|The President writes - June 2013|
|Monday, 03 June 2013|
In recent blogs and articles I have spoken about some of the challenges which currently face us in our professional lives. The situation in the UK continues to be dominated by fiscal constraints in the UK economy and by the dramatic changes which are underway in the NHS in England, the latter of which affect some 75% of this College’s UK membership. In this context, the President’s Meeting in March was a useful time to consider the topic of surgical outcomes, particularly as Sir Bruce Keogh had announced that outcomes for individual surgeons in certain indicator procedures will be part of the revalidation process.
Inevitably, there is a degree of disquiet about this as, with few exceptions (Cardiac surgery and Arthroplasty in Orthopaedic surgery), most of the data that is used comes from hospital episode statistics and many surgeons have doubts about the accuracy of that data. It is noticeable, however, that the issue of coding is not a problem in the private sector, presumably because volume is less and there is a direct relationship between coding and remuneration. In the NHS, we are reliant on coders who will do their best to interpret the information contained in operation notes, discharge letters and clinical notes to provide the information that we regard as inaccurate.
I do have some sympathy with the view that the data used to judge our performance is inaccurate, but I also have sympathy with the position of the coders who do the best they can with little support from us as surgeons. In the face of such problems, it seems to me that a simple and effective action by all Fellows of this College is to arrange a meeting with local coders to establish contact and ensure communication that would improve the accuracy of the data which is used to judge our outcomes. Such action would have the twin benefits of improving the data and demonstrating a commitment to quality improvement.
Another area of contention for surgeons is targets. There is no doubt that they have been effective in reducing waiting lists but they do cause some unintended consequences, particularly where they are applied without consideration of the relative urgency of the conditions to be treated. No one would argue against the proposition that a patient with cancer should be treated as soon as possible or that an elderly patient with a painful hip, whose independence is threatened by reduced mobility, should be given the freedom from pain that a hip arthroplasty can deliver, but to suggest that the same urgency should be applied to other conditions that require surgical treatment but which are neither life threatening nor painful is wrong. Furthermore, the blanket application of targets will ignore the wishes of patients who may have work or family considerations which require a more flexible approach to their treatment.
I believe that the changes occurring in the way that the NHS is working across all four nations of the UK, while disquieting, none the less afford the possibility of addressing some of our concerns. It is essential that all surgeons seek to work with the systems in place and, as they develop, to influence good practice on behalf of our patients.
One of the College’s key roles is to support our membership during periods of significant change. No one could doubt that we are currently in such a period in the UK. We will be keeping up our programme of regional activities throughout the UK to ensure that we continue to support our UK-wide membership. In addition, the successful launch of two new ventures in the past two months demonstrates the commitment of our College to the needs of our membership across the world.
The Faculty of Surgical Trainers, under the direction of Mr Craig McIlhenny, is an innovation of the College which recognises that the Surgical Trainer is in need of support. There are three levels of association with the Faculty which is open to membership from all surgeons and trainee surgeons irrespective of College affiliation, although membership is free to Fellows and Members of the RCSEd. The GMC’s declared intent to accredit trainers in the hospital disciplines as they do for General Practice makes it all the more important for trainers to be prepared to demonstrate in revalidation that they are effective in that role. The Faculty is in the process of defining the standards expected of a surgical trainer as mapped to the domains established by the Academy of Medical Educators. Once this has been done, the Faculty will be able to signpost its membership to appropriate courses and resources that will allow a trainer to demonstrate the competences needed for revalidation.
The Faculty held its inaugural meeting in November 2012 which was very well-attended. Plans are well advanced for the next meeting in October which will be held in Birmingham.
Our second recent initiative, the International School of Surgery signifies the importance that the College places on providing further support for our International Fellows and Members as they develop their surgical skills and knowledge through examinations and training into a process of lifelong learning. Under the direction of Mr Mike Lavelle-Jones, Vice President for External Activities, the College is, through the International School of Surgery, coordinating its international activities so that any surgeon seeking help with the examinations provided through our College will have an accessible portal for all the relevant information, as well as useful resources for study and development. Our ambition is that this will not only help surgical trainees, but will also be a resource for institutions seeking support and advice on such topics as curriculum development, setting up training programmes and developing examinations.
Innovative thinking is the key to adapting to change and new challenges. While we pride ourselves on being an innovative college, the ideas and dedication that lead to innovation come from our Fellows and Members around the world. The principles of commitment to excellence in professional development and training are global – and we are lucky to have both a strong UK and international membership where those values can be shared and developed.