21st March 2016

This week I'm heading off to Leeds for the T&O HST National Selection Interviews. These take place in the less than luxurious surroundings of Elland Road with its bizarre statue of Billy Bremner looking like a hottentot with yellow hair (?!) 

Approximately 500 applicants are interviewed for roughly 100 posts: we heard a couple of weeks ago that the number of interview days was being cut from 4 to 3 because fewer applications had been received than anticipated.

There are two reasons to travel the very, very long way: the first is to provide manpower as each of the four stations requires two consultants and around 150 candidates are interviews per day.

The second is to be up-to-date with the format of the interviews so as to better advise our trainees going up for them next time. There are always adjustments year on year and as it's been four years since I last did it, I thought it was time.

This week the voting forms for @theBMA Council elections have dropped on the mat. It was such an enormous document containing mission statements from all the candidates standing for the 18 posts. This one caught my eye... 

It's hard to pick who to vote for do why not vote for the people you know!! It's a start.

How to Improve Morale

Clare Gerada's piece in the BMJ from earlier this month:

http://careers.bmj.com/careers/advice/How_to_improve_junior_doctors%E2%80%99_morale_and_wellbeing?utm_source=Email&utm_medium=Email&utm_campaign=BMJCareers_GPnewsletter&utm_content=morale&utm_term=

The Problems:

• "A lack of team working and continuity of care

• Terrible shifts designed by computers and not fit for humans to work

• Rotations that take no account of a doctor’s personal circumstances

• The inflexibility of run-through training

• A fear of litigation and a blame culture that is endemic in the NHS."

  The Solutions?

  "Restore the places where doctors can meet and learn and reflect together in groups

  • Establish a national leadership and support programme, so that at pinch points in a doctor’s career they can come together and reflect in a safe, residential space

  • Provide lifelong access to careers counselling and rotations that acknowledge that people can change their mind along the way or even just want to take time out and do something differently

  • Provide confidential support and counselling services for all doctors

  • Provide rotas that acknowledge that doctors are human and have personal relationships with others.

  It is also important to recognise that the whole NHS workforce is demoralised and it would be a mistake to focus solely on the problems facing junior doctors."

A Salutory Lesson

If you use Social Media, you must make sure you read the GMC guidance on best practice: http://www.gmc-uk.org/guidance/ethical_guidance/21186.asp 

You may have seen this story in the press: http://www.dailymail.co.uk/news/article-3470910/A-E-doctor-ran-foul-mouthed-Twitter-account-ranted-neurotic-patients-crippling-NHS-bulls-call-outs-posted-string-anti-Islamic-messages.html

This week, the Medical Practitioner Tribunal Service (MPTS) suspended A&E Consultant Dr Christian Solomonides for the inappropriate use of his Twitter account. The full judgement is here, and well worth a read: http://www.mpts-uk.org/static/documents/content/Dr_Christian_Michael_SOLOMONIDES_4_March_2016.pdf

Forthcoming Attractions

Basic Surgical Skills Courses get booked up quickly, and they are an essential requirement for Core Surgical Training posts. The following courses are in @HEE_KSS:

14th March 2016

This week's blog is a bit 'all about me'. Consultants need to take some time too, to recharge the mental batteries, learn new things, be inspired again. It's also good to take even the briefest time-out from the day job to remind yourself what lit the flame in the first place.

Tuesday: Senior Women's Event, RCS

Tuesday, International Women's Day, saw the Senior Women's Event at the College @RCSnews. 'Senior' before anyone gets cheeky, means 'Consultant' or 'Associate Specialist' - not Elderly.

Many of us were early members of WIST: Women in Surgical Training, a group set up by the College in collaboration with the Department of Health in 1991, to encourage women to stay in Surgery & support training options such as flexible, less-than-full-time-training.

Here are surgeons Claire Murphy @leedsmurph, Laurie Baxter @baxterlaurie and Professor Averil Mansfield

By the 2000s I had fallen out of love with WIST (it got a bit cliquey and seemed to have taken a direction that wasn't particularly relevant to me) but more recently rebadged as 'Women in Surgery' and under the inspirational leadership of Laurie Baxter @baxterlaurie there has come a recognition that it's not just the medical students & junior trainees that benefit from support: consultants need it too.

Laurie had organised an amazing programme with phenomenal speakers. This is Liz Ball @Liz_ORiordan.

If you haven't read her blog, go now immediately and do it: http://liz.oriordan.co.uk/ 

Liz is a Breast Surgeon, and last year discovered she had breast cancer. Her unique viewpoint, brilliantly written, is a must-read for healthcare professionals and patients alike.

This is Stella Vig @svig2 Consultant Vascular Surgeon and Surgical Tutor at Croydon University Hospital. 

Stella is a superstar: an active and vocal supporter of Junior Doctors she was among many Consultants who marched against the Contract in October alongside Humphrey Scott & myself. She organised the letter signed by 1000s of Consultants to Jeremy Hunt and she is standing for College Council, so PLEASE VOTE.

I could go on and on about the fabulous awesome women I met and caught up with, the brilliant keynote speech from BBC's Anita Anand @tweeter_anita in the fascinating story of Sophia: Princess, Suffragette, Revolutionary 

... but it will stretch this blog for pages & pages so if you're interested scroll back through my Twitter feed @surgicaltutor. It was a great day.

Wednesday: Junior Doctors Strike

Cold wet weather couldn't dampen their spirits: this time the action was for two days but it hasn't diminished support from our patients and the public who have listened to the arguments and read the facts. Really good to hear all the positive comments from patients in clinic after they'd come past the picket line. No negative comments at all, in case you were wondering.

Friday: Trip to Munich

On Friday after work a group of us Upper Limb surgeons flew over to Munich to the new training facilities purpose built by Arthrex. It will come as no surprise that we're always keen to practice & try out new techniques & products and this cadaveric lab is state of the art 

This leads me on to...

Surgeon of the Week

About time I showcased Consultant Orthopaedic Surgeon Rohit Gupta 

Rohit is the Godfather of Upper Limb Surgery @ASPHFT. He has not only trained & supported all of us who have since joined the Trust but is a national and international trainer, teaching via live surgeries and cadaveric demonstrations.

In Munich, we were joined by Ioannis Polyzois and our Upper Limb Fellow Paolo Consiglieri 

And Finally...

The Department of Health published this document this week:

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/506143/League_Table.pdf

This league table was derived in part from the NHS Staff Surveys published in February so our position (209/230) is not a total surprise. 

I do think it would be constructive to hear your thoughts as to how the culture here could be improved. Consultants inevitably have a different viewpoint as generally it is the Consultants who report issues. If you've not had the response you expected from reporting a problem, and/or suffered consequences yourself, you're discouraged & may not do it again, which is awful for safeguarding patients.

And don't forget, you're moving Trusts & Deaneries every 12-24/12. You'll have experienced different cultures & practices elsewhere & that insight is really helpful. 

You may have come across the phrase 'normalisation of the abnormal" - Consultants in post for years can get inured to poor practice/culture, particularly if they've felt they've failed to make change. They can fool themselves that it's normal to feel ignored or unheard, pointless to raise concerns. This is dangerous.

If you have any thoughts on this I'd love to hear from you via trust email and in complete confidence as you wish.

7th March 2016

This week I'm answering the question...

What goes on at Ashford Hospital?

Plenty, as it happens. If you are thinking about a career in Surgery and you don't spend some time at Ashford, you are really missing out.

Ashford Hospital is where we do our planned surgeries. This is where pretty much all elective Orthopaedics takes place but we are not alone: you'll find Bariatrics, Upper GI, Breast and Eyes. There's no Urology, and none of the headline Vascular stuff but we still have vascular surgeons coming across for their veins & hernias and the odd Colorectal surgeon too.

I ran around theatres on Tuesday to get a snapshot of activity: here's Theatre 4

...getting ready for our team briefing. Mr Chana was in Theatre 2:

where I noticed he'd pinched my trauma specialist Ronald (2nd from left) which is not on Rishi!! Theatre 5 had more than a touch of the Cylons about it as Dean Michael, Josh Jacob & Karthick had their exhaust helmets on in preparation for joint replacement surgery

... before Dean went for an aseptic game of peek-a-boo where's he gone...?

... there he is!

The beauty of Ashford as a working environment is that it is planned. Beds are ring fenced for elective patients, there are no bed meetings or moves, discharges are organised from pre-assessment clinic... It's all very orderly. 

And there is time to teach. 

It's easy for those working here to feel that all the hard work isn't seen. All of the hoopla all of the time is around St Peter's: for example, no Team Briefing from the Board ever takes place here, none of the Grand Rounds or Staff Meetings. I look on that as a good thing though: there's no drama and we don't get distracted from the fun part of the job, looking after patients.

For example, in my clinic room in the Rowley Bristow Unit at St Peter's there is a constant stream of people coming in and out with questions and problems that can't wait. At Ashford, there's none of that and I can really get on with working with the patients & teaching the St George's medical students. It's lovely.

Surgical LFG

This week saw the Spring Meeting of the Surgical Local Faculty Group. We has lots to discuss after our Deanery visit, highlighting what we're doing right and what we could do even better on. 

We heard first from Mark Hinchcliffe @MarkH_work who is heading up the "Be The Change" initiative.

This is the philosophy that small projects can and will generate improvements for patients and staff and how the Trust can support everyone in seeing their ideas through by helping through the blocks. 

We heard from the Trainee reps and had HR present to listen first hand to the issues and we had some robust discussions on how to improve the trainee and trainer experience. 

I am optimistic that the issues for training highlighted by the Deanery visit will be taken notice of and for example job planning for trainers will at last acknowledge the commitment of this terrific bunch of engaged consultants

Forthcoming Attractions

This looks interesting: created and run by Core Trainees @CLF_London and headlined by Oliver Warren, Consultant Colorectal Surgeon @DrOliverWarren