I have received a warm and enthusiastic reception from our UK Fellows and Members during a number of visits that I have undertaken during my term of office. That enthusiasm spreads beyond the visits into a genuine desire to help the College, as I discovered recently when we sought a volunteer to act as an observer on a London-based Committee; we were overwhelmed with offers of support from some 400 Fellows. The visits themselves have literally spanned the length and breadth of the UK, from Plymouth to Aberdeen; Liverpool to Cambridge; covering all of the devolved nations with visits to Belfast, Cardiff and, of course, a number of cities in Scotland.
I have been joined on these visits by the Office-Bearer team: in each case, our Regional Surgical Advisers (RSA) have played a significant part in the success of the visits by acting as local organisers, ensuring that we have been able to meet as many of our local Fellows, trainees and student affiliates as possible.
The format of the meetings has facilitated discussion of hot topics in small groups and we have always come away with a clearer idea of the problems which are causing most concern to our Fellows and Members UK-wide, including, of course, the rapidly-approaching and essential hurdle of revalidation. Thus, the RSA network is effective and growing in influence: it is certainly able to provide us with, and facilitate the distribution of, on-the-ground information about matters which directly affect you.
The rapid expansion of the RSA network, which is now some 60-strong has been one of the success stories of the past three years and I am particularly pleased that so many Fellows across the spectrum of experience and specialties wish to help the College in some way. In addition, our RSAs provided key support during the highly successful medical students’ skills competition, which was a key part of our Lister Centenary celebrations earlier in the year.
I hope that this same network will be there to provide you with similar support for the revalidation process, an activity which will now commence early in 2013. Key individuals in the College, along with Responsible Officers and appraisers, are already undergoing generic training for revalidation. This Academy-based training will then be cascaded down to our RSAs as well as to others within the College by late autumn. Training for those working in the devolved nations will also be given; specialty-specific guidance will also be available through the RSA network and through the College website so that Fellows and Members of this College, wherever they work in the UK, will be able to obtain accurate advice and appropriate support via the College.
Interpretation of variations in performance and the setting of performance and quality indicators in a consistent manner across all surgical specialties is key to advancing the primary objective of analysis of surgical outcomes – the advancement of standards of care.I would also like to take this opportunity to remind you that Surgeons’ Portfolio, an intercollegiate project in which this College has made a significant investment by developing a key component, the e-logbook, is also freely available to Fellows and Members in good standing. Surgeons’ Portfolio comprises highly sophisticated software which will provide you with all of the necessary tools to help with appraisal and, subsequently, revalidation and I would strongly recommend that you make full use of this member benefit.
Another major issue which is receiving increasing scrutiny and debate is the subject of surgical outcomes. Council debated this topic recently when it met with Presidents and Representatives of the Specialty Associations and the Chairs of our own Surgical Specialty Groups. The lively debate which took place suggested that, at present, there are still rather more questions than answers on a subject of increasing significance over the coming months.
The discussion, which spanned methods of identifying outliers, the analysis of variation and factors which pre-dispose to variance, indicated that this is a subject which requires wide input far beyond the College and Specialty Associations at an early opportunity.
Although there was widespread agreement that individual surgeons should be responsible for ensuring the accuracy and contemporary nature of their data, there was much less accord about how data should be recorded and whether currently available systems are fit for purpose. Data transfer and analysis must be seamless and robust and collected only once; this is a topic for early and fundamental debate.
There is, as always, an issue regarding who should pay. Undeniably, there will be many who will wish to see the profession in the shape of the Colleges and Specialty Associations underwrite the significant cost of development of a system. However, accurate data collection takes time and resource, whether or not collection remains the individual responsibility of the clinician concerned, or is delegated to a third party. The cost of software development, data storage and data analysis for use throughout the UK is significant and will require central funding. The priority focus for the Colleges should be the development of standards and the ongoing identification and management of variation of performance, in association with the Specialty Associations. Therefore, engagement with Government agencies and employers is a crucial early step in order to identify funding before significant work is undertaken.
Interpretation of variations in performance and the setting of performance and quality indicators in a consistent manner across all surgical specialties is key to advancing the primary objective of analysis of surgical outcomes – the advancement of standards of care. The importance and relevance of recording and analysing surgical outcomes at individual rather than at team or institutional level also merits further consideration and the usefulness and relevance of the Scottish experience of surgical profiling deserves further discussion in a wider sphere.
Surgical profiling is a collaborative project led by Healthcare Improvement Scotland and the Information Services Division, with support from NHS Boards, the Ancient Royal Colleges and a number of clinical specialty groups. The aim of the project is to encourage improvements in surgical care by making best use of existing Scotland-wide data sources. The surgical profile itself comprises a suite of clinical indicators about the surgical care provided by an NHS board and its hospitals and collected centrally. It is a tool designed to be interpreted and used locally, by those providing surgical care, in order to stimulate reflection on surgical services and, in doing so, to identify opportunities for improving patient care. Four years into the project, it appears to be fulfilling its primary goal of quality improvement by providing clinical teams with the tools to improve patient outcomes.
Council has agreed that variation in surgical outcomes is a topic which will be of major importance in the coming months and the College plans to hold a one-day meeting next March to move this forward on a UK basis.
I have highlighted two areas which I believe will require continuing attention in the next year: this issue of Surgeons’ News also contains the Annual Report, which details several of our other activities in the past year, which are underpinned by our strategic plan. I hope that you will spare the time to read the report: I believe that we have now set the College in the right direction to enable us to continue to grow in these very difficult and fiscally-challenging times within the UK and as a global organisation.
Council will elect a new President in the early part of September and I am confident that when I hand over the baton in mid-November, we shall have moved a considerable way towards completing our strategic objectives which we set as a Council three years ago and that I shall leave the College in good heart, in a position to enable the new President and Council to further consolidate our place as a respected international college of surgery, as well as playing our full part in UK surgical affairs.
Your new President will be installed at the AGM at which I shall have the opportunity to provide further detail of our activities over the last three years. It has been a privilege to have led the College through intercollegiate discussions and to have steered the Surgical Forum towards consensus: I have especially enjoyed the opportunity of meeting so many of you as a
for the College.