NHS Education for Scotland
Meeting of the Surgical Specialties Training Board held at 10.30am on Wednesday 7 January 2015 in Meeting Room 5, 2 Central Quay, 89 Hydepark Street, Glasgow
Present: Dominique Byrne (DB) Chair, John Anderson (JA), Helen Biggins (HB), Angus Cain (AC), Jonathan Dearing (JD), Tracey Gillies (TG), Gareth Griffiths (GG), Douglas Orr (DO) part meeting, Ian Holland (IH), Mike Palmer (MP), Rowan Parks (RP), William Reid (WR), Andrew Renwick (AR), Ian Ritchie (IR) part meeting, Hamish Simpson (HS), Satheesh Yalamarthi (SY).
By Videoconference: Aberdeen (1) – Gillian Needham (GN); Aberdeen (2) – Chris Driver; Edinburgh (1) –-James Garden (JG); Edinburgh (2) – Anne Dickson (AD), Kenneth Stewart (KS); Inverness –
Kenneth Walker (KW).
In attendance: David Arnot (DA), Helen McIntosh (HM).
Apologies: Alison Graham (AG), Brian Howieson (BH), Lorna Marson (LM), Sai Prasad (SP), Rachel Thomas (RT).
Action1. / Welcome and apologies
The Chair welcomed all to the meeting and in particular:
· Dr Tracey Gillies, SAMD representative, attending her first meeting.
· Dr David Arnot, Clinical Leadership Fellow working with the Scottish Government on modelling workforce supply and demand, observing today’s meeting.
· Professor Kenneth Walker, now Simulation representative.
· Professor Gillian Needham, interim North of Scotland representative.
The Chair also congratulated Mr Gareth Griffiths on his appointment as ISCP Surgical Director and he will represent ISCP on the STB. His appointment has resulted in a vacancy in representation for East of Scotland and a replacement was awaited.
The Chair noted that Mr Laurence Dunn has demitted office and confirmation of a replacement Neurosurgery representative was awaited.
Apologies were noted.
2. / Minutes of meeting held on2 October 2014
The following amendments were noted:
Page 1, List of apologies, to add ‘Ian Ritchie (IR)’.
Page 5, Item 4.2, second paragraph, second sentence to read ‘…whose expected CCT date falls after 31 December 2018 will be well advised to move to the new Vascular training programme …’
Page 7, Item 7.2, General Surgery update, second paragraph, first sentence to read ‘…the new guidelines for the indicative numbers of …’
Addendum to item to read ‘The statement was being reviewed.’
With these amendments the minutes were accepted as a correct record of the meeting and will be posted on the NES website.
3. / Matters arising
3.1 / HR support for 2nd round Core recruitment
Formal HR support has been secured for a 2nd round of recruitment to Core Surgery in Scotland if required.
3.2 / Trauma & Orthopaedics recruitment
Jackie Sutherland has confirmed she will provide HR support for T & O recruitment.
3.3
3.4
3.5 / Inter Regional Transfer (IRT) policy
The policy has been circulated and it was noted that conditions were clearly described and similar to that of IDT while the process differed slightly.
Transfer of Vascular trainees to the new Vascular Curriculum
DO drew the Board’s attention to a modification of the statement on the date by which General Surgery trainees with an interest in Vascular Surgery would have to declare their intention to transfer to the new Vascular Curriculum. This date has now been amended from 31 December 2014 to 28 February 2015.
SAC Guidelines on indicative numbers of procedures
GG indicated that the earlier statement on the need for relevant procedures to have been undertaken only within the six formal years of specialty training was currently being reviewed.
4.
4.1 / Single Scottish Deanery
Medical Educational Leads (MELs)
RP confirmed much work has been taking place on processes since the move to the single Deanery model and some changes to administrative staff roles. The STB role was being developed in relation to Training and Quality Management and each allocated a senior Medical Education Lead (MEL); Professor Reid remained the MEL allocated to this STB. The aim was to achieve single system working and consistency across Scotland and will result over time in changes in the various reporting lines. The main driver for this work was the GMC visit in 2017 when NES will demonstrate single system processes were in place or that it was working towards this. WR added that much operational detail was still to evolve for some aspects and that there will be crucial work coming to the STB to ensure standard/equivalent experience for trainees across Scotland. Regional teams will continue to look after the trainees in their regions and it would be good practice during the transitional period to ensure that communications are circulated to both the regional team and the Scotland-wide team allowing overlap of the old and new systems.
4.2 / Flexibility
JA raised the issue of flexibility in trainee distribution across programmes. Some specialties offered Scotland-wide national programmes while others delivered training programmes on a regional basis. Some regions were unable to provide all training and the new IRT process did not take account of the potentially beneficial movement of trainees between regions for training/career aspirations ( eg Transplantation Surgery). At present the PG Deans discussed any such requests received. DB said it was not always possible to provide all possible subspecialty training preferences within single programmes, most notably in the specialties which are registered with GMC as 4 regional programmes, since the service is not configured in that way; one possible solution would be for 4 regional programmes to apply to become a single programme. JA also noted that a recent request for an exchange between Cambridge and South East Scotland would be badged as an OOP period for the Scottish trainee involved; he also noted the recent suggestion that STs could only apply for one OOP period within the period of their training and that exchanges such as this one therefore imposed significant restrictions on trainees’ training. WR confirmed that while the Gold Guide states that trainees should normally only have one OOP period (and this guidance has largely been followed), Deans do have some latitude to allow additional OOP opportunities. OOP arrangements were currently the subject discussion designed to allow the development of a process which would not stifle opportunities. It was likely that OOP might ultimately become a post-CCT opportunity, but in the meantime requests for OOP submitted with appropriate TPD support and a clear identification of career opportunity were likely to be approved if feasible. He stressed the need for an honest assessment of the career prospects of applicants. AD said there should me more options available within the single Deanery to add new geographical placements to programmes subject to GMC approval.
5. / Overseas Advanced Medical Training Fellowships
The chair introduced this Scottish Government initiative. Six applications from surgical specialties had been received and circulated to the STB. The STB was asked to judge these but not to rank them and to provide NES with its view on whether it supported each application or not.
· Application 1 – Colorectal Surgery at Western General Hospital, Edinburgh;
· Application 2 – Transplant Surgery at Royal Infirmary of Edinburgh;
· Application 3 – Pelvic Floor Surgery at Ninewells Hospital.
JA considered that each post offered educational value and that their creation would not jeopardise current trainees. In terms of bringing benefit to current training, he acknowledged that this would be provided indirectly by increasing (or maintaining) the pool of doctors on a given rota and that the greater benefit would be to the service. However, he felt that all three posts and in particular the Pelvic Floor post could potentially have been useful for post-CCT UK trainees; JA queried whether funding could be an issue.
· Application 4 – Head and Neck Cancer Ablative and Reconstructive Surgery at St John’s Hospital.
IH confirmed the educational value of the post There would be no detriment to existing trainees and he could anticipate a benefit to them as the presence of a senior Fellow could release trainers to work more closely with junior trainees and provide greater flexibility.
· Application 5 – Plastic and Reconstructive Surgery within NHS Lothian.
KS confirmed educational benefit of this proposed Fellowship which would provide experience in various areas of Plastic and Reconstructive Surgery (eg breast-oncoplastic/hand/paediatric burns). They would not specify in advance what the appointed Fellow would do but would instead focus on the individuals’ area of interest. They were in the process of appointing 2 new consultants and so would have an increased number of educational opportunities; there would also be benefit to existing trainees and to the programme in general as a result of cross fertilisation of ideas from across the world. Interest had apparently been noted from Australia/North America. On-call experience would also be improved.
· Application 6 – Vascular and Endovascular Surgery at Ninewells and Victoria Hospital.
DO confirmed the educational value of this proposed Fellowship and agreed that current trainees would not be disadvantaged. In terms of benefits, Ninewells was unable at the moment to provide a separate Vascular rota so this post could help trainees to gain experience in the emergency aspects of Vascular Surgery by increasing the number of people available to contribute to such a rota. There would be no competition with other trainees as this post would cover high end and complex cases using post-CCT type skills.
The STB agreed its support for each application.
STB members expressed some reservations concerning the posts:
· Selection and recruitment for posts, and training aspects. This must be at a level to ensure training and educational benefit. Person specifications could stipulate the need for evidence of having already completed training to a level equivalent at least to that of ST6, perhaps using way points/markers at that level for equivalence for overseas applicants, or using FRCS which should have defined criteria for overseas doctors. The College MTI programme insists that applicants meet Faculty standards and that those in post are placed there primarily for training and not simply to support workforce. Similar assurances should be sought for the proposed new Fellowships. . IR noted the initiative was a Scottish Government response to problems in recruiting to Acute and Emergency Medicine. Although he had concerns he felt there was potential for good training in these posts for overseas doctors and this was something the NHS has always provided. The initiative differed from the MTI programme previously discussed. This would be an opportunity for the College to support the process via its established links.
· Potential to deprive local trainees of opportunities for high level experience.
JA had earlier alluded to the possibility that these Fellowships would offer high-level training to overseas doctors which might also have benefited Scottish trainees at the peri-CCT or post-CCT stage of their career. Thus while not directly detrimental to current training, they might nevertheless have the effect of diminishing the expertise of locally-trained surgeons by depriving them of this experience
· Global health responsibility. JG felt that there should be an obligation to support opportunities more widely across the world although he acknowledged these posts might not be the most appropriate for a wide pool of people. There was general agreement among STB members of the need to provide opportunities to overseas trainees. AD noted the Government will want to adhere to the WHO code of practice. The question of responsibility for provision of Tier 2 visas and sponsorship was also raised.
· Certification of experience and from which body.
RP stressed that responsibility for the posts lay with Health Boards and that as these were not NTN posts, NES had not committed itself to Quality Assuring them. NES will report back to the Scottish Government which will then consider its timetable for advertising and recruitment.
In addition to responding to Jean Allan confirming the STB’s support for the individual applications received, DB will note the STB’s reservations on certain aspects of this initiative, in particular (i) the potential conflict between home and overseas trainees, (ii) the recruitment process and selection criteria, (iii) global distribution of the recruitment process, and (iv) certification and from which body. / DB
6. / Regional teaching programmes – study leave applications
KS confirmed that the specific issue precipitating his enquiry to the Board had been resolved with agreement on advance bulk application for trainees in programme.
The STB discussed the provision of study leave for regional teaching days. Variable practice was reported, some specialties insisting on the submission of Study Leave applications for release to attend (usually as a block application) while others did not insist on formally recording this as Study Leave. OMFS and Urology did not insist on study leave but expected all trainees to attend; ENT had 10 days per year for which there was a formal block application process; in Core Surgery the majority in WoS did not request study leave and there was no formal process in EoS; T & O did not insist on formal Study Leave application for normal routine teaching but did ask trainees to submit applications for some other Scottish wide meetings and events; Vascular Surgery held a 2 day residential course twice per year for which it did not require study leave requests, although it was possible that some applications might be made via General Surgery TPDs; General Surgery also did not require study leave forms to be submitted and the onus was on trainees to inform service of their planned absence.
WR confirmed that study leave applications should be required and approved even for courses where no funding was requested. Recording study leave provided an audit trail and allowed trainees protected time and official recognition that they did not need to be present for service on the relevant day. The Training Management workstream was considering study leave and AD noted it was hoped TURAS would include a process by the end of March for applications to be made and signed off online. It should be possible to set up a template for bulk applications for regional training days. The recording process would be for all Scotland.
7. / Recruitment 2015 – Round 1 and Round 2
The latest Oriel monthly update compared application numbers between 2013 and 2015. This showed that Core Surgery has experienced a slight increase; there had been a sizeable increase in applications to ST1 runthrough programme in T & O – the latter was also reflected in competition ratios. The updates contained little information for surgical specialties at present as there was very limited involvement in Round 1 recruitment. However monthly updates will be circulated to the STB for information and tabled at future STB meetings. / DB