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 Our membership numbers continue to increase, reflecting our ongoing activities and effectiveness as a UK and international college. This increase in our membership confirms the relevance of our role as standard-setters and our support for surgeons worldwide. We can achieve this best by working together in partnership with other organisations and, at the same time, ensuring that we are responsive to your needs as our members.
Surgeons Portfolio (www.surgeonsportfolio.org) is an example of what can be achieved by collaboration between the Colleges. This is an e-portfolio and logbook for use by surgeons throughout the UK and Ireland to provide an e-record of activities which will be required for appraisal, now the basis for revalidation. This College has refrained so far from advertising surgeonsportfolio as a member benefit prior to its formal pan-collegiate launch in October but I want to stress that it is presently available for all surgeons in near final form and I would encourage you to sign up for it now, particularly if you are involved in revalidation pilots being conducted anywhere in the UK.
During the course of the past year I have, along with Office Bearers, been able to meet a number of you through a series of meetings which have taken place around the UK. These events would not have happened without the energy and commitment of our Regional Surgical Advisers (RSAs) supported by our maturing Membership and Communications Department and I am grateful to them all for their help. The RSAs have met also with Council Member, Roger Currie, and Vice-President, Ian Ritchie, to discuss how we might develop the programme further in your best interests; I value their unstinting support which is facilitating the growth and success of the programme. There is much more for us to do in this regard but we are now able to understand and respond much better to your needs as we begin to involve members of our specialty groups in the process.
During our now established annual meeting between Specialty Association Presidents, Chairs of Surgical Specialty Groups and Council, we recently spent the day deliberating over a number of issues of mutual interest which would not necessarily be picked up otherwise. For example, we debated the challenges of workplace-based assessment, and delivery and ‘policing’ of CPD. There was recognition, during a discussion on ‘Tomorrow’s surgeons’, voiced by many of those present, that surgical training needs to respond more flexibly to the changing requirements of the NHS and patients.
We must ensure that trainees gain appropriate training and sufficient experience in the management of surgical emergencies before the award of a CCT, as well as gaining sufficient experience in the 80% of surgical procedures that are most commonly performed. This is in direct contrast to the present and increasing trend towards more subspecialisation, and I know what I am suggesting will not immediately be welcomed by those who wish to see an even greater degree of specialisation. However, before you reach for your smart phone to email me, let me qualify my remarks.
Different solutions will be required for different specialties, and it is now time for us to come together to discuss how best to tackle the problems of increased delivery of care by fully-trained surgeons, the reduction in numbers of surgical trainees, and the catalytic effect of financial pressures on long-needed service reconfiguration around emergency care and provision of specialist treatment in those centres capable of delivering high-volume activity.
A move in this direction will require more, not fewer, fully-trained surgeons, particularly for the provision of out-of-hours services. We must also recognise that the activities of the majority of trained surgeons will be centred around delivery of the 80% of procedures that are carried out on a regular basis. At the same time, increasing evidence that improved surgical outcomes are associated with a higher volume of surgical activity will reduce the need for every hospital to be staffed by surgeons who are highly trained in a narrow subspecialty. It may be more logical, therefore, to train to a level of specialisation which reflects that service requirement by the time of the award of the CCT, with a view to subspecialisation later as the needs of the service dictate.
The delivery of subspecialist training to the highest standards (probably through pan UK Fellowships) should remain a function of individual SACs as agents of the JCST. The ultimate responsibility for recognising such training posts and maintaining surgical standards would remain with all four Colleges as at present.
In order to achieve the highest standards of surgical care for patients throughout the UK, we need to review the changing pattern of healthcare delivery. The debate required regarding the direction of surgical training for the next decade is complex and demands discussion by (sub)specialist societies, Specialty Associations, and Colleges across the UK. The discussion should centre around the degree of subspecialisation required to deliver best care, the timing of such training, and the number of surgeons required to deliver care to the highest standards – not simply whether subspecialty training is a universal requirement. The debate should also provide the profession with an opportunity to influence service reconfiguration to increase the ability to deliver care in highly-specialised, high-volume centres, where appropriate.
The opportunity for radical change to the NHS through the NHS reforms has been lost. However, the chance to address workforce challenges and to use these as an opportunity to modify surgical training in order to address the anticipated service needs remains. The Colleges and Specialty Associations have an opportunity through the Surgical Forum of the UK and Ireland to discuss these issues and reflect a common view of the future shape of surgery within the UK to the government in Westminster and in the devolved nations.
David Tolley
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