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.

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

13th June 2016

**ARCP Alert**

The time for end of year sign-offs for our Core Trainees is fast approaching. Please check your inboxes for email from the TPDs highlighting what, if anything, needs to be uploaded in time for Friday 17th June.

Trainers, especially Assigned Educational Supervisors, final meetings will need to be completed as soon as possible.

There have been a couple of new things thrown at us this year which are 'optional' on ISCP but have been made mandatory by HEKSS. These are completion of a 'NOTSS' and topics in Generic Module 10 which I have uploaded to all the portfolios.

The ARCPs are being held at St Peter's @ASPHFT in the PGEC from 8am to 1pm, delightful news for me as it will be a joy to attend the CSTC afterwards (rather than traipse over to Maidstone like we do in January)

I don't think there are any more surprises ahead of the sign-offs but you never know ... 

Guardian Update

This week saw a meeting of the Local Negotiating Committee. This is where elected BMA members (Consultants and Junior Doctor representatives) meet with members of the Hospital Executive.

Dr Jill Pritchard, Consultant in Sexual Health Medicibe, is Chairman of your representative group

Couple of items to mention from the meeting: there have been several applicants for the post of Guardian of Safe Working. This is good news and interviews will be held shortly, at which Junior Doctor representatives will be on the panel and will be able to exercise a veto.

The other item to mention is Diary Carding - another round is due shortly and will largely include Medicine as well as Foundation Surgery.

If you feel you have to stay on past your shift end, you must must must contact your Consultant on call. Must. 

There are great tranches of the Trust with no mobile phone signal. Theatres for example is a particularly awful reception area. If you can't get through to your Consultant, Dr Fluck has instructed that you contact him personally via Switchboard. Seriously. Don't be nervous about it: if you have to stay on, he can help perhaps to allocate more pairs of hands to where you are.

Forthcoming Attractions

The John Hunter Lecture at the RSM @RoySocMed is a free event, and this year the topic is on Trauma Care

https://www.rsm.ac.uk/events/events-listing/2015-2016/groups/public-engagement-programme/peg12-2016-john-hunter-lecture-world-class-trauma-care-lessons-learnt-from-the-military.aspx

Time to think ahead regarding Portfolio Preparation, particularly if you are thinking of applying for Core Training in November. BSS, CCrISP and ATLS are requirements to get the maximum portfolio points on courses. Here are some locally-run courses @RCSnews:

6th June 2016

Weeks with Bank Holidays in are still packed with activity: beginning to wonder what a "day off" might be like...

TPDs Training Day

Last Thursday, College Tutors and Programme Directors from HEKSS gathered in Croydon to hear updates on the curriculum and the changing face of postgraduate education in the current contract climate.

We heard from the Dean, Graeme Dewhurst, on recent GMC evaluations of our region and on the whole we did good. GMC @gmcuk have some specific requirements of us, number one of which is weekend supervision of trainees (already a box ticked in Surgical specialities). Number two is an obsession: banning the use of the term "SHO". No idea why they've got such a bee in their collective bonnet about that one, strikes me there are much higher priorities than that, but what do I know.

GMC Requirements

1. Weekend supervision of trainees

2. Abolition of the term "SHO"

3. Handover - formal time AND location

4. Rota gaps - impinge on clinical supervision of trainees

5. Excessive workloads negative impact on training

6. Feedback from incident reporting

As you can see, the majority of this requires engagement of organisations to make this happen, and will be a focus for the Guardian of Safe Working (see last post)

Appointments Advisory Committee

The following day I shot up the M6 to the very pretty cathedral city of Lichfield, Staffordshire

Not much time to look around, though plenty to see, as I was there as a College Representative for a Consultants Appointnent panel

I have been a representative on behalf of @RCSnews for a couple of years now, and it's a really interesting gig. This is the first time I've done a military one though, and they are set up a little differently

This gave me cause to reflect on the different goalposts the Surgical subspecialties set themselves to benchmark the standard at CCT. Of course I am familiar with the requirements in T&O: x2 closed loop audits, x2 first name publications in good quality journals, specified numbers of index logbook procedures all before you're 'allowed' to sit the Exit exam. 

I gather General Surgical specialities are placing less emphasis on the need to publish and audit, and this made me think - why do we make trainees do it?

Audit is an important pillar of revalidation, so getting into good habits is a reason I suppose but what I think self directed investigations of topics (and that's what most clinical research is) shows curiosity, interest in doing things better, providing best care for patients. 

CVs with no research projects or audit are what I would call 'old style' in other words CVs that would get posts 15-20 years ago. For a Chief Executive, that means employing like-for-like, a younger version of the retiring consultant (but with significantly less experience). Not exactly a winning scenario.

CVs that show some dynamism with service improvement projects, clinical research topics and engagement in self-audit suggests a dynamic appointment, someone who is going to drive the department forward, give added value. Much more appealing.

Anyway, congratulations to former South Thames trainee Jeremy Granville-Chapman @JGC_Ortho on his appointment at Wexham Park Hospital, Frimley Health @frimleyhealth

Surgeon of the Week

We've had an Appointments Panel of our own in T&O this week so it is my pleasure to introduce to you our latest Consultant colleague Mr Josh Jacob

Josh will be a familiar face as he is currently our Lower Limb Fellow and will shortly start with us as an additional Trauma Consultant. 

And finally...

Congratulations to Arshad Khaleel: the Chertsey Ilizarov Course has been formally recognised as an accredited Royal College of Surgeons course. This is no mean feat and demonstrates the quality of training meets the College standards for surgical education & training 

 

23rd May 2016

Guardian of Safe Working

Whilst contract discussions have been underway, even whilst awaiting the new ballot, the JDC has asked Local Negotiating Committees (LNCs) to support the process of recruiting a Guardian of Safe Working.

http://www.nhsemployers.org/~/media/Employers/Documents/Need%20to%20know/Jnr%20Dr%20guardian%20of%20safe%20working%2030%2003.pdf

This role is an important one. Whilst any 'senior person' can apply, it is expected it will be a doctor & someone with sufficient gravitas to gain the confidence of junior & senior doctors and management.

They will be responsible for collating quarterly reports on rota gaps & staffing needs, identifying where excessive hours are being worked and setting up the necessary changes to bring them back to contracted hours. Without breaking the locum cap or spending any extra money.

Fines are levied if a Trust does not resolve the issues and that money gets ploughed back into education & training (so it doesn't leave the Trust).

The Guardian is directly line managed by the Medical Director, but is required to be independent of the management structure. The advert is currently out, carrying an allocated time in the job plan of one session (4 hours a week).

Quality & Safety Half Day 

Thursday afternoon was Educational Half Day, and in T&O it was a really good one.

Our Trauma Fellow Tim Iliopoulos presented some really good work demonstrating benefits of early transfusion (on day of admission) to our NOF patients to improve their outcomes.

 Our ST3 Natasha Morrisey presented an audit that showed patients over 65 years did much better than you'd think with an ilizarov frame & Foundation Drs Rosie & Sophie did an excellent job of clearly presenting the M&Ms.

🎉Congratulations Corner🍾👏🏻

Absolutely delighted to hear the news this week that our Senior Registrar Kieran Gallagher has passed the Exit Exam and can add FRCS (Tr&Orth) to his collection of letters

Kieran has let us viva him to distraction, which I know has startled some of our junior colleagues but that really is how the Exit Exams go: as soon as they ask candidates to sew the answers on a lace pillow in fluffy pink wool with flowers & kittens then we'll take it down a notch. But until then... 

16th May 2016

Final sign offs

Much in demand this week as it's that time of year again: eportfolio provisional sign-offs. It's also the time to really think about what you want to do next. 

With so much uncertainty surrounding the contracts, it is no surprise that many want to wait and see what happens before committing further to a career in medicine. 

More promising is the news that the 5 day 'pause' for renewed negotiations between NHS England & the JDC has been extended into a second week.

http://www.theguardian.com/society/2016/may/13/junior-doctors-and-goverment-extend-contract-talks

Good News

This week AJ Jibawi who has been a locum with us, accepted the substantive appointment as Consultant Vascular Surgeon 

AJ is a regular fixture round the Surgical LFG table and it is good to see his commitment rewarded with this post.

He joins Barun Majumdar & Magdy Moawad (seen above) as the more recent appointments in Vascular Surgery, all of who are fully engaged with training here @ASPHFT.

More Good News

Congratulations also this week to Young-Seok Cho, current a Core Trainee in T&O, who has heard this week that not only was he successful at obtaining a T&O Registrar training number but also securing his first choice Deanery - @HEE_KSS. 

Hopefully that means we'll see him back again in the future, on the registrar rota.

Forthcoming Attractions

Might seem a way off for BOA Congress is coming up fast upon us http://congress.boa.ac.uk/

This year it's in Belfast and you still have a couple of days left for the early bird discounts 

9th May 2016

SCReaM if you want to go faster...

This week I got to play the part ... of a Surgeon. I took part in some simulated operating theatre emergencies as part of the SCReaM Course.

Initially a project between @ASPHFT & @RoyalSurrey, Surrey Crisis Resource Management is an initiative to manage theatre emergencies in a safe, effective team-driven way. Led by anaesthetist Dr Rob Menzies, we got out head mikes on and heard about a ready-reference guide that from July will be available in every theatre.

These guides allow team members to have protocols for all the possible differential diagnoses of for example bradycardia, hypovolaemia, local anaesthetic toxcity and more, without having to keep all the details in your head (and maybe remember them wrong)

We had an awesome sim dummy to work with, who had pulses, lips that went blue, blinking eyes and everything

... all linked up to an iPad anaesthetic machine to give us all heart attacks as it went into VF.

This is a really good initiative: having been in theatre when challenges have occurred before knife got anywhere near skin, this is a staggeringly good way of ensuring there's no panic & no forgotten steps. If you have an opportunity to take part, do. 

Sam Simmonds Meeting

This Friday saw the annual Sam Simmonds Meeting, this year hosted by Brighton & Sussex University Hospitals @BSUH_NHS with Mr Ben Rogers at the helm @BenedictARogers. Each of the Hospital groups that make up the rotation take turns to host what has become a pretty big meeting of around 250 surgeons. We've long outgrown post-grad lecture theatres and this year we met at the Ashdown Park Hotel @AshdownPark in the sunshine 

This event is the only occasion where T&O surgeons, both trainees and consultants, from the South West Thames Orthopaedic rotation can get together. The morning session is made up of Registrar presentations and our own Mr Sohail Yousaf presented his work on civilian traumatic amputations

The afternoon session is made up of invited speakers and this year we heard from the CEO of the British Orthopaedic Association @BritOrthopaedic on the progress of "Getting It Right First Time" (GIRFT). All Trusts are about to receive their second visit to see if they are performing as expected or if they are outliers from the mean. This is hugely important work in standardising care across England & Wales.

We also hold the Consultants' Meeting where we hear about the state of training which continues to be tinged with gloom. There is concern that there will be unfilled posts at CST & HST in August and all Trusts are hoping to attract a smaller & smaller pool of applicants for Trust grade positions.

Good to see women Consultants well represented. Feels like we might be knocking on the door of 10% of the Consultant body of E&W...

Hip Surgeons Ms Kate Gill @RoyalSurrey with Ms Sam Hook @westernsussex

Paediatric Orthopod & BOA Council member Ms Karen Daly @StGeorgesUni, Ms Natasha Morrisey HST @ASPHFT & Hand Surgeon Ms Becky Owens @FrimleyHealth

Hand Surgeon Ms Shamim Umarji @Shami_Umarji @StGeorgesUni coping well being photobombed by Mr Anthony Sakellariou @FrimleyHealth

Forthcoming Attractions

In this section I have previously highlighted courses coming up that may be useful for CPD. This week I want to draw your attention to e-learning.

The L-word ("leadership") has traditionally made my heart sink and my eyes roll but it is a mandatory part of training so I must suppress my cynicism. It is also usually the part of trainees' portfolios that's most likely to have tumbleweed rolling through it so any opportunity to fill that gap should be embraced.

Have a look at this e-learning programme: http://www.e-lfh.org.uk/programmes/leadership-for-clinicians/

It may help you get started and even interested in the subject.