MINUTES of the Surgery Specialty Training Board Meeting Held in Edinburgh, Westport Room

MINUTES of the Surgery Specialty Training Board meeting held in Edinburgh, Westport Room 6, at 10.30am on the 2nd of July 2013

Present

Dominique Byrne (DB) Chair

John Anderson (JA)

Helen Biggins (HB)

Brian Howieson (BH)

Jen MacKenzie (JMcK)

CalanMathieson (CM) Deputising for Laurence Dunn

AnasNaasan (AN)

Douglas Orr (DO)

Sai Prasad (SP)

Angela Riddell (AR)

Ian Ritchie (IR)

Hamish Simpson (HS)

Rachel Thomas (RT)

By Videoconference

Angus Cain (AC)

Ian Holland (IH)

Ken Walker (KW)

Apologies

Lorna Marson (LM), Rowan Parks (RP), Graham Mackay (GMcK), James Garden (JG), Andrew Renwick (ARW), Graham Haddock (GH), Bill Reid (WR), Alison Howd (AH), Laurence Dunn (LD), (CalanMathieson deputising), Mike Palmer (MP), Richard Buckley (RB), AntheaLints (AL), Alison Graham (AG), Gareth Griffiths (GG).

In attendance

Paola Solar (PS)

1. Welcome and apologies

The group was welcomed to the meeting and the apologies were read. DB apologised for not intimating the apologies at the last meeting.

1. Minutes of meeting held on 18th April 2013

The minutes of the previous meeting were approved.

1. Matters arising
2. North and East General Surgery programmes

DB had not received further communication about the intention to amalgamate the North and East General Surgery programmes. KW reported that after discussions with trainers, trainees, TPDs and Associate Deans, it had been agreed to shelve the idea for the time being. It was felt that, although the idea was good, it would not add much value at the moment. Communication between Deaneries will be kept open and they will work on the movement of trainees, stopping short of a final amalgamation of programmes. It had also been agreed that amalgamation might be re-considered in the future, for example if there were to be further reductions in numbers.

It was noted that NES was supportive of the amalgamation of programmes, especially for the smaller specialties.

• QM – Scottish QM reporting template

DB reported that he had discussed this with Graham Haddock and the Quality Management Team. The matter has been left to the side for the moment while changes to the JCST survey are awaited, including amendment to wording of some of the questions. DB added that the JCST QA group was keen to wait until October to provide data, as this would then allow two full years of survey returns to be analysed.

• Cardiothoracic Surgery – training capacity

The Chair reported that he had discussed this item with Bill Reid, Alan Kirk and SP. The Golden Jubilee only had capacity to accommodate one additional trainee. The specialty is still hopeful of identifying further capacity for one trainee in the South East, as well as finding necessary funding in the location corresponding to any proposed additional training posts. In this connection, SP indicated that in the South East they were waiting for the Medical Director’s approval.

• NES Knowledge Service

Ann Lees had made a request for lists of core learning materials, databases, etc. so that NES Knowledge Services can maintain subscription to these resources. Specialty representatives who had not replied yet but wished to do so should contact Ann on .

1. Recruitment
2. Recruitment 2013 – feedback from specialties

• Cardiothoracic Surgery

SP reported that Cardiothoracic Surgery had made 2 appointments, one at ST1 and one at ST3. There were 22 posts in the UK, but only 15 candidates had been deemed appointable, the remainder of the posts would be filled by LATs. The ST1 trainee appointed to Scotland would come from London to the West Deanery, where he would do an initial rotation of Cardiothoracic Surgery, Critical Care, General Surgery and Plastic Surgery.

There was some discussion about the quality of candidates overall in the UK since only 2/3 of the posts could be filled. It is hoped that for 2014 there will be more applicants to ST1 coming from Core Surgical Training and that the quality of applicant would therefore be higher.

SP noted that there had been some difficulties with the online shortlisting which is based on log books, and it was felt that some candidates should perhaps not have been shortlisted. For example, one Scottish trainee, whose logbook had not been validated, had misrepresented his case numbers and had consequently ranked very highly – this had come to the interviewing panel’s attention as his knowledge level was not in keeping with such a number of procedures. As a result the trainee had resigned his NTN and left the programme. His logbook had been corrected for ARCP. The TPD for CST is aware of this issue which would be discussed at ARCP. The online application form has been amended and clearly states that falsifying information is a serious probity issue which will be referred to the GMC.

DB will write to AH once the ARCP process is completed to enquire whether any action has been deemed necessary in the case above.

Action: DB

AR noted that HR only keeps paperwork for one year and that evidence in situations such as this might be destroyed before it is reported to the GMC if action is not taken timeously.

• ENT

AC gave positive feedback on the first experience of National recruitment in Leeds and, in particular, on the organisation. The process had been very similar to the previous Scottish one, although there had been some fears that Scottish trainees might be at a disadvantage having to travel to England for recruitment.

It had been decided to put only 6 posts for recruitment in 2013 and to retain 3 salaries (1 LAT and 2 AMTFs). They had 5 new NTNs and 1 LAT in the East, and 1 NTN and 2 AMTFs in the West.

• General Surgery

JA indicated that the experience of the selection process had been good. They had interviewed 500 candidates over 10 days. A score of 290 had been set as the threshold for appointability. The candidates were allowed to apply to General Surgery, Vascular Surgery, or both.

The ST3 offers had been accepted very quickly, the LATs less so as many were holding out for other offers, and some applicants had accepted and then withdrawn.

Applicantsscoring 289 or lower were deemed appointableonly to LAS positions. Those higher up on the list got their choice of Deanery and specialty.

The specialty had encountered some difficulties in the offers process due to London and some of the other Deaneries in England having a training year from October to October, rather than August to August. Wishaw would interview for LATs and this process would hopefully resolve the issue for this year by appointing a group of doctors who would cover the short term vacancies.

• Vascular Surgery

DO reported that Vascular recruitment had gone along with that of General Surgery. They had 256 candidates for 26 posts. Scotland had 2 trainees. There had been some discussion about recruiting independently in 2014 but the decision was that Vascular Surgery should combine its recruitment process with that of General Surgery again.

DO highlighted again the possible issue that might occur in the future with trainees in some Deaneries starting in August while others would start in October. This has not been a problem in the past 3 years but might become a serious issue in the future

All new ST3 Vascular Surgery trainees excluding those in Scotland and Wales would start in October. This could potentially result in their employment being interrupted for 2 months; this could in turn have HR implications for the trainee, such as pension contributions, and entitlement to sick leave or maternity leave. Conversely, trainees coming to Scotland or Wales might not be free to take up their post for 2 months with the consequent disruption to the Service. AR noted that the HR Subgroup is looking at the timescale differences between Scotland and England.

DB highlighted the fact that discussions about the possible staggering of changeover dates were taking place outside this group and that the Board may look to the outcome of these discussions for guidance.

• OMFS

IH noted that recruitment had been more successful than previous years, with 17 applicants all appointed to fill the 17 vacancies.

• Paediatric Surgery

DB gave feedback in Graham Haddock’s absence: the single vacancy in Scotland had been filled in National recruitment. There was some concern about continued over-recruitment in this specialty.

• Plastic Surgery

AN reported on what was thought to have been a very successful process. Applicants submit their own score online and then have a face to face interview about probity, before the final interview. Of 154 applicants, 58 were deemed appointable and 32 new NTNs in the UK had been appointed, with 20 LATs overall.

In Scotland they had appointed 8 new trainees and 1 LAT. Only 1 of these would have to start in October, the remainder all starting in August.

• Urology

Mike Palmer was not present, but DB indicated that Scotland had appointed 4 new NTNs in Urology and 3 LATs.

• Neurosurgery

CM reported that recruitment had taken place in Leeds and had successfully appointed 23 trainees, including 3 for Scotland. There had been 263 applicants. CM had been involved in the process and had been impressed by the standard and fairness of the system.

• Ophthalmology

No feedback available.

• Trauma and Orthopaedics

HS indicated that there had been 2 ST3 appointments to the West and none to the East. The outcome of earlier recruitment to ST1 had been described at the previous meeting of the Board.

• Core Surgical Training

DB reported that CST had completed recruitment, with the 10 remaining vacancies from Round 1 being filled during round 2. IH noted the good turnaround and the surprising number of Scots or candidates with a Scottish background in the second round who, for some reason, had not been selected in the first round.

Recruitment at round 2 had also been complete for the remainder of the UK, and this large number of successful applications to Round 2 might reflect the number of trainees who did not apply to round 1. JA suggested that it might be worth investigating this, as interviewing all the candidates at round 1 would avoid the onerous task of a second round of recruitment.

It was noted that there was a proposal for CST to have a single UK recruitment process in 2014;interviews would take place in London over 2 weeks.This would result ina lesserrequirement for Scottish interviewers, going from the current approx. 50 days to an estimated 28 days. This move would need to be approved by the Service and MDET. The main argument against the proposal is the geographical/travel implicationfor many trainees, and perhaps a sense of disenfranchising of some consultants. HS noted that there would be a loss of local knowledge and there wouldn't be individual information about the candidate. It would be fairer to the trainee though, as they could choose from all areas and core rotations.

BH highlighted some concern that trainees may have about the Scottish Referendum and what this might mean for their training. The group felt thatthis was a very important issue and they would need to alleviate the possible worries of candidates thinking about posts in Scotland. Some felt that some English candidates may not even consider coming to Scotland. In this regard, the group noted the START Alliance project that has been put in place to help attract and retain trainees in Scotland.

The Board agreed to support the single recruitment process for CST. DB will convey this to MDET seeking its support.

Action: DB

4.2Recruitment 2014 - future trainee numbers

Paper 2 was a first proposal from the Scottish Government to start discussion about Recruitment numbers for 2014. DB warned that there were some inaccuraciesin the document which would be corrected for later versions.

Paper 3.a (for discussion) was a first draft of the STB proposal for recruitment in 2014. DB noted that the details held by the Scottish Government about projected consultant retirals are very vague, but it was accepted that by age 61, around 50% of consultants are retired.DB had discussed projected numbers with each specialty lead before compiling paper 3.a. and asked the Board for further comments.

• Cardiothoracic Surgery

The proposal is to increase trainee establishment by up to 3 trainees over the next 3 years - they felt that they needed to reach 11, but there is limited training capacity in the system. Sources of possible funding were currently being sought in West and South East where it was hoped that one new training post (each) could be envisaged.

• ENT

The specialty had chosen not to fill 3 NTNs last year; instead, these had been replaced with 1 LAT and 2 AMTFs. The proposal is to return the LATsalary to recruitment in 2014 but to maintain the 2 AMTFs for another year in the first instance, expecting to return these salaries to recruitment in future years when CCT numbers are lower.

• General Surgery

The proposal is to ask for a pause in the reduction (other than the continued transfer of training posts to Vascular Surgery), until the composition of the existing consultant establishment can be analysed in further detail. There was an increasein numbers of consultants who do not take part in Acute care. It was felt that Acute service was likely to require an increased number of Consultants in the next few years.JA informed the Board that he was doing some research into this and that preliminary results confirmed that a substantial proportion of Consultant General Surgeons do not contribute to the General Surgery on-call.

JA informed that some of the trainee numbers werelocated in pure Vascular posts and could therefore also not be included in the General Surgery on-call rota from ST4 onwards. The transfer of posts from General Surgery training programmes to the Vascular surgery programme might not completely rectify this.

KW noted that a further increase in Consultant numbers may be needed due to the impact of any reduction in trainee numbers onGeneral Surgery rotas. The calculations of projected Consultant vacancies are based on the existing numbers, and it is uncertain what will happen when the reductions take effect.HS indicated that Glasgow had been looking into reducing the number of Acute centres. The group noted that this might result in a need for an increase in the Consultant numbers rather than a reduction due to the intensity of the new service.

The Board discussed the potentialservice implications of replacing retiring Consultants with new Consultants who do not contribute to Acuterotas. The Board's suggestion would be that reductions in General Surgery be paused until the consultant numbers and distribution are better understood.

• OMFS

The proposal is to increase trainee establishment by up to 3 over the next 3 years. DB indicated that potential funding had been identified from a "dormant" salary in the West of Scotland, and the possibility of putting an unused Staff Grade salary back into training in Lothian. Attempts were being made to identify other potential sources of funding in North and/or East.

• Paediatric Surgery

The position had not changed -the specialty is aware that it needs to reduce training numbers. Salaries would hopefully be returned to the Service. It was suggested to reduce trainee establishment by 1 or 2 over the next 2 years, the preference being for any reduction to occur in the West before the South East.

• Plastic Surgery

The current trainee establishment is deemed too high by the Scottish Government, suggesting a requirement for 14 rather than the exisiting 31 trainees in programme. AN noted that the CfWI in England had not considered necessaryany reductions and they accounted for 90% of training. AN had brought this up with Paul Padfield, noting the danger of reducing trainee numbers by around 50% and the likely need to replace this with Consultants. The position of Plastic Surgery is that the reduction to 14 would result in collapse of the Service.

There are currently 2 training posts at ST2 level which are thus not included in HST although still included in specialty numbers. The specialty would therefore advise a reduction to 29 at the most, and would ask that salaries be returned to the Service.

DB indicated that it would be useful to have a summary of the anticipated consultant needs for the next 10 years. AN will send it to DB so that he can present the case to Scottish Government.

Action: AN/DB

• Urology

The specialty was fixed at establishment.

• Neurosurgery

The proposal is to increase the trainee establishment by 2-3 over the next 3 years. DB noted that a second "dormant" salary from the West of Scotland was earmarked for potential viring to Neurosurgery. In addition, West and East could look at resources for another 1 or 2 posts from existing service salaries returning to training.

• Ophthalmology

The specialty was fixed at establishment.

• Trauma and Orthopaedics

Consultant Headcount was at 225 but with 8 vacancies. 20 CCTs are anticipated in 2014. The specialty could potentially consider transfer of 4 posts to CST with recruitment to the remaining 16 posts. HS will check with the new TPD in the West about the possibleinclusion of 2 posts at ST3, with the remainder (14) being recruited at ST1.