RCSEd Unveils 10 Step Plan for Surgery

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12 Jun 2024

The Royal College of Surgeons of Edinburgh (RCSEd) is the oldest medical Royal College. First incorporated as the Barber Surgeons of Edinburgh in 1505, the College is now one of the world’s largest surgical bodies, with over 32,000 Fellows and Members. As over half of these are based in the UK, we provide professional training and support to a sizeable proportion of the NHS’s surgical workforce.

As our sole aim is to help improve patient care, we work with NHS bodies and policy makers to develop solutions to the problems they face. NHS waiting lists and waiting times are putting unprecedented pressure on patients and clinicians, so we believe our 10-point plan will help address the major problems surgeons are experiencing.

Workforce Planning, Recruitment and Wellbeing

There are currently around 8,750 secondary care vacancies in England and record numbers of experienced medical staff are leaving the NHS or retiring early. Staff are also burnt out with 34% of staff feeling burnt out because of their work.

We are therefore calling for the new government to 1) commit to existing plans to double the number of medical school places and 2) properly fund and deliver the NHS Long Term Workforce Plan. This must be done alongside an equivalent plan for social care to improve the prompt discharge of medically fit patients.

Given the time it takes to train doctors, the ethical recruitment of international medical graduates must continue in the medium term, so we are also calling for 3) 1500 MTI places to be made available each year. This will help overseas doctors develop new skills and competencies and reduce the £10.4bn spent on agency and bank staff in 2022-23.

The surgical workforce also has unacceptable levels of workplace bullying, undermining and sexual misconduct that affects across all grades and specialties. We therefore need 4) a renewed and ongoing system-wide approach to tackle these behaviours wherever they occur.


Health Inequalities

Health inequalities directly influences NHS productivity as patients with later stage diseases and multiple long-term conditions require more resources and staff time to deliver quality care. Overall, an estimated 45% of hospital costs can be attributed to 3% of patients who often have modifiable issues such as unhealthy lifestyles, frailty, and unmanaged co-existing conditions. Moreover, each year around 135,000 on-the-day surgical cancellations take place costing the NHS an estimated £400m annually in lost operating theatre time.

The reasons behind this are manifold, but many patients are not in a suitable state to have surgery on the day of their operation and are at increased risk of surgical complications and prolonged inpatient stay if they go ahead. Additionally, many patients arrive for surgery with modifiable issues such as frailty, unhealthy lifestyles, or unmanaged coexisting conditions.

We therefore support all policies and programmes that improve public health and wellbeing, and tackle health inequalities. In the long term there needs to be 5) increased and sustained investment in public health and prevention, but an immediate action should be to reintroduce the Tobacco and Vapes Bill as well as further tighten restrictions on the amount of sugar added to drinks and food.



Short term productivity gains could be made by properly 6) incentivising and rewarding staff who volunteer to work additional hours, pooling staff across Trusts and “super clinics” to assess patients and perform high volume, low complexity surgery. However, any steps in this direction must be subject to independent oversight, so that no-one is compelled to work additional hours, staff wellbeing is protected, and normal work plans are not compromised.

In the medium term, we also support NHS England’s plans to 7) increase the number of surgical hubs and ringfence beds for elective surgery. This requires a significant increase in the number of surgical and theatre staff, a further expansion of 24/7 diagnostic services and guaranteed training time.

However, such changes will depend on the continued goodwill of a surgical workforce that is already under significant pressure. It is imperative that government works in partnership with the medical professions to systematically improve workplace cultures, such as 8) guaranteeing protected training time for both learners and educators, improving access to less than full time working and the NHS paying trainee’s first-time examination fees up front. Experienced clinicians who have recently retired from NHS practice but have kept their licence to practice should be encouraged to return to work to help provide clinical care, education, and training so we support 9) the continued development of the NHS Emeritus scheme.

Given the parlous condition of many hospitals, there also needs to be a 10) long-term capital programme to ensure there are sufficient operating theatres, beds, and other related infrastructure. We support the NHS Confederation’s estimate that capital funding needs to increase to at least £14.1 billion annually, a £6.4 billion increase from the current level of £7.7 billion if we are to increase productivity and reduce waiting lists. We also expect a full implementation of the New Hospitals Plan that promised forty new hospitals in England by 2030.

We will be working with government, parliamentarians, policy makers and influencers over the coming months to raise these issues and devise practical solutions. For more information, contact us at birmingham@rcsed.ac.uk.

Read the full plan here.

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