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The President Writes - September 2017

"High-level outcomes by trainees will be based on a professional global assessment from their trainers and marks a move away from some tick-box exercises that have created concern in the past."

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.

The new curricula contain a shift in emphasis, with measurement of successful progress based on a trainee’s acquisition of skills and knowledge to perform the regular tasks that a consultant might be expected to perform. The achievement of these high-level outcomes by trainees will be based on a professional global assessment from their trainers and marks a move away from some of the tick-box exercises that have created concern in the past. There is no doubt, however, that workplace-based assessments will play a key part in all of this, but the tools themselves will need to be refined.

An emerging favourite may be the concept of Entrustable Professional Activities, where trainees may be judged on their ability to perform an authentic task, such as managing a ward round or running an outpatient clinic. I think we shall hear much more of this type of holistic assessment going forward, and it may be an acceptable bridge between the theory of competency-based training and the reality of clinical practice. Neither of these GMC documents could be described as light reading, but I would commend them to you, whether you are a trainer or a trainee, as a pointer to what lies ahead.

A few weeks ago, I attended the ‘Next steps for STPs’ event hosted by the King’s Fund in London. Any cynicism I may have had regarding the future of sustainability and transformation plans (STPs) was quickly dispelled as I sat among an audience of 180 Trust representatives, CEOs and STP leads drawn from across England. All were there to hear Secretary of State Jeremy Hunt and CEO of NHS England Simon Stevens outline the next steps of the STP project as the initiative moves from planning to implementation.

The event was supported by presentations from three of the best-performing vanguard STPs as exemplars of what can be achieved. Several key themes that had contributed to their success emerged: confidence in the leadership of those organisations; a willingness to embrace change; and a move towards a collaborative approach, especially across the ‘boundaries’ of primary and secondary care.

A key theme was the immediate need to take pressure off secondary care services and there was some evidence that this has been achieved in the more successful STPs, with reduction in A&E attendances and outpatient referrals from primary care. The event coincided, somewhat unexpectedly for the majority of the audience, with the announcement of a £325m capital investment for local projects that will help the NHS to refashion healthcare delivery across 15 areas of England with a promise of more to follow. Clearly, as Stevens put it, “the starting gun has been fired” and I was left with the feeling that STPs must succeed and that, for the moment, this is the only show in town as the NHS in England moves forward.

Our College constantly seeks to make its voice and opinion heard. At the beginning of June, we launched Let’s Remove It, our campaign against bullying and undermining. This initiative, led by our Trainee Representative on Council, Alice Hartley, has caught the mood of the profession – especially our trainees – with possibly the highest level of engagement on social media that the College has achieved. We look forward to working with similar initiatives from BOTA, ASiT, JCST, our sister Colleges in the UK, and with RACS in Australia where much of the momentum originated. Can I ask you all to support this project to achieve its aims?

The recent publication of Improving the Working Environment for Safe Surgical Care draws together the output of several work streams undertaken by our College during the past 12 months. The report, which collates opinion from a wide cross-section of the UK surgical workforce, clearly points to the adverse effects that the breakdown of team structure in the NHS has on morale, communication, training opportunities and stress levels.

I hope that this publication, along with its recommendations, which are detailed further in this edition of Surgeons’ News, will be used as a framework for discussion and improvement in our workplace.

Earlier this year, the College held a stakeholder event with the focus on provision of emergency general surgery – recognising its importance as one of the highest-volume surgical workloads in the UK. The output of this event has now been published jointly as a consensus statement (available on the College website) with ASGBI, the Emergency General Surgery Board and the National Acute Surgery Forum, and defines the provision of emergency surgery and its relation to the surgical disciplines. As a College, we are acutely aware of the concern trainees have regarding tensions between elective and emergency practice as they look towards their own clinical futures, and it is my hope that this position statement will go some way to allaying their fears. More widely, I hope these examples of our ‘College voice’ will provide reassurance that we continue to strive to address issues that are close to the heart of our membership.

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