|The President writes - December 2011|
|Thursday, 24 November 2011|
Large disparities in health and access to adequate healthcare still remain a significant social health issue within the UK. There are UK-wide postcode discrepancies in the provision of care, particularly with respect to out-of-hours services and specialist surgical care. Significant service reconfiguration will be needed in order to improve access to surgical care and to ensure that the same standards are met, irrespective of postcode or time of day.
Those standards should be the same for all patients, whether they are undergoing cancer, elective specialist or emergency surgery – and if we are to achieve the triple goals of better access, surgical outcomes and training opportunities, we must move towards delivery of care in specialist centres. We need to engage politicians and patient groups throughout the UK to press home the message that better results can be achieved in specialist centres through service redesign by moving away from the principle of local delivery of care for all conditions; this model is no longer in the best interests of patients as it fails to deliver uniformly high standards of care and surgical training.
The over-arching conclusion from the recent Clinical Commissioning Summit, attended by some four of our RSAs and Council Members, was a strong sense that colleges and professional bodies want to lead rather than react to the clinical commissioning agenda. This includes the requirement to review future training needs as the NHS responds to the changes that are bound to arise as a result of clinical commissioning.
There was also an overwhelming belief that strong, clinical leadership was the make-or-break of clinical commissioning. I think therein lies a real opportunity for the surgical community to address variation in surgical outcomes and, in parallel, how we train surgeons to meet society’s changing needs. We must work towards speaking with a united voice for UK surgery if we are to make real progress on these matters. By working more closely with our sister Colleges and the specialty associations, I believe that we can begin to address these challenges to best effect. It seems that recent intercollegiate agreements might facilitate this.
For example, the imminent launch of Surgeons’ Portfolio provides the membership of all Colleges with a practical tool to assist with the requirements for enhanced appraisal and revalidation. In time, analysis of available data should ultimately provide the Colleges with a powerful means with which to provide further evidence (if it were needed) that better surgical outcomes – and opportunities for our surgical trainees to gain maximum experience in elective specialist and more especially in emergency surgery – are centred around volume, which can only be delivered in centres of excellence. A parallel debate about how the remaining 80% or so of surgical activity (which makes up the bulk of surgical procedures) can best be delivered locally, and at the same time offer the highest standards of ‘general’ care, training and experience, will complete the picture. The signing of an agreement to develop an international Fellowship examination by all four
Presidents at the Joint Surgical Colleges Meeting (JSCM) in Glasgow earlier in the autumn is another example of effective intercollegiate collaboration. Stemming from an initiative led by this College, this paves the way for the introduction of an examination, which will be delivered internationally to the same standard as the present intercollegiate Fellowship.
There is still a considerable amount of work to be done through a new international subcommittee of the JCIE. A pilot diet will be established and subject to scrutiny by JSCM of the business model, which will ensure that there is no cross subsidy from income from the present Intercollegiate Specialty Boards examinations. It is anticipated that this could be delivered late next year, with a full roll-out to follow.
It was clear from a number of meetings I attended in London and in Edinburgh during the year that workforce planning is still fragmented across the four home nations with little, if any, sharing of data, which is at best incomplete and therefore unreliable. The free (and significant) manpower movement between England and Scotland mandates joined up thinking throughout the UK, particularly as the number of training posts available is reduced. Following discussion at the Surgical Forum, we have agreed that we shall work towards collecting data, in order to provide the Colleges with a comprehensive picture of workforce trends UK-wide. This year’s successful pilot of national selection will include selection into Scottish posts next year, so that ultimately we should be able to select aspiring surgeons to posts on the basis of a much more reliable and longer term picture of surgical vacancies across the UK.
The Lister Surgical Skills Competition has been greeted with great enthusiasm by our student affiliate members with almost 1000 applications for the heats which have taken place over the autumn throughout the UK. I look forward to meeting all of the finalists during the Lister Centenary meeting at the College from 9-11 February 2012 (www.lister2012.com).
A similar degree of interest for a career in surgery has also been demonstrated by those attending the College’s Surgical Roadshow, run by the Outreach Section. This gives intending surgeons an insight into careers in any of the surgical specialties, but for those already committed to a surgical career, the oversubscribed Highland Surgical Boot Camps, held in association with NHS Highland over the summer, provided a unique opportunity to gain intensive training through simulation, combined with a true outdoor Highland experience.
Attendant service pressures in a largely target driven service means that training is no longer seen as a priority by many: the reduced time and opportunity available for delivery of surgical training presents us with a challenge to ensure that quality and excellence of delivery of surgical training is recognised and supported. Earlier this year, Council debated this issue – the result was agreement to develop a Faculty of Surgical Trainers. Professor I am grateful to Chris Bulstrode who carried out a considerable amount of the ground work on our behalf, taking the Faculty to its launch: it is apparent from recent road shows that most surgeons involved in training would value the tangible recognition and support which would come through the Faculty. Mr Craig McIlhenny is now leading the pilot programme in Scotland and outlines his proposals for the further development of the Faculty elsewhere in this issue.