|The President writes - March 2012|
|Friday, 24 February 2012|
I want to begin by offering my congratulations to the Editor and his team on becoming ‘Member Magazine of the Year’ at the Scottish Magazine Awards in November. This is a marvelous achievement and represents a significant effort on the part of all who contribute to the continuing success of Surgeons’ News.
I have been aware for sometime of the difficulties that an increasing number of you have in obtaining professional leave in order to carry out work on behalf of the College (examining or training committees, for example) which is in the ‘wider interests of the NHS’. This has always been a difficult area, but in the past employers have generally been supportive and it has been possible to reach a satisfactory compromise between medical directors and clinicians at local level in order to minimise the impact on service . However, as the financial crisis within the NHS deepens, so colleagues have faced increasing barriers to gaining professional leave of any kind, and SPA time in job plans has been increasingly challenged as the NHS strives to maintain its level of service.
The Colleges, through the Academy, have continued to lobby chief medical officers and have asked them to support the profession by highlighting the difficulties clinicians face in gaining to attend both NHS and College or Specialty Association committees which are not directly related to their employer’s interests. Therefore, I was delighted to see the recent letter, signed by all four CMOs, the NHS Medical Director and the Chairman of the GMC, drawing the attention of NHS employers to this important issue and endorsing the benefit of national (including College) work to UK healthcare systems . A copy of the letter is available for download from the members’ area of the website and I hope that you will find this useful in job planning exercises.
Revalidation is no longer an event that ‘will happen next year’. The GMC now expects to ‘introduce revalidation from late 2012’ following a ‘test of readiness’ assessed at the end of the second wave of revalidation pilots taking place currently. The timetable for implementation will be dependent on NHS employers and other healthcare providers ensuring that local systems are in place to support the process. Although the GMC is currently working with its delivery partners to look at the options for implementing revalidation, the precise timing of individual implementation will, according to the latest advice, depend on ‘the state of readiness’ of individual employers.
There is also significant work taking place through the Academy of Medical Royal Colleges’ (AoMRC) revalidation team which, ultimately, will provide advice for appraisers and responsible officers from the Colleges’ perspective, but more importantly, there is ongoing Academy work to develop a system which will provide individuals with consistent generic advice about revalidation. The source of specialty-specific advice will probably remain with the Colleges and Specialty Associations, and consistency within the process for surgeons will be discussed by the Forum Revalidation Group in due course.
In the interim, therefore, I would urge all of you to ensure that you are collecting the required supporting information which will enable you to demonstrate that you are continuing to meet the principles contained in the GMC Framework for appraisal and revalidation. There is already ample guidance on the College, (AoMRC) and the GMC websites, but by far and away the simplest means of ensuring that you have all of the information required for your next appraisal, and any prior appraisals that will form part of your own revalidation cycle, is through using surgeonsportfolio.
This intercollegiate product, which I referred to in July 2011, comprises an e-logbook, familiar to all Fellows in its previous guise as the FHI logbook, and a new e-portfolio which contains a reflective element. If you haven’t already done so, you should register through the College website. After initial registration, access is quick and any information from your former FHI log is transferable across to the new system. There is no charge for Fellows and Members to use surgeonsportfolio and I do hope that this valuable member benefit will do much to ease the resistance felt in some quarters towards this statutory process.
Maintaining a comprehensive record of your CPD and, most importantly, a reflection upon your activities to demonstrate appropriate engagement and learning will be a key part of revalidation so make sure that you review recent appraisal documentation and address any deficiencies in your personal development plan. Surgeonsportfolio has been designed to facilitate this and the CPD section is very user-friendly and intuitive. The Academy has produced a template for all Royal Colleges to follow to determine the standards and requirements for CPD and its various categories. This has become an intercollegiate document for surgeons which will be displayed on the College website in due course, and is a useful resource upon which the collection of CPD will be recommended.
Recently, the Surgical Forum discussed the issue of the need to match training to the future needs of healthcare. The pattern of disease, and indeed its management as a result of earlier detection, is changing and it is important that we have the debate now about how we respond to such changes. That debate has been held within our College and other UK colleges, at a recent meeting of heads of Schools of Surgery as well as the SAC in general surgery, and as a result, agreement on the need for change is gathering momentum.
The key lies in focusing on a more general but still competency-based training, with a CCT awarded at the end of that period, followed by a period of consolidation as a generalist to build up experience of the competencies acquired during training. Thereafter, further subspecialty training would be by competition and where need is identified.
The issue of service affordability, a reduction in the number and availability of surgical trainees, an increasing expectation that patients are treated by a fully-trained surgeon irrespective of the time of day, and inevitable reconfiguration of services throughout the UK, will result in significant changes to the way surgical care is delivered and this will impact further on surgical training. Clearly, different models will apply according to specialty and demand, but the present trend towards earlier subspecialisation will need to be reversed. The challenge of delivering high-quality care to remote or rural populations will also need to be considered as this requires different solutions for both training and service.
The consensus which emerged during the Surgical Forum discussion allows an opportunity for the Colleges and Specialty Associations to play a leading role in shaping the future surgical workforce, and we now need to have a wider debate which extends beyond surgical boundaries to produce a solution which will fit best with societal needs for the next decade and beyond. Agreement among surgeons is key and therefore the Forum supported the proposal that there should be a ‘summit’ immediately prior to its next meeting in Edinburgh. This will enable groups not present at the Forum to express their views in advance of engagement with employers, chief medical officers and the regulator at a meeting in the summer in order to move this matter forward as quickly as possible.
The recent, and justifiable, public anxiety which followed the revelations that poly implant prosthese (PIP) breast implants contained substandard, industrial grade silicone has sparked a wider debate over the paucity of regulation of non-medically qualified individuals carrying out other cosmetic procedures. The development of a regulatory framework to address this issue will take some time but the related, and potentially greater, problem concerning the minimal regulation of Botox and other injectables, many of which are supplied via the internet, could be addressed much more quickly through MHRA (Medicines and Healthcare products Regulatory Agency).
There is an urgent need to ensure that all products used in an industry, which is now worth in excess of £2 billion per year, are subjected to the same rigorous testing and licensing as injectable materials and other implanted devices used by the medical profession in the treatment of a variety of conditions and I have written to Sir Bruce Keogh, the NHS Medical Director who is conducting a review for the Health Secretary on the regulation of the cosmetic surgery industry, requesting that this issue is addressed within his review.