3rd July 2015

• Audit finds high mortality for emergency bowel surgery
• GMC proposes credentialing system for doctors
• FDS alarmed by nine-fold variation in dentistry hospital admissions
• New duty of candour guidance for doctors, nurses and midwives
• NHS England to take forward specialised commissioning plans
• RCP introduces new Faculty of Physician Associates
• Two out of three NHS trusts forecasting deficits, with £1bn deficit for foundation trusts

Audit finds high mortality for emergency bowel surgery

The results of the National Emergency Laparotomy Audit (NELA) show that there are still high mortality rates following bowel surgery. The NELA project, which was commissioned by the Healthcare Quality Improvement Partnership and began in 2012, looked at outcomes measures for patients undergoing emergency laparotomy.

In response to the results, RCS President Miss Clare Marx said, ‘We are concerned that mortality remains high for patients that require emergency bowel surgery. This audit demonstrates patients are still not accessing a consistently high standard of care from initial assessment through to post-operative care.’ Miss Marx encouraged those working in emergency surgery services to focus on improving these standards, and said this may involve services being reshaped to deal with complex surgery.

GMC proposes credentialing system for doctors

The GMC has released consultations on two sets of changes to medical training. Firstly, the regulator is considering introducing a credentialing system that shows doctors’ standard of knowledge or skills. The system would be accessible to patients and the public, in order to help protect patients who may be vulnerable, such as those undergoing cosmetic surgery. The College has been vocal in calling for such a credentialing system, and was disappointed that it was not included in this year’s Queen’s Speech.

The other proposed set of changes is the introduction of a framework that sets out the core professional values, knowledge, skills and behaviours expected from all doctors during their postgraduate medical training.

FDS alarmed by nine-fold variation in dentistry hospital admissions

Data released by the Health and Social Care Information Centre (HSCIC) show considerable variation in hospital admissions for dental care. The South Yorkshire region has over nine times the rate of hospital admissions for dentistry in children under fifteen compared to the rates in Leicestershire and Lincolnshire. In response Professor Nigel Hunt, Dean of the Faculty of Dental Surgery (FDS) at the RCS, said that ‘Today’s data is a stark reminder of the inequalities in children’s oral health that persist across the country’. He noted that five to nine year olds continue to account for the highest age group to be admitted to hospital for tooth decay, despite this being nearly entirely preventable. FDS is therefore calling for a national public health programme to tackle preventable tooth decay.

New duty of candour guidance for doctors, nurses and midwives

New guidance on the duty of candour has been released by the GMC and Nursing and Midwifery Council (NMC). It sets out standards for all UK doctors, nurses and midwives, in order to foster an open and honest working environment where clinicians report incidents and learn from their mistakes. The new guidance advises speaking and apologising to the patient as soon as something has gone wrong, and reporting errors at an early stage. To encourage this approach, managers should protect those who report incidents or raise concerns, states the guidance.

In April the RCS released its own guide on the duty of candour specifically for surgeons and their employers, which also aims to ensure that patient safety incidents are handled in an open and honest way.

NHS England to take forward specialised commissioning plans

In response to a public consultation held earlier this year, NHS England have confirmed plans to introduce a framework for deciding which specialised treatments to commission nationally.

The framework includes four orders of prioritisation that dictate which treatments should be made available on the NHS. In the RCS submission to the consultation, we disagreed with this framework and highlighted concerns that it may bias commissioning towards new and drug-based treatments. However, NHS England stated its intention to engage with stakeholders during 2015/16 to refine the framework for future years.

Stakeholders suggested in response to the consultation that NICE (National Institute for Health and Care Excellence) should lead the process of reviewing the clinical evidence used to decide whether a treatment is funded. Consequently NHS England has agreed with NICE to explore how it could play a role in this process in future.

RCP introduces new Faculty of Physician Associates 

The Royal College of Physicians (RCP) has launched the Faculty of Physician Associates (PAs), a new faculty which aims to improve training for PAs and accredit university programmes. The RCP hopes it will strengthen the working relationships between physicians and PAs.

PAs are healthcare professionals trained in the medical model who work under the supervision of a doctor. They undertake a national curriculum and exam which qualifies them to carry out physical exams, diagnose conditions and treat illnesses. The Faculty of PAs has been established as the PA career path is becoming increasingly popular.

Two out of three NHS trusts forecasting deficits, with £1bn deficit for foundation trusts

Ahead of the Government budget announcement, a King’s Fund survey of NHS trust finance directors has found that two thirds of trusts are forecasting an end of year deficit, compared to only one in four this time last year. For acute trusts, things are worse, with almost nine in ten likely to face a deficit, up from two in ten last year.

The King’s Fund warns that a reduction in agency spending and increased productivity will be insufficient to close the ‘black hole’ in NHS finances. The additional £8bn annual NHS funding must be front-loaded in order to tackle this, says the King’s Fund.

As the foundation trust (FT) sector is predicted to face a 2015/16 deficit of nearly £1bn, nearly triple that in 2014/15, health regulator Monitor Chief Executive Dr David Bennett warns that not tackling this problem successfully could completely erode FTs’ freedoms. Dr Bennett believes that FTs have not improved their performance quickly enough and adopt best practice in efficiency, and Monitor plans to clamp down on this.