Dear Richard /Liam
.very interesting indeed.............no easy answers
Cheers
Nia Fraser
----- Original Message -----
From: "Richard Lindley" <rmlindley@...>
To: <paediatricsurgerytrainees@yahoogroups.com>
Sent: Sunday, November 28, 2004 4:30 PM
Subject: [paediatricsurgerytrainees] BAPS ASGBI Meeting 26th Nov - Important




Dear All,

Liam and I have recently attended the BAPS consultant's meeting.

PLEASE READ THIS CAREFULLY - WHAT WAS DISCUSSED WILL AFFECT THE REST
OF
YOUR WORKING LIFE!

The discussion mainly focussed on the impact that Modernising Medical
Careers will have on paediatric surgery in the UK. There were
several
important facts that came out of this.

1. Consultant numbers will expand greatly - another 100 consultants
by
2010. NTN numbers are projected to go from 48-ish at present to 75
by 2007. We should all therefore get jobs, but the way we work will
change. Largely the increase in consultant numbers will be as a
result of the General Surgery of Childhood (GSC - a buzz word you
should all know about: it is the `joinery/groinery' -hernias,
hydroceles, orchidopexies, appendicectomies, laparotomies for
intussusception, malrotation - that actually provide the majority of
our workload already) being done entirely by paediatric surgeons. At
present about 50% of GSC is done by adult general surgeons who had a
very long training. The new style general surgeons DO NOT DO ANY
PAEDIATRIC SURGERY. This means the job that the majority of us do
will be largely GSC. The number of neonates is not increasing - it
is if anything decreasing - so we will not all be able to do these
cases. There may not be enough cases to train everybody to do
everything as at present, and clinical governance will stop people
from doing a single case a year!

2. Modernising medical careers will become a reality. What this
means is still not decided. It probably means 8 years from
graduation at medical school to qualifying as a "consultant"- 2
years foundation, 1 extra year in surgical SHO like jobs then 5years
speciality training. At the end of this the CCT (not CCST) will be
awarded. We will have to work with (and probably supervise) these
people. The nature of the training the these people will get is not
yet decided. Paediatric surgery could end up being split into a
number of different streams: General surgery of childhood, neonatal
surgery, urological surgery, ETC.

3. The Department of Health has declared that from some unspecified
point in 2005, no more CCSTs will be granted, and that we will all
initially get a CCT. This would appear to be a political move to
make CCT equivalent to CCST. This includes people who have been
trained under the old arrangements - and even will catch people like
me [Liam] who have done the old style training and also Urology sub-
specialty training - we will all get a CCT. If in the future CCST is
introduced this means that trainees caught in the transfer might
well be at a huge disadvantage: will I, for example, have to do sub-
specialty training again? Or will I simply not be able to move
consultant jobs as appears to be increasingly happening?

4. How can this happen? Prof Mundy is driving MMC changes in a
Urology model with "CCT'ed" office urologists leading onto a
further "CCST" for a smaller number of people who will be trained
as "Specialist Urological Surgeons". Prof Mundy is now in charge of
the JCHST, and may very well be able to force all specialties into
some version of this. Even he has however been seriously wrong-
footed because the department of health has now said that there will
be no central funds to pay for this CCST training.

5. As a result of all these half-trained consultant paediatric
surgeons, it is envisaged that paediatric surgical units will change:

BAPS has decided to move away from the old "setting standards"
approach (BAPS motto "setting a standard not a monopoly") where
other (mainly adult) surgeons also operate on children to
a "monopoly" approach where only paediatric surgeons will operate on
children. Initially this may be from the age of 5 and less but may
grow
to include all children under 16 years of age.

It was envisaged that this would result in large units of (say) 6
junior consultants who operate on groins and perform
appendicectomies,
sometimes going out to operate in the DGH's (hub and spoke model), 6
senior consultants who can operate on neonates etc and possible one
or
two pre-retirement seniors who will teach, train etc and not
participate
in emergency cover.

A big issue which has not been resolved is how the junior consultants
will have the time and money to undergo further training to allow
them
to do the TOFs etc.

SO, I NEED TO HEAR YOUR VIEWS ON THIS.

I will create a few polls and forums on the Yahoo group - please use
them, join if you are not a member and get others to join too

http://health.groups.yahoo.com/group/paediatricsurgerytrainees/

Let me know by email if you prefer.

I especially want to hear people's views on the move to deprive us of
the CCST. I think we were appointed on the basis that we would
progress
to a CCST given satisfactory performance and have a contractual
agreement to this.

Yours

Richard
Liam








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