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:

https://www.bma.org.uk/news/2016/april/non-junior-doctors-guidance-for-industrial-action

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.

http://www.bbc.co.uk/news/uk-england-oxfordshire-37237302

Post-Francis it is heartening to see safe staffing taken appropriately seriously, including here at the former Mid Staffs where paediatrics has been suspended:

https://www.bma.org.uk/news/2016/august/nhs-trust-suspends-emergency-paediatric-care?imgdoctors=

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.

Forthcoming Attractions

This FREE event on Saturday 15th October @RCSNews is a must if you're an F1 thinking about Surgery as a career:

https://www.eventbrite.co.uk/e/asit-preparing-for-a-career-in-surgery-tickets-26739304981

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

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:

http://www.nhsstaffsurveys.com/Page/1044/Latest-Results/Acute-Trusts-A-to-I/

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