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 

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

Patients' Association: http://www.patients-association.org.uk/wp-content/uploads/2016/02/press-release-imposing-new-junior-doctor-contract2.pdf?platform=hootsuite

Surgical Royal Colleges Joint Statement @RCSnews: 

http://www.rcseng.ac.uk/news/surgical-royal-colleges-joint-statement-on-the-junior-doctors2019-contract?utm_source=&utm_medium=&utm_campaign=#.VryiFqNFCB8

Royal College of Physicians @RCPLondon https://www.rcplondon.ac.uk/news/rcp-deeply-disappointed-breakdown-negotiations-and-imposition-contract

Association of Anaesthetists @AAGBI: http://www.aagbi.org/news/aagbi-response-imposition-england-junior-doctors-contract

RCGP @rcgp: http://www.rcgp.org.uk/news/2016/february/rcgp-response-to-government-decision-to-impose-junior-doctors-contract.aspx

Psychiatry @rcpsych: http://www.rcpsych.ac.uk/mediacentre/pressreleases2016/imposedjnrdoctorscontract.aspx?theme=mobile

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

A summary of the 2016 contract is here: 

http://www.nhsemployers.org/~/media/Employers/Documents/Need%20to%20know/1516%20PO07314%20%20Summary%20JD%20OFFER%20%20Final%20version%20180216.pdf

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

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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

The next event is Saturday 12th March: http://www.rcseng.ac.uk/surgeons/supporting-surgeons/regional/events/trainee-voice-sessions-1/london-and-the-south-east-trainee-voice-session-12-march

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

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.^1, 11
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:

http://www.newstatesman.com/politics/health/2016/01/junior-doctors-arent-just-going-strike-theyre-trying-warn-us

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

https://benhansenhicks.wordpress.com/2016/02/13/my-name-is-sharmila-i-am-an-nhs-whistleblower/

2) Paediatrician Dr David Drew @nhswhistleblowr

http://www.telegraph.co.uk/news/health/9177143/The-toxic-treatment-of-Dr-Drew.html

3) Cardiologist Dr Raj Mattu

http://www.dailymail.co.uk/news/article-3443311/Branded-rapist-daring-NHS-whistleblower-brave-surgeon-sacked-exposing-needless-deaths-smeared-sex-attacker-bosses.html

... 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

http://news.bbc.co.uk/1/hi/health/1384854.stm

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...

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.

1st February 2016

CST Interviews

Surgeons from all over the country have descended on London this week to take part in the Core Surgery National Selection. Over ten days, 1340 junior doctors are interviewed through 3 stations: Portfolio, Management and Clinical. These are run as five 'circuits' across three floors of the Amba Hotel Charing Cross. Each station has two interviewers and an observer who could be a Consultant surgeon (eg the clinical lead for the circuit) or Senior Registrar or a lay observer. 

We start each morning gathered in our circuits to listen to a preparation video where @Humphrey_Scott reiterates the process before taking up our posts for the day. This was Circuit 3&4: 

Great care is taken to standardise the interviews so that every candidate can have the same experience. That was my job this week, as 'clinical lead' for my circuit I sat in on each of the stations, made sure there was no wide discrepancy between marks from the two panellists and checking up on any issues flagged up in the portfolios.

Data Protection

The commonest issue was patient identifiable data. You may think that just means names, but it also means hospital numbers so please check your logbooks. Imagine if, say on your way back from the interviews, you left your portfolio on the train. Your logbook details are then fair game to any passing Daily Mail "journalist" who has the name of the institution, date of procedure, hospital number, age and operation details. It's a very short step to get a name then a front page splash. 

We have to take those pages out and shred them on the spot. Nearly all of you are using elogbook - use the filters to generate anonymised data and summary sheets. Get into the habit, you'll be doing that for every ARCP. 

Thank you cards: black out the names of patients or sadly we will have to take those out and shred them too. As consultants, our entire appraisals @ASPHFT, a whole year's worth of collated data and professional development, can be rejected by the Responsible Officer if a single patient's name is even faintly discernible under the black marker pen (oh yes, he's THAT finnickety) so get used to the process.

There's still a week of interviews to go: good luck to all those candidates. It has been wonderful to see the standard of so many dedicated junior doctors, it's is fantastic to see.

LETB Visit 26th February

Quick update for all those who are on leave or unavailable to attend the Deanery Visit:

Trainees, particularly Urology trainees who have their ARCP in Brighton that day, the Visitors will take email submissions so @unclehester get in touch with me and I will pass on email details. If you're on nights or leave, you can do the same: I know @youngseokcho has already done so, thank you.

Educational supervisors, you can do the same. @HEE_KSS are particularly looking for any areas you've been struggling to develop improvement projects: they would like to help if they can.

Tackling Undermining @ASPHFT

You may know that a couple of years ago I was part of a pilot project with @HEE_KSS led by Dr Kevin Kelleher @fflintstone11 looking at trying to improve the trainee experience. At that time, Obs & Gynae was the speciality with the highest reported incidences of bullying & undermining & @RCObsGyn had initiated a network of champions through the Trusts to address it.

Once the pilot project came to an end I wanted to maintain the spotlight it had cast on addressing challenging behaviours. No one underestimates how hard it is to manage a bully in the department. The perceived easiest option, to sit it out (4 months just flies by, doesn't it?) doesn't help those of us here for the long haul improve the educational environment. And it does nothing for patient safety. 

I was this week alerted by one of our Educational Supervisors, to challenging behaviour exhibited towards a very junior trainee. I cannot ignore this, just as the Educational Supervisor could not ignore it. 

What annoys me is how this behaviour can go unreported and therefore unacknowledged as an issue, and this is what I want to change.

I have completed Datix reports on behalf of the trainee with their consent, withholding their name and I will update them on developments. Once a Datix is done, there is a time frame within which a response is required, but more importantly it is a record, a log of events and as such must be taken seriously.

Please come and tell me, or if not me your Educational Supervisor, if you are not experiencing a healthy working environment. I promise you, you won't be told as I was when I was training to 'put up or shut up'.

And if you're wondering why @DeanMichael1971 is shouting at @hine_jo in the illustrating photo, they very kindly staged a photo story for me for a presentation at last year's "Student & Trainee Voice" - he's a big softy really! 

If you've been following the story of Dr Caroline Tan, http://m.theage.com.au/victoria/surgeon-caroline-tan-breaks-silence-over-sexual-harassment-in-hospitals-20150311-141hfi.html you'll know the Royal Australasian College of Surgeons @RACSurgeons has been forced to act strongly to overthrow the perceived culture of 'an Anglo-Saxon old boys' club' where surgeons have been described as 'eating their young'. And it wasn't  just pale, male surgeons either http://m.smh.com.au/national/senior-monash-surgeon-accused-of-bullying-20150522-gh7oi8.html

We owe it to our colleagues to create the best working environment we can, for better communication, for better team building and ultimately for the safest patient care.

Surgeon of the Week

We have a new arrival in the Rowley Bristow Orthopaedic Unit and a sad goodbye too: say hello to Spinal Surgeon Mr Vish Prasad and farewell to Fracture Clinic's Sr Ann Fletcher 

Vish was with us a Registrar and rejoins us having been a Consultant at Medway Maritime. He's married to @ASPHFT anaesthetic consultant Claire Cunningham.

February 12th is the last day in the Trust for Sr Ann Fletcher. I won't embarrass her here (I'll save that for her leaving party send-off) but there's no doubt she'll leave a massive void in the department.

Forthcoming Attractions

This year's ASiT @ASiTofficial 40th Anniversary Conference is fast upon us: if you haven't booked leave or your place in Liverpool, you still have time

http://www.asit.org/events/conferences/2016

25th January 2016

CST Interviews

Good luck to everyone going up for the CST Interviews over the next two weeks. From all the portfolios I've seen, you have  such good prospects: application numbers mean you have a 2:1 shot. But you're not just aiming to get a post, you're aiming to rank, as high as you can, so you can get the region you want. 

Keep calm, try and engage eye contact just as you would in any conversational situation (always a bit weird when you're talking to someone and they are staring at the wall behind you). And don't  forget to blink (again, weird when people don't). 

Think of your responses as having a beginning, middle & end. Bit like musical phrasing. Monotonous rambling kills interest, much better to have a direction. Practice: asks friends to video you answering a question, it can be illuminating. 

Your portfolios are an amazing record of your hard work and industry. The interviewers have 10 minutes to go through the whole lot. So think of that one thing, or things, you don't want to leave the room without making sure the interviewers have seen. That closed loop audit, that service improvement project you had, that poster presentation: draw it to their attention. Inevitably, things in the back 1/3rd of your portfolio can't get looked at as forensically as the stuff at the front, because of the time pressures. 

#PinkWednesday

We did our bit: thanks @unclehester for roping in passers-by into the spirit of the day, celebrating the part women play in the NHS (and not, as @thesundaytimes published, bringing about its downfall)

LETB Visit 26th February

Surgery, Anaesthetics & Medicine are the subjects of a Deanery Visit (now known as Local Education &Training Board) on Friday February 26th.

This Visit has been triggered by the results of last year's @gmcuk GMC National Trainee Survey. Surgery will be looked at by the Core Surgery Programme Director Miss Elizabeth Sharp @HEKSSspeciality 

All surgical trainees, CST and HSTs will need to be available between 11 and 12 for an informal discussion with Miss Sharp. I will circulate this information to your departments but you should make preparations to be available. This is your opportunity to share what's good or less than good about your training experience @ASPHFT and what might improve it. 

To my dwindling band of Educational Supervisors: it would be tremendously helpful if as many of you as possible could also attend. We all know the hurdles we face finding the time & summoning the energy to train in the current climate - and the acknowledgment, let alone recognition we get for it. Help me make the case for improving the quality and quantity of surgical education @ASPHFT and celebrating the great trainers we have here.

Surgeon Fundraiser of the Week

Max Fax surgeon Alex Creedon is this week sporting half a beard for the Stroke Association @thestrokeassoc 

On Sunday, he had his half shave and will be sporting it for the week so please have a look at his @JustGiving page and support him: 

https://www.justgiving.com/alex-creedon

Forthcoming Attractions

Some interesting events coming up @RoySocMed (including the Trauma Symposium starring @ASPHFT surgeons) and @RCSnews

18th January 2016

Junior Doctors' Strike

Tuesday was the Junior Doctors' Strike @theBMA. Pretty much everyone pulled together to ensure our patients were safe on the day: congratulations to those who took the trouble to plan ahead and reallocate resources.

There were some grumbles: let's not name the one or two who, faced with Fracture Clinic for the first time in a decade, took umbrage - they were by far the minority. I love that Matron Kelly Irvine felt she was "awash" with Consultants & was struggling a little to know what to do with them all. Special mention to @bobpeet1 Chief Operating Officer Bob Peet who took Cathy Parsons @cparsons007 and I seriously when we highlighted potential issues ahead of possible December strike dates and co-ordinated a pragmatic response throughout the hospital.

Lovely feedback from our Admin staff who spent the day liaising with patients about rearranged care. Ronnie Elliott @nannyrons told us every single patient she spoke with expressed support for the junior doctors, which was lovely to hear.

Wednesday and we were back to normal working. I went on an @RCPLondon course held at Frimley Park, hearing about the new GMC requirements for revalidation as an Educational Supervisor.  As with all ARCP/ Appraisal information collection, it's much better done prospectively and a considerable amount of material is required. I came away with the major concern that many Consultants currently in that role may look at the demands the GMC have stipulated ...and wash their hands of it. A topic for our next LFG @humphrey_scott & @jacquelin_joyce: how can I retain our existing AESs? 

There's a long history here of medical education #meded being undervalued & ignored. Making it even harder for my tiny band of committed enthusiasts to stay accredited when their teaching time has already been busted down to squat in aggressive rounds of job-planning, could see really great teachers walk away. Looking forward to your constructive thoughts on retention!

Before I get depressed about educational headaches to come, let's turn to celebrating what we have...

Surgical Trainer of the Year 2016

We have a victor! Despite many juniors having a very elastic definition of a deadline, I have collated all the citations and come out with a 'winner'

This was never going to be about numbers of votes: there would be a mismatch across subspecialties and that couldn't be fair. Instead I looked at quality & depth within the citation, and matched that with my own experience of engaging with the educational process in the Trust

So... *drum roll* ... @ASPHFT Surgical Trainer of the Year 2016 is... Consultant Urologist Bill Dunsmuir *wild applause* 

I'm all about celebrating success: here is part of the citation that won him Top Gun

 

"Mr Dunsmuir is a fantastic trainer, who seems to live and breathe teaching.  Every clinical situation, he makes into a learning opportunity, from theatre, ward rounds and even more difficult situations in A&E.  He is always careful to check a trainee’s experience level and then assists only as much as is necessary.  He is a rare gem of a trainer as he initiates and requests work based assessments at every encounter. Practically, he is full of expert tips that I have found invaluable, and his feedback has always changed my technique for the better.  Even when ‘examining’ in a regional skills competition, he could be spotted teaching candidates wherever possible."

We also have some Highly Commended runners up: Robin Cole, Humphrey Scott and Jon Trickett so bravo to you all, certificates and citations will be on their way to you.

Finally... CST Interviews

If you are attending the CST interviews in a week's time and you haven't already... PLEASE COME AND SEE ME WITH YOUR PORTFOLIO

I can't help you after the event but I think there is lots I can do to help you during. And those I've seen already but required quite a bit of reworking: let me glance over the improved version if you can.

#pinkwednesday #likealadydoc

If you saw that extraordinary article by professional-pundit-despite-having-absolutely-no-knowledge-of-the-subject Dominic Lawson in the Sunday Times this weekend, you'll see that all the ills of the NHS and in particular the origins of the dispute leading to the Junior Doctors Strike lie in the fact that there are too many women in medicine. http://www.thesundaytimes.co.uk/sto/comment/columns/dominiclawson/article1656813.ece

Oh yes indeed, we have been catapulted back to the 1950s. 

Regardless of your gender, wear pink on Wednesday & send a selfie to @thetimes & @thesundaytimes #pinkwednesday. The profession is a better place for having the brightest & best, even if some of them happen to prefer skirts.