

Induction (lasting at least two weeks depending upon individual need)

To become acquainted with the training location, organisation structures, roles of Health Protection Agency staff and centres, and roles of partners. An induction programme is set out in the Annexe

Main work period (lasting about nine weeks)

Trainees undertake supervised work: spending time working on the Duty Desk taking calls and dealing with cases, undertaking projects and work at a strategic level, attending planning and outbreak and incident meetings, and writing reports.

Conclusion period (lasting about two weeks)

Bring together the knowledge, skills and attitudes acquired during the placement, completing the learning log book, signing off competencies, agreeing assessment process for on-call duties.

An example of how a placement may look is outlined in the Appendix B.

Pre-placement assessment for trainees 

Trainees should plan for their Health Protection Agency placement well in advance. Negotiation over the start date may be needed if the Health Protection Agency training location does not have adequate resources at the time, e.g. staff shortages or trainees already taking up a training place. Trainees should approach the Speciality Tutor for the Unit who will help to coordinate the placement.

At least one month in advance trainees should arrange a pre-placement meeting with their health protection supervisor so that an assessment of the foundation knowledge and skills can be undertaken and to agree a programme for their placement based on the individual’s needs.

At the pre-placement meeting the trainee should also make the health protection supervisor aware of any special needs they may have, 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.

During the pre-placement meeting trainees must discuss and agree their training needs with their health protection supervisor. Together they are expected to draw up a learning contract (Appendix C). This will be reviewed halfway through their placement and revised if required (Appendix D).

Each piece of work should be defined in terms of aims and objectives, time frames, outcome and audit, the learning outcomes that will be addressed, and the individual to whom the trainee is responsible for that piece of work should also be specified. A project plan template is provided in Appendix E and a list of example projects is included in Appendix F.

At the pre-placement meeting trainees should be provided with an induction pack and agree with their health protection supervisor the relevant visits and key individuals they should meet during their placement. Trainees should start to make arrangements for these visits prior to starting their placement.

Induction 

All trainees should have a structured induction and use the induction pack (Annexe) as the basis for their experience and learning during the first two weeks of their placement. Trainees should also familiarise themselves with the local on-call reference materials, resource pack and local regular tutorials they can access.

All Specialty Registrars in Public Health are CRB checked at the start of their training and records are held by the training programme.

Responsibilities of trainees during health protection placements 

In addition to working on the Duty Desk and out of hours work, the following are expected from trainees during their health protection placements:

Trainees will:

  • Inform their health protection supervisor of any special requirements, ideally at the pre-placement meeting
  • Agree a learning contract with their health protection supervisor
  • Attend the work place as required and on time
  • Share their diaries with the Health Protection Agency staff
  • Notify their health protection supervisor (or unit administrator if not available) when sick
  • Act in accordance with the Health Protection Agency policies and procedures
  • Agree tasks and projects with their health protection supervisor
  • Take responsibility for arranging one-to-one sessions with their health protection supervisor and visits to key contacts
  • Work closely with all members of the health protection team
  • Let their health protection supervisor know if non-health protection pieces of work have to be completed during the placement
  • Ensure critical responsibilities and timescales are met
  • Alert their health protection supervisor in case of slippage of timescales
  • Hand-over of cases and significant events at work in a timely manner
  • Maintain high quality records in accordance with Health Protection Agency policies
  • Inform the health protection supervisor of any difficulties straight away, including concerns about lack of opportunities to gain experience
  • Attend on call and other local health protection training events
  • Reflect on learning experiences and document these in their health protection log book
  • Provide mutual support of other trainees attached to the unit, such as Foundation Year Two doctors.
  • Recognise the pressures on other members of the health protection team

Responsibilities of the Health Protection Agency during placements 

During placements with the Health Protection Agency, the organisation will provide:

  • An approved health protection supervisor who will:
    • Identify the learning needs of the trainee
    • Provide learning opportunities which contribute to meeting competencies
    • Offer regular one-to-one training sessions
    • Set the training agenda for the trainee
    • Regularly monitor the trainee’s performance taking into account feedback from other members of the health protection team and relevant partners
    • Assess the individual’s competence in health protection, including that required to go on the supervised on-call rota
    • Sign and return the Annual Review of Competence Progression (ARCP) forms in a timely manner
    • Liaise with the Educational Supervisor
  • Access to desk-space, a computer, telephone, the internet, email and IT support.
  • Access to the Health Protection Agency library resources and signposting to other key national and regional resources.
  • Relevant information to support daily work
  • An on-call pack, or similar resource, for out of hours work

Trainees will be expected to do most of their typing for report writing etc, although some administrative support will be available by negotiation. When trainees are on-call, they may utilise the usual administrative support for the on-call team.

Meeting learning outcomes 

Trainees are expected to participate in the investigation and management of single cases of communicable diseases and outbreaks/incidents including chemical incidents, as well as attend relevant meetings. There will be an opportunity to complete relevant health protection projects during their placement. Table One outlines examples of evidence that a trainee could provide for specific learning outcomes related to health protection. Appendix G provides a sheet which can be used to summarise all activities undertaken during a placement that can be used if the e-portfolio is not being used.

Where direct experience cannot be achieved in the three months (e.g. outbreak management) specific tutorials, exercises or discussion will be arranged to address these needs. Trainees will be offered the opportunity to shadow key staff, such as CsCDC, HPPs, EHOs and microbiologists. This will be identified through the learning agreement between the trainee and the health protection supervisor. Trainees will also be able to meet competencies through participating in the daily response to calls and notifications to the Acute Response Centre and by preparing for participation in the out of hours service.

 

 Table One             Learning outcomes for key area six

 

Number

Learning Outcome

Phase and Evidence

6.1

Identify known or potential health effects associated with a particular hazard relevant to health protection which is common in a population

Phase 1 - Report or CBD

6.2

Characterise the hazard identified, both quantitatively and qualitatively

Phase 2 - Report or CBD

6.3

Characterise the hazard identified, both quantitatively and qualitatively

Phase 2 - Report or CBD

6.4

Integrate hazard identification, characterisation and assessment  into an estimate of the adverse events likely to occur in a  population, based on a hazard commonly found in that population

Phase 2 - Report or CBD

6.5

Be able to complete a risk assessment for a hazard not commonly found in a population, drawing on external expertise as appropriate

Phase 2 - Report or CBD

6.6

Describe complex issues clearly to individuals, groups and communities

Phase 2- DOPS , OSPHE

6.7

Meet the educational requirements for commencing supervised on call. Particular standards to be reached before commencing on call are identified in a separate document

Phase 2- OSPHE

6.8

Meet the educational requirements for undertaking on-call as a generic consultant in public health (operating within limits of own professional competence and with the advice of a medical consultant who specialises in health protection available at all times)

Phase 3 CBD based on duty desk work

6.9

Ask appropriate questions to recognise a problem when presented with a health protection challenge

Phase 2- DOPS, CBD

 

Number

Learning Outcome

Phase and Evidence

6.10

Interpret the answer received and recognise the need to ask for relevant advice where appropriate

Phase 2- DOPS, CBD

6.11

Identify and confirm the risks and possible exposures

Phase 2- DOPS, CBD

6.12

Describe the organisation of infection control and apply effective and appropriate procedures and policies to reduce risk

Phase 2- CBD

6.13

Advise on and co-ordinate public health action required in the light of existing local & national policies and guidelines

Phase 2 or 3 DOPS, CBD

6.14

Describe the general principles of emergency planning and managing a major incident

Phase 2 CBD, Part A

6.15

Participate in and make a significant contribution to the investigation of an incident/outbreak including preparation of final report

Phase 2 or 3 DOPS, report

Number

Optional Special Interest Learning Outcomes

Phase and Evidence

6.16

Integrate different types of data, using complex data sets, or collection of ad hoc data to draw appropriate conclusions for disease control, environmental and chemical hazards control and health improvement

Phase 3- special interest Report, CBD

6.17

Lead or take a major role in the investigation and management of a significant incident, to include an outbreak, non infectious disease incident and a look back

Phase 3- special interest DOPS, report

6.18

Evaluate the management of an outbreak or incident

Phase 3- special interest Report, CBD

6.19

Evaluate a health protection service improvement

Phase 3- special interest Report, CBD

 

Number

Optional Special Interest Learning Outcomes

Phase and Evidence

6.20

Apply heath protection principles to services relevant to health protection in particular settings and in high risk groups (e.g. prisons, with asylum seekers, in dental health, port health)

Phase 3- special interest Report, CBD

6.21

Undertake a complex health protection health needs assessment

Phase 3- special interest Report, CBD

6.22

Understand and apply the theoretical models of behaviour change, in the context of health protection for the general population and high risk/ hard to reach groups

Phase 3- special interest DOPS, CBD

6.23

Develop and test/audit a multi agency incident control plan

Phase 3- special interest Report

6.24

Establish or evaluate and quality assure a specific health protection surveillance system, including reporting and early warning, to meet a specified need for a defined population

 Phase 3- special interest

6.25

Lead or make a substantial contribution to the implementation of a health protection policy or campaign

Phase 3- special interest

6.26

Show appropriate judgement on the basis of potentially incomplete/conflicting clinical information

Phase 3- special interest

6.27

Identify and intervene when a clinical risk to the health of the public is identified

Phase 3- special interest

6.28

Generate hypotheses for health protection problems and test them in appropriate epidemiological studies

Phase 3- special interest Report, CBD

1.5

Use a range of routine information sources and surveillance systems including, as a minimum, mortality, hospital admission, census, primary care, communicable disease, cancer registry, reproductive and sexual health data, and government surveys to support public health activity

Phase 3 Report, CBD

2.3

Make use of others in finding and retrieving evidence (e.g. librarians, information specialists)

Phase 1, 2 and 3 CBD, DOPS, report

 

Number

Learning Outcome

Phase and Evidence

3.1

Display awareness of current national public health priorities

Phase 1 and 3 CBD

4.17

Negotiate and Influence in a multi-agency arena

Phase 3 DOPS, CBD

4.2

Work collaboratively with the media to communicate effectively with the public

Phase 2 DOPS, CBD

5.1

Play an active role in engaging the public in solving their own health problems

Phase 1, CBD

7.1

Evaluate and audit services to assure and improve quality.

Phase 2 or 3 CBD, report

8.4

Use data with a full appreciation of the legal and ethical aspects of data collection, manipulation and release (confidentiality, security, privacy and disclosure) in order to balance societal benefit with individual privacy

Phase 2, DOPS, CBD

8.7

Treat information about patients as confidential

Phase 1,2,3 CBD, MSF

8.8

Provide information needed and requested and in a way that can be understood

Phase 2 DOPS, report, OSPHE

9.11

Help the public to be aware of and understand health issues

Phase 3, DOPS, CBD

9.12

Contribute to the education and training of other staff, medical students and colleagues

Phase 3 DOPS, CBD

EMS 1

Recognise and work within the limits of professional competence including working within the limits of personal clinical competence when dealing with individual patients

MSF

EMS 2

Be willing to consult colleagues

MSF

EMS 3

Keep clear, accurate and contemporaneous records including clinical record as necessary

MSF

EMS 4

Keep colleagues well informed when working in partnership including referring appropriate clinical issues

MSF

 

Number

Learning Outcome

Phase and Evidence

EMS 5

Establish and maintain trust by listening to and respecting others' views including giving patients and others the information they need in a way they can understand

MSF

EMS 6

Treat others with courtesy

MSF

EMS 7

Respect the rights of the public and patients to be involved in choices

MSF

EMS 8

Treat information about patients as confidential. If in exceptional circumstances you feel you should pass on information without a patient or an individual's consent, or against their wishes, you should follow agreed guidance on confidentiality and be prepared to justify your decision

CBD

EMS 9

Treat colleagues fairly and maintain the public's trust through avoidance of unfounded criticism

MSF

EMS 10

Respect skills and contributions of colleagues and maintain professional relationships and effective communication in multi disciplinary teams

MSF

EMS 11

Be readily accessible to the public and colleagues when on duty including arranging suitable cover

MSF

EMS 12

Pay regard to efficiency while not discriminating against individuals/populations

CBD

EMS 13

Keep knowledge and skills up to date, including regular audit, appraisal and reflective learning

Report

EMS 14

Practise safely including assuring professional indemnity, safeguarding the public from others' unsafe practice, adhering to safe management practice through maintenance and development of an environment and culture that improves health, safety and security

MSF

EMS 15

Deal with complaints fairly and co-operate with enquiries into practice

MSF

EMS 16

Demonstrate probity in professional and personal practice

MSF

EMS 17

Seek and follow advice where health concerns may affect practice

MSF

EMS 18

Work within a value system appropriate to public health advocacy

MSF

 

Acute Response Centre (ARC) experience (reactive work) 

Health protection units receive many enquiries from other professionals and the public on a wide range of issues. Callers may request advice on communicable diseases and infection control or wish to report outbreaks or incidents. Other professionals such as Environmental Health Officers and teachers may request advice on individual cases, follow up or exclusion periods.

Health professionals usually contact the Health Protection Agency to:

  • Notify infectious diseases, such as meningococcal disease, hepatitis A, E. coli O157, legionnaires’ disease etc. All of these will require a public health response;
  • Report outbreaks, which require further investigation and management;
  • Report and seek advice on exposures to non-infectious environmental hazards, such as chemicals, poisons or radiation hazards
  • Seek advice on individual cases including exclusion periods;
  • Seek advice on immunisation schedules or contra-indications to immunisation.

Calls are managed by a team rostered to the Acute Response Centre for the day. In Health Protection Agency SW North, the Acute Response Centre is located in the Brockworth office. In Health Protection Agency SW South, it is located in the Exeter office. However, in the South the acute work is coordinated from the ARC but there is close working with duty teams in the satellite offices in Dorset and Cornwall who take forward much of the acute work.

Trainees will be briefed about arrangements for managing response to day-time calls in the unit where they are placed. The average trainee would need to spend between 50% and 75% of their placement working in acute response in order to gain the required competence. All trainees are expected to participate in acute response work at least one day per week during their placement, dependent upon their level of competence. An equivalent period will be worked out for flexible trainees on a pro rata basis. In the south, the frequency of attending the Acute Response Centre in Exeter can be negotiated.

During this period the trainee will be expected to respond to acute incidents and enquiries in order to manage cases along with the duty team. Trainees will not be expected to work alone and appropriate support will be provided. The timing for joining the rota should be reached by agreement between the trainee and the trainer following the induction period and a suitable period of shadowing.

Trainees should recognise the limits of their competence and be prepared to ask for advice and assistance. The duty consultant will be accessible to support and advise the trainee, and advice can also be sought from the health protection practitioners. When working with the duty desk team, trainees will also be expected to take part in clinical review meetings that take place on a daily basis.

Trainees who need to travel long distances to attend the Acute Response Centre should discuss available support with the Programme Director.

Before working on the Duty Desk trainees will have:

  • Become adequately familiar with the Health Protection Unit
  • Reviewed common previous enquiries with their health protection supervisor or other nominated health protection specialist;
  • Developed a working knowledge of HPZone
  • Received information and instructions from their health protection supervisor or other members of the team on:
    • Confidentiality
    • Documentation using HPZone
    • Using standard questionnaires, e.g. for meningococcal disease and chemical incidents;
    • Public health response to meningococcal disease
    • Response to outbreaks of diarrhoea and vomiting
    • Flow of information on notifications within the Unit
    • How to access local and national policies
    • Standard Operating Procedures
    • Patient leaflets
  • Access to a copy of “Communicable Disease Control Handbook” by Hawker et al
  • Access to telephone numbers of key contacts, e.g. infection control teams, and Local Authority Environmental Health Officers

When rostered to work on the Duty Desk trainees will:

  • Be available at the pre-agreed time
  • Work under the supervision of the health protection duty team
  • 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 Health Protection Agency policy and standard operating procedures
  • Enter the details on HPZone.

After working on the Duty Desk trainees will:

  • Review the calls 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 trainee will not be available later or the following day
  • Record in their training log the details of cases, enquiries and issues dealt with
  • Identify learning points and issues, which require further discussion.

Trainees should also work closely with the duty desk team at other times during and after their placement if necessary to learn about the public health response to communicable diseases and chemical incidents as they arise.

To meet outstanding competences trainees will be expected to be involved in the event of major incidents/outbreaks anywhere in the Region and should be informed of and invited to take part in:

  • Incidents requiring mutual aid across PCTs, or
  • Response to incidents that would provide a good training opportunity

Partnership (proactive) work 

Trainees will be offered the opportunity to attend scheduled meetings with local partners, together with a CCDC or HPP. The main aims of attendance for trainees are to: develop an understanding of key issues, the role of the Health Protection Agency in these contexts, the roles of a range of partners and how the Health Protection Agency works with partners.

Examples of meetings may include routine partnership meetings such as 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, local resilience forum; incident meetings such as planning for a patient notification. Other opportunities may arise to attend meetings for example with Department for Environment, Food and Rural Affairs (DEFRA) or the Health and Safety Executive (HSE).

There should be an opportunity to discuss the meetings with the CCDC or HPP to reflect on how they contribute to learning.

Project work 

Trainees will be encouraged to undertake appropriate projects during their placement. The projects chosen will be negotiated between the trainee and the health protection supervisor and should address gaps in the trainee’s competencies whenever possible. The health protection supervisor of the trainee will oversee their project either personally or in conjunction with another health protection supervisor or project supervisor in the Health Protection Unit who leads for the specialist area of the project. See Appendix E for a project proposal template.

 

Teaching/Training Sessions 

  • Trainees should participate in regular case/incident review meetings as part of their training.
  • Trainees will have access to ongoing educational sessions and clinical meetings organised by the Unit. These may be 1:1 or as part of the team.
  • It is recommended that trainees access Health Protection Agency training opportunities even before their placement. Information on these can be found on the Health Protection Agency South West website:
  • The Health Protection Unit will provide regular refresher training for on-call, which trainees will be expected to attend.
  • Additional learning opportunities will be provided by the Health Protection Agency using various means such as taught courses, newsletters, teleconferenced events.
  • Trainees who have completed their Health Protection placement will be expected to maintain their Health Protection competencies, including competencies for on-call, by keeping themselves up-to-date with the requirements for Health Protection duties.
  • Trainees will be encouraged to organise specific teaching sessions with specialists from among the Health Protection Unit team on health protection topics they wish to address.

Developing competencies for out of hours work (on-call rota) 

Following completion of the initial 3 month WTE health protection placement, the eligibility of trainees to undertake supervised out of hour’s on-call will be assessed and the trainee must be signed off as competent. Regional procedures for assuring competence are outlined in 18.0

Once assessed as competent, the health protection supervisor will inform the relevant Deanery that the trainee has competed the necessary training and is competent to undertake supervised out of hour’s on-call duties. It would be possible to organise further attachments if required to meet competencies.

The frequency of on-call will be in line with the Faculty guidance and agreed with Deanery and the European Working Time Directive. Trainees will be allowed dedicated time to familiarise themselves with the relevant unit on-call pack and relevant information

  • Prior to going the on-call rota trainees will be briefed on the up to date out-of-hours on-call information, including such as area covered, contact details, general practices in the area.
  • Trainees will be first on-call in the rota and be backed up by a health protection specialist who will be on a higher tier of the on-call rota.
  • Trainees should be aware of local standard operating procedures for communicating with the second on call to highlight significant issues, e.g. a new case of E coli O157, an outbreak or a complex scenario requiring higher-level decision-making and outside the trainee’s level of competence.
  • Any action taken by the trainee out of hours should be communicated to the Health Protection Unit first thing on the next working day and to the second on call if relevant, e.g. on a bank holiday weekend or when different people are covering the patch over the weekend.
  • Trainees should take part in the daily SITREP teleconferences
  • Arrangements should be made to ensure that trawling questionnaires are either faxed to the Health Protection Unit urgently or posted on HPZone.
  • The Health Protection Unit will feedback to the trainee on the outcome of cases/incidents that he/she has dealt with.
  • Cases dealt with on-call should also be included in the trainee’s log.
  • Trainees who participate in the on-call rota should have their own on-call reference material and should have access to a mobile phone.
  • On-call arrangements should be reviewed annually and include a discussion between the Programme Director and Speciality Tutor and all trainees on-call.

Assessment of competence for supervised out of hours on-call duties 

Background knowledge and experience

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

Specialty Registrars

  • Passed part A of the Faculty of Public Health membership
  • Completed, or be part way through, an Health Protection Unit placement
  • Be keeping a logbook documenting cases and incidents experienced and reflecting on the events as a learning experience
  • Completed 12 months in a PCT/HPU
  • Have experienced, or received training in, the full range of scenarios listed in Figure 3.

Health Protection Practitioners and other public health staff new to on-call duties

  • Completed an induction to health protection programme
  • Completed a structured learning programme based on individual needs
  • Experience working in the acute response centre (HPPs for at least three months)
  • Have experienced, or received training in, the full range of scenarios listed in Figure 3.
  • Be keeping a logbook documenting cases and incidents experienced and reflecting on the events as a learning experience

Individuals may also need to undertake additional tutorials for specific health protection skills, e.g. history taking, microbiology, on-call training days, clinical updates (depending on need and accessed through various routes). It is also recommended that they undertake a short course in the principles of health protection, either before or within one year of going on call (see Appendix I).

Tutor and Mentor

To help individuals developing competences required to participate in the public health rota the following support will be provided:

  • Specialty Registrars will have a health protection education supervisor and be supported by other members of the health protection unit for the duration of their placement and any subsequent placements.
  • Health Protection Practitioners and others attached to the Health Protection Agency in order to develop on call competence will be provided with a mentor. The mentor will be an individual deemed competent by the Unit Director for this role.

Other members of the health protection unit will be encouraged to provide feedback on performance either directly to the individual or to their health protection supervisor or mentor. 

Assessment objectives

Ensure the individual:

  • Is safe and confident to undertake supervised on-call duties
  • Has attained the minimum standard of practice
  • Has a basic understanding of on-call principles
  • Is knowledgeable about how and when they would seek timely information from the second on call or another expert

It will also identify individuals who need further support, training or assessment. The assessment process will include a formative and summative assessment of competence.

Assessment process

Individuals will be assessed against performance criteria identified in the Faculty of Public Health Specialty Training Curriculum and the Skills for Health National Occupational Standards using the assessment proforma, which can be used formatively and summatively (Figure Two). A hard copy, with space for dates and signatures, is provided in appendix M.

All individuals must be assessed as competent in all components before they can be judged as competent overall to start supervised out of hours on call duties. Assessments (type and timing) should be planned and agreed between assessor and the individual being assessed. Protected time should be set aside and agreed for feedback after each assessment.

It is recommended that two health protection trainers conduct the summative assessment, one of which should be the health protection supervisor, the other could be a consultant or a health protection practitioner deemed by the Unit Director as competent for this role.

  • The proforma sets out the assessment components with descriptors to aid the assessment. The proforma also allows documentation of specific descriptive feedback and identification of areas of work which need further development with recommendations for action.
  • Formative assessments should be carried out during the placement, or development period, and individuals should demonstrate competence in all aspects/criteria before they undertake the summative assessment.
  • The summative assessment is based on the guidance from the Faculty of Public Health. For consistency, this will be used for everyone who wishes to undertake on out of hours on call.
  • For the summative assessment three scenarios will be discussed, at least one of which will be a non-communicable disease. These may be current case-based scenarios or pre-prepared scenarios. Examples of common scenarios that may be used are presented in Figure Three.
  • A small number of criteria, indicated on the proforma, will need to be assessed through the evidence of competence documented at the formative assessments.
  • Assessment types may be:
    • Direct observation
    • Case based discussion
    • Case based discussion with logbook
    • Review of case documentation
    • Feedback on performance including multi-source feedback.
  • Speciality Registrars must be assessed as competent to undertake supervised on-call before they complete their health protection placement, other than in exceptional circumstances.
  • Should a trainee fail their assessment, they will be referred to a health protection supervisor in another unit for further assessment.
  • Should they fail this assessment, the health protection supervisor will meet with the trainee’s educational supervisor to discuss the situation.

Informing the Public Health Training Programme Director of eligibility

Having assessed an individual Speciality Registrar in Public Health and deemed them competent to undertake supervised out of hours on call duties, the health protection supervisor must:

  • Inform the Programme Director and Programme HR & Development Manager by letter
  • Contact the Programme HR & Development Manager to agree a start date
  • Ensure that trainees are not rostered for on call duties until a start date has been agreed, otherwise there may be problems with payment.

Returning to out of hours work after a break

Individuals returning to out of hours work after a lengthy break should discuss with the Unit Director whether there is a need for refresher training, e.g. working on the duty desk, and/or re-assessment before recommencing health protection out of hours on-call duties.

Figure Two Assessment proforma 

Risk assessment

 

 

 

 

 

Gather and analyse information appropriate to situation

6.9;

6.10;

6.11;

6.7

HP1; HP5; HP11

1.Does not gather sufficient information to allow assessment and actions

2. Gathers sufficient information and analyses/ assesses problem based on information available with appropriate conclusions

Additional discussion points:

Limitations of the information, discussion on alternative options.

 

 

Identification of common risks and associated hazards

6.1; 6.2; 6.3; 6.4; 6.7

HP1

1. No or limited ability to identify sources of information and guidance; limited or no ability to identify relevant risks; limited or no ability to define associated hazards or relevant population

2. Can identify sources of information of guidance; can identify relevant risks and define the associated hazard; can define the relevant population

Additional discussion points:

Define the strengths and weaknesses of the evidence/available information used

    

Component for assessment

Matched to Faculty Of Public Health Learning Outcomes

Matched to Skills for Health National Occupational Standards

Assessment outcome - descriptors re competence for supervised OOH on call

1. Needs further development

2. Meets competence

Circle level

Assessment type e.g. Direct Observation etc

Date and Assessor

Specific descriptive feedback comments and agreed recommendations for action

Risk management

 

 

 

 

 

Identify and coordinate appropriate public health actions

6.13; 6.7

HP5; HP6; HP7

1. Does not recognise appropriate timescale / priorities. Identifies none or some of the appropriate actions; no or limited ability to coordinate appropriate actions

2. Acts within appropriate timescale. Identifies appropriate actions; demonstrates ability to coordinate necessary actions.

Additional discussion points:

Ability to recognise alternative options

 

 

Identify the need to ask for advice and support

6.10; 6.7; EMS 1

 

1.Does not ask for advice and support when appropriate in relation to own skills, knowledge and experience

2. Asks for advice and support when appropriate in relation to own skills, knowledge and experience.

Additional discussion points:

Ability to reflect and identify future learning points

    

Component for assessment

Matched to Faculty Of Public Health Learning Outcomes

Matched to Skills for Health National Occupational Standards

Assessment outcome - descriptors re competence for supervised OOH on call

1. Needs further development

2. Meets competence

Circle level

Assessment type e.g. Direct Observation etc

Date and Assessor

Specific descriptive feedback comments and agreed recommendations for action

Risk Communication

 

 

 

 

 

Provide and update information to key people / agencies appropriate to situation

6.10; 6.13; 6.7

HP6

1. Unable or limited ability to identify key people / agencies for information. Updates not provided.

2. Able to identify the relevant key people / agencies with whom to communicate. Provide updates as appropriate.

Additional discussion points:

Ability to recognise priority and timescale

 

 

Provide information, appropriate to audience, on risks to health and necessary actions / management to prevent / reduce / control

6.6; 6.7

HP6; HP7

1. Unable, or limited ability, to communicate risk information in appropriate language and format

2. Demonstrates ability to communicate risk information in appropriate language and format. Checks understanding of information given

Use evidence of competence documented during formative assessment; not assessed summatively

 

Document information identified, advice given and actions taken accurately, clearly and in a timely manner

6.1; 6.2; 6.3; 6.4; 6.6; 6.7;6.9; 6.10; 6.11; 6.13

HP1; HP5; HP6; HP7; HP11

1. Documentation missing relevant information; lack of clarity in recorded information; late documentation.

2. Completes documentation: clear and accurate; recorded in a timely manner.

Use evidence of competence documented during formative assessment; not assessed summatively

  

Component for assessment

Matched to Faculty Of Public Health Learning Outcomes

Matched to Skills for Health National Occupational Standards

Assessment outcome - descriptors re competence for supervised OOH on call

1. Needs further development

2. Meets competence

Circle level

Assessment type e.g. Direct Observation etc

Date and Assessor

Specific descriptive feedback comments and agreed recommendations for action

 

Figure Three Examples of 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

Fuel spill

Measles

 

Diphtheria

 

Pertussis

 

Invasive HIB

 

Inoculation injury

 

Invasive Group A Strep

 

Contact with rash during pregnancy

 

Dog bite or bat bite

 

Outbreak of diarrhoea and vomiting

  

 

Continued professional development after the placement 

Consolidating competence

For a period of time trainees, and other staff who are new to working on the rota, are expected to discuss all cases and incidents that they deal with out of hours with the consultant on call. This period should be at least two months, but negotiated with their health protection supervisor and extended as necessary depending upon the individual’s need.

Maintaining health protection learning outcomes

To maintain competence in dealing with health protection cases and incidents and ensuring individuals are up to date with current protocols and procedures after completion of their placement, trainees should:

  • Attend at least one health protection training event per annum
  • Continue to undertake supervised out of hour’s on-call duties

If the trainee and their educational supervisor agree that further development or updating of competence is required, additional experience on the health protection duty desk and opportunities to support the management of outbreaks and incidents can be arranged to meet specific learning needs.

Outlines of local and regional training events can be found in Appendix I.

Documenting learning experiences 

The South West Public Health Training logbook (Appendix J) and a summary sheet should be completed for each piece of work, and cases managed, including reflection by trainee and health protection supervisor whilst omitting confidential details. Appendix K – includes a hard copy version if the e-portfolio is not being used.

Extended specialist training pathway in Health Protection 

Trainees who wish to pursue a career in health protection will usually be attached to the Health Protection Unit for extended periods which may vary between minimum of 6 months up to 2 years, depending upon their learning needs and interests should seek opportunities for attachments to Health Protection Agency specialist centres (Appendix H).

The training offered to these trainees will include all the elements as outlined above, but there will be an expectation that such trainees will achieve a higher level of knowledge, skills and experience in the investigation and public health management of communicable diseases, health protection epidemiology, environmental hazards and emergency planning.

During the Phase three training programme, it may be advantageous for trainees to transfer to a relevant health protection educational supervisor who will take on the responsibility for signing off the outstanding competences.

The Faculty of Public Health provides detailed guidance on specialist health protection training . Trainees should refer to this guidance to discuss and plan their specialist attachments with their health protection supervisor including attachments outside the region early on in the health protection training.

These trainees will be offered the opportunity to deputise for the Consultant in Health Protection and will be offered the opportunity to chair meetings as appropriate to stage of training. They will be expected to undertake larger and longer projects, requiring in-depth application of health protection skills.

The Faculty of Public Health lists training locations that offer specialist training opportunities. These are known as "national treasures" because the posts are open to trainees from outside their own deanery.

Attachments to specialist Health Protection Agency centres and other units such as the Regional Epidemiology Unit, the Centre for Infections, the Centre for Radiation, Chemicals and Environmental Hazards, and the Centre for Emergency Preparedness and Response at Porton Down are standard options available as part of the Health Protection Specialist Training programme offered by the South West Public Health Training Scheme.

Trainees are advised to identify potential projects prior to starting specialist attachments and should aim to achieve a publication based on the work done during this period and present their work at national health protection conferences. These attachments should be fully supported by the health protection educational supervisor and Training Programme Director. Refer to Appendix H for further details on specialist health protection attachments.

Other health protection attachments 

In order to gain a broad understanding of health protection and the roles of other professionals and organisations, it is recommended that trainees arrange short attachments or visits to the following:

  • Environmental health departments
  • Hospital and community infection prevention and control teams
  • Microbiology department
  • Regional epidemiology unit
  • Port health setting
  • Genito-urinary medicine clinic
  • Tuberculosis clinic
  • Water company

The main objectives for these visits are:

  • To gain an understanding of respective roles and working relationships
  • To understand key health protection risks and issues
  • To be aware of relevant legislation, regulations and good practice standards

Expected objectives should be negotiated on an individual basis. Appendix H provides examples of objectives that may be acquired through some of these attachments.

Evaluation of placements 

Trainees should provide feedback on their health protection placement on its completion. They should complete and return an end of placement questionnaire to the Health Protection Agency SW learning and development lead for collation and review (Appendix L). This will be used to review placements and make improvements to the training offered by the Health Protection Agency South West.

Trainee sickness and leave arrangements 

Trainees will be expected to report sickness absence to their health protection supervisor during the period of their placement with the Unit. Annual leave, study leave and other planned leave should be negotiated with the health protection supervisor. Trainees will be entitled to attend training days and events organised by their training programmes.

Trainees should not usually take more than one week’s leave during their 3 month health protection placement. Requests for longer periods of leave should be negotiated with the health protection supervisor and it is possible that the placement may need to be extended.

Grievance procedure 

Any grievance procedure regarding training issues will follow the policies and procedures of the training location in the first instance, and if issues cannot be resolved locally, the South West Public Health Training Scheme procedures may be followed. For any employment issues, trainees can access the Training Scheme policy procedures.

Occupational health issues 

Trainees are advised to receive immunisations recommended by the training programme. At the pre-placement meeting there should be discussion of possible biological hazards that trainees may encounter during their placement, e.g. while attending a care home during an outbreak of infectious disease. Trainees should have the opportunity to discuss any specific individual health risks and concerns at the meeting and to be provided with any necessary guidance on or equipment for personal protection.

Attachments for other trainees in public health roles 

The principles described in this document can be applied to other trainees who need to gain competence in health protection. Examples of potential trainees are environmental health practitioners, specialist community public health nurses, public health intelligence analysts. The key issues are:

  • A professional from the relevant background should be nominated as point of contact to ensure that the attachment is timetabled appropriately and meets mutual expectations
  • A pre-attachment meeting to discuss arrangements and individual needs
  • Clearly identify and agree the competences which can be met during the attachment and how these could be achieved in the given time frame
  • Provide an induction appropriate to the duration of the attachment
  • Consider the need for the trainee to sign the confidentiality form
  • Provide an opportunity to evaluate the attachment using an abridged version of the evaluation form in Appendix L.