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News Surgical training yet to recover since pandemic
The Royal College of Surgeons of England (RCS England) and the Association of Surgeons in Training (ASiT) have issued a stark warning to the government and NHS England’s top medics that access to operating theatres for surgical training has not recovered since the COVID-19 pandemic, and planned government reforms, if not carefully implemented, risk creating further barriers. New evidence suggests resident doctors
have missed out on over three million training opportunities since March 2020. Writing to Professor Sir Stephen Powis, NHS England National Medical Director, and Professor Sir Chris Whitty, Chief Medical Officer, Mr Tim Mitchell, President of RCS England and Miss Roberta Garau, President of ASiT, said: “If we do not act now to protect and expand surgical training, the NHS will struggle to maintain a sustainable surgical workforce for future patients”. Data from RCS England’s most recent surgical workforce census revealed that 61% of resident doctors in surgery identified limited theatre access as a major challenge, while 52% report inadequate time for training. Similar challenges are cited by SAS and locally employed doctors. In a letter, Mr Mitchell and Miss Garau, urged the
co-chairs of NHS England’s postgraduate medical training review to “send a clear, unequivocal message to all NHS leaders: training must be prioritised alongside service delivery.” RCS England and ASiT said that to prevent government reforms from exacerbating the challenges around training resident doctors in surgery face, three urgent
providers and their involvement in training. The letter said, “Many of these providers are actively engaged in high-quality training. Nevertheless, we continue to hear of NHS Trusts unwilling to release resident doctors for training opportunities outside their organisation, as well as independent sector providers reluctant to meaningfully support opportunities for resident doctors. The expansion of independent sector provision must not come at the cost of our future workforce and patient care.” RCS England and ASiT are calling on NHS Trusts
actions are needed: l Better balancing the needs of training and the focus on service delivery.
l Requiring the private sector to support training opportunities.
l Ensuring surgical hubs deliver on training opportunities.
The letter states that it is “absolutely right” tackling unacceptably long waits for patients remains the top priority, but “there is a real risk that training opportunities will be sacrificed at the altar of productivity” in the drive to meet ambitious waiting time targets. The surgical leaders say that resident doctors in surgery must be actively involved in the evening, weekend, and high-intensity theatre (HIT) lists introduced to reduce waiting times. They also address the increasing proportion of NHS care delivered by private and not-for-profit
to establish flexible job plans for resident doctors in surgery that include timetabled time working in the independent sector. The two surgical organisations have welcomed the recognition of concerns about training in the independent sector in a partnership agreement between the government and the Independent Healthcare Providers Network (IHPN), published alongside the elective reform plan, but add that to maximise its impact, this commitment now needs clearer implementation details and tangible outcomes. Surgeons have advocated for the establishment
of surgical hubs, which Mitchell and Garau describe as a crucial reform to increase elective activity, giving patients quicker access to procedures, and providing a ringfenced environment for resident doctors to develop their skills. However, emerging data from the Joint Committee on Surgical Training (JCST) suggests these opportunities are not being fully realised, with fewer than 10% of surgical training episodes currently occurring in hub centres.
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