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It may have seemed that Armageddon threatened during the Medical Training Application Service / Modernising Medical Careers debacle and now again with the soon-to-arrive 48 hour guillotine of the European Working Time Directive (EWTD). Despite these portents of doom, it appears that Departments are getting on with doing their job. And why is that? Not the sole reason but possibly the largest contributor, I believe, is Professionalism. A concept now sexier than chocolate, the idea of teaching and, obviously, assessing professionalism is being taken up into University undergraduate curriculum development, postgraduate medical training (via NES) and by the Colleges, the GMC and PMETB. Previously, professionalism could be summarized by a dictionary definition “the competence or skill expected of a professional” (Compact Oxford English Dictionary). This perhaps is no longer “fit for purpose”. New and situation-dependent definitions are appearing throughout medicine. Will these explicit professionalism attributes help the Consultants of the future deliver anaesthesia services better than we do presently? Who knows the answer to that question! What is known is that many training centres have accepted that the out of hours component of our job can no longer be covered totally by the trainee body but that it has to be shared with other groups. To date, this “other group” has been ill-defined. Is it staff and associate specialists / the specialist doctor; or is it consultants; or is it a composite; or even a non-doctor? Whatever the answer, departments have so far had to find their own fix and deliver strategies. The Scottish Government has been expected to report on an exercise reviewing the role of the doctor within the setting of MMC in Scotland. That is to say, whether we will deliver service via an expanded consultant number or will there be development of a sub-consultant grade or perhaps the addition of non-doctor roles. It will be important to acknowledge that one solution might not suit all. That report should be available soon. Health Boards have been addressing the perceived service delivery gap by using (or arguably misusing) the flexibility of the consultant contract – specifically, by advertising consultant jobs with less than 2.5 SPAs. In addition there has been a request for Clinical Directors to explore “more creative” job planning to facilitate maintenance of service delivery (job plans with resident or second on call duties, perhaps reprising the senior registrar role). Quite rightly, these proposals have stirred emotion. There is evidence though that anaesthesia is not being singled out as a specialty and, that similar practices are afoot south of the border. Departments without trainees faced these issues at the time of the new contract introduction and thus have used the job planning process to prioritise service delivery. There is good advice for those with trainees to be had from that source.
Over the past 12 months the SSC has made every effort to keep abreast of these and all other issues affecting anaesthesia in Scotland. In summary form these include: · Chronic Pain Services · Scottish Multidisciplinary Anaesthesia Assistance Delivery Group - anaesthetic assistance · Physicians Assistants – Anaesthesia · Introduction of specialist doctor contract · National theatre operating system and critical incident reporting · Review of the Consultant Appointments process in Scotland
Two new elected members of the SSC are: Dr Philip Oates (Southern General Hospital, Glasgow) and Dr David Ray (The Royal Infirmary of Edinburgh, Edinburgh). This ensures an elected membership from all geographical areas of Scotland.
The AAGBI remains committed to delivering quality education opportunities locally in Scotland. To that end, Neil McKenzie organised a very successful Core Topics day in Edinburgh. The next Core Topics meeting will be held in Glasgow on Oct 29th 2009 with Hilary Aitken at the helm. The Standing Committee would like to take this opportunity to thank publicly Dr Catriona Connelly for all her hard work and commitment in helping to establish the excellent programme of seminars held at Scone Palace. In conjunction with the Events Team at Portland Place, the Standing Committee plan seminar dates and topics for the 2010 calendar. The 2009 Open meeting in Stirling provided excellent continuing professional development. The programme was linked together by core themes of excellence in practice and safety. The standard of speakers was superb and delegates were guaranteed to leave better informed by the day. Our keynote speaker was Professor Colin Suckling who developed the theme of excellence in practice using his experience of the SACDA process and also his father’s analytical chemistry invention, halothane, to illustrate the point.
SSC activities for the near future include: · Consideration of the effects of EWTD for anaesthesia in Scotland · Forthcoming consultant job descriptions and job planning with relation to SPA activities and out of hours commitments · Population of the Scottish Standing Committee page on the AAGBI website giving relevant and up-to-date information for anaesthetists in Scotland
The Scottish Standing Committee aims to be in the forefront of developments in the specialty, to ensure dissemination of good practices, clinically, academically and managerially and to raise awareness of risks across these domains.
Kathleen Ferguson Convenor On behalf of the Scottish Standing Committee of the AAGBI |
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Scottish Standing Committee Report to the Scottish Society of Anaesthetists March 2009
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