Sunday 9 October 2016
Sunday 2 October 2016
3rd October 2016
Last Blogspot
This will be the last post from the blogger.com site as after the iOS 10 update it is finally giving up the ghost. I will be experimenting with other sites next week. Sad to see it go, it made it easy for a dinosaur like me to communicate!
See you on https://surgicaltutor.wordpress.com/?p=5
New Doors
New Doors have appeared at the entrance to Theatres. This is to encourage good practice and restrict the flow of unnecessary foot traffic into what should be a clean environment. 
It does mean entering the "long way round in order to leave outdoor shoes in the changing room but in fact there's nothing new about this policy. It's how it was done when I was a registrar here and we all must do everything we can to reduce harm.
If you have to enter through the front doors, overshoes and gowns are hanging up ready for you to use though clearly the size range hasn't catered for Mr Johnson... 
So please heed the notices and give extra time to your trip into theatres to get changed. 
Going to give up here as the site has crashed so many times doing this I am going a little insane.
Definitely more news next week
Sunday 25 September 2016
26th September 2016
Whistleblowing
What do you do if you believe harm has taken place? This week we heard from four experts on their interpretations on Whistleblowing.
Here is the GMC @gmcuk guidance on Whistleblowing:
Amongst the experts which included NCAS, GMC and Cathy Taylor our Industrial Relations Officer from the BMA, was Andrew Rowlands from Capsticks Solicitors.
A letter from Capsticks is never one you want to fall on your desk and Andrew's talk on protections for whistleblowers was sobering listening.
QASH Day
The 6 Quality & Safety half days we have a year contribute in small part to reducing harm and highlighting lessons learned through audit and M&Ms. In addition most surgical specialities @ASPHFT hold multidisciplinary team meetings (MDTs) where upcoming cases can be discussed in order to deliver the best care for patients. Communication and lack there of is cited as the biggest reason for complaints: communication & transparency at MDT level is key and perhaps the risks inherent in blowing the whistle will not need to be taken if an MDT approach is used as routine.
Directorate meetings take place on QASH days and here's a rare shot of most of T&O round one table. Split site working means we often only see each other as we pass on the M25 so it's good to enjoy these rare treats
Forthcoming Attractions
The closing date for Core Surgical Training is in 14 months' time. It's never too early to start Portfolio Preparation and mandatory courses get booked up quickly so now's the time to get on it.
Regional courses are always easier to get places on the dates you want rather than London. Check out:
You'll need BSS, ATLS and CCrISP and that's your three maximum points for courses right there.
Thursday 15 September 2016
19th September 2016
Busy week this one, so here we go...
Laurie has done so much to energise women surgeons to expand their roles, broaden their skill sets and take on leadership roles. She's now driving the Emerging Leaders programme at the College @RCSnews.
Follow my timeline @SurgicalTutor on social media for more encounters with inspiring women at the meeting where our speaker was the brilliantly articulate co-creator of the Women's Equality Party @sanditoksvig 
New Chair of WinS: Prof Farah Bhatti
Even Consultants need a boost these days and on Wednesday I raced out of clinic to get to the Senior Ladies Dinner held on this occasion at the Royal College of Anaesthetists, my mum's old College, in Red Lion Square (Holborn)
This is a gathering organised by Dane Carol Black, once a rheumatologist at the West Mid and now a senior policy advisor on work and health to the British Government. She is also Chair of the Board of the Nuffield Trust, the health policy think-tank.
Some truly astonishing & inspiring women leaders are there, and if I pluck up the nerve, they are so happy to share their advice & experience.
Two of my favourite Surgeons were there too: outgoing Women in Surgery (WinS) Chair Laurie Baxter @baxterlaurie and her successor Professor Farah Bhatti @drFBE
Farah is phenomenal: Consultant Cardiothoracic Surgeon, and Honorary Associate Professor at Swansea University, she was the first female CT consultant in Wales and fourth in the UK. She has delivered a Gresham College lecture at the Science Museum, was highly commended at the Asian Women of Achievement Awards and was one of only 3 surgeons named by the Health Service Journal in its inaugural BME Pioneers list. A force of nature and one of my very favourite people to catch up with at these events.
... and all this on a school night ...
Surgeon of the Week
A big @ASPHFT welcome to Francesca Lirossi who joins us as a Consultant Upper GI & Bariatric Surgeon (here with @humphrey_scott)
Francesca has come to us following research years in Ohio and it the first female general surgeon in this Trust. Can't believe it is 2016 and we're still having 'firsts' like this, but it is terrific to finally break that duck.
RCS Statement on Junior Doctors Contract
Forthcoming Attractions
Women in Surgery Conference 2016
Book now to attend the WinS Meeting on Friday 30th September @RCSnews 
Rates are variable according to grade and a great line-up of speakers is promised.
Surgical Careers Event for Med Students
Weds 19th October @RCSnews 
Good programme includes some Basic Surgical Skills as well as talks from Surgical trainees for a broad insight into a surgical career. A good certificate to add to your portfolio.
Future Orthopaedic Surgeons Conference
Saturday 10th December @RoySocMed: this is aimed at FY doctors and medical students 
Wednesday 7 September 2016
12th September 2016
This week it was business as usual as the September strike week was called off. This has given us time to put plans together for the next one in October where the five days falls across a weekend, but of course the contract roll-out rumbles on.
Away days
On Wednesday I visited Tunbridge Wells Hospital at Pembury for the Mock FRCS (Tr&Orth) exams. 
This is a PFI (private finance initiative) and a lovely light-filled open plan space. Visitors can refer to many TV screens giving airport-style information on the running of the clinics and areas of the hospital are colour-coded and clearly signposted. Lovely. 
The Mocks were organised by Mr Neil Slater @MTWnhs and as always we were grateful for the kind support of the public who allowed themselves to be poked & prodded by registrars of all grades.
Up to Date
Mandatory training is not just for junior doctors, consultants have to do it too. This week I joined a packed room full of healthcare professionals from O&G, Paeds and A&E for Level 3 Child Protection training. 
We listened to Eileen White our Safeguarding Named contact on best practice and heard some harrowing case studies.
Local Negotiating Committee
Friday saw the meeting of the LNC. This is a panel of elected BMA reps drawn from the Consultant body, Speciality & Associate Specialist (SAS) doctors and doctors in training. Together with Cathy Taylor, our BMA Industrial Relations Officer, we meet with representatives from the Board such as (on this occasion) the Deputy Medical Director Dr Imrie, the Deputy HR Director Phil Spivey and Kate Clarke also from Human Resources.
As it is so early in the academic year, junior doctor rep elections haven't happened yet but two volunteers Deborah Aldridge and Ellie James came along to share their thoughts 
We covered topics such as draft Study Leave policies, updates on the STP project (Sustainability & Transformation, with Epsom & RSCH) and our poor showing in the @gmcuk NTS Survey this year. As BMA members we are in dispute about the contract imposition, so we cannot talk about that.
Victoria Derbyshire debated the Junior Doctors' Strike on Wednesday: http://www.bbc.co.uk/programmes/b07tqb3y
Watch and you'll see our own T&O Consultant Ashwin Unnithan making his point: 
Ashwin starts formally in April 2017 but as he's helping us out you may see him around already. Or on the TV.
Forthcoming Attractions
Hurry now to book a place on the @RoySocMed orthopaedic introductory course First Steps on 24th Sept:
This is aimed at Foundation Years and CT1s, and has a great Faculty. 
Sunday 4 September 2016
5th September 2016
Summer's Over
Days are shortening, holidays are over and there's a chill in the air... Industrial action. Not much time to plan this time so it would be so appreciated if you could be as thorough in the run-up to Sept 12th as you were for the other days by preparing ahead as much as possible for safe discharges and making sure action plans are in the notes from the ward rounds.
Guidance on Industrial Action for those who are not junior doctors from @theBMA is found here:
Mind the Rota Gap
I'd like to say a massive thank you to everyone who has supported the wards and rotas by covering the gaps that have become apparent since Induction. In particular those who have helped out on their zero days in T&O: you're all superstars and it shall not go unrecognised.
T&O have at least three posts unfilled and it is inevitable this causes an extra burden. It's no comfort to know this situation is replicated across the country with some units closing their doors altogether. Horton Hospital has closed its maternity for example and more than one A&E is reducing opening hours.
Post-Francis it is heartening to see safe staffing taken appropriately seriously, including here at the former Mid Staffs where paediatrics has been suspended:
Rota gaps are being collated here: http://nhskeyhole.org/rotagaps/
Should the new contract go ahead, it will be the responsibility of the Guardian of Safe Working to collect this data and act on it.
This FREE event on Saturday 15th October @RCSNews is a must if you're an F1 thinking about Surgery as a career:
And Finally ...
In the days before National Selection could send you anywhere, it was not unusual to study, train and finally practice in a relatively contained area. By chance a particular couple of years' intake from (what was then) Charing Cross & Westminster Medical School produced a phenomenal number of orthopaedic surgeons and we have seem to have settled on Frimley, the Rowley Bristow and Royal Surrey to be consultants and have working relationships built up over approaching three decades.
It is therefore with tremendous sadness we learned this week of the passing of our Royal Surrey colleague, Neil Bradley,
one of the biggest personalities in the business. 
Our thoughts are with his family and his @RoyalSurrey colleagues
Thursday 4 August 2016
8th August 2016
And We're Off...
This week we welcomed a new cohort of doctors-in-training. In the surgical specialities we still have our Registrars until the start of October, and this continuity is vital as our new F1s, F2s, GP trainees and our Core Surgical Trainees get settled in.
Wednesday and Thursday were taken up with Trust and Departmental Induction which this year has undergone a revamp in response to previous years' comments. We'll see if we have got any closer to getting it right.
The Role of the Surgical Tutor is (solely) to look after the Core Trainees. This remit does get a bit forgotten sometimes by the powers that be, but this year I'm not going to get drawn in to peripheral issues and I started by bagging some time with all of them together before they got stuck into their placements 
So say a big @ASPHFT hello to (front row) Kamran, Gaj, Mohammed and Theo, (back row) Alex and Kwaku. Ahmed on the end there is one of the Urolgy trust grades.
Thank you to everyone who gave up their time to take part in T&O induction (Kieran Gallagher here helping to reassure in how to get through an on call). It's really helpful for our new colleagues to clap eyes on you, put faces to names and not feel hesitant to ask for your help as they get to grips with a new job.
New Appointment to the Rowley Bristow
I'm delighted to announce the appointment of a Medical Staffing Lisison Officer in T&O. This is a new post as we understand that looking after our doctors-in-training in these challenging times requires dedication.
In the next few weeks we'll be showing our new team member the many different aspects of the department, where our doctors-in-training take part and where their teaching opportunities arise.
It's part of the role to hold a forum for our doctors-in-training so that if there are issues we can deal with them in real time. They will also feed into the Surgical LFG to highlight problems and good practice
Trauma Meeting On The Move Again
As you'll know, the Trauma Meeting is going through an evolutionary process after we outgrew the Rowley Bristow seminar room. The aim is to get the meeting onto Swan Ward to hold a truly multidisciplinary meeting but not even the personal intervention of the Chief Executive @SuzRankin has been able to free up space there - yet. So as an interim step we're moving to Theatres commencing Monday August 8th.
It will be a purely business meeting, primarily addressing handover, with a core group of essential participants and with teaching opportunities kept separate.
Women in Surgery Conference 2016
This conference welcomes all women, from medical students to consultants, with an interest in Surgery. There's a poster competition which if you get in there instantly means a National meeting for your portfolio
"Are YOU Cut Out For It?"
This is the portfolio-boosting competition from @RCSNews for CT2s that I talked about at induction. Keep an eye out for the Regional Heats. I ran it last year so you'll forgive me if I take a step back this year but if Gaj @GajThiru, Mohammed @MohammedDeputy and/or Kamran want to step up and organise it (see link) I will certainly help you.
And Finally...
Anaesthetist of the Week?
Surgeons wouldn't be surgeons without the fantastic teamwork that supports our patients' pathway through theatres so this week in a slight departure from the usual surgical speciality superstars we're celebrating an Anaesthetist
🎉Happy 60th Birthday Jonathan Cooper!🍾👏🏻
Jonathan (seen here with the Small Child) has been a brilliant colleague who was really very kind and supportive to me even as a 4th year T&O registrar. Can't believe he's that old!!
Sunday 31 July 2016
1st August 2016
A Big Welcome
This week @ASPHFT we welcomed brand new doctors to their Induction Week. 
Our Director of Medical Education neonatologist Dr Peter Martin led the introductions supported by the Foundation Programme Directors Vincent O'Neill and Tayo Johnson.
It may seem unnecessarily pessimistic, but early on in the piece I talk to the new doctors on how we can help tackle Bullying and Undermining. It's a bald fact of life that across the NHS as a whole 28% of staff experience undermining from other staff. ASPHFT is no exception as you can see from the 2015 NHS Staff Survey results: 
So if it does seem a bit of a downer I make no apology for spelling out that I'm here to help.
Departmental Induction
Next week sees the turn-around of the vast majority of our junior colleagues. Apart from the Surgical and T&O HSTs who changeover in October, Wednesday will see the arrival of the 2016/17 intake.
Wednesday will be for them spent on Trust Induction which means we should all take this opportunity to be prepared to give our inpatients every support.
I'm looking forward to meeting our new tranche of Core trainees on Thursday when our first action will be a group crash course on how to steer ISCP, the portfolio whose evidence forms the basis of their revalidation.
T&O ARCPs at Stewart House
This week I made my first visit to Stewart House, the new Russell Square home for @HEE_KSS.
Right alongside the brutalism of Senate House (see below), Stewart House has a good set-up for the ARCP process with access to functioning Wifi and big screens so everyone can see what evidence has been uploaded
And Finally...
The afternoon saw the STC meeting where we had feedback from trainees on their experiences in the different Trusts in the region. Lots to digest and discuss, for @ASPHFT at any rate.
HEE KSS has three TPDs in T&O, to cover this enormous territory. Phil Housden from William Harvey (Kent), Sam Hook from Worthing (Sussex) and Matt Solan from Guildford (Surrey) 
Forthcoming Attractions
(Some dates for the diary)
Careers Fairs coming up: first @theBMA's offering
Happy Birthday Mr Michael
Wednesday 20 July 2016
25th July 2016
In Praise of Educational Supervisors
It's that time of year again. The Foundation Programme's winding down, the final core training sign-offs are under way and the registrar ARCPs are looming.
This means Assigned Educational Supervisors are suddenly in high demand. In Surgical specialities, these are full-time consultants with a full-time commitment to patient care in theatres, in clinics and on call. It's also the time of year when holidays feel well deserved so hopefully no-one's left it to the last minute to get their final meetings done.
Most of us have shoehorned training into our working day because we enjoy it. It's a huge buzz to see a junior colleague grab opportunities to progress and along the way teach you stuff you didn't know before. Some specialities don't get any extra time to train, others have a nominal hour a week which is timetabled (to look compliant) in "lunchtimes" (yeah, I know, heard of those)
Well things are changing. From July 2016 the GMC @gmcuk require AESs to show evidence of educational activity as part of their annual appraisal. This is not only evidence of delivering teaching (with feedback and reflection) but also supporting professional development in teaching ie update courses in topics such as 'Supporting the Trainee in Difficulty'.
This means a great deal of additional work (0.25 PAs per trainee looking even more measley now doesn't it) for our AESs and it may not be for everyone anymore. I have asked all my AESs in Surgery to review what's required of them now, and let me know if they want to stand down.
So as you wave goodbye to your placement spare a thought for our committed trainers trying hard to deliver education on top of everything else they do. Unsung heroes they are.
Last weeks of the Job
As July becomes August, it's all too easy to lose track of the current post you're in whilst planning for the next. Try and tidy up: remember what it was you wanted to know when you started and prepare such a handover for your colleague coming after you.
Induction always comes under criticism and thinking about it, it's probably that great absence of Time that's at the bottom of it. Time to get to grips with so much newness, time to absorb new rotas and weekly service plans, time to settle in - it's a luxury we don't have.
Nevertheless Induction is undergoing a revamp but it would be tremendously helpful if you put some thought into, for example, a crib sheet of contact numbers or work-ups for your firm's commonest procedures.
Surgeon of the Week
Haven't done this for a while but was so excited to see Neville Menezes in the building that I had to snap him up. 
Neville flits between us and the Royal Surrey as a hepato-biliary surgeon and is seen here with fellow Upper GI/Bariatric surgeon Shashi Irukulla
Forthcoming Attractions
Those who haven't an Educational Supervision qualification need to shake those tailfeathers & get on the RCP Educators course:
If you don't have a recognised qualification you can't supervise a trainee. This might not sound very exciting but it means you can't be on call with a trainee either. If part of a department has not engaged with the educational process that makes life extraordinarily difficult for service managers planning rosters & the week's schedules.
"Supporting the Underperforming Trainee" another thorny topic that benefits from specific training:
Sunday 10 July 2016
11th July 2016
Surgical LFG
Angela Langwith-Green (in the middle here) our Medical Education Manager has been working tremendously hard to collate responses to the recent LETB visit and help us address issues raised in the GMC NTS Survey. Many of these issues are outwith the control of doctors and are management issues so it was great to put the problems directly to the people who can solve them.
This week saw the Summer Surgical Local Faculty Group meeting. For the first time we were joined by Service Managers from T&O, Urology & Surgery as well as junior doctor representatives, educational supervisors and PGEC staff, for the open part of the meeting.
For example, it was apparent our Service Managers felt the work was covered with few rota gaps as their mark of success was covering the on calls - they had not necessarily appreciated the impact of having daytime shifts uncovered leaving those who were there to do two or three people's work. I have asked them to return to us all rota gaps as this information doesn't seem to be going anywhere and I feel we need a baseline before the Guardian of Safe Wirking starts.
Angela is also heading up a piece of work to restructure Induction across the Trust. Departmental Induction year on year comes under fire in the GMC Survey and the LFG was useful to highlight wide variations in practice across the specialities. Sachin Agrawal and I are dragging everyone with us following the South Thames Foundation School exhaustive model for an Induction programme and whilst all the ground is covered in the Surgical Hanbook available on trustnet, if we don't verbalise it trainees don't feel it's been delivered.
That's all for now...
Short post this week, and out later than usual (apologies) as I am currently on annual leave. This means there'll be no post next week as though I'll be back I'll only have holiday snaps to report back on! Lovely for me, possibly quite dull for you... 😎
Monday 27 June 2016
4th July 2016
New this Week
Changes are afoot in T&O. A new 'MSK' Division has been formed which embraces T&O, Rheumatology, Chronic Pain Services and Therapies. This may sound like a common sense grouping of specialities but it has required for example the wrestling of Rheumatology from Medicine & Pain from Anaesthetics to create a properly MDT approach for the patients.
Part of this evolution is the setting up of governance meetings and we held one this week: the Upper Limb Speciality Review Meeting
This is a rare & welcome opportunity for all the consultants to be in one place at the same time, which otherwise never happens. Never. So it's also a team building experience as well as a review of practice and you see here me, Ioannis Polyzois, Rohit Gupta & Ali Narvani in the historic first-ever photo taken of all of us together.
Guardian of Safe Working
We've discussed in previous posts the importance of this new role and on Thursday 23rd June after open interview, Dr Paul Murray was appointed to this post
Paul is a Consultant Respiratory Physician here @ASPHFT. He has long been engaged in supporting education and we look forward to seeing how he shapes the post of Guardian of Safe Working as it evolves. Congratulations Paul.
New Face on the Block
We welcome back this week Gautham Talewadeker to the post of Locum Upper Limb Consultant
Gautham is helping us out for four months to address the patient pathway. He was last with us as Upper Limb Fellow and rejoins us after a further Fellowship in Canada
#ILookLikeASurgeon
It was lovely to receive a visit this week from Ms Sabahat Gurdezi. 
Sabahat has been a SW Thames T&O trainee and next year will start as an Upper Limb Consultant at East Surrey @sashnhs
Registration has opened for the BMJ Careers Fair October 21/22nd October @bmjcareers. It is FREE & an excellent opportunity to find out about specialities you might not have considered before, as well as a good networking opportunity 
And Finally...
The role of Surgical Tutor is seemingly wide-ranging. This week I was tackled on 'the dispositions required to be a Surgeon' by Year 6 at Wimbledon High School @Juniors_WHS as part of their "Imagine your Futures" afternoon.
Their forensic questioning made me re-appreciate that yes, I do have a really cool job and get to do really cool stuff. You can lose that joy when the management walls seem to close in around you as they did a bit this week, so thank you Year 6 for reminding me what it's all about.
Sunday 26 June 2016
27th June 2016
Not much to report on this week, so I'll keep it brief
Guardian of Safe Working
Interviews were held last Thursday for this post, integral to the success of the Junior Doctors Contract work. Haven't however been successful in discovering who got appointed
EU Referendum
Thursday was a big day for the country all round as the Vote to Remain or Leave got underway. What does the Out vote mean for the NHS? Well certainly not this... 
... as we quickly discovered the pre-election promises were not promises but "possibilities"
It's a concerning time, not only for the thousands of colleagues from the EU but also for any worker whose role had protections established under EU regulations. EWTD is just one but there are numerous rights that will no longer be applicable if membership is waived. As we heard from the Chief Executive Of NHS England @NHSE_Danny:
The implications are far-reaching and I don't think we've scratched the surface of what leaving the EU will mean.
The political earthquake has meant we've lost a great champion in Heidi Alexander who resigned as Shadow Health Secretary @heidi_mp. It is also feasible however that @jeremy_hunt will lose the Health portfolio in the Cabinet of the new PM so swings and roundabouts. Unless he throws his hat in the ring for the top job... then we can all enjoy his style of leadership.
That's all I got this week. Look after each other: it's no fun being perceived as a 'foreigner' in this post-referendum country. Support and value each other as much as we can.
Sunday 19 June 2016
20th June 2016
Busy week again, bit more tiring for some than for others perhaps ...
As we approach the end of the academic year, changes are taking place as part of our efforts to improve the learning environment @ASPHFT.
We've known for some time that we have outgrown the resources available for the Trauma Meeting. After an 18/12 search for a new home we are still no further forward - our goal was to move nearer to Swan and have participation from nursing staff & physiotherapists but a venue cannot be found. We have temporarily set up shop in the Fracture Clinic and whilst this means we can't have a Trauma board & the projector needs to be set up & taken down every day, it does mean there is space, air conditioning and an improved environment 
Let's see if it works.
Core Trainees ARCP
This week I sat on the panel for the ARCPs (Annual Review of Competence Progression), held at St Peter's. We welcomed staff from @HEE_KSS as well as Consultant Panel members from other Trusts to review the 39 CSTs in the region.
Face-to-face meetings are not required for everyone but all trainees do have their ISCPs reviewed closely by the panel. It was a bit disappointing to see just how many have incomplete evidence (Outcome 5): the goalposts are very clearly identified at the start of the year. It has prompted me to ensure that as part of the revamped Trust & Departmental Inductions there will be a (mandatory) CST session with me on Thursday 4th August making sure you can all drive ISCP and I can set up your Global Objectives.
ARCPs were followed by the Core STC Meeting. The timetable for the 2017 Interview process were released
The application window is from 9th November till 1st December 2016.
Another thing discussed was making sure our trainees knew what was desirable in terms of speciality experience to gain points towards HST: 
I think we've accommodated the needs of our new intake, as far as we know. It is easy to clock up the speciality months, esp if you're locumming and before you know it you're penalising yourself.
Forthcoming Attractions
MRCS B results came out on Friday. Congratulations those who were successful. If you weren't, don't lose heart. Talk to your AESs & Surgical Tutors, take stock and try again. And have a look at courses like this @RoySocMed which may help: https://www.rsm.ac.uk/events/events-listing/2015-2016/groups/rsm-professionals/rpg25-mrcs-part-b-revision-course.aspx
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