Protecting Registrar Training: A Quality Improvement Initiative to Improve Access to Protected SPA and Specialty Clinics

Introduction

Supporting Professional Activity (SPA) time and specialty clinic attendance are essential components of higher specialty training. Despite being allocated within work schedules, protected educational time was frequently interrupted by clinical service demands, limiting curriculum progression and trainee development. We aimed to improve reliable access to protected SPA and specialty clinics for Group 1 specialty registrars through low-cost system interventions.

MethodA prospective quality improvement project was undertaken in a district general hospital using two Plan–Do–Study–Act cycles over eight weeks. Baseline and repeat surveys were completed by the local registrar cohort (Cycle 1: n=8; Cycle 2: n=11). Root cause analysis identified poor rota visibility, inconsistent awareness of protected training, and lack of a clear escalation process as key barriers. Interventions included making SPA and clinic sessions clearly visible on rotas, engaging rota coordinators and consultant stakeholders, clarifying escalation pathways when training was interrupted, and promoting shared expectations through departmental communication.

Results

Protected SPA completion increased from 45% to 78%, while successful specialty clinic attendance improved from 55% to 82%. Mean trainee satisfaction increased from 3.1/5 to 4.2/5. Improvements were achieved without additional staffing or financial investment. Variation between specialties identified opportunities for targeted future improvement, particularly where service pressures remained highest.

Conclusions

Simple, low-cost system changes substantially improved access to protected educational opportunities for higher specialty trainees. Improving rota visibility, shared ownership and clear escalation processes enhanced both training experience and curriculum delivery without increasing operational burden. This project demonstrates that protecting educational time is an achievable quality improvement intervention that supports workforce development and, ultimately, patient care by helping trainees acquire the competencies required for independent consultant practice.