NHS Education for Scotland

Meeting of the Surgical Specialties Training Board held at 10.30am on Thursday 02 October 2014 in Meeting Rooms 1&2, 2 Central Quay, 89 Hydepark Street, Glasgow

Present: Dominique Byrne (DB) Chair, John Anderson (JA), Helen Biggins (HB), Angus Cain (AC), Jonathan Dearing (JD), Brian Howieson (BH), Ewan Kemp (EK), Douglas Orr (DO), Mike Palmer (MP), Sai Prasad (SP), Kenneth Stewart (KS), Hamish Simpson (HS), Satheesh Yalamarthi (SY).

By Videoconference: Lorna Marson (LM), Rowan Parks (RP), Rachel Thomas (RT)

Apologies: Alison Graham (AG), William Reid (WR), Gareth Griffiths (GG), Laurence Dunn (LD), Kenneth Walker (KW), Ian Holland (IH), Ron Coggins (RC), Ian Ritchie (IR).

1. Welcome and apologies

The group was welcomed to the meeting and they introduced themselves. Ron Coggins, the new TPD for the North of Scotland region and deputising for KW had to give his apologies at the last minute.

The apologies were noted.

The Chair conveyed the group’s thanks to Nick George who has now stepped down from the group, for his support and contribution.

2. Minutes of meeting held on 02 July 2014

The minutes (Paper 1) were approved as a correct record and they will be uploaded on the website.

3. Matters arising

3.1 Remote and Rural Surgical Fellowship

DB noted that the Committee had failed to appoint to this Fellowship, but there was no further update at this stage.

3.2 Shape of Training

The response from the Royal College of Surgeons of England to the Shape of Training was presented (Paper 2). This was distinct from the joint response of the Forum of Surgeons which had been discussed at the last STB meeting. The RCS response highlighted the accent on improving the quality of training through increased protected time for trainers’ and trainees’ educational activities. The RCS response also suggested that there was no need for curricular change. There was a proposal for a themed early years’ surgical training, which would start at FY2.

This paper was presented only for information.

It was noted that although Ophthalmology had not been involved in these responses, the training committee had been invited to participate in the discussion.

The UK-wide implementation group led by Mr Ian Finlay had resulted in the formation of 6 workstreams, each of which had met over the course of September 2014. The groups are expected to report back and the feedback will be cascaded.

3.3 Scottish Medical Careers Fair 20 September 2014

The first Scottish Medical Careers Fair had taken place successfully, with a very large number of delegates. The Chair thanked the participants for their contribution to the success of the event.

3.4 SAMSAC and Academic

Professor Garden’s report has been submitted to SAMSAC, including comments from the STB.

3.5 Update on Academic Surgery in Scotland

Professor Garden is still working with NES to identify trainees working in academic streams.

3.6 Cessation of routine BMJ Advertising of Scottish medical vacancies

DB reported that he had sought clarification about this with the GGC Board and had been sent the distributed papers (Papers 3a&3b). The decision had been reached centrally not to routinely advertise in the BMJ due to the high costs involved and the comparatively low return. This approach had been tried for 6 months since December 2013 and although there is no report yet, the trial has given enough evidence to support this decision.

DB highlighted that this does not mean an absolute refusal to advertise in the BMJ, but rather not doing so as a matter of routine. There is an acknowledgement that exceptions may have to be made for small or difficult to fill specialties, and Specialty Recruitment Leads should consider making the case for posts which they feel would merit this exceptional approach.

It was noted that an AMTF had failed to attract any applicants when advertised on the website and not in BMJ, but when subsequently readvertised, this time in the BMJ, had obtained a much better response. RP noted that this evidence should be collected and submitted to StART via Alastair McLellan.

3.7 Core LAS appointments

There was no information as yet on the portfolios of recent appointees to Core LAS posts.

3.8 Proposal for AMTF Plastic Surgery

KS reported that the proposal to create AMTFs combining Plastic Surgery with Orthopaedics (for Hand Surgery AMTF) and Breast Surgery had received encouraging replies. The proposal would be to split the Plastic Surgery salary released from disestablishment of a post 50/50 and to match this with contributions from the other two specialties. KS will keep the Board informed.

3.9 Single Scottish Deanery

The first newsletter of the Single Scottish Deanery had been distributed to the group (Paper 4). The main items covered were Shape of Training and Recognition of Trainers. There were meetings arranged to look at a uniform approach to Training Management and Quality Management. Regular updates will be sent.

There are currently no significant changes to trainees and how they are managed. Potential opportunities for flexibility will become apparent.

JA noted that the General Surgery SAC had written to Professor Reid (WR) seeking support for the proposal to rotate trainees between the regions in order to make the most of the training opportunities available throughout the country. He had not received a reply yet. The feeling of the STB in discussion was that if the 4 General Surgery Directors were in agreement, there might be the possibility of arranging mutually beneficial swaps for pairs or groups of trainees. This would effectively require a request for OOPT which would need the PG Deans’ approval in each case.

RP pointed out that as a single deanery, trainees moving within Scotland would be under Scotland’s Inter Regional Transfer system, not under the UK’s IDT. This is different from a swap as it means a one way transfer for the remaining of the programme, under special circumstances. PS will circulate the new IRT policy to the STB for information.

Action: PS

If there was a real desire to create a single programme allowing movement of trainees between regions, t was suggested that a combined statement and proposal from the 4 General Surgery Programme Directors could be prepared. This would ultimately have to be submitted to the GMC via MDET for recognition of a combined training programme. RP noted that this would be looked at for all specialties and QM will have to look at programmes across all 4 regions.

3.10 JCST Simulation

The minutes of the last meeting had been circulated for information. DB highlighted that there is now free access to the North West Simulation Education Network resources. The link to it is on the paper distributed.

Items 4 and 5 Recruitment 2014 and recruitment 2015 respectively) were combined for discussion

4. Recruitment 2014

Report from Core Surgery Recruitment 2014 was discussed together with Recruitment 2015.

4.1 SY reported that 12 CST vacancies had not been filled at National Recruitment and that they had subsequently been filled by LAS appointments for one year. These 12 LAS posts would return to recruitment for 2015. Discussions were under way to address the issue of the imbalance which would be created by having such a surplus to the expected annual number of Core vacancies. The favoured option would be to put a number of vacancies equivalent to half of the total Core Surgery establishment into national recruitment as 2-year Core rotations, and to transform the 12 LAS posts into LATs next year. DB had presented this option to MDET, who had been concerned about holding back posts from recruitment.

There were 96 CST placements this year: 48 CT2, 36 CT1 and 12 LAS. Next year there will be only 36 CT2, and if the 12 LAS go into national recruitment, there would potentially be 60 CT1 which would be very difficult to manage, while trying to create attractive rotations for trainees. The current proposal would instead allow for the admission of 48 new recruits to CT1 with the result that the following year the 36 vacancies created by CT2 finishers would be supplemented by the 12 LAT posts to allow recruitment of another cohort of 48 CT1s. There remains some doubt about the likelihood of filling all vacancies at National Recruitment although the expectations at CSNRO are that fill rates should be higher in 2015 than in 2014 due to a revision of the appointability score.

SY will send an email in a few weeks to all specialties to see how they can contribute to make the 2-year rotation more flexible and attractive for recruitment.

RP pointed out that not filling the posts was a common theme in all Core programmes. Attrition levels sit at around 20-25% every year for core programmes. This is one of the reasons why MDET is concerned about holding back recruitment numbers.

NES is not accountable for LAS posts, therefore there is potential for losing the funding if vacancies are repeatedly filled with LAS appointments. DB added that if an allowance was made for trainees who required additional training time after CT2, the number of posts for discussion would be less than 12. RP indicated the likelihood that MDET would be supportive of this proposal if the number of posts being held back for LAS posts for next year were lower, say 6.

It was noted that the reason for recruiting to LAS rather than LAT posts this year was the failure to secure the support of a HR department willing to run a Scottish second round of LAT recruitment. RP recommended that the Board flag this up with Fiona Muchet in order to secure the appropriate support for 2015 recruitment if this should prove necessary after Round 1.

DB was also investigating the possibility of securing the support of CSNRO for recruitment to 1-year LAT positions at Round 1. RP recommended that both sources of support could be sought at this stage, accepting that in the event that recruitment was complete after Round 1 it would be a simple matter to withdraw from a Scottish Round 2 at that point.

DB will approach Fiona Muchet on behalf of the STB to request HR support for a Scottish Round 2 for LAT recruitment and would also pursue the option of entering the Scottish LAT posts into Round 1 National recruitment with CSNRO’s support.

Action: DB

4.2 Report from Specialties (except Core)

Recruitment 2014 was discussed together with Recruitment 2015.

Recruitment 2014 and 2015

· Cardiothoracic

SP reported that there had been 2 vacancies filled through the 2014 selection process held in Wessex, with both candidates appointed to Scotland at ST3 level.

There will be 2 vacancies for the February 2015 recruitment: one CCT replacement and one resignation from the programme.

· General Surgery

JA reported that 508 applicants had been interviewed resulting in 168 appointments to ST and 93 LAT appointments. 4 vacancies remained at the end of the recruitment process.

There is a planning meeting in London in a few weeks for 2015 recruitment. Now that the glidepath has stopped there will be no losses of General Surgery training posts.

· Vascular Surgery

DO reported that 2014 Recruitment had run successfully along with General Surgery. There were 20 posts nationally of which 2 were based in Scotland. The specialty will continue to undertake its recruitment in combination with General Surgery.

DO then presented the subject highlighted in Paper 7.

There might be an issue for 2015 due to the new Vascular curriculum. General Surgery ST trainees with a special interest in Vascular Surgery whose expected CCT date falls after 31 December 2018 will be well advised to move to the new Vascular training programme which includes Vascular Surgery. However, those General Surgery ST trainees with a special interest in Vascular Surgery who were appointed to their NTN or Academic NTN before 01 January 2013 and whose expected CCT date falls after 31 December 2018 will have to move to the new Vascular training programme if they wish to specialise in Vascular Surgery. Alternatively, they can opt to remain in General Surgery but in doing so would have to adopt the 2013 curriculum. Only 4 trainees in Scotland are in this position. There is no issue with capacity but their transfer might be destabilising for the General Surgery programmes. The four trainees will have to decide before the end of December whether they wish to move to the new Vascular programme or remain in General Surgery, in which case they would have to move to the 2013 Curriculum. DO felt that 3 of them were likely to ask to move to the Vascular programme and their salaries would therefore be transferred. There is also one military trainee, whose salary is not NES; in effect this therefore suggests that there may be no need to recruit to any Vascular NTNs for Scotland in 2015, and only to recruit to one single NTN in 2016, in order to parallel the planned annual recycling of 2 posts from General Surgery to the Vascular programme.

The total number of trainees between General Surgery and Vascular Surgery will remain the same. RP confirmed that MDET will accept the trainees’ preference. Funding for the posts will need to remain badged as General Surgery but can be moved to the Vascular programme for the remaining duration of the trainees’ training before then being formally transferred to Vascular Surgery for reappointment. This will need cooperation between the TPDs in General and Vascular Surgery to ensure that the posts are clearly identified.