|The President writes - June 2012|
|Monday, 28 May 2012|
The invitation from John Duncan to reflect on my time as the Editor of Surgeons’ News highlighted that many of the matters discussed in the earliest issues of the magazine remain relevant to the profession today. Despite the passage of a decade, we are still facing many of the same challenges that we faced as a surgical community in 2002.
The first-ever leading article written by Donald Macleod, the then Vice President, is a prime example. Highlighting the problem of failing morale among surgeons, the piece could just as easily have been written today. The causes – organisational change, loss of clinical autonomy and disagreement between the profession and politicians will be familiar to us all, as will be the proposed solutions – avoidance of repeated changes of policy direction, a supportive workplace environment and professional support and leadership by Colleges.
Perhaps we should not be surprised that the problem still exists during a period which has seen the biggest shake-up that the NHS has ever experienced. Continuing low morale ultimately results in an increase in the number of colleagues seeking early retirement and the requirement for increasing support in relation to stressrelated illness. Given the other distractions and uncertainties surrounding the introduction of revalidation, the future of medical education and the need to reduce NHS spending by an eye-watering sum, it is hardly surprising that low morale in the NHS has become endemic.
"Perhaps we should not be surprised that the problem of low morale still exists during a period which has seen the biggest shake-up that the NHS has ever experienced"
The responsibility for maintaining morale is a shared one between the NHS and professional organisations, and the Colleges can play a major role by acting in unison to provide clear leadership on maintenance of surgical standards, including concerns for the safety of our surgical patients. That leadership is made so much stronger by visible collaboration which also includes the Specialty Associations. Tangible signs of that collaboration have been lacking in recent years, however, the ability to speak with a single voice and to look beyond the present distractions that have occurred during the passing of the Health and Social Care Act to the future needs of our patients and the training of future generations of surgical trainees was amply demonstrated at the Surgical Forum meeting in Edinburgh in April. The mature debate among some 40 representatives from all of the surgical specialties, including trainees and lay members of the Forum, on the future of surgery in these islands resulted in a remarkable display of unity and the opportunity to produce a consensus statement from the Surgical Forum.
It would be inappropriate to share the detail of that agreement before the written document has been rationalised by the Forum but I believe that this is already a clear demonstration of the ability of the Colleges and Specialty Associations to work together and to provide a clear direction to the Westminster and Edinburgh Governments about a way forward which will enable us to provide our patients with the best possible standards of emergency and specialist care.
The most fundamental – and effective – standards that we oversee as colleges relate to patient safety, a matter which should be at the very heart of all that we stand for as a profession. The introduction, for example of the surgical pause and the (mandatory) WHO surgical safety check list are examples of how simple, low cost procedures can be effective in reducing surgical mortality and morbidity. Yet enthusiasm and full compliance with their introduction varies throughout the profession, despite their simplicity.
The onus lies with us individually and collegiately, to lead by example and to encourage our trainees and colleagues to comply fully and support the use of these fundamental tools to maximise the safety of our patients. We need to work with our sister colleges, the Specialty Associations and other professional bodies to deliver an agenda which will improve compliance rates and develop a culture which ensures that the surgical pause and check list become part of the surgical culture is wholeheartedly embraced and led by surgeons as leaders of the surgical team.
I also want to stress the value of the teaching and assessment of NOTTS (non-technical skills) which should become a routine part of training for all who work in an operating theatre environment from the earliest possible stage in their careers. Our joint meetings with the Patient Safety Section of the Royal Society of Medicine have helped raised awareness of NOTTS but we must now work to ensure that their importance is fully recognised as a fundamental part of surgical training and behaviour, by ensuring that they are fully integrated into the ISCP and taught in local surgical training programmes.
If you are unconvinced that morale is falling within the profession, look around at the waning enthusiasm for involvement in surgical training. Many surgeons feel undervalued and under strain as a result of pressure on SPA time for legitimate activities relating to surgical training during job planning with Medical Directors. This short-sighted and, I hope, temporary tactic to squeeze every possible drop of the working week into clinical time contains an inherent danger for the long term as more and more surgeons take the view that participation in training is simply not worth the effort of trying to convince others that training matters. Any reduction in the quality of surgical training will be felt for many years to come through falling standards of patient care, long after the present crisis has passed and it will prove to be very hard to regain lost ground.
It became even more apparent to me recently that we are on the brink of losing the support of countless surgeons – the silent majority who provide mentorship and training to our trainees – when I saw the results of a survey carried out by one of the UK’s major universities. The survey asked some 1500 participants to rank the essential qualities of trainers. I have long forgotten what topped the list of the 20-something priorities which were displayed on a very crowded slide, but what was memorable was the nature of many of the comments made in the free text box, which almost outnumbered the primary responses to the questionnaire.
The comments referred to, for the most part, made for very dismal hearing. Apart from highlighting a significant number of dispirited trainers, many expressed concern that, in addition to pressure from their employers, they feared that they would become further submerged in a quagmire of paper if the GMC’s plans to accredit trainers went ahead.
Although the College will always support initiatives which improve the quality of surgical training, the GMC move to introduce a formal accreditation process to recognise trainers at this stage seems ill-advised, while there are still uncertainties around the detail of the revalidation process – particularly as the process might add a further and unnecessary burden to a (surgical) workforce that is already beleaguered by the ever-increasing bureaucracy that appears to surround our professional lives.
Although we understand the aspirations to improve standards by an accreditation process, there is a risk that a move to introduce this now might have a negative effect on engagement among surgeon trainers and the College stressed this point in our response to the GMC consultation on this issue earlier in the spring. I made the same point when I met senior members of the GMC executive recently and I am hopeful that trainer accreditation will be delayed, or at least simplified, until the structures set out by the Academy for Medical Educators for postgraduate medical education is more widely in place, so that training activities and support for them can be more meaningfully discussed during appraisal.
I also hope that the recognition of named educational supervisors and clinical supervisors in surgery ultimately might be facilitated through membership of the Faculty of Surgical Trainers, which the College is presently piloting in Scotland. This, and other training issues, will be discussed at the Faculty’s inaugural conference to be held in the College on 14 November 2012. The keynote address will be delivered by Professor Richard Reznick, Dean of the Faculty of Health Sciences at Queen’s University Ontario.
Within the College, the considerable work carried out by the Wade Professor of Education, David Smith, and the Vice President, George Youngson, has resulted in some exciting plans to introduce a number of new courses which we believe will be sustainable, relevant and stimulating to the membership at all levels. The appointment of David Sinclair, as the Wade Professor of Anatomy, and partnered by Ian Currie, the Munro Prosector, will result in an exciting new suite of courses to improve anatomical knowledge and technical skills of aspiring surgeons throughout the UK.
As our number of Regional Surgical Advisers passes the 50 mark, the programme of regional visits is set to increase still further in the coming months and I look forward to meeting many of you in various locations throughout the UK.