Workforce and productivity

Simon Hodkinson

It is with great pleasure that I welcome you to this latest edition of the JTO. One hopes by the time this edition drops on your mat we will be experiencing a flaming June but as I write this piece it’s once again pouring here on the South Coast after the obligatory four days of hot weather in May. Our world of orthopaedic surgery is never quiet, as the last few months have shown.

There has been much discussion around the issue of Physician Associates (PAs) and their place in trauma and orthopaedic surgery. The BOA, along with other surgical specialties, has been participating in a process organised by the joint Royal Surgical Colleges to develop a scope of practise for PAs working in surgery. The BOA Council in April considered a paper produced by a BOA short life working group as a basis for the scope of practice for PAs working within T&O surgery.

Currently this document remains confidential whilst it is considered by the Royal College of Surgeons England, but we hope the full scope of practice document – informed by the BOA paper – will be published shortly by the joint Royal Surgical Colleges.

However, as I made clear in a statement published on the BOA website, the BOA will not support any situation where the use of non-medical qualified personnel adversely impacts on the experience and training of our junior colleagues at whatever level.

As many of you are aware, training and trainees are a particular interest and concern of mine. The thread through this year’s Congress will focus on many aspects of training and retention of surgeons within T&O surgery.

I am aware of the main concerns of the British Orthopaedic Trainee’s Association and a BOA short life working group have been formed to evaluate these concerns and to identify solutions. This group will report back at this year’s Congress.

Amanda Pritchard, NHS Chief Executive, a few weeks ago presented NHSE’s latest plans for improving working lives of our junior colleagues. Addressing these issues are an essential part of assuring the future stability of our profession.

At the Royal College of Surgeons of England recently, Amanda Pritchard also told the assembled surgical audience that the government needed more of us. Whilst that means we must retain who we have, we must make a postgraduate career in surgery, T&O in particular, an attractive and viable proposition to all young doctors.

I have met the new National Clinical Director (NCD) for Musculoskeletal (MSK) services, Dr Lesley Kay, Consultant Rheumatologist. We have many shared concerns, and the BOA looks forward to working with her over her tenure as NCD. I would urge you to read the article in this edition on fracture liaison services as she was one of the prime movers in setting this service up but currently only 50% of the UK is covered by such a service.

The BOA is supporting the Royal Osteoporosis Society campaign to secure universal access to fracture liaison services. The BOA has been present at a series of national and local meetings regarding the integration of primary and secondary services for patients with MSK pathology, 20 million in the UK, with 10 million suffering from arthritis in one or more joints.

There are some excellent models of two-way collaboration in the UK many of which have been presented to us but still in many parts of the country there is silo working and this does not help patients. Productivity is a real issue for all of us and if we are to increase the efficiency and effectiveness of available resources across primary, community and secondary care we must have collaboration.

Within our own environment there is a lot we can do to improve productivity, but it does not all rest with us surgeons and we will continue to argue for improvements across the board in theatres and outpatient departments in terms of staffing and facilities.

The best practice pathway for non-ambulatory fragility fractures will have been launched by the time of this edition and the start of the orthopaedic trauma registry is imminent and surgeons will soon receive details of the login process.

Finally, I have had several meetings with the team behind NCIP. The BOA has had some concerns regarding who has access to the data, but it is a valuable tool, and we completely support the process. The team understand the concerns we have raised and have made it clear that NCIP is not a performance management tool. I believe it will become more and more valuable to us all in time and I urge you to look at your data and see what the platform can offer.

Finally, I hope you all have as happy a summer as you can and who knows the sun might shine!