Minutes of the Surgical Specialties Training Board Meeting Held at 10

Minutes of the Surgical Specialties Training Board meeting held at 10.30 am on Wednesday 16 January 2013 in Meeting room 5, Westport, Edinburgh

Present: Professor Rowan Parks (RP) Chair; Mr John Anderson (JA), Ms Helen Biggins (HB), Mr Richard Buckley (RB), Mr Dominique Byrne (DB), Ms Anne Dickson (AD), Mr Gareth Griffiths (GG), Mr Graham Haddock (GH), Ms Alison Howd (AH), Mr Ewen Kemp (EK), Professor Anthea Lints (AL), Ms Jen MacKenzie (JM) part meeting, Mr Bob Meddings (BM), Mr Anas Naasan (AN), Mr Sai Prasad (SP), Professor William Reid (WR); Mr Andrew Renwick (ARen), Ms Angela Riddell (AR) part meeting, Professor Hamish Simpson (HS), Ms Rachel Thomas (RT).

By videoconference: Glasgow (1) – Mr Graham Mackay (GM), Ms Ruth McKee (RMcK) part meeting; Glasgow (2) – Mr Ian Holland (IH); Inverness – Mr Angus Cain (AC), Mr Kenneth Walker (KW).

Apologies: Mr Laurence Dunn (LD), Professor James Garden (JG), Mr Nick George (NG), Dr Alison Graham (AG), Mr Brian Howieson (BH), Mr Alan Kirk (AK), Mr Graham Mackay (GM), Ms Lorna Marson (LM), Mr Douglas Orr (DO), Mr Ian Ritchie (IR).

In attendance: Ms Helen McIntosh (HM).

1. / Welcome and apologies
Professor Parks welcomed all to the meeting and in particular Mr Dominique Byrne newly appointed STB Chair. This will be the last meeting chaired by Professor Parks. Apologies were noted.
2. / Minutes of meeting held on 23 November 2012
The following amendments were noted:
Page 1, Item 3.2, first sentence to read ‘…this will not be put in place for 2013’.
Page 3, Item 4.2, fourth bulletpoint to read ‘Cardiothoracic Surgery’.
Page 8, Item 8.1, first sentence to read ‘The SAC has introduced a required number of procedures (25).’
With these amendments the minutes were accepted as a correct record of the meeting and will be posted on the website.
3. / Matters arising/actions from last meeting
3.1 / North and East General Surgery Training Programme
MDET approved the proposal. Wider consultation with stakeholders was taking place and if approved the programme could be in place for 2014. KW will keep the STB up-to-date with discussion and developments.
Action:
·  KW to keep the STB up-to-date with discussion and developments.
3.2 / WoS Regional Workforce Group approval for 2 AMTF posts in ENT
WR reported this was resolved via email correspondence and an appointment made in Ayrshire; an appointment in Glasgow was currently being arranged. Funding was for one year and at the end of the period will be recycled for ST3 appointments.
3.3 / 2013 recruitment: Round 2
·  T & O selection and recruitment
Single centre national recruitment was agreed and representatives from Scotland, including RB will participate in the process. Interviews will be held 11-15 March. HS and RB will feedback on the process and quality of candidates and whether this is the appropriate direction of travel.
·  Scottish Vascular Surgery programme approval
The GMC noted the quality of the submission and has formally approved the curriculum. RP thanked DO and all who contributed to the Scottish submission.
3.4 / Spinal Surgery AMTF
RP discussed the proposal with Derek Phillips, SEAT Regional Director of Workforce Planning; while he agreed this was a good proposal it could only be funded via disestablished posts. The issue was raised at MDET and RP has also held separate discussions with Stewart Irvine. The general feeling was STBs were not as engaged with Regional Workforce groups as before and this should be re-introduced and a better way of engaging sought.
Regarding this particular post, the proposal was that the trainee appointed would rotate around 3 deaneries and therefore would not be based in a particular Health Board or region. The STB has approved it educationally but there were still practicalities to address. This year 5 T & O posts were being disestablished however the governance process gave Regional Workforce the major say in how the money from these posts was used. Consideration would be given to ringfencing money for such posts and this would require further discussion with various stakeholders and Scottish Government.
It was felt it would be good to have a longer term all Scottish solution. At present there were no agreed terms and conditions for these AMTF posts although this should be resolved soon.
The board agreed there was a real service need for the Spinal posts. HS suggested that meantime they could provide ‘buffer training’ for a post in Stirling and posts in Inverness; this was not ideal but could be done as an interim measure. RP proposed they could perhaps use 1 of the 5 T & O disestablished posts in a particular deanery to host an AMTF and then for a trainee to swap when individuals needed to rotate to other units. KW said NoS could provide the lead on administration and governance of the Spinal AMTF.
Any proposal would have to be approved by Regional Workforce and the PG Dean. HS agreed to discuss and agree a position on the posts with T & O colleagues at the shortlisting session on 17 January. He will then discuss this further with KW, WR, RP and DB.
Action:
·  HS to discuss proposal of using disestablished posts with T & O colleagues; to then discuss with KW, WR, RP and DB.
3.5 / Paediatric surgery/Urology
There was much debate on the provision of the General Surgery of Childhood and Paediatric Urology. Many services in Scotland are currently provided by consultants trained to a reasonable level driven by local demand or via a hub and spoke model. Ad hoc arrangements for future training were in place but a long term position was required.
A specific issue was the number of defined procedures required for CCT which have been set by the SAC. There were no formal arrangements in place for East/West Urology trainees to get index numbers. However GH felt this should not be an issue in Scotland as all 3 paediatric centres undertook outreach operation lists and clinics mostly on a weekly basis, and trainees from other specialties could access these lists.
He noted the work of a group established a number of years ago chaired by Professor Youngson that considered the General Surgery of Childhood in Scotland. The group confirmed the provision of elective procedures was satisfactory, there were areas where Adult General Surgeons retained an interest and there was the capacity to offer outreach to other Health Boards. The opposite situation was the case in England with 80% of elective surgery provided by General Surgeons. The bigger challenge related to emergency procedures which they were working to resolve.
It was agreed the number of set procedures was satisfactory and Scotland was better placed than England in terms of the delivery of Paediatric Surgery and access for trainees to other surgical specialties.
A representative from the STB for the SCCCSS was sought; DB will pursue.
Actions:
·  DB to pursue suitable representation on SCCCSS group from STB.
4. / HAI Programme Board
Professor Cachia has requested information from each STB on the provision of HAI training in the curriculum. Specialty leads were asked to provide this information to RP for a response to Professor Cachia by the end of January.
Action:
·  Specialty leads to send information to RP for response by end of January.
5. / 2013 recruitment
5.1 / Scottish Government paper
Scottish Government has written to formally sign off numbers and provided a colour coded overview table showing those specialties where reshaping was complete/paused etc. The indicative intake was based on CCTs; there were a small number of disestablishments.
RP highlighted:
Neurosurgery – showed 22 funded posts of which 12 were NTN holders. Residuals were being filled locally as ‘standalone posts’. It had been planned to discontinue these but Health Boards found them useful. Target establishment was set at 15.
Cardiothoracic Surgery – 16 establishment posts funded of which 7 were NTN holders. Scottish Government wanted to increase this to 11 NTN holders. This will require discussion involving SP, AK, HB, DB and WR at some point in the future.
OMFS – the specialty needed to expand but could only do so if money was vired between specialties and there was no mechanism for doing this.
5.2 / SMT update
T & O representatives will meet on 17 January to finalise arrangements. 115 applications were received and they will conduct 48 interviews over 2 days.
5.3 / CST
There were fewer applications to CST but a similar number of first choice Scotland applications have been received compared to last year. Clearing will take place after the recruitment round has completed; AH noted the good quality of candidates in clearing last year.
All arrangements for CST recruitment were in place; they will use 3 stations plus 3 pilot stations.
The latest KSS update showed Scotland’s competition ratio was slightly lower than UK average; other areas were doing less well.
5.5 / Report from other specialties involved in national recruitment
·  Cardiothoracic Surgery
SP noted he was awaiting confirmation on a ST1 post; RP confirmed 2 residual posts, one at ST1 and one at ST3 have been signed off by MDET but may still require Deanery sign off. RP will check with Jean Allan whether this has been signed off.
·  Paediatric Surgery
GH said they were planning to recruit to 3 posts however one trainee may not CCT and there was also a question mark over a second. He will liaise with Chris Driver regarding what was shown on the website.
·  ENT
AC confirmed all arrangements were in place.
·  Ophthalmology
EK confirmed recruitment will take place at the end of January.
·  Plastic Surgery
AN said to date only 4 trainees have sat the exam with the next sitting in March; he will then confirm whether they will recruit to 8 or 9 posts.
·  Urology
BM confirmed they will advertise 4 posts plus one LAT for recruitment.
RP noted there was good year on year data available on competition ratios. He confirmed that Deaneries in England were not able to redistribute Scottish vacancies; this was a Scottish Government matter. If there were no posts shown at the time of advert it was not possible to add posts later; if the advert showed a minimum of one post this could be increased later but could not be removed. Posts can be added until the time of interview.
JA confirmed LATs could be for 6 or 12 months. General Surgery in England has now decided to recruit to LAT posts; he will check Scottish numbers.
Action:
·  RP to check Deanery sign off has been received for Cardiothoracic Surgery ST posts.
6. / Quality Management
6.1 / Scottish QM Reporting template
GH produced a reporting template based on General Surgery return; slightly different versions would be produced for the other specialties. Returns would be completed once per year for each programme and checked against Quality Indicators; although the JCST Survey had not aligned this information in the most recent survey this was planned for the next. The JCST Survey had a 70% response rate and so would provide a good source of information which he felt TPDs would be best placed to collate and the aim would be to share good practice with the STB. RP proposed the inclusion of other data eg GMC Survey on one report pulled together by specialty lead plus a lead from another specialty to provide a critique for presentation to the STB on an annual basis.
However AL felt this could be a complex and time consuming process and cautioned against duplicating other surveys. She noted that GP TPDs produced this information using a Deanery template which was not as detailed as the model proposed. WR noted potential crossover between GMC seeking more specialty specific information and JCST Survey; GH said JCST was keen to maintain ownership of its specialty specific information.
AD felt they should focus on the added value brought by the STB and consider what could be extracted from the JCST Survey and triangulate this with Deanery information. The STB would then take a national overview.
It was agreed to start this work with Core Surgery and match GMC/PAQ information. GH and DB will discuss this further and in particular Deanery QM.
Action:
·  GH and DB to discuss Deanery QM.
7. / Surgical Simulation
7.1
7.2
7.3
7.4 / SSC minutes
JCST Simulation Working Group minutes
GMC letter re simulation
Draft Scottish response to JCST
The issue to consider was what was deliverable and how it would be delivered ie locally or nationally. KW said that although this work was in its early stages Scotland was ahead of England. The Surgical Simulation Collaborative was now working as a bicollegiate group with close ties to the STB, tasked with developing strategy for further integrating Simulation into surgical training in Scotland. He had surveyed what was currently available and summarised this information in the paper presented to the board and asked board members for their views on a series of questions.
He outlined the principles adopted so far by the Surgical Simulation Collaborative:
·  Start with Core surgery
·  Inhouse provision as well as courses
·  Learn from good existing examples eg ENT temporal bone surgery which is well-integrated with the training programmes
·  Technical and non technical skills
·  Faculty Development.
He stressed the need to consider the cost implications of any recommendations in terms of resources and job plans and fees for additional courses from study leave budgets and their authority to make stipulations/ recommendations. The GMC was hesitating to develop simulation in the curriculum due to a perceived lack of resources but until simulation was included in the curriculum no development would take place.