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MANAGING MINOR AND SERIOUS PLACEMENT CONCERNS
From time to time problems arise on placement; usually these relate to concerns about the way the trainee is approaching their work, about aspects of placement organisation or about aspects of supervision.
This document represents the position of the three north London programmes (at UCL, UEL and Royal Holloway). Its aim is to indicate how the programmes will manage concerns that relate to supervision and placement organisation. We raise these issues in the spirit of creating as much transparency about the partnership between programmes and supervisors as is possible.
A major omission in what follows is the absence of discussion about problematic trainee performance, and how this is managed. This is deliberate; we think this document is clearer if it keeps to one focus. However, supervisors should be reassured that programmes do recognise and will investigate the potential role of trainees in contributing to any difficulties which arise.
Dealing with 'minor' concerns and problems
Most concerns are identified and managed at the Mid-Placement Review (MPR) - most issues which emerge during this visit can be dealt with easily, usually by direct discussion and negotiation between the programme visitor, the supervisor and the trainee.
The MPR is a formal mechanism for managing quality issues. However, 'informal' contact between the programme and the supervisor can be very useful. Programmes routinely speak to trainees to see how placements are progressing, and supervisors are always welcome to contact the programmes directly if they have any concerns themselves. Because early intervention is often more effective than waiting for problems to become entrenched, programmes are keen to keep these 'informal' channels of communication as open as possible.
Programmes know that minor concerns sometimes reflect issues that arise only for a specific trainee, or are attributable to temporary problems with service organisation. For this reason they may not act immediately, but will monitor the placement to check whether the difficulties recur.
Dealing with serious concerns
More rarely, a problem emerges that raises concern either about the provision or quality of supervision, or the clinical capacity of the supervisor. In such instances programmes have a "duty of care" to trainees, and potentially to patients, and on this basis we would need to investigate any concerns in a more formal manner.
Examples of serious concerns might include:
· offering extremely limited opportunities for supervision (e.g. persistently cancelling supervision sessions, or leaving the trainee unsupervised for a protracted period)
· major deviations from accepted good practice in supervision. Usually this would reflect a combination of failures rather than a single instance - for example, always allowing supervision sessions to be interrupted by phone calls or other demands, a supervisor talking about their own clinical work rather than that of the trainee, or acting in a manner which emphasised status differences between trainee and supervisor
· clear evidence that the quality of supervision falls significantly below the standard expected of a qualified psychologist (e.g. offering advice at clear variance with accepted professional practice, clear indications of minimal or absent knowledge of usual practice in the clinical context)
· unethical professional practice
· breaches of the BPS Code of Conduct
· breaches of standard NHS policies and procedures
· serious doubts about the clinical competence of the supervisor
Outline of procedure: In line with NHS principles and procedures, programmes would initially mount a confidential investigation, to ensure that there were appropriate grounds for concern. Usually a senior member of the programme team would meet with the trainee and the relevant programme tutor to consider the issues being raised.
If, after discussion, the matter was felt to warrant further investigation we would hope to raise any concerns directly and - usually - promptly with the supervisor. The caveat is important: trainees sometimes request that such discussions occur only after they have left the placement (because they worry that their feedback will influence a supervisor's evaluation of their performance). We need to be attentive to such requests, and we may delay taking the matter further until the MPR, or after the placement ends. However, if we judge the concerns raised to be serious, we would override the trainee's anxieties and take up the issue directly and immediately.
Usually a senior member of the programme staff would meet with the supervisor, detail the concerns and discuss them with the supervisor. Hopefully the spirit of this meeting would be open rather than adversarial, with the aim of clarifying concerns.
Outcomes from this meeting would vary. For example:
a) It may become clear that there are no substantial grounds for concerns, and hence that no further action is warranted or necessary.
b) The supervisor and the programme may agree that the placement was problematic. They may then agree to develop an action plan, which would probably include arrangements for monitoring future placements, and if appropriate working with the supervisor to help them address any concerns. We would usually involve line managers in this process by informing them about the action plan.
c) In some cases, concerns raised about supervision may raise significant questions about a supervisor's professional and clinical capacities. We would still hope to discuss an appropriate action plan directly with the supervisor (which could include a decision to not use the placement in future). However, some concerns will be sufficient that (in line with professional guidance) we are required immediately to inform the supervisor's professional or line manager. (Examples would be practice which appears to be at significant variance with acceptable standards, or breaches of the HPC guidelines, BPS Code of Conduct and/or relevant Trust procedures). Supervisors would of course be informed of this action. It has to be stressed that this step would not be taken unless careful discussion with senior programme staff indicated that such a step was warranted.
In some instances there may be a need to 'suspend' a placement from the allocation process while an investigation took place; if this was the case the supervisor would be informed.
Because the three North London programmes work closely together to undertake placement allocation, it is right that there is some internal discussion of serious placement concerns. In this sense, any investigations described above would be carried out on behalf of all three programmes.
Placement feedback is monitored and recorded by each programme using a Placement Quality Audit. From this any serious concerns are discussed across the three North London Programmes. An outline of the serious concern is recorded, along with agreed actions to be taken and date of review. This record is stored securely and confidentially. Any serious concerns about placements are discussed and reviewed every 6 months.
Supervisors will want to be reassured that none of these steps will be taken on the basis of 'trivial' or vindictive complaints. It is in the interest of Programmes as well as supervisors that this is so, and there should be enough checks and balances built into the system to ensure that this does not happen. A powerful reassurance should be the fact that Programmes which took inappropriate and ill-founded action against a supervisor would find it hard to get supervisors to agree to supervise for them - and rightly so.
We hope that this information sheet does not raise too many concerns. It is not intended to alarm but to inform, and we would welcome any feedback from supervisors.
If you have any questions relating to the quality management of placements you can contact;
Sue Watson, Clinical Director, UCL (s.watson@ucl.ac.uk)
Helen Pote, Clinical Director, UEL (h.pote@thul.ac.uk)
Neil Rees, Clinical Director, RHUL (n.rees@uel.ac.uk)