Aligning objectives and preventing harm

Mark Bowditch

When you read this, I shall be three months into my presidential year brimming with ideas and focused on tackling the issues raised in our five-year review. In particular, I am committed to demonstrating to you all the value of being a BOA member. You may have read my monthly blog, I’m pleased to have received comments and replies – keep them coming! With the new Government ‘missions’ becoming clearer, the NHS is very much centre stage, and the new investment is welcome. Our role is to ‘Speak up for T&O’ and ensure that we and our patients benefit from new resource. At a recent event, Chris Whitty, CMO, reminded us that alignment to national strategies is the best way to gain traction with our objectives.

There are three facets to the Government’s new health missions.

1. Hospital to community – Right patient, right professional, right place: Patient pathways, estate, workforce, and training are all key to this. We are working closely with stakeholders to ensure that sensible integrated pathways of care with local T&O input are shared.

As I write, I’m delighted to say that tomorrow I do the very first list in a brand new orthopaedic surgical hub named after Dame Clare Marx. It’s a fantastic facility which will hopefully allow us to continue planned essential care without interruption throughout winter for the first time in many years.

We welcome the commitment to surgical hubs, which the BOA has long campaigned for and the early evidence suggests >20% benefit in throughput. Moving to protected hubs may mean that you lose ‘trauma surge capacity’, so if you are doing so, make sure you demonstrate the need for increased trauma lists.

None of us likes inefficiency but we will advocate for safe, high-quality access and care for patients and members. We can achieve little without teamwork, so be kind and supportive to your colleagues as we move sites and try to do more work.

In all this, please do not forget the ‘future surgeons’. If you have extra lists in the NHS – find a trainee and involve them. With over half of routine joint replacements being undertaken in the independent sector (IS), I have been investigating how trainees might follow the work, drawing on the lessons from international colleagues and speaking with the NHS training leads and the IS to identify barriers.

2. Analogue to digital – EPRs seemed to be spreading like wildfire. Change is difficult and at first seems counter-productive but this is something we have to encompass. To help, we are preparing a ‘T&O top tips’ guide to implementing and using the main systems. Data is the new ‘gold’ and AI has much to offer. It won’t replace orthopaedic surgeons but those who embrace it will replace those who don’t.

3. Treatment to Prevention – Prevention is my theme as President. I have classified this into:

Primary: Prevention is better than cure. We’ve more than enough work so can we influence policy or practice to prevent injuries? In my knee world, this might be an ACL injury prevention programme. All sub-specialties will have an example so get your thinking caps on and let us know!

Secondary: When we do intervene with surgery, we must try to prevent harm by the right evidence-based interventions and reduce complications to a minimum. This includes human factors, infection control and learning from the most common T&O litigation themes.

Tertiary: Wellbeing, team-working and preventing toxic cultures. Continuing previous presidential themes of sustainability and workforce – we need to consider how to do this for ourselves and the whole team. After 25 years with largely the same team at Ipswich, I have been reflecting on the importance of this ‘family’ to my work and life balance. We need to support each other, and we will be looking to you all to share good practice and ways to prevent harm.

My new year’s challenge to you all is can you demonstrate and share the multiple ways to prevent harm whilst transforming T&O lives? I would like to thank you all for your commitment to our patients this year and wish you and your families seasonal greetings. Be kind to yourself, laugh lots, recharge and enjoy the festivities.