Appointments to substantive consultant ICM posts

In June 2021 the Faculty of Intensive Care Medicine (ICM) published Critical Staffing: A best practice framework for safe and effective critical care staffing. This document outlined the agreed Faculty position on appointments to ICM consultant posts, or posts that include ICM sessions as part of the consultant job plan.

Insufficient doctors for demand

The Faculty position recognises there are currently insufficient doctors completing their ICM CCT as either single, dual or triple training in Intensive Care Medicine to fulfil present demand across the UK. The output from ICM national training numbers (NTNs) and equivalent Certificate of Eligibility for Specialist Registrations (CESR) needs to increase. It is important as ICM CCT holders increasingly come from non-anaesthetic backgrounds, that this potential source of ICM CCT appointments is considered by all critical care departments.

The Faculty does not seek in any way to denigrate those CCT programmes that include some training and experience in ICM e.g. Anaesthesia and General Internal Medicine. The Faculty’s position however is that ICM training contained within another specialty’s CCT programme is not as comprehensive as an ICM-specific training programme and therefore does not, in the present era prepare individuals to work on day one as an ICM consultant without them undergoing additional ICM-specific training and needing initial supervision (see 5-10 below). ICM is recognised as an increasingly complex medical specialty with specific training needs and competencies that are not met within other specialties’ own CCT programmes.

A compromise is necessary that some substantive consultant advertisements and appointments, without an ICM CCT or CESR, will in some circumstances need to be made to consultant posts which include ICM daytime sessions. These appointments should be exceptional with prior agreement from the ICM Regional Advisor (RA). If this compromise is not made, intensive care and wider secondary care services in some hospitals, particularly small remote and specialist units will be put at significant risk; this also includes the risk to existing ICM consultants of trying to cover an excessive workload made worse by rota gaps.

The process of safely integrating such appointments into the existing ICM team needs to be recognised by Health Boards and Hospital Trusts and requires processes tailored to the specific individual.
 

Faculty position on appointments

The Faculty position for ICM consultant advertisements and appointments, with some steps to mitigate any risks, are laid out below:

1. An ICM Certificate of Completion of Training (ICM CCT) or its equivalent (CESR in ICM) should be essential criteria for appointments to Intensive Care Medicine consultant posts, or posts where ICM forms a daytime sessional component of the post. The agreement for advertisements and essential criteria should reflect this.

2. Whilst the ICM training workforce continues to go through an extensive period of transition and growth, some hospitals, in particular some specialist units (cardio-thoracics, burns and neuro-critical) and some small, remote, and rural units may struggle to recruit in line with essential criteria.

3. Where units feel they will be unable to recruit in-line with essential criteria, prior discussion with the local Regional Advisor (RA) is best done before adjustments are made to essential person specifications.

4. Attempts need to best match up the advertised post’s service delivery whilst upholding standards of patient safety, and with professional standards outlined in  Guidelines for the Provision of Intensive Care Services (GPICS v2).

5. An agreed time-framed action plan should be put in place to ensure the safe transition of a doctor without an ICM CCT. This is to ensure the appointee is capable of full independent ICM consultant work in the appointing unit.

6. The RA, alongside local critical care medical and managerial staff should be involved in the agreed time-framed transition plan.

7. The transition plan timeframe needs to be cognisant of an individual’s prior training and competencies.

8. The individual must demonstrate commitment to ICM with on-going learning in it (documented within their job plan, annual appraisal, and Personal Development Plan).

9. There should be formal mentorship (e.g. FICM Thrive) and appropriate supervision from a local ICM consultant during integration into the unit to ensure that patients care is safe and effective. Input from an extended network of local, network and regional clinicians would help inform when the appointee is deemed appropriate for independent practice.

10. Review of the ICM curriculum and CESR process to identify and rectify areas of possible weakness in the individual’s training and experience. This may include General Internal Medicine for an anaesthetic trained individual, and Anaesthesia for medical CCT/CESR holders. Until these are addressed, the consultant should not be the named supervisor of Stage 3 ICM doctors-in-training.

11. Reassurance is required for the individual clinician and for their employing organisation that suitable clinical knowledge and competency in ICM has been demonstrated. Trusts and Critical Care Directorates may wish to add this item to their Risk Register.

12. The Medical Director, or their designated representative should be aware of the structures and processes put in place to safeguard the appointed individual, patients, and integrity of the ICU.

13. Active participation in the ICM directorate is required: Morbidity and Mortality, Clinical Governance, Quality Improvement and Safety, Journal Club meetings etc.

14. Providing specified examination criteria are met, the option exists for some of sitting an examination in ICM e.g. FFICM, or European Diploma in Intensive Care Medicine. An examination demonstrates a suitable knowledge base, at a given point in time which may provide reassurance for the individual and employer.