The President Writes
College President Mr Michael Lavelle-Jones provides his regular update on College activities
As I sit down to write today a new year has dawned and Edinburgh and the College are both quiet - perhaps licking their wounds the morning after Hogmanay and the New Year’s celebrations. It seems to me that New Year and those few relatively quiet days in the ‘no mans land’ that lies between Christmas and the turn of the year are a good time to reflect upon the preceding 12 months and to make plans for the forthcoming year.
At the College, events leading up to our Annual General Meeting in November represent the end of our College’s calendar and professional year with newly elected members of Council taking their seats while others demit. This year Pala Rajesh, Consultant Cardiothoracic Surgeon from Birmingham completed his term of office. Pala has made enormous contributions to College life in the UK and the international community, especially in India, Singapore and Hong Kong. I look forward to his continued work with our international portfolio through our Birmingham centre where he will continue to lead on one of our College’s International Fellowship Programmes.
When I arrived in Scotland over 20 years ago I was reminded that summer in Scotland was a ‘retrospective event’, usually judged - somewhat unkindly - on the evidence of two successive days of sunshine. Living in Edinburgh at the College during my presidency has revealed another yardstick by which summer can be judged – the Edinburgh International Festival and the Fringe Festival. The College is situated at the heart of all these activities and provides many venues for Festival events during the month of August. A happy coincidence, as August traditionally is a quiet month for core College and intercollegiate activities when annual leave and vacation time make progress on many fronts frustratingly slow. It does however, provide me with the opportunity to spend time travelling on the College’s behalf. This year was no exception and it was a privilege to spend time in Singapore, Malaysia, Southern India and Sri Lanka.
In Singapore it was my pleasure to welcome 72 new Members and Fellows drawn from more than 10 countries in the ASEAN region to our College at one of our International Diploma ceremonies, many of whom had travelled a considerable distance with their families to attend the event. There is no doubt that, despite the necessary differences in our clinical practices and workplace, membership of the oldest surgical college is a highly valued credential.
When the last edition of Surgeons’ News was published in June, the GMC launched two important documents that will have a significant impact on all of us involved in training and assessment and, most importantly, those in training. The Generic Professional Capabilities (GPC) framework (visit gmc-uk.org for details) mandates how all postgraduate curricula must include training in the broader skills crucial to safe and effective patient care. Among them are communication skills, leadership and patient safety, all of which resonate well with our College’s work on non-operative technical skills and human factors.
Clearly, this GPC framework will be a comfortable fit with the aspirations of Shape of Training. The GPC standards are embedded in the GMC’s new standards for postgraduate curricula, ‘Excellence by Design’. All curricula – and there are 103 of them – will need to meet these standards by 2020. The vanguard specialties implementing these changes are internal medicine and paediatrics, with five of the surgical curricula expected to follow later in 2017.
As I sit down to write this column, spring appears to have finally arrived in Edinburgh, bringing with it, I would like to think, some degree of optimism. While the last three months have been punctuated with the ongoing despair within the NHS, three events that I have been privileged to attend in recent months each give me considerable hope for the future. All relate to the robust health and spirit of undergraduates and early postgraduates contemplating their professional futures.
The Newcastle and Edinburgh surgical societies both held their annual conferences – with not dissimilar themes, focusing on challenges and opportunities of life as a surgeon in the future. The excitement generated by seeing what state-of-the-art surgical practice can bring to an appreciative audience was palpable.
This year sees the College’s close involvement with two significant UK-wide initiatives – citizenAID and the Smoking and Surgery campaign – both of which have far-reaching implications. CitizenAID was developed by civil and military clinicians who are experienced in treating blast and gunshot injuries. The campaign faces up to the need to equip the general public with elementary skills to stem haemorrhage and give life-saving first aid in the aftermath of a multiple-casualty event before the arrival of emergency services.
Launched in January 2017, the citizenAID app had more than 4,000 downloads within two weeks in the UK and a further 1,000 in the US. Hot on the heels of citizenAID is our Smoking and Surgery campaign, undertaken in partnership with the charity Action on Smoking and Health (ASH). The campaign aims to encourage patients to improve their outcomes (and, in some cases, survival prospects) by stopping smoking ahead of surgery, and it has received widespread support from a number of other medical colleges. The campaign cites reduced complication rates, shortened hospital stays and better long-term outcomes in non-smokers. We are also concerned about the impact of smoking on dental practice and have noted increased failure rates following implant surgery for those who continue to smoke.
“The pressures facing the NHS have been clearly highlighted once again, with winter bringing them sharply into focus. This has translated into newspaper headlines and parliamentary debates, but for you, our Fellows and Members, for everyone who works in healthcare, and for our patients, it is more than that, it is our stark reality. As an organisation which represents many thousands of professionals working in the NHS in all four devolved nations, we have been approached on many occasions for our views on these pressures...
“Over the coming weeks I will have the privilege of meeting our membership at a series of RCSEd Forums at which we will be able to discuss and debate not just these pressures, but the future of the NHS as a whole. I hope as many of you as possible will be able to attend but, for those who can’t, I encourage you to contact the College by email or through social media, to share your thoughts and experiences."
"It is your continued membership and support of the College that puts us in the privileged position of leading and representing the surgical and dental professions"
Over the next few months, I will be leading a series of regional events around the UK that will enable representatives of the College to meet with our Fellows, Members and affiliates, as well as all those engaged in healthcare delivery, to discuss the issues affecting our professions. The opportunity to meet with our Members face to face and listen to their views on the challenges and opportunities across surgery is one of the highlights of being President of the College.
The junior doctors voted to reject the new contract, which now looks set to be imposed by government. Stepping aside from the result, this long running and bitter dispute has awakened a long-held view of mine about the appropriateness of the terms ‘junior doctor’ and ‘trainee’, when you consider they encompass all those in training from the moment they leave medical school to a point in time some 10 years later when they embark on their first positions in independent practice. While both terms might be factually accurate, they are somewhat pejorative and probably don’t instil a huge amount of confidence in our patients.
"It will take a lot more than a government-commissioned review of long-standing junior doctors’ concerns to heal these wounds; that was the clear message from trainees at this year’s ASiT conference."
Our College never seems to stand still. On 3 March, we launched the Faculty of Perioperative Care, the culmination of 18 months’ hard work under the careful stewardship of Council Member and Faculty lead Charles Auld. The new Faculty, with its focus on surgical care practitioners, surgical first assistants and all healthcare staff with similar roles, builds on the success of our joint meeting with the Association for Perioperative Practice, held in Birmingham last October. This collaborative event identified the need for educational and professional support for perioperative practitioners, who have a pivotal role in the surgical team. Establishing this Faculty provides clear recognition that we, as surgeons, cannot deliver the service alone. The Faculty will stand alongside our existing four Faculties – Dental Surgery, Pre-hospital Care, Sports and Exercise Medicine, and Surgical Trainers – and is a reminder of the inclusive nature of our College, embracing all aspects of surgical and dental care. I would urge you to help spread the word by telling your wider surgical team about our new Faculty.
"All of us who practise in the devolved nations have a duty to support and protect the NHS."
What a difference a day makes. I think it is true to say that my life has not been the same since I received the call telling me the outcome of the ballot for the presidency. This election differed from those held in previous years in that candidates were subject to a hustings and had the opportunity to present their manifesto for the next three years. This was followed by a fairly robust Q&A session. At times it was challenging to be on the receiving end of the questions, but I would like to think it helped our Council towards an informed decision. I have no doubt that, in some form or another, a hustings will be part of the electoral process for presidents of the future.