Tuesday 23 February 2016

28th February 2016

LETB Visit

This week saw our LETB @HEE_KSS visit. Surgery, Medicine & Anaesthetics/ICM were being assessed and I'd like to thank all the trainees & trainers who came along to share their thoughts with the visiting team.

It was one of those rare opportunities where I get to see all my CSTs in one spot (bar Seok who was on nights)
L=>R Dan, Aphiwat, Kamran, Asad & Sophie
It was also a chance to catch up with fellow trainers, another rare event which highlights to me how much we work in our own little silos with hardly any interaction between the directorates. 
We made the most of it and of course we'll have a full debrief next week at the Surgical LFG but I can give you the main points here.

Surgery on the whole came out ok, generating a supportive training environment. General Surgery did good from the trainees, feeling well supported with good handover. T&O had highlighted the situation the on call consultants are in, either being off site during that on call day and/or off site the following morning at Ashford, & this was queried by the visiting team as not best practice. This ties in with uncertainty from the visitors over whether all the patients have a consultant review every day - ironically the weekend is the time they are most likely to have a consultant review within 24 hours whereas weekdays with elective pressures that may not be the case. Probably not what Jeremy Hunt would expect to hear.

The 50% reduction in Educational Half Days was also brought up as a negative as was the lack of training time allocated in consultant job planning. The biggest message was the weight of service provision at the expense of education and a perceived disconnect between service & education 'at senior board and divisional level'.

I'm really grateful to everyone to came to give their views and help us improve the training environment here. A full report I believe has gone to the Chief Executive, who I think has to provide a response in five days. I have video of the Surgery part of the feedback (saved me making notes!) which I'll show at LFG on Thursday.

Mind the Rota Gap


On Weds March 2nd I'm going to take a snapshot of medical staffing in Surgery for the 24hrs. I want to know how many substantive posts we have and how many locums/gaps. I'll repeat this in April, after the Locum Cap comes fully into action, to see if we have an increase in gaps. The Cap is intended to block locum earning at 55% above the substantive rate. In practice this means a reduction of ~£10 an hour.

I would love to know the data in other specialities. If you can help with that, that would be great. It is a fairly political audit, but an audit with a closed loop in a month nonetheless so come and talk to me.

There is a perception on social media that with the cap the same across the board locums will prefer the less busy specialities leaving gaps in eg A&E harder to fill. 

Already there is anecdotal evidence of Cap-busting rates on offer. I saw one Trust is offering £60 per hour for FY2 cover. True market forces in action, you could say.

Follow the hashtag #mindtherotagap for news on gaps emerging all over the place and how other Trusts are responding to the crisis. For example Addenbrookes has closed its books to new cardiology referrals as they have insufficient doctors to treat the ones on their books in a timely fashion.

NHS Staff Survey 2015

Results of the survey done at the end of last year are now out:

Tutors of the Week

The best bit about Friday was that I got to meet and brainstorm with @jbbince Dr Jackie Ince, College Tutor in Medicine, seen here with Tayo Johnson, Foundation Programme  Director
It could be quite dangerous if we meet more often as we fired loads of ideas off each other and made great plans to change the world. 

And finally...

You may remember late last year @ASPHFT hosted the Regional Heat of "Are You Cut Out For It?" the surgical skills competition for @RCSnews the Royal College of Surgeons (England). The two we judged to be the best that night, Ana & Jen, were in the Finals at the College on Saturday where they were Runners Up! Very proud of them both 

Sunday 21 February 2016

22nd February 2016

This week I met with Ace Thindal @athindal who is part of the team rolling out electronic medical records @ASPHFT @Your_eMR


We're used to a paperless working environment in the private sector, so this system feels very comfortable but of course on a completely different scale. It was a great opportunity to play around with the system and have some tiny input into making it even more friendly to work with. 

Responses to Contract Imposition

The general drift has been negative regarding the Health Secretary's decision to impose a contract. I have collated a few responses here


Surgical Royal Colleges Joint Statement @RCSnews: 





... and my personal favourite, BOA @BritOrthopaedic: http://www.boa.ac.uk/latest-news/boa-statement/

A summary of the 2016 contract is here: 


Surgeon of the Week

Meet Orthopaedic Associate Specialist Alastair Cameron-Smith, seen here with Theatre Practitioner Sabina Khadka: 


Alastair has been a fixture at @ASPHFT since his SHO days at the old Ashford Hospital. Alastair has always welcomed trainees to his operating theatre & last year received a Highly Commended runner-up certificate in the 2014 Surgical Trainer of the Year Award. He is also a qualified pilot.

Forthcoming Attractions

Trainee Voice Sessions

RCS @RCSnews is developing a programme of Trainee Voice Sessions to run alongside its current Regional Events Programme. Sessions will be held across the UK either as part of existing events or as stand alone session. These sessions aim to help us:

  • Understand the concerns of junior doctors and their experience of training and their work environment.
  • Improve the quality of surgical training and support surgical trainees throughout the process.
  • Continue to support trainees and how vital they are to the NHS. We believe the Government should do more to value their professionalism

This Saturday it's the RCP Medical Careers Day. This is a good opportunity to see what's out there that might grab your interest https://www.rcplondon.ac.uk/events/rcp-medical-careers-day?platform=hootsuite


Sunday 14 February 2016

15th February 2016

An introspective post this week: it has been a rather depressing week not only nationally but locally and this page is the upshot...

I am grateful to Dr Alice O'Neill, @alicerawding, for drawing the first topic to my attention 

Whistle-blowing 

We should do it, right? We are obligated to speak up if we see unsafe practice or patients at risk, aren't we?

In Domain 2 of "Good Medical Practice" the GMC @gmcuk highlights the need to respond to risks to safety:

  1. 24. You must promote and encourage a culture that allows all staff to raise concerns openly and safely.111
  2. 25. You must take prompt action if you think that patient safety, dignity or comfort is or may be seriously compromised.

Read the story of Dr Chris Day, @drcmday, and then have a long hard think:


This is actually a question we ask at Core Surgery Interviews: what would you do if the next doctor on shift doesn't turn up? Never imagined it would have this result in real life.

Juniors doctors have vanishingly little protection, despite the laudable efforts of Sir Robert Francis and every single thing we learned from the Mid Staffs episode. In fact, as Hunt is hellbent on destroying all safeguards in his imposed contract, junior doctors are now temporary workers with few rights, 'Guardian' or no.

And if that doesn't make you pause, here are some more (in)famous whistleblowing cases:
1) Radiology Manager Sharmila Chowdhury @sharmilaxx
2) Paediatrician Dr David Drew @nhswhistleblowr
3) Cardiologist Dr Raj Mattu
... and 4) the granddaddy of them all, Dr Steve Bolsin, @SteveBolsin, the anaesthetist whose simple audit  blew the whistle on paediatric heart surgery in Bristol in 1995

Makes terrible reading, doesn't it. I expect we all think that if we were faced with an untenable position, we would all speak up, safe in the knowledge that we would be protected by that loudly trumpeted "Whistleblowers Policy". Unfortunately we are learning that that Policy can readily be thrown out of the window and it is making for a very unhappy department.

I wonder if we'll find out just how unhappy when the embargo is lifted on the 2015 Staff Survey and it gets published in 23rd February. 


I always fill mine out, even though I'm aware it is a futile gesture. The majority of the returns I understand are filled out by non-clinical staff: there is a misconception that because the surveys are bar-coded responses can be traced back to the writer but that is not the case. At least, the things I've written have never come back to bite me. And obviously nothing has changed either.

The bar-codes are to allow Picker to chase up non-responders but it does have the effect in hierarchical clinical structures of putting people off or at the very least being guarded with their responses.

Junior Doctors' Contract


Hunt was always going to impose this, wasn't he. No matter what agreements Sir David Dalton made with @theBMA. Quite certain it will fail its Equality Impact Assessment as it is outrageously unfair to anyone on career breaks (eg maternity leave) but the enormous message it sends out about the disposability of the workforce is horrifying. Thank goodness he's commissioning an Enquiry into Junior Doctor Morale. How else will we have a clue as to why 54,000 educated intelligent people are unhappy (?!)

Goodbye of the Week

Sr Fletcher @12dargue wanted to steal away with little fuss after 29 years of NHS service. Ha ha. 
Obligatory departmental tea party followed by the much more traditionally Orthopaedic wake in the pub...







Sunday 7 February 2016

8th February 2016

Apologies for the short post this week but, for a change, it seems I've just done the regular job. And spent time with the family, doing those things that all too often get shelved for work activities. So this week no added extras, no bolted-on meetings or educational stuff, I just came in, did the clinics, ran the lists, went home. Rare.

Industrial Action

This photo from Saturday's Junior Doctors March is reproduced without comment:

This week we have the second Junior Doctors' Strike, on Wednesday for 24 hours. This will take the same format as the first one, with emergency work still covered. Learning from the first strike I can see the Trust has worked out a bit better what needs deferring and what can go ahead: many more patients will find they are unaffected by the action as day surgery and clinics go ahead as booked.

Surgical LFG March 3rd

The 4 monthly LFG is coming up soon. Please get in contact with your reps Sophie Wrigley & Holly Ni Raghallaigh  with topics or issues you'd like discussed. You might feel that you are all being frequently interrogated this month. Not only do we have our LETB Visit but also an RCS Flying Squad descended looking into the impact on training of having Physicians' Associates on the wards - and of course we're about to go into another cycle of the GMC NTS Survey.

It's all part of making sure the training experience is right for you: it's just unfortunate timing that it is all happening at once. Hope you don't get into questionnaire fatigue: apathy especially in the GMC Survey will not treat us kindly.

Surgeon of the Week

Time for the legendary T&O magician Mr David Elliott. Known for his ability to instantly materialise in any part of the hospital without seeming to move, Mr Elliott is a Trauma God.
Take a moment to hear him talk, on any topic but especially the principles of fracture management and suddenly the scales fall from your eyes.