Harnessing the force of post-F2 doctors - a medical clinical fellow post that transformed locally employed doctor recruitment.

In 2018, North Bristol Trust (NBT) faced difficulties recruiting clinical fellows. In response, a new programme was introduced that includes opportunities for non-clinical time, supervision, and a study budget, as well as flexibility of contract duration and on-call commitment. This has significantly improved the application ratios, with a 94% fill rate in August 2021 and competition ratios of 2.5:1. Not only has it been successful for staffing medical rotas, but clinical fellows also report positive experiences, have gained opportunities that would not be available in a training role and feel the role will benefit their future job applications. This report outlines the new programme and analyses it from the clinical fellow and Trust perspective. We hope that by sharing this successful new programme, other organisations can take inspiration to harness the potential of the high proportion of doctors taking a break from training post-foundation programme.

Mortality rates in teaching hospital complex care wards in England: a retrospective audit.

OBJECTIVE: Existing data examining mortality rates following inpatient hospital admissions in the UK are either condition specific or examining all inpatient mortality based on single time point audits. This clinical effectiveness project aimed to assess mortality rates in patients admitted to complex care (CC) wards managed by geriatricians at Southmead hospital, Bristol. METHODS: Data were collected by the trust's audit department and analysed by the authors. All patients admitted to the four CC wards from July to December 2017 were included. Data collected included age, gender, date of admission, length of stay, date of discharge and date of death if applicable. RESULTS: 2673 patients were admitted to CC wards from July to December 2017. 42.72% of patients were men, and mean age of patients was 82.46 years. Mean length of stay was 16.68 days. 292 (10.92%) of patients died during the index admission. Overall mortality rates were: (1) 1 month: 11.34% (303 patients); (2) 3 months: 21.59% (577 patients); (3) 6 months: 30.15% (806 patients); (4) 12 months: 38.53% (1030 patients). 12-month mortality increased with age from 75 upwards (34.04% in 75-79 years, 42.94% in 85-89 years, 50.27% in 95-99 years, 66.67% in 100-104 years) but was similar in those aged 65-69 and 70-74 years (29.41% and 28.18%, respectively). CONCLUSIONS: An improved understanding of mortality rates in patients requiring an admission under geriatricians may aid clinicians' ability to prognosticate. Appreciating that over a third of these patients are potentially in the last year of life provides further impetus to begin advance care planning discussions during inpatient admissions.