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The President Writes - June 2016

College President Michael Lavelle-Jones provides his regular update

"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. More information is available at fpc.rcsed.ac.uk

March also saw publication of the College report on standards of care in rural surgery. I hope this document will be a catalyst for debate in this vital and frequently overlooked area of practice. So often, the needs of metropolitan surgical practice take precedence and it is important that our College takes a lead in this important aspect of surgical care. Continuing the theme of inclusivity, rural practice in the UK is not unique to the Highlands and Islands region of Scotland, but also impacts on the delivery of healthcare in parts of North and Mid Wales, and in England in Devon and Cornwall, for example. In recent weeks, I had the opportunity to meet with the Minister for Health and Social Services in Wales, Mark Drakeford, and the issue of delivering healthcare in the rural community in Wales was high on his agenda. As a College, we look forward to supporting this agenda across the UK in the coming months. By the time this column appears in print, the first of this year’s regional visits will have taken place beginning at Ysbyty Gwynedd in North Wales and coinciding with the Welsh Surgical Society. This event, organised by our local Regional Surgical Adviser, Vaikuntam Srinivasan, will provide a good opportunity to network and will provide further insight into ways the College can assist our surgical membership working in Wales.

The aftermath and aftershock of the imposition of the junior doctors’ contract continues to be felt throughout the UK despite the implementation being limited to our trainees working in England. It has left behind a bitter taste for many and is likely to be the catalyst for many unforeseen consequences aside from escalating industrial action that has the potential to affect us all – not least our patients. I would recommend careful scrutiny of the NHS England New Contract Document published in February and for you to form your own opinion – at least there is some mention of statutory training and education agreements alongside service commitment, unlike the current New Deal. It will take a lot more than a government-commissioned review of long-standing junior doctors’ concerns to heal these wounds and that was the clear message I received from our trainees at this year’s Association of Surgeons in Training conference in Liverpool.

Choosing Wisely and Global Surgery are two emerging themes in world surgery. The Choosing Wisely initiative emerged in the US as a campaign led by the American Board of Internal Medicine. Its simple aim was to address the problem of patients receiving unnecessary investigations and treatment, reasoning that this might lead to poor outcomes and waste in any cash-strapped health system. The Choosing Wisely concept rapidly gained momentum across the US and in Canada, and was predicated on the need for specialty surgical organisations to make five recommendations to prevent overuse of various treatments in their field. Central to this philosophy is the need to improve patient–doctor communications, and to develop a shared understanding of management plans and options.

In the UK, Choosing Wisely has emerged directly and under the banner of ‘prudent practice’ in Wales and in the Scottish ‘realistic medicine’ proposal outlined in Chief Medical Officer Catherine Calderwood’s annual report for 2016. Choosing Wisely was thoroughly debated at the Surgical Forum meeting held under the chairmanship of John MacFie this January, and brought together the views of the UK and Irish Surgical Colleges and the Federation of Surgical Specialty Associations, all of which were represented and in good voice. The consensus view that emerged was that the UK had already moved beyond the concept of ‘top five lists’ of inappropriate treatments and that we would be better served working together to reduce variation in practice across the UK, and that the Colleges and the Specialty Associations should work together to make this a reality.

Finally, in this issue of Surgeons’ News, we revisit Shape of Training (SHoT), taking account of the views of several specialties on the practicalities of implementing this programme. Little seems to have been heard of SHoT in recent months – perhaps a reflection of the pressing issues of junior doctors’ contracts – but I have no doubt that over the coming months, SHoT, mentoring and credentialing will all re-emerge as key topics and I anticipate that our College will play a pivotal part in the debate.

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