The School of Surgery Present and future. Neville Jamieson Head of School of Surgery EoE and Associate Dean

Transcription

1 The School of Surgery Present and future Neville Jamieson Head of School of Surgery EoE and Associate Dean

2 Yogi Berra Predicitions are very hard to make. Especially about the future.

3 What does the Head of School of Surgery actually do?

4 Responsible for Recruitment Centralised via Lead deaneries Delivery of Training Individual programmes and TPD s College Tutors AES s Quality Assurance of Training School visits Trouble Shooting Problem trainees Problem trainers Problem units

5 Millers Pyramid

6 What is the structure of training?

7 East of England

8 Heaven (London)

9 What is the School of Surgery? Responsible for Core and Higher Surgical trainees in East of England (HEE EoE) How many? 50 core trainees per year (100 total) 350 higher trainees (NB approx 100 on London based rotations) Where? Norfolk, Cambridgeshire, Suffolk, Essex, Hertfordshire, Bedfordshire.

10 Which Specialties All surgical specialties except Opthalmology (a separate School) and Paediatric Surgery which is covered by a larger area including London, Oxford and Wessex) Aren t they all different? Yes very much so! What share of the country does HEE EoE represent? On a weighted capitation basis 10%

11 Specialty Numbers Specialty Number of Trainees Cardiothoracic 11 General Surgery 63 Neurosurgery 10 ENT 23 Plastic Surgery 21 Trauma and Orthopaedics 49 Urology 18 OMFS 5 Total including London trainees rotating into region approximately 250 And 100 Core trainees spread across CT1 and CT2

12 ONS population statistics RCS Surgical Workforce report 2011

13 Current Consultants RCS Surgical Workforce report 2011

14 Regional breakdown RCS Surgical Workforce report 2011

15 Medical School the past

16 And now - Harvard

17 Gender breakdown RCS Surgical Workforce report 2011

18 No trainees Trainees - gender Male Female Year of training

19 Specialty interest RCS Surgical Workforce report 2011

20 Academic trainees ACF 3 years 75% Clinical No time penalty?phd 3 years ACL 4 years 50% Clinical possible doubling of training time Should then aim for Surgeon Scientist Award

21 Academic Training Lotus eaters? "I was driven thence by foul winds for a space of 9 days upon the sea, but on the tenth day we reached the land of the Lotus-eaters, who live on a food that comes from a kind of flower. Here we landed to take in fresh water, and our crews got their mid-day meal on the shore near the ships. When they had eaten and drunk I sent two of my company to see what manner of men the people of the place might be, and they had a third man under them. They started at once, and went about among the Lotus-eaters, who did them no hurt, but gave them to eat of the lotus, which was so delicious that those who ate of it left off caring about home, and did not even want to go back and say what had happened to them, but were for staying and munching lotus with the Lotus-eaters without thinking further of their return; nevertheless, though they wept bitterly I forced them back to the ships and made them fast under the benches. Then I told the rest to go on board at once, lest any of them should taste of the lotus and leave off wanting to get home, so they took their places and smote the grey sea with their oars." Homers Oddysey

22 National Selection Now in place for all specialties recruitment co-ordinated nationally usually with a host deanery which is different for each specialty Most specialties recruit after Core at ST3 level. Neurosurgery appoint at ST1 to run through. Cardiothoracic are running a trial of ST1 appointment to improve quality

23 Square pegs for round holes?

24 Manpower who decides?

25 The purpose of this document is to make recommendation to inform planning for future medical training numbers in Trauma and Orthopaedic (T&O) Surgery in England over the next CFWI Orthopaedics Medical Specialty Workforce Summary Sheet Trauma and Orthopaedic Surgery Specialty group: Specialty: Surgery Trauma and Orthopaedic Surgery RECOMMENDATION The CfWI recommends a sustained reduction of 30 NTNs phased over the next three years. This could be done by reducing ten posts a year over the next three years. This will need to be reflected within CST posts to reduce the risk of mismatches between CT2 graduates and ST3 posts. Not all SHAs will need to reduce numbers (for example East Midlands and East of England), based on weighted capitation alone, NHS London is identified for greater reductions. A further review is recommended for Introduction

26 The Professions responses

27 CFWI Weighted Capitation T&O

28 Who is in Charge? Deaneries (LETB s) College/JCST Schools of Surgery HEE CFWI Trusts DOH/Minister National Clinical Director Commisioners/Specialist Commisioners

29 And our trainees love us

30 Core Quality indicators

31 ENT Core Quality Indicators Expectations for us to meet T&O

32 Joint Committee on Surgical Training Guidelines for the award of a CCT in General Surgery These will be applied to all trainees following the 2013 curriculum 1 and applied flexibly to those following earlier curricula. All trainees seeking a CCT in General Surgery must: a) be fully registered with the GMC and have a licence to practise. b) have undertaken 6 years of higher surgical training in a UK or Ireland training programme 2. c) have successfully passed the Intercollegiate Specialty Board examination. d) have been awarded an outcome 6 at a final ARCP (gained all required competencies). The following are required to help demonstrate the required competencies:

33 General surgical procedures Appendix 1 Indicative minimum operation numbers for General Surgery (P+ S-TS + S-TU + T) General - All trainees inguinal hernia 60 cholecystectomy 50 emergency laparotomy* 100 to include: Hartmann s 5 (excl appendicectomy) Segmental colectomy 20 appendicectomy 80 Breast Special Interest breast lump excision 40 mastectomy 50 sentinel node biopsy 70 axillary clearance 45 Colorectal Special Interest anterior resection 30 fistula surgery 20 segmental colectomy 50 haemorrhoidectomy 15 prolapse surgery 4 (some colonic resections should be laparoscopic) UGI Special Interest Major UGI procedures 35 (includes anti-reflux, obesity and upper GI/HPB resection) cholecystectomy 110 (some trainees will choose to focus primarily on benign and others on resectional) Vascular Special Interest AAA repair 15 (including 10 open - elective or emergency) carotid endarterectomy 30 infra-inguinal bypass 60 varicose vein surgery 60 (some AAA repairs should be endovascular)

34 T&O Procedures

35 Three strikes and your out

36 Repatriation When the boundaries of the educational areas (currently LETB s) were redrawn they were geographical rather than reflecting existing training networks Many cross boundary rotations still exist largely London based moving out in adjacent areas. These may all be returned current policy is no cross boundary rotations Watch this space!

37 Future Prospects

38 The future General Practice!

39 HEE mandate for General Practice 50% of trainees leaving Foundation should go into General Practice Does anything matter? Psychiatry Emergency Medicine Not Surgery!

40 The Old Man of Coniston the Grasmere fells..