SOCIETY FOR CARDIOTHORACIC SURGERY IN GREAT BRITAIN … · 2017-08-01 · 2 Meeting RCS Eng with Mr...
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SOCIETY FOR CARDIOTHORACIC SURGERY
IN GREAT BRITAIN AND IRELAND
EXECUTIVE COMMITTEE PAPERS
Friday 9th October 2015
10:30hrs Moynihan Room, Royal College of Surgeons, London
1. STANDING REPORTS
i. STANDING REPORT FROM THE PRESIDENT
T Graham
A. MEETINGS ATTENDED / PARTICIPATED
MEETING DATE MINUTES
Meeting NHS Choices NHS Eng at RCS Ed Birmingham 04.06.15
SCTS Executive RCS Ed Birmingham
05.06.15
FSSA meeting Glasgow
Joint FSSA / RCPSG meeting
15 – 16.06.15
Malaysia review national CT surgery training
programme
20 – 27.06.15
Meeting Pres RCS Eng and Jackie Weller Director of
Internal Services RCS Eng Project 2020
01.07.15
HQIP data validation day London and subsequent
meeting with NICOR and HQIP
01.07.15
Meeting Scott Prenn re marketing strategy
01.07.15
NACSA database review meeting SCTS/ NICOR at RCS
Eng
03.07.15
Teleconferences WSSHC re CT surgery in Wales
10.07.15
Teleconference with Director of Planning WHSSC and
RCS Eng Wales advisor
10.07.15
Teleconference Jane Ingham CEO HQIP
17.07.15
Teleconference Chair SSG RCS Ed re joint working 27.07.15
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Meeting RCS Eng with Mr Chukwuemeka and RCS
Professional Support Manager and Ass Director for
Professional standards re SCTS/RCS approval
consultant jds / job plans and input of SCTS into AAC
process
07.08.15
Attended JSCFE General Surgery exam Kuala Lumpur
as JSCFE Chair and Examiner Assessor
17 – 21.08.15
KL – meeting with provisional Malaysia board of
cardiothoracic surgery / MACVTS at Acadamy of
Medicine Malaysia
21.08.15
Attended 3rd International Heart Care Conference
Bangkok Thailand
Spoke at Joint Global Harmonisation of Education
session
03 – 06.09.15
PLG NICOR meeting UCH London
16.09.15
Birmingham Review Course
17 – 20.09.15
EBCTS Examination Amsterdam
01 – 02.10.15
EACTS Amsterdam
03 – 07.10.15
Chaired Postgraduate Educational session
04.10.15
National Specialties Associations Meeting
06.10.15
Meeting with RCS England Mr Fountain Internal
Services re SCTS Legacy / Project 2020
08.10.15
Meeting with SCTS Meetings Team / Education team
at RCS Eng
08.10.15
SCTS Showcase event (Scott Prenn) at RCS Eng
08.10.15
B. MATTERS OF INFORMATION FOR THE EXECUTIVE COMMITTEE:
President meetings and commitments schedule as above
Most of these issues will be raised in the body of the Executive meeting – but I would like to
focus the Executive’s attention on the following:
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• National Clinical Audits
The SCTS / NICOR NACSA for 2011 – 14 has now completed and the information is available on
the SCTS website for units and individual surgeons and on the COP / NHS website for individual
surgeons. We have had a difficult summer with NICOR HQIP and COP/NHS E which has
required considerable effort from SCTS officers to maintain the position and interests of SCTS
and members.
A final list of individual surgeons’ positive and negative outliers was provided to SCTS on 5 June
following which calls were made to individuals, some of which needed to be reversed – causing
embarrassment
NICOR were committed to publishing positive outliers despite SCTS advice and initially a large
number were identified. Following a challenge and 3 different sets of statistical methodologies
there were no major positive outliers identified.
All the previous outcome data was taken down from the SCTS website at one point by an
external party without permission or knowledge of the SCTS.
There were several other issues as well which the clinical audit chair will describe including the
timeline and details of events in his report including the current situation with the COP outputs.
These events have undermined the relationship between SCTS and in particular NICOR. Before
the next NACSA phase SCTS have requested a meeting with NICOR HQIP COP/NHS E.
SCTS could consider supporting an analyst at NICOR to facilitate our research interests. There is
the proposal for an Adult Cardiac Surgical Outcomes in the Elderly project which SCTS should
support and facilitate with other stakeholders.
We are waiting for HQIP to respond to a further request to them for help with a complete audit
of Adult Thoracic Surgery including non cancer surgery.
• Relationship with Mr Ionescu (MI) / Educational issues
The education programme for the non NTNs supported by MI has commenced.
SCTS Education are proposing to organise a 2nd universities postgraduate training day in the
calendar year possibly aligned with the Birmingham Review Course in September with support
from MI and as part of the Ethicon portfolio of Postgraduate education with SCTS.
MI has recently sent 2 cheques – one his annual contribution to the AGM/Universities day and
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one to fund the first paper published edition of the Bulletin and the second one planned for the
next December / January edition.
SCTS will visit MI in December in Monaco and Graham Cooper and Rajesh Shah are scheduled to
go on 16 December.
• New Committees and Appointments
Gavin Murphy has been appointed as SCTS Research Committee Chair – he will outline his
committee and terms of reference – one of the first tasks will be to liaise with RCS Eng and their
research programme
Andrew Owens has been appointed SCTS Professional standards and Governance Committee
Chair. He will outline his committee and terms of reference – one of the first tasks that should
be considered are SCTS Guidelines for the introduction of new technologies and techniques into
NHS practice in view of difficulties being encountered by patients and members.
• External Agencies
We have met with the Professional Standards Group at the RCS Eng to improve how JDs for
posts are dealt with and how the SCTS input to the AAC process can be optimised (in England).
We continue to have meetings with RCS Eng regarding the potential for physical and owned
facilities/real estate within the RCS Project 2020 should SCTS receive a large legacy but this is
complex. We are watching the situation carefully with the 2020 project because of the
inevitable need to move the SCTS Admin team off site for some time and the requirement for all
our activities to continue (and potentially expand)
We are actively attending FSSA meetings and note and support their proposal for a British
Surgical Association (aka Surgical BMA)
The “Getting it Right first time “initiative funded and supported by DOH / NHS has commenced.
The communication with SCTS to date has been poor and further discussions are planned to
both engage with and advance the project in Cardiothoracic Surgery as appropriate.
• Scott Prenn showcase
A further showcase event is occurring at the RCS Eng the day before the Executive meeting.
This will focus on partnerships, education and on supporting advanced surgical techniques and
clinical audit.
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• Workforce document SAC / SCTS
The workforce document has been produced jointly between the SAC and SCTS and is an
excellent example of the potential for joint working. The President SCTS and Chair SAC are
distributing the document to appropriate agencies including JCST, GMC etc.
• ACCEA process
Submission of SCTS nominations for all awards and the required citations were submitted on
15/6/15.
• Mr Lincoln lifetime achievement award SCTS
Mr Lincoln has accepted the invitation to receive this award at the AGM in Birmingham in March
2016
Marjan Jahangiri will liaise with him regarding arrangements and she will present the citation at
the AGM.
C. MATTERS FOR CONSIDERATION BY THE EXECUTIVE COMMITTEE:
Working in the NHS
The environment in which we work within the NHS is becoming increasingly difficult and the
SCTS and members need to consider this .
Two consultant cardiac surgeons have been dismissed by trusts in the last 6 weeks and several
others are in difficulty with their employing trusts with restricted practice. None of these
instances are due to the direct effect of monitoring surgeons’ outcomes. The overarching theme
is that of professionalism and behaviour in the workplace.
Potential changes to newly appointed consultants’ contracts within the proposals for 7 day
working are of concern – the trainees require the consideration and support of the Executive at
this time.
The Professional Standards Committee will be asked to consider these issues and how SCTS
should move forward with professional support for members.
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ii. STANDING REPORT FROM THE CHAIR OF THE CLINICAL AUDIT COMMITTEE
David Jenkins
David Jenkins (chair), David Barron (congenital), Doug West (thoracic)
(other members Rajesh Shah (see below), Andrew Mclean, Ben Bridgewater, Tim
Graham)
A. MEETINGS
MEETING DATE MINUTES
Mon TC calls, weekly re adult cardiac data publication June-Aug 2015 Available,
notes on file,
secretary
Outliers NICOR PLG working group meeting, TC 25/06/15 Available PLG
Revision of NACSA risk factors working group meeting 3/7/15 Report tabled
here
NICOR PLG meeting 28/7/15 Available
NICOR
NACSA project group and research meeting 20/8/15 Awaited
NICOR
Telephone calls to outliers June and Aug
2015
Telephone and email correspondence with NHS
choices
June-Sept 2015 Available on
request
B. MATTERS OF INFORMATION FOR THE EXECUTIVE COMMITTEE:
Thoracic (DW)
(1) LCCOP. This is the HQIP-sponsored Consultant Outcomes Project in Lung Cancer Surgery. It
applies to England. It first reported in 2014 (on 2012 data) and will produce a 2015 report
(2013 data) at the end of this year. It uses National Lung Cancer Audit (previously known as
LUCADA) data.
Due to recommissioning of the national lung cancer audit by HQIP there will be no change to
the LCCOP this year in terms of data collected or outcomes reported.
After concerns earlier in the year that the audit may be delayed, good progress has been made
in the last 6 weeks, with data going out to units for validation in August. The deadline for
submission is mid-October. Reporting is anticipated Q1 2016.
I now sit on the NLCA Executive Board to represent the SCTS and attend their regular Board
meetings. The relationship with the NLCA team (both during Richard Page's tenure and my
own) has been cooperative and productive.
I have been advocating within NLCA for an increase in perioperative data (specifically, name of
responsible surgeon, procedure performed, surgical access and use of regional anaesthesia) to
become part of the core dataset, and this has been accepted in principle by the NLCA Board.
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This would recognise that the NLCA is now acting as a surgical audit, and needs better data on
the process of care delivered to function effectively.
SCTS are working with the Roy Castle Lung Foundation on a project to understand what
information lung cancer patients would like to see reported in national audit. I believe this to be
a genuinely novel approach. Results are expected in late 2015.
(2) SCTS database. Una Lane the Director of Revalidation at the GMC has recently confirmed
that the GMC will co-fund the third and final year (2015-16) of the planned three year pilot of
this project.
This project faces major challenges. I do not think that it can or should continue in its current
form after GMC funding ends in March 2016. Over 7000 case have now been registered.
However, data upload has been declining. The problems are;
(a) excessive data requests to units from the three current projects
(b) the Dendrite database cannot be linked to NHS data (NLCA, COSD etc)
(c) To maintain the Dendrite database, SCTS will need to identify an
ongoing funding stream for database maintenance and reporting
We will report all three years of the SCTS database to date in a single "Blue Book" in Q3/Q4
2016. The project needs fundamental review if it is to continue beyond March 2016.
(3) The SCTS returns. This longstanding project is running well. There was strong support to
continue the project at SCTS Manchester 2015. We have complete data for all English Scottish
Welsh and Northern Irish units. Engagement in the Republic of Ireland has fallen off.
For the first year we have issued guidance notes for submission of the returns, which were
developed after discussion in the new thoracic audit group.
We have recently released a three year data summary (or "mini blue book).
Congenital (DB)
1. 2015 analysis complete and no concerns with overall performance across all centres
and two positive outliers. Three alerts on individual procedure funnels currently being
cross checked.
2. Some concern over level of analyst support and succession planning in NICOR. - we are
almost entirely dependent on David Cunningham, who is looking to retire.
3. The risk adjustment model may need re-calibrating - but there is already a funded
project underway to develop 'PRAiS 2' which will effectively achieve this.
4. There is no robust risk adjustment model for ACHD surgery which continues to be a
work in progress.
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Adult Cardiac (DJ)
1. Significant workload of discussion with NICOR, NHS choices, NHS Eng and external
statistical advisors over publication of 2011-14 data, including format of data
presentation, statistics of outlier identification, and false discovery rates. Contribution to
updating SCTS website. Timeline of events enclosed.
2. Communication to members before the adult cardiac surgery COP release and SCTS data
refresh on 15/09/15.
3. Updated SCTS website member support information, Sept 2015.
4. Contributions to NICOR PLG outliers working group , SCTS represented by DJ and SK.
Final document nearly ready for publication.
5. Review and comment on HQIP COP outliers governance manual.
6. Negotiations with Dendrite and NICOR re new ‘Blue book’, ongoing.
7. Contribution to revision of NICOR PLG terms of reference and job descriptions for
appointed clinical audit leads.
C. MATTERS FOR CONSIDERATION BY THE EXECUTIVE COMMITTEE:
1. Future publication of additional outcome measures, adult cardiac.
2. Decision on rationalisation of thoracic audits.
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Timeline of NACSA events 2015
1. Instruction from NHS Eng to report ‘positive’ outliers at surgeon level for NACSA
in 2015. Debated at SCTS executive Feb 2015, concerns about no patient benefit,
but accepted on HQIP advice after joint telephone conference and potential for
‘good news’ story. Concerns also expressed to NHS Eng and NHS choices March
2015, and the need for careful PR exercise agreed.
2. Discussion at NACSA steering group meeting 15/05/15. Confirmation from
NICOR audit lead that NACSA would have external statistical review prior to
publication in 2015.
3. Final validated NICOR data report returned to units in standard format with
positive and negative local outliers, document dated 29/05/15.
4. NICOR presented 2011-14 outliers to senior members of SCTS exec 04/06/15.
The question of external statistical sign off raised, but NICOR audit lead
explained a letter would be sent to HQIP confirming appropriate. The
spreadsheet of alert and alarm outliers at unit and surgeon level was entitled
‘NACSA 2011-14 outliers final’. It demonstrated 2 surgeon and 2 unit negative
outliers and 5 unit and 19 surgeon positive outliers. All members of SCTS exec
present understood from the NICOR audit lead that this was the confirmed final
list. The NICOR lead was questioned about the unexpected high number of
positive outliers at surgeon level, and confirmed the data were correct.
5. Standard SCTS policy involved contact of surgeon and unit outliers by telephone
in advance of data release, usually performed by the president. This year,
because of the increase in contacts due to reporting of positive outliers and the
potential perception of conflict of interest with the president, this task was
divided between the president (TG), president elect (GC), honorary secretary
(SK) and chair of the clinical audit committee (DJ). Calling commenced the week
of 8th June after NICOR had confirmed to HQIP (email BB to JI 01/06/15) that the
audit was ready for publication. Date of publication planned for end of June and
therefore timescale tight.
6. Senior members of SCTS executive contacted on 11/06/15 and told to suspend
further calls as data may be incorrect, and an external statistical review was now
taking place.
7. On going communication between SCTS president and NICOR CEO about the
situation. Publication date deferred.
8. No further official information from NICOR until 22/07/15 when a new set of
data was sent to units, in a new format without discussion with SCTS, causing
confusion for local audit leads and database managers. Superficial explanatory
email included.
9. Verbal information from NICOR audit lead 22/07/15, that when over dispersion
corrected for, all the positive outlying surgeons disappeared.
10. Current 2010-2013 outcome data removed form patient section of SCTS website
by NICOR on 27/07/15 without discussion with or authorisation by SCTS.
Confusion and anxiety for patients and increased workload for SCTS admin staff
and audit chair.
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11. DJ attends NICOR PLG on behalf of SCTS, 28/07/15. Informed of combined audits
meeting on 5/8/15 and need to discuss NACSA with the NICOR audit lead and
complete template in advance. NICOR audit lead contacted, who explained that
the meeting was an internal NICOR meeting and that SCTS opinions would only
be necessary after the meeting.
12. Alternative new formats for data display on public website circulated to SCTS on
29/07/15 with no public/patient field testing. SCTS found none satisfactory and
confirmed confusing by SCTS lay representative.
13. Letter from NICOR CEO to president elect of SCTS explaining NICOR account of
events on 31/07/15.
14. SCTS solicit independent statistical advice on the presentation of NACSA data as
sufficient worries about the understandibility of the NICOR options.
15. Information from external statistical advisor on 05/08/15 about the relative
merits of data presentation and the certainty of observed outliers being true
outliers.
16. NICOR audit lead circulates NACSA template proposal form on 06/08/15.
17. Data finally goes live on NHS choices website and SCTS website in acceptable
format on 15/09/15, with no adverse publicity. No press release made.
18. As of 30/09/15 continuing errors on NHS choices website with no data
displayed for many surgeons.
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iii. STANDING REPORT FROM THE TREASURER
Kulvinder Lall
A. MATTERS OF INFORMATION FOR THE EXECUTIVE COMMITTEE
FUNDS HELD AS OF 6.10.15 SCTS EDUCATION £131,653 SCTS £141,851 IONESCU ACCOUNT £185,297 CARDIAC & THORACIC SURGERY UK £144,850
SCTS MEETING MANCHESTER SURPLUS OF £74000
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iv. STANDING REPORT FROM THE HONORARY SECRETARY
S Kendall
A. MEETINGS
MEETING DATE MINUTES
Teleconference to Appoint Chair Research Committee 24.08.15 yes
Teleconference to Appoint Chair Governance
Committee
09.09.15 yes
Multiple Conference Calls SCTS x12 yes
Multiple Conference Calls Scott Prenn x 6 yes
WSCTS 25th AGM Edinburgh 22.09.15 no
NACSA meeting 20.08.15 yes
Thoracic Sub Comm teleconference 28.09.15 yes
British Cardiovascular Council 02.10.15 yes
Collaboration with BUPA Patient Website 08.10.15 film
B. MATTERS OF INFORMATION FOR THE EXECUTIVE COMMITTEE:
Chair of SCTS Research Committee appointed Professor Gavin Murphy
Chair of SCTS Professional Standards and Governance Committee appointed Professor Andrew
Owens.
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v. STANDING REPORT FROM THE THORACIC SUB-COMMITTEE
S Kendall/J King
A. MEETINGS
MEETING DATE MINUTES
Thoracic Committee Teleconference 28/9/2015 Y - below
B. MATTERS OF INFORMATION FOR THE EXECUTIVE COMMITTEE:
Minutes of Thoracic Sub-committee Teleconference 28/9/2015.
Co-chairs: Simon Kendall, Juliet King.
Present: Tim Graham, Graham Cooper, Doug West, Henrietta Wilson, Richard Page,
Richard Steyn, Sri Rathinam, Kostas Papagiannopoulos, Mahmoud Loubani, Steve Woolley.
Apologies: David Baldwin, Rajesh Shah.
Agenda
1) Update from D West re future plans for thoracic surgery audit data collection, and
the lung cancer consultant outcomes project (LCCOP).
Currently there are three different national audit projects relating to thoracic surgery outcomes
being run. There are the national returns which continue in usual format to collect unit-level
data on all procedures by approach and diagnosis, with non risk-adjusted mortality. Second
project is the Dendrite-run thoracic surgery dataset. This has been beset by problems with poor
submission rates and inability to utilise NHS numbers for patients. Funding has been secured
for last of the 3-year proposed period (until end March 2016) and units are being encouraged to
submit as much data as possible for this year. Plan is to publish a new “Blue Book” for thoracic
surgery, sponsored in part by Ethicon next year. It is likely that after 2016 this the full dataset
will no longer continue and we need to think about how we best capture non-lung cancer
surgery activity in the future.
The submission deadline for validated LCCOP data is fast approaching and so far only 1 unit has
returned their data. Data submission is mandatory and units not complying likely to have non-
validated raw data published, with the potential for negative outcomes for units. DW should
have final version of letter detailing support for outliers by October and information regarding
which units are outliers before publication date in Jan 2016.
For next round of LCCOP it is hoped that risk stratification (based on Nottingham score) will be
introduced and that units will have opportunity to submit some surgical data-fields directly
rather than relying on MDM input. This will require IT support for trusts to get Infoflex onto
local computers. No feedback from HQIP and Ben B regarding future direction of lung cancer
audits so far.
Discussion: previously noted issues of missing and inaccurate data again flagged up (JK/SR).
Concerns raised re future of data collection for non-cancer work and how this fits into national
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audits. Validation of data very time intensive in format it is sent in, with little support at trust
level. Emphasis on need to have similar level of data quality assurance across all national
cardiothoracic surgery audits (TRG). GC raised possibility of improving data collection at MDM
level via peer review. DW congratulated by all in terms of progress made.
Actions:
a) Topic of LCCOP to be added to agendae for BORS, SCTS, BTOG and thoracic forum,
and written update in SCTS Bulletin (DW/JK/SK).
b) DW to update Executive at meeting on 9/10/15 as to which units have not yet
submitted data, giving a week to contact unit audit leads and try to ensure
submission before deadline (16/10).
c) TRG / GC to contact HQIP / Jane Ingham / Ben B.
2) CRG update (R Page).
Limited progression in terms of finalising and signing off service specification for lung cancer
for England since last discussed. Commissioning panel has asked for further information in
following areas: impact on interdependent services, evidence of likely effect on workforce
planning (particularly changes in number of surgeons undertaking mixed CT practice),
outcomes measurement and minimum unit surgical volumes, and trauma.
In view of delays, the recommended timeframe for cessation of mixed surgical practice has been
pushed back to 2020. In terms of workload there is some evidence that better outcomes seen in
units performing > 150 lung resections / year. Currently there are a few units in England below
this level, but relocation of a couple of smaller units and general increase in resection rates
means that most units will probably attain this level of activity in near future.
Role of trauma care within service specification unclear – impression is that a split into thoracic
and cardiac surgery rather than CT surgery may improve trauma care but other factors may
affect this adversely (see below, trauma update)
Discussion:
GC emphasised the importance of defining and balancing outcomes measurement with respect
to UK model of care. Reassured by RP that service spec indicates a direction of travel and
outcomes not currently “written in stone”. We will need to feedback to members re impact on
mixed practice posts and to inform trainee choices re specialisation. SR queried whether
minimum no of cases / surgeon likely to be enforced – currently unit volumes only, likely to
mean minimum 3 surgeon-units. KP raised potential impact of 7-day working – not specifically
covered in document. ML queried what would happen if unit activity < 150/LC cases – may not
be commissioned. Validity of some outcomes measures e.g. 30 and 90 day mortality not proven.
DW stated that outcomes would need to be aligned between CRG and lung cancer audits.
Actions: RP to circulate latest version of service specification.
3) Update on training and workforce planning (S Rathinam and R Page)
SAC / SCTS workforce report and Sri’s updated survey distributed and discussed. Sri’s survey
did not get update from any Irish units and one other unit so last years responses used.
Clarification re number of sessions vs days in theatre required and not all units submitted full
job plan information, but generally very good overview, and Sri congratulated on completion.
Discussion:
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ML queried minimum requirements for thoracic surgeon (1 all day list and 1 supported MDM /
week). Proposed by DW that document should be made available on SCTS website for reference.
GC suggested that document could be used as basis for publication in Thorax to provide
overview of current practice and speciality aspirations as aligned with CRG service specification
so that respiratory physicians and MDM’s can see direction of travel.
Actions:
a) SR / RP / ML and ? Jon Anderson to finalise documents for submission to NHS England
and consider preparation of summary publication before end of year– to be discussed with
David Baldwin (? To be co-author), GC to be kept in loop re progress. R Page to lead this
publication.
b) Thoracic Survey and Workforce Report to be uploaded to SCTS website after next Exec
meeting (9th Oct) – SK/JK/IF to action.
4) Trauma Update (R Steyn and R Page)
RS tabled 2 documents on trauma delivery: “Audit standards for trauma” and “Required
standards for major trauma (with relation to cardiothoracic surgery)”. Take home messages of
the importance of high quality care for chest trauma, need for national guidelines and
importance of involving CT surgeons in any trauma audits. Fundamental problem is that not all
MTC’s are co-located with CT surgery units, and so attendance by CT surgeon within 30mins not
always achievable. Chris Moran has asked for formal guidelines to be drawn up.
Discussion: general consensus that trauma requiring urgent CTS input was rare but there was
increasing need for CT surgeons to be available for second line support, and in training of
trauma surgeons and in audit of trauma outcomes.
GC stated that it was vital to minimise impact of trauma management on elective cancer
workload, particularly management of trauma in elderly, and it was important that trauma skills
training not negatively impacted by “Shape of training” and focus on generalist rather than
specialist skills. RP – trauma provision also being considered within CRG service specification.
SK: SCTS need to make statement re vision of trauma delivery in UK as relates to our speciality.
Actions:
a) RS and PR to collate relevant docs from different sources into summary document to
clarify what support needed from CT surgery in trauma provision and national
guidelines?
b) To Liaise with David Jenkins chair of cardiac surgical committee to male an SCTS
“position statement”
5) Feasibility of formalising second opinion for high risk lung cancer resection patients
(JK)
Previously discussed whether a formalised process should be instituted to enable second
opinions on fitness for surgery in patients turned down for radical treatment by local MDM.
Discussion: all supported principle of second opinion if sought, and often this was already
possible from either second surgeon in same unit, or via centralised MDM. Vitally important that
second surgeon “protected” from taking on higher-risk cases by organising a formal discussion
in second MDM to validate decision. Impression was that few patients would pursue this option
if appropriately counselled as to why surgery not recommended in first place, but should be
available if desired.
Action:
JK to discuss with DB as to whether formal guidelines for MDM’s should be drawn up.
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vi. STANDING REPORT FROM THE CONGENITAL SUB-COMMITTEE
D Barron/G Cooper
A. MEETINGS
MEETING DATE MINUTES
Phone Conferencing May-June 2015
David Barron, Graham Cooper Co-Chairs
Conal Austin, Andrew McLean, Prem Venugopal, Andrew Parry Andreas Hoschtitsky, Mark Redmond B. MATTERS OF INFORMATION FOR THE EXECUTIVE:
1. Structure of the Congenital Sub-Committee
After discussion on the executive we had proposed that the Sub-Committee be expanded to
include a representative from each unit in the UK. Given the relatively small number of units
this created a ‘mini-BOR’ and was widely supported by the surgeons across the UK.
Most centres have now put forward a representative and the first meeting of this expanded sub-
committee will be at the Annual Meeting 2016.
The constitution has been duly changed for the definition of the sub-committee.
2. NICOR Reported Outcomes:
No major concerns with outcome monitoring and analysis. Anxiety that NICOR need more
personel/time-commitment for the analysis.
3. PICU Bed Availability:
Discussion with the PICU CRG has been helpful and they have agreed for there to be a
representative of the congential CRG now co-opted onto the PICU CRG to help raise the issue of
cardiac bed capacity
4. NHSE Congenital Heart Review
Standards are now agreed and implementation is to be April 2016. Standard will be for a
minimum of 4 surgeons per centre by 2021, but all must have a minimum of 3 surgeons by April
2016. Heated debate regarding concept of ‘super-networks’and of split-site appointments for
surgeons acorss more than one centre in a network. (see attached letter)
C. MATTERS FOR CONSIDERATION BY THE EXECUTIVE:
a) Confirm change in structure of the Sub-Committee
b) Consider support for the SCTS position on Split-Site Appointments.
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Counter-argument for the Proposal of Split-site Appointments in Congenital Cardiac
Surgery
The principles of the current review of congenital heart disease services are to design and
deliver the best model of care for our patients. To borrow the touchstone of the previous
review, clinical services must be both safe and sustainable for the patients and for the units and
their staff delivering these highly complex services.
Cardiac Surgery in babies and infants is one of the most high-risk, technically demanding and
clinically challenging area of modern surgery in the NHS. It requires extremely high level of
clinical expertise, decision making, technical skill, multi-faceted technology and close team
working between highly motivated teams of cardiac surgeons, cardiologists, anaesthetists,
perfusionists and intensive care specialists. Few other fields of modern surgery depend on this
level of coordinated multi-disciplinary input. This is amplified by the fact that the stakes are so
high, with the very nature of the conditions making each and every procedure literally a life-or-
death event. At the core of this whole process is the need for close and unambiguous
relationships between the teams and the individual key players involved. Unfamiliarity or
insufficient exposure to each other within these teams is a recipe for disaster.
The surgical procedure itself is only one part of a complex and time-consuming process that
requires total engagement from the key individuals (in this case, meaning the surgeon,
cardiologists and intensivists) from the point of diagnosis through decision making, MDT, pre-
op planning, consent and establishing trust and good relations with the family. The post-
operative phase can be the most critical of all and needs true multi-disciplinary care delivered
at the bedside. The surgeon and cardiologist are intimately involved with every step of the post-
op care, especially while in intensive care….often needing critical decisions on management
plans and need/timing of any investigations or re-interventions. The surgeon is ultimately
responsible for the outcome of the patient. It is the surgeon’s name that is published against
outcomes on the public portals and who has to face public scrutiny, media attention and GMC
referral if results do not match expectation. It is the surgeon who has to face the family if things
do not go well and it the surgeon who the family expect and want to see caring for their child in
those critical post-operative days.
Split site appointments have been very successful in other areas of medicine where the nature
of the clinical care is either in an outpatient setting or in performing investigations or in an
administrative role. However, as soon as on-going clinical in-patient care is required then this
model becomes dangerous and rapidly deviates from acceptable practice. It may work if the
procedures are low-risk, elective cases that do not require any sort of planned in-patient care
(generally day-case surgery) but even here this would not generally be accepted as ideal
practice. Furthermore, they have only ever been acceptable if the two sites in question are
geographically close (usually the same city or even within the same Trust) and the individual
can readily and safely travel between the two within the normal NHS requirements for
consultant practice (ie 30 min to bedside).
With these facts in mind, the concept of a split-site appointment for a paediatric cardiac surgeon
would raise the following issues:
1. On-Call: It is not possible to perform this type of surgery without being available out-of-hours
to attend the bedside. No matter how close-knit the surgical team might be, the operating
surgeon carries the ultimate responsibility and has the unique knowledge of that patient’s
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anatomy and physiology. Should a patient deteriorate in ITU or need emergency re-intervention
then it is essential that the operating surgeon is involved and available. Anything less than this
would be unacceptable practice.
2. Travel and Availability: The split-site surgeon has to be within 30 min of bedside. The
geographical arrangement of the networks is such that paired surgical centres (except in
London possibly) are between 40 and 150 miles distant from eachother. For a split site
appointment to be viable then the surgeon would have to be resident on both sites when
operating. To do so one day at a time would require unacceptable daily commutes and the
requirement for a second home. An alternative would be to work for blocks of time at each site
(? a week at a time) requiring even greater logistics to support such a lifestyle. It still raises the
question of what happens if the surgeons’ cases from the end of the week are still providing
clinical concerns the following week and who will take responsibility for key decisions. You may
take the view that this could be devolved to the ‘in-house’ team. I am not sure that the patients’
associations would take the same view.
3. On-Call Rota: The standards are absolutely clear that surgeons cannot work more than a 1:4
on-call rota in any unit to ensure that teams are large enough and sufficiently robust to provide
safe cover in any eventuality. NHSE have clearly accepted this in their proposals for split-site
appointments. Thus, each site in a network would still need to have a minimum of four surgeons
in-house to satisfy the Standard regardless of whether or not any of the appointments were
split-site or not. Thus, each unit still has to achieve the minimum caseload of 500 cases with or
without split-site appointments. Furthermore, the split-site surgeon cannot be used to achieve a
1:4 on BOTH sites since this will mean that the individual in question will be required to provide
up to 1:2 cover – which is completely unacceptable. The maths simply don’t stand up.
4. Unsafe Practice: If split-site appointments are to be used then the surgeon cannot be present
at every MDT at both centres, nor can they be present for the entire ICU stay of all their patients.
Thus, they will not be part of the decision-making process and will either have to accept the
decisions of others or be prepared to over-ride the in-house team, leading to potential conflict.
The result is a clear deviation from everything the Standards describe as good practice. Not only
is this bad for the patients and bad for the clinical teams but it runs the risk of a deterioration in
outcomes and causing actual harm to patients. It is unthinkable to imagine what a coroner
might conclude should events lead to a mortality where the operating surgeon was absent or at
loggerheads with in-house management or trying to coordinate management remotely.
5. Risk to Team Performance: The importance of integrated and functional teams is at the
heart of this whole process. The very reason that minimum sizes were chosen was because
these are widely recognised as being the best model in which to generate the best quality of
care. They imply a critical mass of key team members that is necessary to provide the best
environment for
mentorship, teaching, good governance, sharing of ideas, research, innovation and training
while ensuring resilience to on-call work, succession planning and unforeseen absence. If one
team member is to be contracted to work only part-time in each of two centres then the result
will be a partial contribution to each team and a failure to be fully recognised as a full partner.
The individual will not be able to be present at all MDTs and professional development
meetings and so will not be seen as an equal on either site. There will inevitably be different
management styles and techniques used in each centre and so the split-site individual will
either have to adopt both sets of working practice simultaneously or impose one method on
both. The result is a weakened surgeon and potential conflict within both teams with lost
opportunities for all concerned.
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6. Lessons Already Learnt: The only previous attempt for split-site appointment in this
specialty was between Alder Hey and Manchester. In theory this would have been an ideal
example as they are relatively close geographically (although still too distant to allow the same
consultant to cover both sites) and consist of the same paediatric and adult congenital services
of the same region. The arrangement lasted less than a year because the peripatetic surgeon
simply could not provide adequate input to the inpatients at Alder hey and his colleagues were
not able or prepared to manage the post-operative care and pre-operative decisions for a
remote surgeon.
7. Surgical Standards: The concept of surgeons in high-intensity specialist areas being
appointed to two remote centres with fixed commitments has never previously described in the
health service. It is most likely that the Royal College of Surgeons, the Society for Cardiothoracic
Surgery and the British Congenital Cardiac Association would regard this as unsafe practice and
an unacceptable risk to both patients and to the surgeon. Any such job-plan would not be
acceptable.
8. Lifestyle: This previously untried concept of appointment to two remote sites would entail
extraordinary hardship on the individual(s) concerned. A daily commitment to one site is
unworkable, so the presumed model would be to work for blocks of time in each centre. This
would require a lifetime committed to living in two homes and require repetitive and sustained
periods remote from spouse and children which, to most, would be an intolerable lifestyle and
introduce untold stresses into what is already a hugely stressful job. There is nothing that could
possibly be described as ‘good’ about such a job-plan and this is partly why the Professional
Societies would not accept such an arrangement.
9. Fundamental Principles of The Review: The very core of this process form the outset has
been to describe and then implement the best and safest model of care for patients with
congenital heart disease. Everything the standards describe has been about defining that model.
The concept of split-site surgeons working across distances of 150 miles with two separate
teams is so completely alien to this concept that it is difficult to put into words just what a
negative and detrimental decision this would be. The result would be a service that is actually
worse than the system it has set out to replace. The appointments would disrupt teams, invite
conflict and undermine trust; the quality of care would suffer on both sites and the strains on
the individuals involved would be unthinkable.
10. The Danger of Suggestion: It is inevitable that units feeling threatened by the standards
will be looking at every possible means to make themselves viable. Thus, the very suggestion by
NHSE that this could be a solution will inevitably be considered by such centres, regardless of
whether or not it is something that would otherwise have been welcomed. There is no
possibility of such appointments being sustainable, but they may considered be made as a
means to circumvent the necessary standards for entirely the wrong reasons.
11. Patient and Parent Opinion: The concept of split-site appointments for surgeons is so
completely alien to every principle of Good Clinical Practice than the need to provide a counter-
argument seems superfluous. However, if NHSE are not prepared to listen to the advice of the
professionals then they should at least consult the parent and patient groups to seek whether or
not they feel this would be a good model of care for their children.
The Standards have been written after the most gargantuan and comprehensive process in the
history of the modern NHS. There is no other service specification within the entire NHS that
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has come close to this amount of cogitation, review, public consultation and scrutiny. They are
an outstanding piece of work which has been roundly and universally supported by clinicians
and patients alike as the best thing to have come out of the whole Review. Nothing has received
more attention than this central issue of the numbers of surgeon per centre and minimum case
volume (or case-load per surgeon). The standards were not written so that they could be
circumnavigated, abused or ignored. They were written to be as unambiguous as possible –
particularly on these key issues – in order to describe what good practice should look like. If split-site appointments and peripatetic surgeons were thought to be a ‘good thing’ then do you not think the standards would have said so? This process was not a game where the first response to
a standard is to look for a loophole in the wording or to twist the meanings to undermine the
whole ethos of the process. Yet, before the ink had even dried on the document NHSE have quite
deliberately come up with this extraordinary and dangerous concept as a means of warping and
undermining the standards. If NHSE are not prepared to accept the Standards then why on
earth did they support them up to this stage? The option of 3 surgeons as a minimum was hotly
debated, foreseeing this dilemma that we are currently faced with – but there has been a clear
and strong decision for 4 surgeons as a minimum – strongly championed by NHSE themselves –
so it would be incomprehensible to then try and undermine this at the first opportunity.
It is my request that NHSE expunge this dangerous and ill-thought suggestion from the entire
process and that such action is taken immediately before any further damage is done.
Unfortunately, since the concept was introduced into the formal documentation by NHSE in its
presentation to the Executive then the wording will need to be formally and publically
withdrawn in order to remove any ambiguity.
David Barron September 2015
Consultant Cardiac Surgeon
Birmingham Children’s Hospital
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vii. STANDING REPORT FROM THE CARDIAC SUB-COMMITTEE
T Graham/D Jenkins
A. MEETINGS
MEETING DATE MINUTES
Mon TC calls, weekly re data publication June-Aug 2015 Available,
notes on file,
secretary
Risk factor meeting for NACSA 3 July 2015 Mins and
report
enclosed,
tabled for exec
today
Ethicon SCTS cardiac surgery symposium, supported
by members of ACSSC as speakers/chair.
19 June 2015 Feedback from
delegates
TC with PHE re Mycobacterial infection CPB
heater/coolers.
9 June 2015 Available,
secretary
B. MATTERS OF INFORMATION FOR THE EXECUTIVE COMMITTEE:
1. Risk factor/NACSA review report forwarded for comment of ACSSC Sept 2015.
2. Heater/cooler infections, meetings with PHE and advice to membership, June 2015.
3. Letter to NICE to review guidelines on endocarditis prophylaxis, July 2015.
4. Letter to ICU CRG about implications of proposed standards for CT critical care to
support ACTA, June 2015.
5. The committee is responding to NICE requests for registration for consultation, latest
for trauma clinical guidelines review.
6. Continuing workload to review job descriptions for RCS(Eng).
7. Preliminary work on proposal for research into outcome of cardiac surgery in the
elderly, retrospective and prospective studies.
8. Advice to Welsh cardiac surgery collaborative model, ongoing.
9. Contribution, with Simon Kendal, to SCTS workforce document for adult cardiac
surgery.
10. Contribution to Safer Surgery research proposal.
11. Survey of ACSSC members about care of urgent pre op cardiac surgery patients on
behalf of unit request.
12. Update on cardiac ECMO, UK meeting including commissioners planned for January
2016, DJ will represent SCTS.
B. MATTERS FOR CONSIDERATION BY THE EXECUTIVE COMMITTEE:
Future chairmanship of this committee.
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NACSA database review meeting Friday 3 July RCS(Eng)
Present: David Jenkins, Samer Nashef, Mark Jones, Tim Graham, surgeons Tracey Smailes, Sarah Powell, Philip Kimberley, database managers Robin Klinsman, database provider Anthony Bradley, Vlad Demian NICOR
Apologies: Uday Trivedi, Ben Bridgewater (Both provided input pre or post meeting)
1. Welcome and introductions. DJ welcomed all to the meeting and explained the importance of the group. There was representation from surgeons, SCTS, database managers, Dendrite, and NICOR. The main priority was to make the risk factor definitions fit for contemporary practice and offer guidance on interpretation. The order of discussion should follow 3 principles; clinicians to confirm as most correct, database managers to confirm practicality, database providers to confirm feasibility. In addition several questions posed by NICOR are to be debated. The notes from BB had been circulated in advance. Changes would be incorporated into the database from April 2016. SN was able to comment from his experience of EuroSCORE. TG agreed that the former task was most important and that consideration of morbidity outcome measures should be deferred to another meeting. TG thanked all for providing their time on behalf of the SCTS executive.
2. Revision of risk factor definitions. These were taken in order, debated in turn, and guidance decided.
1) Age. Continuous variable, in years. All satisfied, no changes suggested. 2) Sex. Male or female. No major issues. No changes suggested. 3) Chronic pulmonary disease. Some issues. EuroSCORE I and II were the same, but the
current NICOR/SCTS definition was different as the latter included FEV1 < 75% predicted. MJ commented that some colleagues in Belfast had a higher incidence of this factor. The potential problem of a risk factor definition precipitating increased patient investigations was debated, especially if an artificial threshold did not influence the surgical management. There was some concern that the FEV1 criterion may influence patient investigations and differed from EuroSCORE. SN explained that one of the principles of EuroSCORE was that the data should be easily available and non subjective. The EuroSCORE definition specified ‘long term use of
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bronchodilators or steroids’. It was thought that to be future proof, a definition should be more inclusive as new therapies are used for chronic lung disease.
New definition: Current use of medication for lung disease. Guidance: Use of this medication up to admission for surgery. Change: Previous FEV1 criteria and ‘history’ of lung disease removed. NICOR action: To make dataset change to remove 3 options and change to N/Y as defined above. 4) Extracardiac arteriopathy. Again some concerns, especially as the current
NICOR/SCTS definition included clinical examination findings. It was commented that these would be very difficult to revalidate and were too subjective. It was noted that EuroSCORE II included amputation as a fourth factor in addition to those in EuroSCORE I. There was a discussion over‘claudication’, but it was concluded that this described a relatively precise clinical syndrome.
New definition: Anyone or more of, claudication, carotid occlusion or >50% stenosis, previous or planned surgical intervention, amputation for arterial disease. Guidance: Definition of claudication exertional calf or buttock muscle pain, not explained by arthritis and under investigation or previously investigated for vascular disease. Any of the 4 factors to score. Presence of atheroma found incidentally on CT scans should not score as difficult to quantify and classify. Change: Remove previous definition of reduced or absent foot pulses, angiographic stenosis of >50% and carotid or femoral bruits as evidence of PVD.
5) Neurological dysfunction. Noted change in EuroSCORE II as poor mobility included as a new field, independent of neurological disease. Discussion about difficulties of interpretation, as mobility subjective. Dendrite confirmed both field available in their dataset so that Euro I and II could be calculated. The original Euro I and NICOR/SCTS definitions were compatible and could be retained. All satisfied, no changes suggested.
Unchanged definition: Patient has neurological disease affecting ambulation or day-to-day functioning. Guidance: A neurological diagnosis and the need for mobility aids (eg walkers, wheelchair, stair lifts) or inability to self care.
Euro II mobility field, with Euro definition to be added as a separate field to the NICOR dataset (already present in Dendrite). 6) Serum creatinine. Few concerns. Actual level in micromol/L at the time of surgery.
Euro II and NICOR/SCTS fields compatible, with creat as a continuous variable. Previous scoring of > 200 micromol/L for Euro I also possible as actual number entered into field, as is criteria for new Euro II, because Dendrite confirmed a dialysis field of Y or N is already present.
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Unchanged definition: Serum creatinine value. Guidance: Most recent result documented prior to start of operation. 7) Previous cardiac surgery. Accepted Euro I principle that a previous major cardiac
operation was necessary and opening of the pericardium was essential to score. Discussion that both were necessary to score, but that a complete sternotomy was not necessarily required eg previous closed mitral valvotomy or MIDCAB would count. It was felt that the current NICOR/SCTS variation that counted implantation of pacemaker leads should be changed, as this was not a major cardiac operation, the breach of the pericardium was very limited and the impact on future surgery was minor, unless performed via a full sternotomy. Hence, definition acceptable, but guidance to change.
Unchanged definition: Previous major cardiac operation requiring opening of the pericardium. Guidance: Cardiac procedure should be major eg CABG, valve, congenital correction, the pericardium must have been opened. Any previous full sternotomy, for whatever reason, and opening of the pericardium should also score. A minor cardiac procedure eg insertion of pacemaker leads without sternotomy should not score. 8) Active endocarditis. No major concerns, but thought that original Euro I definition
most objective – patient still on antibiotic treatment for endocarditis at the time of surgery. All agreed this was more objective than current NICOR/SCTS field of ‘active endocarditis’ from the native valve pathology field.
Guidance: Patient needs to be taking antibiotics specifically for treatment of the endocarditis at the time of surgery.
9) Critical preoperative state. Felt no need for formal definition as variables collected separately from other fields to allow subsequent calculation to score. However, guidance important. Dendrite confirmed Y or N fields for critical state already present in their dataset. Broad agreement between Euro definitions and NICOR/SCTS, but the latter specified some forms of mechanical circulatory support in addition to IABP (impellar) that therefore excluded others (ECMO). At the time of Euro I only IABP was available in most centres, and Euro II did not change. It was felt that the definition should be modernised to include contemporary forms of circulatory support to be fit for future practice, but not be too prescriptive. The dataset included provision for mechanical circulatory support, and ECMO, or new devices, could be included in ‘other’ box.
Guidance: The events to score should have occurred prior to arrival in the anaesthetic room, during the current in-patient treatment episode, not necessarily same hospital but without discharge to home, or precipitating the current admission (eg OOHCA). Mechanical circulatory support should include any form, IABP, “impellar” type device, temporary VAD, VA ECMO. 10) Unstable angina. It was recognised that practice had changed and the original Euro I,
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and NICOR/SCTS definition were now both obsolete. TG confirmed that this was the problem field that resulted in the revalidation and changes last year. The definition was changed in retrospect after data had been submitted to NICOR because of abnormal distribution of the prevalence. This was an improvement, but not perfect. It was noted that for Euro II a simple definition of CCS class 4 angina was used. SN agreed that although useful to have backward and forward compatibility between risk score systems, it was justified to make the change as clinical practice had evolved. After much discussion it was agreed to make a further change. This would not need a specific field for ‘unstable angina’, but the condition would score if 3 fields were positive: non-elective CABG and CCS 4. NICOR were asked to check how many patients would score with this new definition compared with the latest NICOR/SCTS definition from 2014, which included heparin +/- iv nitrate.
New definition: Non-elective plus CABG plus CCS 4, derived from 3 fields. Dataset field change: Remove ‘iv nitrate’ field. Guidance: Unstable coronary syndromes will be determined from other fields, CCS 4, non-elective surgery and CABG. The CCS grading should be the most symptomatic for the current hospitalisation episode (usually symptoms on admission). This also applies to NYHA grading.
11) LV dysfunction. The Euro I definition was clear, and did not change substantially in Euro II, although a separate category for very poor function has been included (< 21%
EF). The EuroSCORE definitions did not include any guidance about the means of measurement. The current NICOR/SCTS definition does include examples of imaging techniques, but also states an “eyeball” value could be used if no objective measurement was available. The latter was thought to be no longer acceptable as it could not be validated and all patients should have a formal pre or intra operative assessment in 2015. It is also technically different from Euro as “Fair” is described as LVEF 30-50%, rather than moderate at 31-50%.
New definitions: LVEF Good, EF>50%, Mod 31-50%, Poor 21-30%, Very poor <21%. Dataset change: Include very poor (EF <21%) category for compatibility with Euro II. Guidance: Subjective determinations not acceptable. Category should be supported by an objective measurement documented in case notes. Clinicians should be careful to note the boundaries of EF between categories. If more than measurement or different modalities, then the most contemporary should count most, acceptable to count the lowest measurement if different modalities at a similar time were either side of a boundary. 12) Recent MI. Within 90 days of surgery, concordance between Euro definitions and
NICOR/SCTS. No changes suggested. Unchanged definition: MI < 90 days before surgery. Guidance: MI defined by ECG, CKMB enzyme rise, Troponin rise. For biochemical markers the local reference lab range should be used.
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13) Pulmonary hypertension. Actual systolic PA pressure recorded, continuous variable. No need to change field. The original Euro I and NICOR/SCTS concurred, with SPAP > 60 mmHg to score. Noted that Euro II had complicated the issue with a new category, moderate PH SPAP 31-55 mmHg and severe PH SPAP > 55 mmHg. As the figure entered was a continuous variable, the field could be unchanged and both scores could be calculated.
Unchanged definition and field: as above. Guidance: Recognised as important. Accepted pre operative right heart catheter best evidence, but that pre CPB PA catheter readings would also count (if anything underestimated under GA). Echocardiography estimates of SPAP are acceptable records (including intraoperative TOE), but clinicians are reminded that CVP should be added (and this could be assumed as 10 mmHg, unless documented higher value). 14) Operative urgency. The original definition of emergency in Euro I was noted, on
referral, before the beginning of the next working day. Four classes in Euro II, (elective, urgent, emergency, salvage) with good concordance with the current NICOR/SCTS definitions. There was an important discussion that emphasised that some of these classes were defined by the admission status and others by the decision to operate or working day. The newest Euro II descriptions were felt to be most helpful.
Unchanged definitions: elective, urgent, emergency, salvage, as in Euro II, see guidance. Guidance: Critically important to be correct as salvage and emergency cases would not be included under individual surgeons data. The published operation list was a useful arbitrator, as emergency or salvage cases would never be listed in advance. Elective, routine admission for operation. Urgent, patients not admitted electively for an operation, but who require surgery on the current admission for medical reasons and cannot be sent home without a definitive procedure. Emergency, operation indicated before the beginning of the next working day. Salvage, patients requiring CPR en route to the operating theatre or prior to induction of anaesthesia. The highest urgency category should always prevail, as should the decision to operate over admission status eg a patient admitted electively for surgery the following day, who arrests on the ward at 5am and is massaged into theatre becomes a salvage. 15) Other than isolated CABG. No significant concerns, over field (Y/N) or definition,
but felt that guidance was essential. The Euro definition stated that it had to be a ‘major cardiac procedure’ other than or in addition to CABG.
Unchanged definition: as above. Guidance: Only major cardiac procedures count eg valve surgery. Major procedures under ‘other’ in the Dendrite system include: VSD, ASD, myxoma excision, pericardectomy, pulmonary embolectomy, LV aneurysmectomy, myomectomy, should all also score, as should MAZE procedure and complex pacing lead extraction. Exclusion of the LA appendage or insertion of pacing leads should not count. 16) Surgery on the thoracic aorta. No major issues, but there was a problem with the
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Dendrite field with respect to root replacement – MJ to send information direct to Dendrite.
Guidance: Includes surgery on the ascending (including root), arch and descending thoracic aorta. 17) Post infarct ventricular septal rupture. No concerns with definition or field. Noted that
this condition no longer scores in Euro II as frequency of occurrence now lower. Overall, recommended that all Euro II fields should be included to make the dataset future proof. Definitions and guidance should appear as a box with a hover/prompt. 1. Guidance on interpretation.
Performed as above 2. Consideration of morbidity outcome measures for units/COP.
The chairman had circulated a draft list in advance. However, due to time pressure this item was deferred for a separate meeting. There was concern that data would have been collected retrospectively and used for purposes unknown at the time of data entry. TG thought this issue merited a meeting in its own right, but that this same group would be appropriate to perform the task. Action SCTS to organise a further meeting after September, pending NICOR progress and agreement on the presentation of survival data.
3. Compatibility with other international systems eg STS.
The STS database was reviewed. It was recognised that this was a more complex database with > 160 fields, with paid subscription in the USA, but did not incorporate all cardiothoracic hospitals. It did include more demographic data and all agreed a race/ethnicity field would be beneficial in NACSA, as included in BCIS already. Decision – NICOR to add for NACSA. NICOR explained that fields not contributing to the EuroSCORE were less well completed, and therefore felt increasing fields to approach the STS comprehensiveness would not be helpful. It was recognised that some illnesses eg liver disease, did impact on survival, but were not included in EuroSCORE – to discuss further with SN.
Research information from Ben Bridgewater’s work also indicated the social deprivation impacted survival. Hence, calculation of the deprivation score may be helpful if easily performed?
4. Preparing for EuroSCORE II, adding fields.
All agreed essential for future proofing, and discussed, as above. All database providers will need to update, already incorporated in the latest Dendrite version. Action –database providers.
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5. Other data to collect
eg incisions/robotics for minimal invasive surgery. Agree that operative approach increasingly important since last revision. Five years ago the majority of cardiac surgery was performed via median sternotomy, but this was changing. There was much discussion. Conclusions for operative approach fields: full conventional sternotomy, partial sternotomy, thoracotomy, mini-thoracotomy (one choice only). CPB Y or N, if Y, central or peripheral cannulation for arterial and venous. This would also allow successful exclusion of inappropriately entered TAVI cases, ie AVR with no CPB.
6. Other database issues to resolve (NICOR).
The database issues from Ben Bridgewater’s comprehensive preparation paper were reviewed. Field for destination/discharge, where no data assumed death. However, also field for status at discharge alive or dead, so potential conflict. Agreed best to remove latter field. Action – notice to database managers. Previous cardiac surgery. There is a box for number previous cardiac operations 0-123 etc, and also previous cardiac surgery Y or N. Fields present in different areas of the database. To remove latter and keep number previous operations, with guidance note hover box as above. Operator grade. Acknowledged that titles changed and will need up dating. Consultant unchanged, NTM middle grades now ST1-8 and SA now SCP. Agreed NICOR to check for commonality of definitions in the BCIS and MINAP databases. Conduit harvest for CABG. Agreed needs update. Expanded fields under each graft for type of vein harvest: conventional open, bridged, endoscopic. Include ethnicity, but not MDT discussions. Post operative variable, blood loss and products etc. Agreed important, but to discuss at subsequent meeting on other outcome measures.
7. Review of this working group report by ACSSC of SCTS?
TG felt that this was unnecessary as current group appropriately configured and could inform NACSA steering group and main SCTS executive.
8. Conclusions and next steps.
All to review this draft Report to next NACSA steering group meeting 20 August 2015
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viii. STANDING REPORT FROM THE PRESIDENT-ELECT
G Cooper
A. MEETINGS
MEETING DATE MINUTES
Conference Calls 8/6/15. 9/6/15,
18/6/15,
22/6/15,
29/6/15,
6/7/15,
31/7/15,
3/8/15, 4/8/15,
10/8/15,
14/8/15,
18/8/15,
24/8/15,
7/9/15,
28/9/15,
29/9/15
RCS Eng Council 11/6/15,
9/7/15,
10/9/15,
8/10/15
Yes
FSSA 9/7/15,
10/9/15,
Yes
B. MATTERS OF INFORMATION FOR THE EXECUTIVE COMMITTEE:
i. British Surgical Association
ii. FSSA initiative based on premise that BMA does not adequately represent surgeons.
Survey results, attached, strongly supported and establishment of BSA being pursued.
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British Surgical Association: survey of interest
FSSA/090715/DocD
Surgeons, like many clinicians in today’s NHS, are unhappy. Morale is at an all time low. There are many reasons for this: a
perceived loss of professionalism, a culture of fear and intimidation in the work place and perhaps most importantly, a
perception that surgeons are no longer in control of their own destinies. These are often determined by non clinical staff
and politicians for whom cost containment is the absolute priority.
Whilst surgeons frequently point the finger of blame for their altered circumstances to our political and managerial masters
and mistresses, much opprobrium also falls upon Colleges and Specialist Associations. How often does one hear the
accusation “what do the Colleges or the Associations do for me?”.
The problem here is defining what surgeons expect from Colleges and Associations. If it is certification, examination,
maintenance of standards, development of crafts skills or encouragement of research, then really surgeons have no reason
to gripe. The Colleges and Associations throughout the UK and Ireland actually perform these tasks with considerable
aplomb and have done so for many years. The perception that they are glorified dining clubs for an aging elite is simply
wrong!
If, however, surgeons are disgruntled because they feel no-one is looking to their professional interests as defined by their
terms and conditions of work, or their salaries and pensions, or job contracts, or disciplinary procedures then they may
have a point. Colleges and Associations are largely Charities and as such their actions are determined by the Charity
Commission which specifically states that their activities must be for the benefit of the public and not exclusively for their
surgeon members. Of course, there is inevitably some fudging of the boundaries and Colleges and Associations frequently
justify activities on the basis that some benefit will accrue to patients as a secondary benefit to helping surgeons. But the
inescapable fact is, and is often not appreciated by surgeons, that the Colleges and Associations are effectively powerless to
intervene on surgeons’ behalf with respect to terms and conditions of service. This latter is the role of the BMA which is the
recognised trade union for medically qualified individuals. And, as is well known, surgeons are not particularly well
represented in this organisation which is largely comprised
of general practitioners.
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For these reasons, I and others* suggested some years ago that consideration should be given to the creation of a “British
Surgical Association (BSA)”. We recognise that surgeons are traditionally conservative with a small “c” and are usually
reticent to become involved in matters appertaining to trade unions. Also, we recognise that there are already arguably too
many surgical Colleges and Associations and speciality groups. Nonetheless, numerous discussions have occurred and we
were advised that no progress could be made on this suggestion without some verification that there was support for this
idea in the surgical community. Hence, this survey.
A letter inviting surgeons to complete the survey was sent out on behalf of the FSSA from all 10 Specialty Associations. It
read as follows:
Re: British Surgical Association: survey of interest
As many of you will be well aware, there has been discussion in recent months about the suggestion that the UK would benefit from the creation of what has been called “a British Surgical Association”.
The aim of such a Professional Association would be to act as a ‘Trade Union’ for surgeons and to look after their interests irrespective of Surgical Royal College or Surgical Specialty Association affiliation. As such, it would be able to involve itself in matters relating to terms and conditions of service, contracts of employment, litigation, insurance and other matters which the majority of Surgical Colleges and the Associations are effectively excluded from on the basis of their charitable status.
A BSA would emphatically and specifically not be in competition with the Surgical Colleges or Associations, as these have remits relating to professional standards, education and membership activities and are not permitted to act, in any way, as a trade union. Indeed, it is apparent that any potential success from a BSA would only occur if it existed in harmony with the Surgical Colleges and Associations.
We have been informed that there is no theoretical impediment to Surgery as a defined craft Profession establishing its’ own trade union.
For your information, the subject of BSA has been informally discussed with Presidents of all four Surgical Royal Colleges as well as informally with members of government and ACAS.
We are advised that an important preliminary step in establishing a BSA would be to substantiate the fact that there is popular support within the Profession for such a move. Hence the need for a survey.
This proposal (to sample surgical opinion using a survey distributed to members of all 10 speciality associations and facilitated by FSSA) has been discussed by the executives of all speciality associations.
We are grateful to you for your cooperation and would welcome any comments.
The questions were as follows:
1. Please state grade (Consultant / NCCG / trainee) 2. Number of years in present appointment (<1 , <5, <10, <15, <20 years) 3. Do you agree that terms and conditions of service for surgeons should be considered separately to those
of other specialities 4. Do you consider that terms and conditions of service are adequately dealt with at present 5. Would you support, in principle, the establishment of a “British Surgical Association” 6. If ‘yes’ would you agree that such an Association should be independent of Colleges and Specialty
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Associations but work closely with them
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Results
Over 1500 responses were received.
A total of 82% were consultants. As regards years in practice approximately 10% were within 1 year of
appointment and then there was an even distribution of about 20% each for the bands up to 5, 10, 15 and 20 years
respectively.
When asked the question “do you agree that terms and conditions of service for surgeons should be considered
separately to other specialities?” 78% said yes and 22% no.
In answer to the question “do you feel terms and conditions of service are dealt with adequately at present?” 85%
said no and 15% yes.
Question 5 asked “would you support, in principle, the creation of a British Surgical Association?”, 82% said yes
and 18 %, no.
The final question asked: “ if yes, would you agree that such an Association should be independent of Colleges and
Speciality Associations but work closely with them?” No less than 95% said yes and 5% no.
A total of 496 responses included free text. These are shown in full on the FSSA website (http://fssa.org.uk/BSA
survey/responses). The majority were in support of the suggestion that a BSA should be established. The most
commonly recurring theme was that surgeons were poorly represented and that the BMA was not fit for purpose
from a surgical perspective.
There was a vocal minority who argued that we already have an ample sufficiency of representative associations
and do not need anymore.
Discussion
Notwithstanding “survey fatigue” which afflicts most of us, this survey generated over 1500 responses in less than a
month. There is absolutely no doubt that surgeons are disgruntled about their terms and conditions of service and
a majority of respondents were very supportive of the concept of a British Surgical Association.
These results were discussed at a recent meeting of the FSSA. Three important points were raised:
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1. The fact that a survey shows a professional group are unhappy with terms and
conditions of service may simply be a reflection of low morale throughout the NHS
2. The results might have been different if we had included a question asking whether or
not surgeons would be prepared to pay a fee to join a British Surgical Association
3. It was pointed out that a notable feature of the free text responses was that very many
were critical of the BMA. Perhaps therefore these results are a manifestation of
discontent with the BMA rather than an appeal to create another association. In this
regard I emphasised that reference to the BMA was deliberately omitted from the
questions as I felt this would have inappropriately detracted from the main issue.
The FSSA have agreed that the next step should be to meet with the BMA in an attempt to determine
whether or not they are prepared to specifically consider surgeons concerns. In the absence of any
progress, then further enquiries would be made about other options; these include affiliation to another
existing union, the formation of a voluntary union which can negotiate on members’ behalf without
using legal procedures and usually in liaison with ACAS or formation of an independent statutory union.
Recognition as a statutory union necessitates application to a Central Arbitration Committee and needs
as a basis proof it would be likely to attract a majority in favour in a ballot. This survey achieves that!
Comments received with interest.
Professor John MacFie, President of the Federation of Surgical Specialty
Associations, June 2015 Mr Paul Blair President, Vascular Society
Mr David Burge President, BAPS
Mr Michael Davidson President, BAOMS
Mr Tim Graham President, SCTS
Mr Richard Kerr President, SBNS
Mr Nigel Mercer President, BAPRAS
Mr John Moorehead President, ASGBI
Professor Tony Narula President, BAO-HNS
Mr Mark Speakman President, BAUS
Mr Ian Winson President-elect, BOA
*acknowledgements
In particular to Professor Nick Gair, CEO of ASGBI who made informal enquiries of regulatory
authorities to determine if there was any legal impediment to the proposed BSA and who was informed
that the concept was perfectly feasible.
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ix. NURSING & ALLIED HEALTH PROFESSIONALS REPRESENTATIVE
C Bannister
A. MEETINGS
MEETING DATE MINUTES
SCTS Organisers Site Visit, Belfast & Dublin Centres 09-10/06/15 N/A
6th Cardiac SSI Surveillance Meeting, London 19/06/15 Available
CTSNet Allied Health Committee Conference Call 07/07/15 Available
SCTS Organisers Meeting RCS, London 15/07/15 N/A
CTSNet Allied Health Committee Conference Call 28/07/15 Available
CTSNet Allied Health Committee Conference Call 18/08/15 Available
Scott Prenn / BUPA Conference Call re Website 26/08/15 Available
SCTS Education Sub-Committee Meeting RCS, London 04/09/15 Available
SCTS Organisers Meeting RCS, London 07/09/15 N/A
NCBC Steering Group Meeting, BCS London 22/09/15 Available
SCTS Developing an Advanced Allied Health
Professional Practitioner Service Course, St. Thomas’
Hospital, London
02/10/15 N/A
EACTS Postgraduate Nurses Day @ EACTS Annual
Meeting, Amsterdam
03-07/10/15 N/A
SCTS Organisers Meeting RCS, London 08/10/15 N/A
B. MATTERS OF INFORMATION FOR THE EXECUTIVE COMMITTEE:
• The Nursing and Allied Health Professional Cardiothoracic Forum at the Annual
Meeting. The CT Forum is planned to be held at International Conference Centre in Birmingham
in March 2016 and will once again run a nursing and allied health professional stream at the
SCTS Ionescu University. This will be planned along the lines of the Heartlands Advanced
Cardiothoracic Course, and will consist of a half day cardiac and a half day thoracic course.
Feedback from last year’s University stream was excellent and hopefully through advertising
throughout this year we will have a larger number of participants at the meeting in
Birmingham. We would like to thank the entire surgical faculty for their participation in
Manchester and also the companies that took time to teach the participants, and we look
forward to their participation once again.
Plenary speakers planned to be invited:
Ms Andrea Spyropoulos & Ms Cecelia Anim – past & current RCN President’s who gave the
‘Opening Remarks with a topical Nursing UK perspective’, and the Closing comments. As the
NMC are bringing in nurse revalidation starting in April 2016, we are planning to invite a
leading member of the RCN to discuss the issues surrounding this topic.
On a clinical perspective we are also planning to re-invite Jill Ley, Nurse Specialist in Cardiac
Surgery at the California Pacific Medical Centre, San Francisco, USA & Fellow of the
American Association of Nursing, Scott Balderson, Lead Cardiovascular & Thoracic
Surgical Physician Assistant, from Duke University Medical Centre, and David Lizotte, the
President of the Association of Physician Assistants in Cardiovascular Surgery (APACVS).
All have attended the CT Forum before and their perspectives from an international level are
invaluable, they also are planned to teach at the CT Forum University stream.
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Following a successful session at the EACTS Postgraduate Nurses Day on clinical guidelines we
are also planning on inviting Philippe Kolh from the University Hospital of Liege and Joel
Dunning to share their knowledge with the UK nurses and AHP’s. Both are also planning to
participate in the CT Forum University Stream.
Abstract submission is now open and hopefully we will have a large amount of abstracts
submitted for next years’ meeting. We again encourage everyone to support as many nurses &
AHP’s to attend that meeting. We are planning this year to film the CT Forum Ionescu Nursing &
AHP stream and then also the entire 2 day CT Forum meeting. Once edited this will create an
advertising opportunity for all nurses and AHP’s to see the impact of the CT Forum and the
benefits they will gain from attending.
• Ionescu Nursing and Allied Health Practitioner Fellowship
This year SCTS Education has advertised the opportunity for two Ionescu Nursing and Allied
Health Practitioner Fellowships worth £2,500. We had a number of excellent applications
from across the UK and Ireland and shortlisted 4 applicants to be interviewed at the annual
meeting in Manchester. I am extremely happy to say we offered two nurses the Ionescu
fellowships and we look forward to the feedback from both Emma Hope and Daisy Sandeman’s
experiences.
Emma plans to gain insight into the Aortic Aneurysm pathway and create an Aortic Nurse
Specialist role for the service at Southampton General, through her planned visits to Liverpool
Heart and Chest Hospital and the Queen Elizabeth II Hospital in Birmingham. Daisy currently is
in her 2nd year of her PhD focussing on delirium in cardiac surgery, she plans to visit John
Hopkins Institute in Washington, USA where they have specialist teams and units dealing with
post-operative delirium. Daisy plans to create a risk assessment model which could be used in
all centres in the UK and Ireland based on the knowledge she gains.
Both Fellows have started their fellowship visits and will present their experiences at the next
annual meeting in Birmingham, and will also create a paper each for the SCTS website and
Bulletin.
• Bupa/SCTS Patient Information Website Portal.
Currently there is a nursing project running to create patient information pages for the SCTS
and Bupa Websites. The aim is to create a central repository of Quality Assured information
which will provide accurate information regarding cardiac surgery for both patients and their
relatives; and to provide a resource for nurses and allied health practitioners working with
cardiac patients. A group of nurses met during the annual meeting in Manchester with
researchers from Bupa for an insight meeting and discussed the patient journey and pathway
around Aortic Valve Surgery. A patient survey has been given to a group of patients with
regards to the information they receive. The written information has been created and is
currently being edited and referenced. Plans are underway for nurses, surgeons and patients to
film videos for the websites, detailing their experiences.
• Consultations with the Surgical Care Practitioners remain ongoing, currently there are
many streams of work progressing.
Following consultations with the Royal College of Surgeons of Edinburgh, the SCP exit exam is
planned to be held on the 10th December at the RCS, Edinburgh in Birmingham. This exam is
open to those that have successfully completed a recognised SCP training programme as
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described in the National curriculum framework, with the content of the cardiothoracic
pathway as a basis for the exam. Closing date for applications will be 30th October 2015. There
was a revision course held prior to the exam on the 1st and 2nd September 2015 in the CTCCU
seminar room, Wythenshawe Hospital, Manchester, details again on both the SCTS and ACSA
websites. This year’s exam will be based upon the current SCP exam structure and questions.
Work is ongoing to update the SCP course for next years’ exam, with a rigorous QA process
being developed. Thanks go to the RCS, Edinburgh for all their help, support and backing for this
process. A ‘silver scalpel’ award for the best candidate will once again be awarded at the
annual meeting with support from Swann Morton.
Throughout 2015 there are a number of Master Classes planned at the Manchester Surgical
Simulation Centre, Manchester in collaboration with SCTS Education and Ethicon. In April 2015
there was a SCP Master Class in Thoracic Surgery, the Master Class in Cardiothoracic
Surgery was held on the 23rd June, and the Master Class in Cardiac Surgery ran on the 8th
September 2015. The courses were well attended and feedback was excellent. We would like to
thank the surgical faculty and all the clinical international trainers from Maquet, Sorin, Terumo,
Sonasite and Karl Storz for their participation in these courses, and we also thank Ethicon for
sponsoring the courses
Discussions are continuing for increased involvement of ACSA with the SCTS, especially with
regards to formal recognition of the Cardiothoracic Surgical Care Practitioners.
• This year’s Advanced Cardiothoracic Course is planned for the 24th and 25th October
2015 at the education centre, Solihull Hospital, Lode Lane, Solihull. Cost is £30 for one day and
£50 for two days. Details are on the SCTS website. Please see the SCTS website for a link to a
film of the course.
• SCTS Education and Covidien have also supported the Nursing & AHP group in
sponsoring a course, a how to guide on ‘Setting up an Allied Health Practitioner
Programme’. The course is aimed at managers and clinicians who do not have such a
programme and will give tips and hints on how to set up a successful service. The 2nd course was
held at St Thomas’ Hospital in London on the 2nd October 2015; Advanced Nurse Specialists
across the UK presented their experiences of setting up their services. The course was well
attended and feedback was positive.
• Work towards creating SCTS Band 5 & 6 nursing training course and competencies
is progressing. This initiative has been brought about by a call from nurses on the
cardiothoracic wards, asking for guidance and support in basic cardiothoracic training. A
Cardiothoracic Nursing Clinical Development Course ‘Core Principles of Cardiothoracic
Surgery and Care of the Patient following Surgery’ is currently being created. This course
will be aimed at Band 5/6 nurses and we plan to create a framework of core competencies for
ward based nurses that will underpin a 1-4 day programme. The course will compose of
lectures and scenario simulation with an aim to identify local trainers that will be able to
replace the core SCTS faculty and teach the course at a local level, utilising the resources of
written lectures and content provided by the SCTS. The aim is to create a national workforce of
nurses with appropriate knowledge to care for the cardiothoracic patient and to act as a
benchmarking assessment tool across the UK and Ireland. Currently the lectures are being
written by advanced nurse specialists and SCP’s in cardiothoracics across the UK. The plan will
be to run the first course in Spring 2016.
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• The postgraduate nurses’ & AHP day at EACTS was once again run by nurses and
allied health professionals from the UK, the Netherlands, Denmark and Germany. This was held
at the Amsterdam RAI Conference Centre, Amsterdam on Sunday 4th October 2015, and had a
focus on patient frailty and creating safe environments for patients. The SCTS CT Forum top
marking presentations were invited to present at this meeting, and plenary talks from Specialist
Nurses from across Europe were also presented. The meeting was extremely well attended this
year, we had a total of 117 delegates for the pre-lunch session, and around 50-60 for the
morning and afternoon sessions. This year EACTS presented an award for the best presentation
at the Nurses & AHP day which was peer marked based on the system used within the CT Forum
at the SCTS annual meeting. I am extremely pleased to say this was won by Brenda Andrews, a
thoracic Nurse Case Manager from Southampton. Brenda received a certificate from Jose Luis
Pomar. Congratulations go to Brenda and thanks to EACTS for the opportunity.
• The SCTS Nursing & AHP Website Pages have been amalgamated into one page with a
subpage for course, with a link to the CT Forum at the Annual Meeting; and a subpage for
contacts and useful Nursing & AHP websites and links. All the information on these pages has
been recently updated and the most recent Bulletin article is attached there for all nurses &
AHP’s to read. Please encourage all your nurses & AHP’s to look at the page and see the benefits
of membership, especially in relation to SCTS Education courses.
C. MATTERS FOR CONSIDERATION BY THE EXECUTIVE COMMITTEE:
• Support for Nurses and AHP’s to attend the courses planned throughout the year and
also to attend the CT Forum University & Programme at the SCTS Annual Meeting.
• The nursing bursary, previously was £500 and the recipient needed to provide a report
for the bulletin. There had been an application. Where will the money come from
now? Is it an education issue?
• Discussions with Atricure with regards to creating some development and training for
theatre nurses. Cardiosolutions keen to be involved with nurse and AHP training also
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x. STANDING REPORT FROM THE MEETING SECRETARY
C Barlow
A. MATTERS OF INFORMATION FOR THE EXECUTIVE COMMITTEE:
The Meeting Secretary will update the Executive on the current status of arrangements for
Birmingham 2016, Progress with the Action Points (included) and a Succession Plan (included).
There is a meeting of the Meeting Secretariat with Senior Executive Officers on Thursday 8
September. The outcome of this Meeting, including all updates, will formally be presented on
Friday 9 October.
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xi. STANDING REPORT FROM THE CHAIR OF THE SAC
S Barnard
A. MATTERS FOR CONSIDERATION BY THE EXECUTIVE COMMITTEE:
SAC Report September 2015
ST1 Pilot progress
This has been running for 3 years (2013-2015 intakes) and early indications at the selection day
and subsequent clinical progress have been encouraging. A more formal assessment has been
agreed to be made and this will take place next year, to allow feedback from the 2015 cohort to
take place. Dr Plint will write to Tara Willmott at the GMC to enquire what they would look for
in the report for the ST1 pilot, to be submitted in summer 2016.
National Selection 2015
The 2015process was reviewed, a significant spreadsheet issue was addressed. Applications and
bids were discussed in the September 11th SAC meeting. The whole process had been moved
forward 3 months to fit into LETB/Wessex Deanery timelines: the outcome is summarised
below.
Training Programme
ST1 ST3 Congenital
East Midlands 1
East of England 2 1
London 1 3
Northern 1 (ACF) 1 ⃰
Northern Ireland 1
North Western 1
South West 1
Wales 1
West Midlands 1 1
Yorkshire and Humber 1 1
Total numbers 8 8 2
National Selection 2016
National selection will be held in Botley Park Hotel on 1st & 2nd February 2016. There is to be a
meeting in the Wessex Deanery on the 13th November, where the possibility of running the
process in a single day will be explored (given the relatively low number ST3 posts).
SAC/TPD Joint meeting
It had been agreed in the last joint meeting in June 2015, that the joint meeting in 2016 would
be held on one day (SAC meeting in the morning, and meeting with the TPDs in the afternoon).
The date is Thursday, 9 June 2016.
GMC E&D
There is a 60 page document from the GMC (available on their website) regarding curriculum
change with respect to Equality and Diversity requirements. There is a lack of clarity as to how
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the requirements would affect NTNs (as opposed to non-NTNs) and it was agreed to raise a
query with the ISCP Team, in the first instance, so clarification could be sought from the GMC.
GMC Standards
New GMC standards for medical education and training will come into effect from January 2016
and will cover both undergraduate and postgraduate training. There were 10 standards in total
and a series of requirements for each, which organisations would need to evidence that they
were complying with in order to demonstrate they were meeting the standards. The LETBs are
supportive of the new standards.
Workforce Planning Report SAC/SCTS 2015
The final workforce planning document has been circulated to the SAC by email; paper copies
were distributed to members at the meeting and we will be sending copies to other
stakeholders (eg JCST, DoH, GMC) in early October.
Transplantation:
A third periCCT post is to be created and competitively bid for by end of 2015. It is hoped that
the applications/interview will follow soon thereafter and the successful applicant be in post in
April 2016. This (coupled with the other two periCCT posts in Transplant) would mean, in
theory at least, that one new Transplant proficient CCT holder is produced every 6 months.
OOPT:
Once the trainee is back from their OOPT, it will be left to the ARCP panels to make the decision
as to whether that time should count towards certification. It will be the role of the liaison
member to comment on that OOPT at the ARCP meeting and agree about time towards
certification.
Curriculum Change
This meeting with the GMC o discuss curriculum change (streamlining cardiac and thoracic
surgical training) was put back at the GMC request from August to October 19th.
S P Barnard
Chairman SAC
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xii. STANDING REPORT FROM THE EDUCATION SECRETARIES
M Lewis/R Shah
A. Meetings
MEETING DATE MINUTES
SAC 12th Jun/11th
Sept
JCSFE board 15th July
Education Subcommittee Meeting Friday 4 Sept
Ethicon update Thursday 17th
Sept
SCTS University /Birmingham review Course
development
Friday 18th Sept
Ethicon Telecon Monday 5th Oct
B. MATTERS OF INFORMATION FOR THE EXECUTIVE COMMITTEE:
1. AHP Stream
Courses 2015-2017 • Surgical Care Practitioner (SCP) master courses
• The SCP exam Revision Course
• The SCTS Advanced Cardiothoracic nursing course
• How to set up an AHP service
• The Core Principles in Cardiothoracic course portfolio
2. NTN Stream
• Introduce new courses - ST4B (Core Thoracic), ST5B (NOTSS), ST8A (Pre-
Consultant) and ST8B (Professional Development), ST1
• Continue to evolve current courses - ST3B, ST3A, ST2, ST4A, ST5A, ST6AB and ST7A
• Operative video prizes and operative video database
• Quality assurance of courses from RCS Ed / SCTS (Mahmoud)
• Measures of success / outcomes. Develop robust formative assessments criteria for
the courses
Assessment of Outcomes • DOPS (type) assessments pre and post courses
• Tracking of procedure numbers over the 12 months
• Clinical supervisor evaluation of trainee response to courses
• Self-evaluation of trainee
• Development of assessment group in partnership with RCS Ed
• Improve attendance through encouraging ARCP oversight
3. Consultant stream
• Non clinical learning. Aim is for every consultant to have access to a prof devel
course in a revalidation cycle. Delivered through Academyst.
4. Non NTN Stream
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• Still working on non-NTN database. Engagement remains an issue.
• 2 courses to be run: 1 workshop on professional development, 1 on clinical issues
5. Medical Student Stream
• Bristol student engagement event success
• making 6th formers aware of the speciality
• 50 students at 2015 Annual Meeting; 50% female
• Request for 3 national events a year
• Scholarship scheme for elective
6. Accreditation & CPD
• Aims: o Develop a robust process of quality assurance of courses and awards of CPD
points
o Ensure Trainee SCTS Education courses are mapped to ISCP
o Ensure that the educational content, the teaching methods and the learning aims,
and learning outcomes are appropriate for the target audience
o Encourage appropriate evaluation of educational activities
o All cardiothoracic course providers to aspire for SCTS Education Accreditation
• Challenges: o Credibility (Link with RCSEd could be useful?)
o Manpower
o Publicity
7. VATS lobectomy Project
• Programme to improve VATS lobectomy outcomes
• Piloting in Manchester and Wolverhampton
• Ongoing mentorship and site visits from trainers
• Similar ideas around TAVI and mitrial repair in the works
8. Fellowships
• Advertising and application dates to be brought forward
• Aim to advertise 1 December; close 15 January; 4 week for assessment (Ethicon will
be later)
9. SCTSed.org.uk
• Developed by John Butler and Kasra Shaikhreza
• Platform for delivering and hosting SCTS education material
10. SCTS University
• Proposal for development of second University day. Industry support.
• Most likely linked to Birmingham Review Course
11. JCSFE
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• Likely first clinical in Bangalore Sept 2016
C. MATTERS FOR CONSIDERATION BY THE EXECUTIVE COMMITTEE:
Both Ed secretaries likely to demit in next 12months. Succession planning.
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xiii. REPORT FROM THE CHAIRMAN OF THE INTERCOLLEGIATE EXAMINATION BOARD
J Anderson
A. MEETINGS
MEETING DATE MINUTES
Intercollegiate Specialty Board 20th Jan 2015 Available
Intercollegiate Specialty Board 1st Sept 2015 Unconfirmed
B. MATTERS OF INFORMATION FOR THE EXECUTIVE COMMITTEE:
No change in format for CT exam. Awaiting SHOT review before SAC decides on curriculum
change. E and D training now embedded into examiner training and exam briefings.
C. MATTERS FOR CONSIDERATION BY THE EXECUTIVE COMMITTEE:
Entry criteria unchanged but only 4 attempts at section 1 and 4 attempts at section 2. No
exceptional attempts after Jan 2016
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Unconfirmed
Present: In attendance:
MINUTES of the MEETING of the INTERCOLLEGIATE SPECIALTY BOARD in Cardiothoracic Surgery held on Tuesday 20 January 2015 in the Reception Room at the Royal College of Surgeons in Edinburgh. Mr J R Anderson – Chair Mr S Barnard (SAC Chair) - Honorary Secretary Mr C Barlow (RCPSGlas) Mr J Hinchion (RCSI) via Teleconference Mr Rana Sayeed (Leader, Panel of Question Writers S1) Mr Rajesh Shah SCTS Ed via Teleconference Mr A Sepehripour (SCTS Trainee Representative) Mrs C R Digance-Fisher – Specialty Manager Mrs L Sheen – Specialty Manager
1. Welcome and apologies for absence
Apologies were received from Mr M E Lewis (SCTS), Mr M T Jones (RCSEng), Mr J McGuigan (RCSEd) and Mr J A J Hyde (SCTS).
The Chair welcomed Mr Amir Sepehripour (SCTS Trainee Representative) to his first meeting.
2. Minutes of Meeting held on 20th September 2014 at the Intercollegiate Office, Edinburgh.
The minutes were accepted as a true and accurate record and signed by the Chair.
Mr Anderson gave an update on the Equality and Diversity profile of the Examiners. These were overwhelmingly male however Mr Sayeed highlighted that a large proportion of the Question Writing Group were female.
3. Matters arising not covered elsewhere on the agenda.
The Chair confirmed that there is a new JCIE approved Equality & Diversity training presentation which would be circulated to examiners before each examination. Action: Secretariat The Board agreed that Mr T Graham would be retained as an assessor for a three year term.
Action: Secretariat Members discussed the criteria for applicants and that trainees must have an ARCP Outcome 1 at ST6 to be granted eligibility and discussed whether this could be part way through the year. This would be discussed at next SAC meeting and Mr Barnard agreed to update the Training Programme Directors. Action: Mr Barnard
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4. To receive Unconfirmed Minutes of the JCIE Meeting held on 8 October 2014 in Edinburgh
The Board noted that the examination fees would be reviewed at the next JCIE Meeting. The Board noted that the Joint Surgical Colleges Fellowship Examination in Cardiothoracic Surgery has been established. The Board noted that Mr Richard Hedges would extend his term as Chair – Oral Question Writing Groups until April 2016. The Board noted that candidates who have been unsuccessful in Section 2 twice may receive more detailed feedback. This would be discussed at next JCIE meeting. The Board noted that JCIE is keen to recruit more diversity for the Panel of Examiners.
5. To receive Unconfirmed Minutes of the JCIE Internal Quality Assurance (IQA) Committee
Meeting held on 30 October 2014. The following points relevant to Cardiothoracic Surgery were noted:
The Board noted Dr Featherstone’s Psychometrician report. It was agreed to implement the automation of feedback to examiners after each diet of an examination, to provide analysis of their marking patterns and feedback from assessors. The May diet of the Cardiothoracic Surgery examination will see the introduction of this examiners’ feedback. The Board noted that Equality and Diversity training will be a component at the examiner induction course. Yearly monitoring (5 years in Cardiothoracic) with gender, ethnicity, religion, disability etc. would also be done. Mr Anderson suggested that all the banked Oral questions be reviewed. Two or three Writing Group Meetings would be required for the Oral questions and many more for the Section 1 Questions.
Mr Barlow expanded on the feedback to unsuccessful candidates confirming that the Training Programme Directors receive a copy of the final performance reports The Board noted that there remain gaps in the Section 1 questions mapped to the Curriculum and some of these are significant. The gaps would be actively looked at and it is hoped that they would be plugged by the end of this year. Members agreed that there should be a move to create higher order thinking questions rather than recall questions. Action: MCQ Mr Barlow summarised the numbers of questions in the various banks and the Board noted the low number for Cardiothoracic Surgery
6. To receive a report from the SCTS Trainee Representative
Mr Anderson welcomed Mr Sepehripour to the meeting and explained the Board structure.
7. Section 1 and Section 2 Reports
i. Section 1 – 8 July 2014 – CBT
a. The Board noted the report from Mr Rana Sayeed, Leader of the Section 1 Panel
of Question Writers
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The Board noted that eight new members have been appointed to the Writing Group and that most of these are recent Consultant appointments.
b. The Examination report was noted.
The cut score for the examination was: 58.03
SEM for the examination was: 2.92
The eligibility to proceed mark was set at 603.95%
12 out of 23 (52%) candidates had been granted eligibility to proceed to Section
2.
The results by candidate type were noted as follows:
Type 1 (3a-2012 Regs) – 5 out of 6 (83%) passed
Type 2 (3b-2012 Regs) – 0 presented
Out of Training (O-2012 Regs) – 7 out of 17 (41%) passed
c. The Board noted the Survey Monkey Feedback and agreed that the majority of
questions are relevant to clinical practice and this proportion may further
improve with the question review.
ii. Section 2 – 15/16 October 2014 – Bristol
a. Members noted the Examination Report. 10 out of 14 candidates (71%) passed the examination Type 1 (3a-2012 Regs) – 5 presented and passed (100%) passed Type 2 (3b-2012 Regs) – 0 presented Out of Training (O-2012 Regs) – 5 out of 9 (56%) passed
The winner of the McCormack Medal was Mr Neil Cartwight (MRCSEd) with a total mark of 518.
b. The Examiner Assessor Report was Noted
The principle of an image bank was discussed, Mr Tsui had suggested this and it was felt this was a good idea but needed further work. It especially lent itself to Thoracic, but good cardiac echoes with representative views of common conditions would also be appropriate. The discussion expanded into using the imaging from an Examination centre to reuse into the Imaging section or the Oral questions in subsequent Examinations.
c. The Psychometrician’s Report was noted and the Board noted the low Thoracic
Oral intermarker reliability. Members discussed the differences in marks and
how this can be addressed. Debate between Examiners to establish facts with
respect to any uncertainty regarding performance before marks are given.
8. To note the 2015 Board Members and the Panels of Examiners, Assessors and Question Writers [S1]
i. The Board noted the 2015 list of Board Members
ii. The Board noted that the following Members of the Panel of Examiners are due to
retire from the Panel of Examiners on 31 December 2015:
Mr A J Bryan – 2nd term
Mr S Hunter – 2nd term
Mr S W H Kendall
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Mr S K Ohri – 2nd term
Mr R D Page – 2nd term
The Board agreed that Mr Kendall would be asked to extend his term for a further 5
years. Action:
Secretariat
iii. The Board noted that Panel of Assessors and noted that Mr Kay and Mr MacArthur
will complete their term in December 2015.
iv. The Board noted the Panel of Question Writers for Section 1.
v. Two applications had been received for the Panel of Examiners and there was
agreement to appoint the following:
Mr John Dunning FRCSEd and Professor Mark Redmond FRCSI Action:
Secretariat
9. Dates, Venues and Local Organisers for Future Section 1 and Section 2 Examinations
i) Mr Jim McGuigan will host the examination in Belfast on 21st/22nd October 2015. ii) Mr Suku Nair will host the examination in Newcastle on18th/19th May 2016. iii) Mr Jonathan Unsworth-White will host the examination in Plymouth on 2016 in Plymouth.
10. To note the arrangements for Section 2: 19/20/21st May 2015
The proposed schedule for the Section 2 examination in May 2015 being hosted by Mr Mark Pullan in Liverpool was noted. The examination would be held at the Liverpool Heart Centre. The Examiners would stay at the Radisson Blu Hotel. Mr Page would organise the Thoracic component. A total of 27 candidates are entered.
11. On-going development of the Intercollegiate Specialty Examination in Cardiothoracic
Surgery Mr Barnard updated the Board about progress with Curriculum development. The Chair of the JCIE favours a 4:2 split, whereas the SAC had favoured a 5:1 split. It was agreed the sequence needs to be deciding the nature of the split, change the curriculum to reflect that and then change the Examination to suit. It was felt that the Examination may not change until 2019. Mr Barnard to write to the GMC to get written confirmation of proposed change.
Action: Mr Barnard
12. Any other business
There was no other business.
13. Date and time of next meeting
i) Late 2015
Date: Tuesday 1st September 2015 Time: 10.30am Venue: RCS Edinburgh ii) January 2016
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Date: Tuesday 19th January 2016 Time: 10.30am Venue: Edinburgh
Signature of Chair: ……………………………..……….…………………..………..
Date of Signature: …………1 September 2015……………………………
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xiv. REPORT FROM THE TRAINEE REPRESENTATIVES
A Sepehripour/J Afoke
A. MEETINGS
MEETING DATE MINUTES
Teleconference with AsiT Director of Education 17.9.15 Yes
B. MATTERS OF INFORMATION FOR THE EXECUTIVE COMMITTEE:
1. Databases-The NTN database has now reached a critical phase with movement from the
initial establishment to the practicality of tracking trainees due to LATs, OOPEs, research
etc. All NTNs were emailed to ask which ST level they are; there has only been a 40%
response rate. A non-NTN database has been created and will evolve over time as it is
used.
2. Curriculum issues-Following discussion at last SAC meeting, agreement to begin work
on a trainee manual mapping out progression through training in terms of case numbers
and competencies.
3. Work experience projects-The application to Mercers was declined; the feedback
obtained by Scott Prenn was that the application and the philanthropic aims of Mercers
didn’t fully align. Nevertheless the work experience project in Plymouth run by Mr
Unsworth-White was extremely successful and oversubscribed with excellent feedback,
reflecting the strong set up. We are awaiting the feedback from Leeds who have set up a
de novo project.
4. Medical student engagement/foundation taster weeks- we have received feedback from
most Foundation schools about official policy on taster weeks. It should be noted that
for practical reasons, taster weeks are encouraged and generally allowed in the latter
part of F1 since that would precede applications in the early part of their F2 year for ST1
applications. Plans to link with Mr Coonar and build a central list of elective/taster week
opportunities.
5. Accepted invitations to meetings: ASiT Preparing for a career in surgery London October
2015, Medical student engagement day Cambridge November 2015, ASiT pre-
conference course March 2016.
6. Discussion about current junior doctors contract negotiations. Following an online
enquiry on the social medium Facebook from Mr McCormack, there has been a request
from several trainees whether the Society will respond to the latest contract
negotiations and take an official position.
C. MATTERS FOR CONSIDERATION BY THE EXECUTIVE COMMITTEE:
1. Database/curriculum issues already considered by education sub-committee and SAC
2. Further plans to continue work on building central list of elective/taster week
opportunities with Mr Coonar.
3. Forum for continuing work experience projects.
4. The issue about the junior doctors’ contract negotiations is extremely complex. The
major issue highlighted is about pay and social/non-sociable hours; it is reasonable to
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say that exact facts and figures are currently lacking. We will be presenting limited data
on this and results of a trainee survey. There is also keenness amongst trainees for the
Society to take an official position, not only regarding cardiothoracic trainees, but junior
doctors as a whole.
xv. PERFUSION REPRESENTATIVE REPORT
T Pillay & H Luckraz
A. MATTERS OF INFORMATION FOR THE EXECUTIVE COMMITTEE:
MEETING DATE MINUTES
Council Meeting for The College of Clinical Perfusion 9/6/15
Council Meeting for The College of Clinical Perfusion 10/9/15
B. MATTERS OF INFORMATION FOR THE EXECUTIVE COMMITTEE:
Disciplinary Policy and procedure for Perfusionists – see attached document
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THE COLLEGE OF CLINICAL PERFUSION SCIENTISTS
OF GREAT BRITAIN AND IRELAND
DISCIPLINARY POLICY AND PROCEDURES AND FITNESS TO PRACTISE HEARINGS
PART 1 – INTRODUCTION
1. There are three committees that deal with allegation, complaints and fitness to practise:
the Investigating Committee, the Conduct and Competence / Fitness to Practise
Committee and the Appeals Committee. Together they are known as the Professional
Practice Committee.
2. Each Professional Practice Committee is made up from at least three people who may be
registered Clinical Perfusion Scientists, Cardiac Surgeons or Cardiac Anaesthetists and Lay
Person. If a lay person cannot be found, then an alternative medical professional may sit
which can be a Clinical Perfusion Scientist, (who may be recently retired if appropriate).
One member of the panel will be appointed as Chair. The Professional Practice
Committees are held in public with the parties concerned. Private meetings may be held
leading up to this. These panels can be supported by a Legal Assessor (appointed to
provide the Committee with legal advice) and / or a Medical Assessor, and by a clerk or
panel secretary (to assist in the administration of the meeting or hearing).
3. A legally trained Case Presenter or Prosecutor may be appointed to present the case on
behalf of the College.
4. All complaints and allegations against a Clinical Perfusion Scientist working in Great
Britain or Ireland are considered including allegations that fitness to practise is impaired
by reason of:
i) Misconduct
ii) Lack of competence / seriously deficient performance
iii) A conviction or caution in the UK for a criminal offence, or a conviction
elsewhere for an offence which, if committed in England and Wales, would
constitute a criminal offence
iv) Physical or mental health
v) A level of proficiency in the knowledge and use of the English language that is
insufficient for the safe and competent practise of the perfusion profession
vi) An entry in the Register that has been fraudulently procured or incorrectly made
5. Any allegation or suspicion that an entry on the Register relating to the Registrant has
been fraudulently obtained or incorrectly made will be investigated.
6. Allegations can be received from any persons including employers, work colleagues,
patients, the police, NHS Protect or equivalent, other regulatory bodies and members of
the public. The College can also initiate its own investigation.
7. Refusal of annual re-registration or removal from the Register will be considered if a
Registrant is convicted of a criminal offence or accepts a police caution that involves one
of the following types of behaviour:
• Violence
• Abuse
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• Sexual misconduct
• Supplying drugs illegally
• Child pornography
• Offences involving dishonesty
• Offences for which a prison sentence is received
PART 2 – FUNCTION AND CONSTITUTION OF PRACTICE COMMITTEES
Investigating Committee
8. The Investigating Committee will consider in respect of each formal allegation referred to
it whether there is a case to answer.
9. In considering whether there is a case to answer, the Committee will consider the
evidence before it and decide whether there is a realistic prospect that the College will be
able to demonstrate that the registrant’s fitness to practise is impaired.
10. Hearings will be held in public.
11. When an allegation has been received, the Clinical Perfusion Scientist will be notified and
a request for information about their employment status will be made. In appropriate
cases, the allegation will be notified to the Clinical Perfusion Scientist’s employers.
Interim Order
12. The Investigating Committee will consider applying an interim order which restricts the
registration of the Clinical Perfusion Scientist if the allegation or event is considered
serious enough. It will only make such an order if it determines that it is either:
a) necessary for the protection of members of the public
b) in the public interest
c) in the interests of the Clinical Perfusion Scientist concerned
13. The Committee can make an order directing the College Council to suspend the
registration (an Interim Suspension Order) or impose conditions that the person must
follow (a Conditions of Practice Order).
14. A risk assessment in relation to every allegation that is under investigation to find out
whether it may be necessary to impose such an order will be carried out.
15. The decision to make an interim order may be made in the absence of the Clinical
Perfusion Scientist provided sufficient opportunity has been given to attend and make
representations. They and their employer will be informed of this decision and this will
be published on The Society of Clinical Perfusion Scientists of Great Britain and Ireland
website.
16. The duration of an order will be set by the Committee having regard to all of the
particular circumstances of the case. It will be reviewed every three months, when new
evidence relevant to the interim order becomes available and on receipt of
representations from the Clinical Perfusion Scientist.
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17. On review, the Investigating Committee may not vary any condition imposed by it or
replace one interim order with another without giving the Clinical Perfusion Scientist the
opportunity to appear before the Committee and give their views on whether such an
order should be made. This requirement is met by sending an interim order notice to the
Clinical Perfusion Scientist.
18. Notice will be given to the Clinical Perfusion Scientist where the Committee revokes or
confirms the interim order.
Conduct and Competence / Fitness to Practise Committee
19. The Fitness to Practise Committee shall consider any formal allegations against a Clinical
Perfusion Scientist referred to it by the Investigating Committee and decide whether a
Registrant’s fitness to practise is impaired. The Fitness to Practise Committee will not
include any member of the Investigating Committee.
20. These hearings will be held in public with the parties.
21. In considering the allegations, evidence and mitigation, the Fitness to Practise Committee
will consider the following when determining sanction:
i) The number and nature of offences or events
ii) The seriousness of the offences or events
iii) When and where the offences or events took place
iv) Information provided by the Clinical Perfusion Scientist to explain the
circumstances
v) Character and conduct since the offence or events
22. This is not a full list of factors which can help to decide the seriousness or significance of
the issues being considered.
23. The possible sanctions the Fitness to Practise Committee may apply but are not limited to
are that they may be:
1) Sent a warning letter with advice and or specific conditions with respect to
periods of re-training aimed at improving clinical or other skills as deemed
necessary.
2) Moved from the full College Register to the Provisional section of the Register
with the right to restoration retained. During this time, the Clinical Perfusion
Scientist will have to meet criteria for returning to work under the rules of
provisional registration. See Registration document – Provisional Registration.
This may include a period of supervised practice for a designated number of
cases over a scheduled return to work programme.
3) Suspension for period of time not exceeding twelve months but remaining on the
Register. This may include a period of supervised practice of a designated
number of cases over a scheduled return to work programme.
4) Struck off the College Register.
24. The Clinical Perfusion Scientist cannot apply for restoration until 5 years have elapsed.
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Appeals Committee
25. The Clinical Perfusion Scientists and any other individuals that have been involved in an
investigation by the College Council or by a Professional Practice Committee will be
informed in writing by the Secretary of the College of any decision and recommendations
made.
26. After being informed of the decision the Clinical Perfusion Scientist may appeal within 21
days by giving written notice of appeal to the College Administrator. The letter must give
the reason for the appeal and why he or she feels that the decision, the notice or the
recommendations or sanction were wrong.
27. The Appeals Committee will determine if:
• due process was followed
• decisions made were based on accurate data and evidence
• recommendations and actions taken were reasonable
28. The Appeals Committee will review all the paperwork from the original case. The Appeals
Committee will not include any member of the Investigating or Conduct and Competence
/ Fitness to Practice Committee. If it is deemed necessary to review the case in full the
procedure for the appeal hearing shall be similar in form and structure in terms of
evidence and procedure applied to the first hearing.
29. A note of evidence must be taken during the course of the appeal hearing.
30. A general right of appeal shall be retained by those justifiably aggrieved by a decision
against them. The sorts of reasons why a wrong decision will be made will probably
surround the grounds for:
• review of administrative actions and the reasons for the decision
• granting an appeal in the criminal courts
31. With respect to the grounds for review of administrative action, these are:
• error of law on the face of the record
• if decisions external to the College are amended the College can review the case
• excessive use of powers
• fettering discretion
• improper delegation
• improper purposes
• irrelevant considerations
32. With respect to appeals, a decision can be set aside because in all of the circumstances of
the case, it is unsafe or unsatisfactory, or that there was a material irregularity in the
course of the hearing. With respect to appeals against recommendations or sanctions, an
appeal can be launched on the basis that the recommendations were wrong in law or that
the recommendations were wrong in principle or manifestly excessive. If none of the
general grounds for allowing an appeal against conviction applies, the appeal must be
dismissed. If one or more does apply, then the Appeals Committee must be for allowing
the appeal. The test for a decision that it is either unsafe or unsatisfactory is a subjective
one.
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33. All appeal decisions will be relayed in writing to the Clinical Perfusion Scientist via the
College Administrator or the College Secretary on behalf of the College Council or the
Professional Practice Committee.
34. It is essential that all correspondence goes through the College Administrator and or the
Secretary to protect all parties from influence or unwanted involvement.
35. In a situation whereby the Secretary of the College is involved in the Professional Practice
Committee, a nominated member of the College Council, not involved in the case, will act
as Secretary to the College. This will normally be the President, Vice President or
Treasurer.
36. The Appeal will be conducted in accordance with the Appeals Policy and procedure.
Membership, Quorum and Voting of Practice Committee Members
37. The College Council holds a list of people from which Professional Practice Committee
members can be selected to hear a particular case. This is done on a case by case basis.
38. Each Practice Committee shall consist of not fewer than three members appointed by the
College Council.
39. The quorum of each panel shall be equal to its membership.
40. Each Committee will contain a Clinical Perfusion Scientist, Cardiac Surgeon or Cardiac
Anaesthetist and where possible a Lay Member although an alternative medical
professional may otherwise be used. A Legal Assessor may also be appointed to advise all
parties on the proceedings. A Chair will be appointed for each Committee. A Case
Presenter (Prosecutor) may be appointed who will present the case on behalf of the
College. Where a legally qualified panel member is appointed he/she will fall within the
role of Chair and may also fulfil the role of Legal Assessor in which case the requirement
to have a Legal Assessor may be dispensed with.
41. No member of the Professional Practice Committees shall sit on the hearing of a Clinical
Perfusion Scientist’s case if that member has previously been concerned with that case ie.
participated in one of these panels.
42. Decisions of all Committees shall be taken by simple majority and the Chair may exercise
a casting vote.
43. Each Practice Committee will be assisted by a clerk or panel secretary who shall be
responsible for the administrative arrangements for the hearing. The clerk will not
participate in the decision making of the Committee and will not have a vote.
44. A record of the proceedings and events will be made.
Conflicts of Interest
45. If any member of the Professional Practice Committee has or considers there to be a
conflict of interest, which may affect or may appear to affect his or her judgement in
dealing with a complaint, then he or she must declare that conflict and decline to sit on the
Professional Practice Committee.
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46. If circumstances change and a conflict subsequently arises or appears to arise, then this
must also be declared and that committee member shall stand down.
47. A conflict of interest will arise if:
• the committee member has had a personal or close professional relationship
with the complainant or Clinical Perfusion Scientist
• the committee member has been involved in the matters that are the subject of
the complaint
• there is any other factor that may cast reasonable doubt as to the fairness and
impartiality of the handling of the case
48. Where a subsequent conflict or the appearance of a conflict arises, the committee member
concerned must take no further part in the handling of the case on the Committee.
Removal of Committee Members
49. A person:
a) is not eligible to be appointed or sit as a member of a committee if disqualified or
suspended from membership of another committee or panel and
b) shall cease to be a member of a committee if:
i) the member resigns which they may do at any time
ii) a conflict of interest arises
c) may be removed pursuant to the procedures of the College Council
Appointment of a Legal or Medical Assessor
Legal Assessor
50. The College Council may appoint a Legal Assessor to assist the Committee in procedural
or legal matters.
51. The role of the Legal Assessor shall be to advise the Committee on questions of law and to
ensure that the proceedings before the Committee are conducted fairly. The Legal
Assessor shall inform the Committee immediately of any irregularity in the conduct of the
proceedings.
52. The parties shall have the opportunity to make representations on the contents of any
legal advice before any decision is announced by the Committee.
53. The Legal Assessor may also assist in the drafting of the reasons for any findings,
determinations or decisions of that Committee.
54. The Legal Assessor shall not be entitled to vote nor take part in any deliberations or the
decision making process.
Medical Assessor
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55. The College Council may appoint a Medical Assessor to advise the Committee whenever it
is considering a formal allegation that the Clinical Perfusion Scientist’s fitness to practise
is impaired by virtue of their physical or mental ill health.
56. The role of the Medical Assessor shall be to give evidence on matters as an expert witness
relating to the Clinical Perfusion Scientist’s physical or mental health.
Postponing or Adjournment of a Hearing
57. Hearings may be postponed by the Committee Chair on their own motion or following a
written request by the Clinical Perfusion Scientist stating the reason for this request.
58. Where a hearing is postponed the Clinical Perfusion Scientist will be given notice of the
new date to which the postponed hearing will be held which will not be before 14 days
after the original scheduled date.
59. Hearings may be adjourned by the Committee Chair or at the request of the Clinical
Perfusion Scientist providing no injustice is caused to either party. This decision can only
be made after hearing representations from the parties and taking advice from the Legal
Assessor.
60. In considering whether or not to grant a request for postponement or adjournment, the
Committee Chair must consider the following:
• the public interest in the case being completed quickly and efficiently
• the potential inconvenience caused to a party or witness to be called by that party
• fairness to the Clinical Perfusion Scientist
Service
61. Any form, warning, notice, decision or request for information given by the College may be:
a) sent by post to the home address of the Clinical Perfusion Scientist as it appears on
the Register and shall be treated as having been sent on the day of which it was
posted
b) sent to the Clinical Perfusion Scientist’s last known address and shall be treated as
having been sent at the time of its posting
c) served on the Clinical Perfusion Scientist by hand at either of the addresses at a) or
b) above or otherwise and shall be treated as having been sent at the time of the
personal service
d) sent by email to the email address provided to the College by the Clinical Perfusion
Scientist as it appears on the Register and shall be treated as having been sent at the
time of its sending
e) service shall be deemed the second day after posting.
PART THREE – INVESTIGATING COMMITTEE
Referral of Complaint / Information
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62. Where the College receives a complaint or information about a Clinical Perfusion Scientist
and that individual is already the subject of an inquiry by the police, the Hospital Trust
Board, NHS Protect or equivalent, another regulatory body, or there are ongoing criminal,
civil or regulatory proceedings, the College may defer the investigation or referral of a
complaint or information until the enquiry or proceedings have concluded.
Procedure of the Investigating Committee
63. The Investigating Committee will sit in private in the absence of the parties.
64. The Committee must send to the Clinical Perfusion Scientist:
a) a copy of the complaint or information and any documentation in support
b) information on how to access these rules
65. The Committee shall invite the Clinical Perfusion Scientist to submit written
representations upon the complaint or information or other matter to be considered,
together with any additional documentation.
66. Where written representations are received, the College may if it seems fit, send the
complainant a copy of the written representations inviting them to provide any written
comment on these representations for consideration by the Committee. The Clinical
Perfusion Scientist will be sent a copy of the complainant’s response.
67. If the Committee considers there is not a realistic prospect of a finding of impairment in
relation to the grounds of misconduct, lack of competence / seriously deficient
performance, a criminal conviction or caution, mental or physical health, or the proficiency
level of the known and spoken English language, then it shall inform the complainant, the
Clinical Perfusion Scientist and any interested third party that no further action will be
taken and provide an explanation for that decision. All decisions shall be made in writing.
68. In respect to any earlier allegations which the College previously determined there was no
case to answer may be taken into account subsequently if the Clinical Perfusion Scientist
has been notified. The notification contains a statement that the case may be taken into
consideration if further allegations arise.
69. The Committee must decide based on the evidence available to them as to whether the
Clinical Perfusion Scientist has been in breach of the Codes of Practice, Standards of
Practice, and Codes of Ethical Conduct or has brought the profession into disrepute.
70. Where the Committee determines there is a case to answer and decides to proceed to the
next stage, it must provide written reasons for its decisions for referral to the Conduct and
Competence / Fitness to Practise Committee.
Procedure for an Interim Order
71. Where the College Council or Investigating Committee wish to apply for an Interim Order,
it shall send a notice of hearing to the Clinical Perfusion Scientist. This notice shall:
a) include details of the matters upon which the application is based
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b) include a statement setting out why the Clinical Perfusion Scientist’s practice should
be restricted or registration of the individual should be suspended
c) provide reasonable notice of the hearing
d) include notification that the hearing may proceed and be decided in the absence of
the Clinical Perfusion Scientist should he or she (or their representative) not attend
e) inform the Clinical Perfusion Scientist of:
i) his or her right to attend the hearing
ii) the time and venue for the hearing
iii) his or her right to give evidence in person, to call witnesses and to cross-
examine any witnesses called by the panel
iv) his or her right to make oral submissions to the panel in person or to be
represented by another person (e.g. solicitor, barrister, professional body or
trade union representative)
72. Where the Committee is considering whether or not to make an Interim Order, the order of
proceedings shall follow:
a) the College shall outline the facts of the case and set out the reasons why the Clinical
Perfusion Scientist’s registration should be made subject of an Interim Order,
together with any evidence in support
b) the Clinical Perfusion Scientist may set out the reasons why such as an application
should not be granted by the panel, together with any evidence or other material in
support
c) the Committee may obtain advice from the Legal Advisor where one is appointed
d) the Committee shall determine the application and announce its decision and the
reasons for it in the presence of the parties if present and applicable
73. As soon as possible after the decision and conclusion of the hearing, the College shall send a
notice of decision to the Clinical Perfusion Scientist which shall:
a) set out the decision of the Investigating Committee
b) specify the reasons for the decision
c) where an Interim Order has been imposed, set out the period of suspension or
restriction, beginning on the date on which the order is made
d) inform the Clinical Perfusion Scientist of the right to appeal to the Appeal Committee
PART FOUR – CONDUCT AND COMPETENCE / FITNESS TO PRACTISE COMMITTEE
PROCEDURES
Notice of Hearing
74. The College shall send the Clinical Perfusion Scientist notification of hearing no later than
28 days before the hearing of the formal allegations before the Fitness to Practise
Committee. This shall include:
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a) the date, time and venue of the hearing
b) the allegations / charges against the Clinical Perfusion Scientist
c) his or her right to
i) attend the hearing
ii) give evidence to the panel
iii) make oral submissions to the panel either in person or through a
representative (e.g. solicitor, barrister, professional body or trade union
representative)
iv) call and cross examine witnesses
d) the possible sanctions open to the panel in the event of a finding of impairment
e) the panel’s power to proceed and determine the matter in the absence of the Clinical
Perfusion Scientist, or their representative at the hearing
75. The evidence to support the allegations will be sent out to the Clinical Perfusion Scientist
with the letter of notification or to follow shortly after.
76. The hearing shall not be scheduled for a date earlier than the 28 days from the day after the
sending of the notice of hearing except with the agreement of the Clinical Perfusion
Scientist.
77. The College shall publish the notice of the hearing on The Society of Clinical Perfusion
Scientists of Great Britain and Ireland website.
Disclosure of Case and Service of Documents
78. No later than 6 weeks before the date of the hearing, the College shall serve on the Clinical
Perfusion Scientist copies of all documents and reports relied upon which it intends to use.
79. No later than 14 days before the date of the hearing, the Clinical Perfusion Scientist shall:
a) advise the College what if any of the evidence served by the College they agree and
b) serve on the College copies of all documents and reports upon which they intend to
reply.
80. Upon receipt of the Clinical Perfusion Scientist’s case, the College shall consider whether
there are any further documents in the College’s possession which may assist the Clinical
Perfusion Scientist and shall serve copies of such documents, if any to him or her.
81. No later than 7 days before the hearing, the College shall send to members of the panel
copies of any documents or reports provided by the parties (whether agreed or otherwise).
Preliminary Meetings
82. The Fitness to Practise Committee may hold a preliminary meeting in private with the
parties, their representatives and any other person the panel considers appropriate if such
a meeting would, in the opinion of the panel or the Chair, assist the panel to perform its
functions.
Joinder
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83. The Fitness to Practise Committee may consider an allegation against two or more Clinical
Perfusion Scientists at the same hearing if considered fair to do so.
84. Consideration of one or more categories of allegation relating to a conviction or caution is
heard after any allegation of misconduct has been heard and determined although this may
not always be the case.
85. Consideration may be given to a new allegation, which is of a similar kind or is founded on
the same facts, at the same time as an existing allegation, even when the new allegation was
not included in the notice of hearing.
Absence of the Clinical Perfusion Scientist
86. Where the Clinical Perfusion Scientist has been notified of the hearing and he or she does
not attend and is not represented, the Committee may nevertheless proceed with the
hearing if it is satisfied that all reasonable steps have been taken to give notice of the
hearing to the Clinical Perfusion Scientist and that it is in the public interest to proceed.
Vulnerable Witnesses
87. In proceedings before the Committee, the following may be treated as a vulnerable witness,
if the quality of their evidence is likely to be adversely affected as a result:
a) any witness under the age of 17 at the time of the hearing
b) any witness with a mental disorder within the meaning of the Mental Health Act
1983
c) any witness who is significantly impaired in relation to intelligence and social
functioning
d) any witness with physical disabilities who requires assistance to give evidence
e) any witness, where the allegation against the practitioner is of a sexual nature and
the witness was the alleged victim
f) any witness who complains of intimidation
88. Subject to any representations from the parties and the advice of the Legal Assessor, the
Committee may adopt such measures as it considers reasonable and desirable to enable it
to receive evidence from vulnerable witness.
89. Where a formal allegation concerns an allegation of a sexual nature, the Clinical Perfusion
Scientist shall not be permitted to cross-examine the complainant in person without the
consent of that person.
Procedure at the Hearing
90. Subject to the requirements of a fair hearing, the panel may decide its own procedures
generally and may issue directions with regard to the prompt and just determination of the
proceedings but will follow all the stages of the process, being:
a) preliminary matters
b) findings of fact
c) deciding whether the Clinical Perfusion Scientist’s fitness to practise is currently
impaired
d) mitigation and sanction
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91. The Committee may exclude from the whole or part of the hearing, any person whose
conduct in their opinion has disrupted or is likely to disrupt the hearing.
Reading of the Formal Allegations
92. At the opening of the hearing, the Chair will commence with introductions where all
present will identify themselves and confirm that all have the same and complete set of
paginated papers.
93. The Chair will confirm the registration number of the Clinical Perfusion Scientist and swear
in or affirm them.
94. The formal allegations will be read out to the Clinical Perfusion Scientist where upon the
Chair shall ask him or her whether any facts or convictions, cautions, relevant
determinations, health issues or false entries alleged in the formal allegation are admitted.
95. Subject to the requirements of a fair hearing, the Committee may amend the formal
allegations at any stage prior to findings of facts of the case and having taken advice from
the Legal Advisor if appointed.
Presentation of the Case
96. A member of the Investigating Committee or Case Presenter (Prosecutor) if appointed will
begin with a presentation of the case against the Clinical Perfusion Scientist including the
investigation, documentary evidence and allegations.
97. Where no admissions are made or some relevant facts remain disputed, the Case Presenter
(Prosecutor) shall present evidence in support which may include calling witnesses.
Evidence
98. Subject to the advice of the Legal Advisor, the requirements of a fair hearing and of
relevance, the Committee may:
a) admit evidence whether or not it would be admissible in a court of law in the UK and
Ireland
b) exclude evidence, where doing so ensures fairness to the Clinical Perfusion Scientist
and or the College
99. The panel may receive oral, documentary or other evidence of fact or matter which appears
to it to be relevant to its consideration of the case.
100. Either side may instead of or in addition to calling witnesses, present a written statement
or affidavit by or on behalf of a witness who is unable to attend the hearing. Any such
document must clearly identify the name and address of the person making the document
and must be signed and dated. The panel may at their discretion agree to receive or reject
such written evidence having regard among other things to the reasons for the absence of
the person giving evidence, the nature of the content and the unavailability for questioning
of the witness.
101. The findings of fact and certification of conviction of any UK or Irish criminal court or the
findings of a judge in any UK or Irish civil court shall be conclusive proof of the conviction
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or finding and the underlying facts.
102. Any relevant determination and findings of fact by any regulator or an equivalent regulator
outside the UK and Ireland shall be conclusive proof of the determination and the
underlying facts.
Witnesses
103. Witnesses shall be sworn or required to affirm.
104. Witnesses shall be examined by the party calling them and may then be cross-examined by
the opposing party. The party calling the witness may then re-examine the witness.
105. The parties may then question the witnesses on matters arising out of the panel’s
questioning. The party calling the witness shall question the witness last.
106. Further questioning is at the discretion of the Chair.
107. Witnesses shall not be allowed to attend or watch the proceedings other than to give their
evidence.
Half Time Submission
108. At the close of the case against the Clinical Perfusion Scientist, he or she or their
representative may submit that the College has not presented sufficient evidence to
demonstrate that, taken at its highest:
a) the facts of the formal allegations are capable of proof
b) the grounds are not capable of being made out
c) there is no realistic prospect of a finding of impairment
109. The Conduct and Competence / Fitness to Practise Committee will consider any such
submissions after having heard representations from both parties and having received any
such advice as it considers necessary.
The Clinical Perfusion Scientist’s Evidence
110. At the end of the evidence presented against the Clinical Perfusion Scientist, he or she or
their representative may address the panel before calling evidence in support of their case.
111. The Clinical Perfusion Scientist will then give their own evidence followed by any
witnesses called following the above procedure again.
Closing Submissions
112. After completion of the evidence, the Clinical Perfusion Scientist or their representative
may make closing submissions to the panel. The Investigating Committee Chair or the
prosecutor will then make a closing submission.
113. The Legal or Medical Adviser if appointed will then provide any advice required by the
Fitness to Practise Committee.
Burden and Standard of Proof
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114. The burden of proving the facts alleged in the formal allegation which are in dispute shall
rest upon the College.
115. The standard of proof shall be on the balance of probabilities.
Findings of Fact
116. The Conduct and Competence / Fitness to Practise Committee shall retire to consult and
not give their decision orally or immediately. The decision may be by a majority.
117. If no relevant facts have been proved or there is no finding that the allegations have been
made out, the formal allegations will be dismissed.
118. The Committee shall makes findings as to whether some or all of the allegations are
proved.
119. The panel shall make findings as to whether the Clinical Perfusion Scientist has been in
breach of the Codes of Practice, Standards of Practice, and Codes of Ethical Conduct or has
brought the profession into disrepute.
120. The Committee shall inform the College Council of its findings as soon as possible and give
reasons on how it reached this decision. The Clinical Perfusion Scientist will be informed of
the decision and outcome as soon as possible thereafter.
121. Findings will be posted on The Society of Clinical Perfusionists of Great Britain and Ireland
website.
Fitness to Practise
122. If the allegation(s) are found to be proved, the Conduct and Competence / Fitness to
Practise Committee shall then consider if the Clinical perfusion Scientist’s Fitness to
Practise is impaired.
123. The Clinical Perfusion Scientist may address the Committee and call any evidence as to
current fitness to practise.
124. Where witnesses are called, they may be questioned by the Committee and the Prosecutor.
125. After completion of any evidence, the Clinical Perfusion Scientist or their representative
may make closing submissions to the Committee. The Fitness to Practise Committee Chair
or the Prosecutor will then make a closing submission.
126. The Legal or Medical Adviser if appointed will then provide any advice required by the
Fitness to Practise Committee.
127. The Conduct and Competence / Fitness to Practise Committee shall retire to consult and
not give their decision orally or immediately. The decision may be by majority.
128. The Committee shall inform the College Council of its findings as soon as possible and give
reasons on how it reached its decision. The Clinical Perfusion Scientist will be informed of
the decision and the outcome as soon as possible thereafter.
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129. Findings will be posted on The Society of Clinical Perfusionists of Great Britain and Ireland
website.
Mitigation
130. The Clinical Perfusion Scientist may address the panel in mitigation, present references and
testimonials and call character witnesses in support.
131. Where character witnesses are called, they may be questioned by the Committee and the
Prosecutor.
132. Where the Clinical Perfusion Scientist has chosen not to attend the hearing, he or she may
provide details of mitigation in writing in advance to the College which will be presented to
the panel.
133. Where the Committee finds the Clinical Perfusion Scientist’s fitness to practise is impaired,
the College shall provide the panel with details of his or her previous disciplinary record
with the College and may present evidence and make submissions in relation to the
appropriate sanction to be made by the Committee.
134. After completion of any evidence, the Clinical Perfusion Scientist or their representative
may make closing submissions to the Committee. The Fitness to Practise Committee Chair
or the Prosecutor will then make a closing submission.
135. The Legal or Medical Adviser if appointed will then provide any advice required by the
Fitness to Practise Committee.
Notice of Decision
136. As soon as reasonably practicable at the conclusion of the hearing, the Committee shall
send a notice of its decision to:
• the College Council
• the Clinical Perfusion Scientist
• the complainant
• any interested third party
137. The notice of decision shall
a) set out the panel’s findings of fact, its decisions on the grounds, impairment and
sanction
b) state the reasons for the panel’s decisions
c) where a Suspension Order or Restriction Order has been imposed, set out the period
of suspension, restriction or retraining
d) inform the Clinical Perfusion Scientist of the right of appeal to the Appeals Committee
e) inform the Clinical Perfusion Scientist that any sanction imposed by the panel took
effect from the date it was made
138. Where there is a finding of impairment, the College shall publish the notice of decision on
The Society of Clinical Perfusionists of Great Britain and Ireland website.
139. The names of Clinical Perfusion Scientists struck off the Register shall remain on the
website for 10 years and remain on the College’s record indefinitely.
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140. The College may also at any time provide a copy of the notice of decision to any of the
regulatory bodies or interested third parties if it is in the interest of justice to do so.
PART FIVE – SANCTIONS
141. The Committee will retire to consider the appropriate sanctions having heard any evidence
and/or submissions as to mitigation. The possible sanctions are set out in paragraph 23.
Restoration to the Register
142. Clinical Perfusion Scientists stuck off the Register will be considered for restoration to the
Register after five years have elapsed if the Clinical Perfusion Scientist makes a request to
the College at that time subsequently.
143. This procedure will follow similar guidelines to the Appeals Committee.
144. If there is as an overturning of a criminal or civil conviction or a miscarriage of justice has
been proven, then the Clinical Perfusion Scientist has the right to make a request to the
College for it or the Appeals Committee to review their case.
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GLOSSARY
Appeals Committee shall mean the committee established under the College’s Disciplinary
Policy and Procedure which forms part of a Professional Practice Committee. It hears the case
for appeal and determines if the outcome and any recommendations or sanctions are fair and
just.
Appellant shall mean the Clinical Perfusion Scientist appealing against a decision,
recommendation or sanction against them and their registration.
Burden of Proof shall mean that the burden of proving the facts alleged in the formal allegation
which are in dispute shall rest upon the College.
Chair shall mean the chairman or chairwoman of the Investigating Committee, The Conduct and
Competence / Fitness to Practise Committee or the Appeal Committee that collectively form the
Professional Practice Committee.
College shall mean The College of Clinical Perfusionists of Great Britain and Ireland.
Conditions of Practice Order shall mean an order imposed by the College or Investigating
Committee that imposes restrictions or conditions on them in their practice to work. This may
also be called a Restriction Order.
Conduct and Competence / Fitness to Practise Committee shall mean the committee
established under the College’s Disciplinary Policy and Procedure which forms part of the
Professional Practice Committee. The disciplinary panel hears the case and determines
outcome and any recommendations and or sanctions to be imposed.
Day(s) means any day including weekends, bank holidays and religious days.
Formal Allegation shall mean the allegation that the Clinical Perfusion Scientist’s fitness to
practise is impaired by reasons of one of the grounds set out in the Disciplinary Policy and
Procedure.
Investigating Committee shall mean the committee established under the College’s
Disciplinary Policy and Procedure which forms part of a Professional Practice Committee. It
investigates the case, reviews evidence and determines if there is a case to answer.
Interim Order shall mean an order made by the Investigating Committee or College to limit the
practice or suspend the registrant’s registration prior to a Conduct and Competence / Fitness to
Practise Committee having disposed of the matter.
Joinder shall mean where the Conduct and Competence / Fitness to Practise Committee may
consider an allegation against two or more Clinical Perfusion Scientists at the same hearing if
considered fair to do so.
Professional Practice Committee shall mean a committee set up by the College to investigate
serious complaints concerning Clinical Perfusion Scientists that are not straight forward and or
complicated which cannot easily be dealt with by the College Council.
Register shall mean the register or directory the College holds of all Clinical Perfusion Scientists
working in Great Britain and Ireland. This includes Accredited, registered, limited or
provisional registrants and trainee Clinical Perfusion Scientists.
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Registrant shall mean any Clinical Perfusion Scientist, whether Accredited, limited with
restrictions or training, on the Register.
Respondent shall mean the College in an appeal process lodged by a Clinical Perfusion
Scientist.
Standard of Proof shall mean that the proving of something which is disputed lies on the
balance of probabilities.
Suspension Order shall mean an order imposed by the College or Investigating Committee that
suspends the registration of a Clinical Perfusion Scientist.
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THE COLLEGE OF CLINICAL PERFUSION SCIENTISTS
OF GREAT BRITAIN AND IRELAND
APPEALS POLICY AND PROCEDURE
Function and Purpose
1. These rules set out how the Appeals Committee established by the College will consider
appeals by Clinical Perfusion Scientists made:
a) against a decision by the College to refuse to enter that individual onto the
Register
b) against a decision by the College to refuse to renew the registration of a
Registrant
c) against a decision by the College or the Investigating Committee to impose an
Interim Order restricting the practice or suspending the Clinical Perfusion
Scientist
d) against a decision by the Conduct and Competence / Fitness to Practise
Committee that a registrant’s fitness to practise is impaired and or any sanction
imposed
2. Appeal hearings shall not be way of a re-hearing, rather they will review all the
paperwork from the original case and the previous decision made to determine that if
due process was followed, the decisions made were based on accurate evidence and that
any recommendations and/or sanctions taken were within the range of reasonable
decisions.
3. If it is satisfied that it is just and reasonable to do so, the Appeals Committee may permit
the Clinical Perfusion Scientist or appellant to rely on grounds not stated in the notice of
appeal.
4. If it is deemed necessary to review the case in full, the procedure of the appeal hearing
shall be similar in form and structure in terms of evidence and procedure applied to the
first hearing.
5. Appeal hearings will be held in public.
Notice of Appeal Hearing
6. The Clinical Perfusion Scientist may appeal the decision within 21 days of being
informed by giving written notice of appeal to the College Administrator. This must be
addressed to the College and state that it is the notice of appeal, be signed by the Clinical
Perfusion Scientist themselves or their representative and shall include:
i. the name and address of the appellant Clinical Perfusion Scientist
ii. his or her College registration number
iii. the date, nature and any relevant details of the decision against which the appeal
is brought
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iv. a concise statement of the grounds of the appeal reasoning why he or she feels
that either the decision, the notice or the recommendations or sanction were
wrong
v. the name and address of the appellant’s representative (if any) and a statement
as to whether the College should correspond with that representative or directly
with the Clinical Perfusion Scientist concerned
7. The Clinical Perfusion Scientist shall attach to the notice of appeal a copy of any
documents on which he or she proposes to rely on for the purposes of the appeal.
8. Once the College has received the notice of appeal, it may serve evidence or
representations in response to the evidence replied upon by the appellant. This must be
served within 28 days from receipt of the notice of appeal.
Acknowledgement and Notice of Hearing
9. Within 28 days of receiving a valid notice of appeal, the College shall:
a) acknowledge receipt and confirm a date and time for the appeal hearing which
shall not be more than 90 days following the receipt of a valid notice of appeal
b) send a notice of appeal hearing to the appellant which will inform him or her of:
i) the right to attend the hearing
ii) the date, time and venue for the hearing
iii) the nature of the appeal hearing, namely that it is by way of review
rather than re-hearing
iv) the right to give evidence in person and to call witnesses in accordance
with the restrictions on evidence
v) the right to make oral submissions to the panel in person to be
represented by another person (e.g. solicitor, barrister, professional
body or trade union representative) and
vi) that if he or she does not attend, the appeal may proceed in their absence
Notice of Attendance
10. Within 28 days of the notice of hearing being sent, the appellant shall inform the College
whether or not they intend on attending or to be represented at the hearing and
whether or not they intend to call any witnesses or submit any other fresh evidence
subject to the requirements specified and if so, must provide their names and addresses
to the College.
11. If the Clinical Perfusion Scientist does not intend on attending or to be represented at
the hearing, may no less than 7 days before the date of the hearing send to the College
additional written representations in support of his or her appeal.
Appeal Committee
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12. The Committee shall comprise no fewer than three members appointed by the College
under the rules of the College’s Disciplinary Policy and Procedure and shall include a
Clinical Perfusion Scientist, a Cardiac Surgeon or Cardiac Anaesthetists and a Lay
Person. A Chair will be appointed from the former two professions.
13. A person who has been involved in any other capacity in a case which is to be
considered by the Committee shall not be appointed as a member of that panel.
14. Decisions will be made by a majority vote of the panel and in the event of a tie, the Chair
shall have the casting vote.
15. A clerk or panel secretary will assist the Committee and shall be responsible for the
administrative arrangements for the hearing. The clerk or panel secretary will not
participate in the decision making of the panel and shall not have a vote.
Removal of Committee Members
16. A person:
a) is not eligible to be appointed or sit as a member of a committee if disqualified or
suspended from membership of another committee or panel and
b) shall cease to be a member of a committee if:
i) the member resigns which they may do at any time
ii) a conflict of interest arises
c) may be removed pursuant to the procedures of the College Council
Representation
17. The College may be represented in appeal proceedings by any person and shall be
known as the respondent.
18. The appellant may be represented in any proceedings by any person whether or not
legally qualified, except a Registrant on the College Register.
19. Where the appellant or the College are represented at an appeal hearing, references in
these rules to them may also be read as references to the representatives.
Preliminary Meetings
20. The Appeal Committee may hold a preliminary meeting in private with the parties, their
representatives or any other person the Committee considers appropriate if such a
meeting would, in the opinion of the panel or the Chair, assist the panel to perform its
functions.
21. Preliminary meetings may be held electronically or by telephone if the Committee
considers that it would be in the public interest to do so.
Powers to determine an Appeal without Hearing
22. The Appeals Committee may determine an appeal without an oral hearing on the basis
of any documents provided as set out in the rules where:
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a) the College does not receive a reply from the appellant within the time specified and
the Committee is satisfied that all reasonable steps have been taken to give notice or
b) the appellant replies to the effect that he or she does not wish to attend or be
represented or
c) both the appellant and respondent consent to the appeal being determined without
a hearing and
d) the Committee consider it to be in the public interest to do so
23. If the Committee determines an appeal without a hearing, it shall take into account any
written representation provided by the appellant and the respondent.
Absence of the Appellant
24. Where:
a) the appellant has been notified of the hearing
b) the appellant does not attend and is not represented
c) the respondent does not consent to the appeal being determined without a
hearing
the Committee may nevertheless proceed with the hearing if it is satisfied that all
reasonable steps have been taken to give notice of the hearing to the appellant and that
it is fair and in the public interest to do so.
Postponement or Adjournment of a Hearing
25. Hearings may be postponed by the College either of its motion or at the request of the
appellant up to 14 days in advance of a hearing after receiving representation.
26. Where a hearing is postponed, the College shall send the appellant notice of the
rescheduled date of the hearing. This shall not be less than 14 days unless the appellant
agrees otherwise.
27. Hearings may be adjourned by panels from time to time as they see fit either before or
after the commencement of the hearing, either of the Committee’s motion or at the
request of the appellant.
28. Reasonable notice of the rescheduled hearing date must be provided by the College to
the appellant.
Conduct of Hearing
29. The Committee Chair shall conduct the hearing in such a manner as it considers most
suitable to the clarification of the issues before it and the just handling of the
proceedings.
30. The appellant shall present their case for why the decision should be overturned
followed by the respondent as to why the decision, recommendations or sanctions are
correct.
Evidence
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31. If the Appeal Committee is satisfied that it is just and reasonable to do so, the Clinical
Perfusion Scientist may be permitted in exceptional circumstances to present evidence
not previously relied upon (fresh evidence) if he or she seeking to rely on the material
and can satisfy the panel that:
a) the fresh evidence was not reasonably available at the time the decision being
appealed against was made and
b) the fresh evidence is relevant to an issue that is being considered by the panel
32. If fresh evidence is relied upon by the appellant, the College may serve evidence in
rebuttal.
33. Witnesses shall not be permitted to give live evidence to the Appeal Committee unless it
is connected to the fresh evidence being submitted.
34. Subject to the rules on evidence and the advice of the Legal Adviser, the requirements
for a fair hearing and of relevance, the Committee may:
a) admit evidence whether or not it would be admissible in a UK court of law
b) exclude evidence, where doing so ensures fairness to the College
35. The Committee may receive oral, documentary or other evidence of any fact or matter
which appears to it to be relevant to its consideration of the case.
36. The findings of fact and certification of conviction of any UK criminal court or the
findings of a judge in any UK civil court shall be conclusive proof of the conviction or
finding and the underlying facts.
Powers of the Appeal Committee
37. The Appeal Committee shall have the power to:
a) allow the appeal whether in full or part or
b) refuse the appeal or
c) remit to the original Conduct and Competence / Fitness to Practise Committee
for rehearing or redetermination of any issue, finding or sanction imposed or
d) substitute any decision of fact, grounds, impairment or sanction made by the
original Conduct and Competence / Fitness to Practise Committee (where the
substituted decision is one that the previous Committee could have made)
38. Where the Committee decides to remit the original decision, a person who has been
involved in any other capacity in the case shall not be appointed as a member of the
Committee to which the decision is remitted.
Notice of Decision
39. Within 7 days of the hearing, the Appeals Committee shall notify the appellant and the
respondent in writing of its decision and the reasons for reaching that decision.
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40. The decision of the Appeals Committee shall be final and there shall be no further right
to appeal to the College.
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xvi. STANDING REPORT FROM THE FIPO REPRESENTATIVE
R Uppal
A. MATTERS OF INFORMATION FOR THE EXECUTIVE COMMITTEE:
We currently do not belong to FIPO and pay no subscription to this body. There are currently 2
issues that are live.
1. FIPO has gone to the high court to appeal on the matter of fees, network arrangements
and preferred providers. The hearing for this is scheduled for next summer. In essence,
if FIPO were to lose this we would see a fundamental shift in practice and the evolution
of managed networks etc.
2. PHIN has been mandated by government to provide data on clinical outcomes and
quality and plan to begin publishing next year. This is likely to be highly contentious in
that there appears to be little infrastructure to look at the nuances of outcome
assessment. They are keen to have SCTS input and I know Tim is in the loop through the
FSSA.
B. MATTERS FOR CONSIDERATION BY THE EXECUTIVE COMMITTEE:
1. The executive should consider us becoming a fully fledged member of FIPO cost
£1000/yr. It allows the SCTS to be involved rather then observe.
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xvii. STANDING REPORT FROM CHAIR OF GOVERNANCE/PROFESSIONAL STANDARDS
A Owens
Terms of Reference
Professional Standards and Governance Committee
Society for Cardiothoracic Surgery Great Britain and Ireland
The demands on the Professional Societies are increasing. To meet this demand the SCTS has
formed three core committees for the sub specialties of cardiac, thoracic and congenital cardiac
surgery. There is also the Education committee.
Throughout the year there are several matters arising that require specific attention referring to
Professional Standards. At present the SCTS structure is not able to give appropriate time nor
adequate responses to such matters.
It is proposed that a Professional Standards Committee ("the Committee")is formed to handle
these specific tasks as well as issues pertaining to sound governance in the structures and
processes of the SCTS.
The Committee will be responsible for advising the Executive Committee (the "Executive")on all
matters relating to Governance including the self-assessment report and the appointment of
Members to the Executive. Specifically it will:
1. Review and make recommendations on the composition and balance of the
Exceutiveand its sub-committees.
2. Gather, screen and shortlist and, as a routine, administer the appointment of non-elected
Members to the Executive and its sub-committees.
3. Review the process whereby candidates are nominated for non elected positions on the
Executive.
4. Develop and recommend to the Executive, policies and procedures for induction and
further governance development of Members.
5. Advise the Executive on Standing Orders for the Conduct of its Business.
6. Advise the Executive on the Code of Conduct and Register of Interests for its Members.
7. Ensure, as appropriate, compliance at all times with legislation.
It is proposed that the Committee will consist of President Elect and Elected Trustee (co-chairs)
with the Lay Representative. The Committee will co-opt other members from time to time,
appropriate to specific tasks.
The Committee will, with the Executive, establish a rolling program of actions and activities to
ensure sound governance of the Society. It will respond to requests for advice from the
Membership, through the Executive,
Proposed Structure:
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Co Chairs – President Elect (2 years) and Elected Trustee (3 years)
Members – Lay representative (3 years),
Co-opted members as appropriate - including but not limited to chairs of sub specialty
committees, industry advisers, HR advice (Royal College of Surgeons)
Report to President.
Submit Report to each Executive committee.
Items of work will come through the Executive, the sub specialist committees and the SCTS
administrative office.
(http://www.scts.org/sections/society/constitution/index.html).
Isabelle Ferner [email protected]. Simon [email protected]
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xviii. STANDING REPORT FROM CHAIR OF RESEARCH COMMITTEE
G Murphy
Summary of SCTS Academic and Research Committee (ARC) Members
Co-Chairs: Prof GJ Murphy and SCTS President
Role: To coordinate the activities of the ARC. To communicate developments, opportunities
and initiatives related to research to the SCTS executive. To communicate where appropriate
and when requested with external agencies (CRUK, BHF, Wellcome, RCS) on behalf of the
committee and the executive.
SAC Representative: Prof Marjan Jahangiri
Role: To sit as an invited member of the SAC on the ARC. To communicate the status of
current academic trainees (numbers, successful mentorship, successful applications for
fellowships, trajectory) to the SAC. To communicate the views of the SAC to the ARC with
respect to recommendations of the numbers of academics in training, their success and the
likelihood that the academic workforce will be sustainable.
Scientific Meeting lead: Mr Clifford Barlow
Role: To sit as an invited member of the Scientific Meeting Committee on the ARC. To
coordinate with the SCTS scientific meeting/ University committee with respect to the
organisation of suitable research seminars within or co-localised with the annual scientific
meeting and University.
RCS Lead: Prof Gavin Murphy
Role: To communicate with the ongoing RCS initiative to develop academic surgery. It is
hoped that this candidate will be able to make representations to the RCS Academic and
Research Board. To communicate the views and policies of the RCS Academic and Research
Board, new funding opportunities and other opportunities for engagement to the ARC and to
the SCTS Executive.
Specialty Leads:
Adult cardiac surgery lead: Mr Mahmoud
Loubani Thoracic surgery leads: Mr Eric Lim
Congenital cardiac surgery lead: Mr Massimo Caputo
Roles: To inform important stakeholders in cardiothoracic surgery research; NIHR, BHF, CRUK,
Wellcome, as to the opportunities and infrastructure that are available in the UK to address
important research questions or for the development of evidence based guidelines. To
communicate the views and strategic objectives of these organisations as well as possible
funding or investment opportunities to the SCTS executive or relevant academics in the field.
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NIHR ACF/ ACL Lead: Mr Nishith N Patel, (Dr Claire Burdett co-opted)
Role: To provide up to date information on the status of all NIHR ACFs/ ACL nationally. It is
envisaged that the ACF/ACL lead will be aware of the career stage of each ACF/ACL, their
named supervisor, timeline for fellowship or grant applications and important barriers to
career advancement. The ACF/ ACL lead will also be able to inform these post holders as to
new opportunities for funding or career development.
NASCA Research lead: Mr Joel Dunning (TBC)
Role: To communicate developments and research opportunities that may be relevant to the
aims of both the ARC and the NASCA to the relevant SCTS committees and the executive.
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Society for Cardiothoracic
Surgery Academic and
Research Committee Terms
of Reference
1. Terms of reference:
1.1. Advise the SCTS Executive and Board on academic issues relevant to cardiothoracic
surgery.
1.2. Provide advice to the SCTS Scientific Meeting Committee regarding education and
research activities through representation on this committee.
1.3. Advise the SCTS Executive in relation to SCTS Research Fellowship Awards.
1.4. Provide advice to the SAC in Cardiothoracic surgery through academic
representation on the SAC.
1.5. To represent academics, and trainees, in matters related to academic
cardiothoracic surgery careers and cardiovascular/ thoracic medicine research in
the UK on behalf of the SCTS and as agreed by SCTS Executive and Board.
1.6. Represent the SCTS in other national and international research initiatives at the
request of the SCTS executive.
1.7. Advise on and undertake other activities related to academic cardiothoracic
surgery and cardiovascular/ thoracic medicine research as agreed by SCTS
Executive.
2. Constitution
2.1. The Committee shall be called the Academic and Research Committee of the
Society for Cardiothoracic Surgery in Great Britain and Ireland.
2.2. The Committee is accountable to the SCTS Executive.
2.3. The SCTS Executive shall appoint the chairman of the committee which is
not open to election by the Ordinary Membership.
2.4. The SCTS Executive, having considered nominations of the committee chair shall
determine the membership of a committee.
2.5. Membership of the committee is restricted to Ordinary Members of the Society.
In exceptional circumstances non-members may, with the approval of the
Executive, be co- opted to serve on the committee.
2.6. The committee should have a maximum of eleven members, including the
chairman. In exceptional cases the Officers may endorse the appointment of
additional members.
2.7. The chairman of a committee will normally serve for a term of three years.
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Members will normally serve for three years.
2.8. The membership of the Committee will include a Chairman and the President or
another Executive member of the SCTS, a representative from the SCTS Scientific
Meetings Committee, and SAC. The Committee will have also have designated
leads for Thoracic Surgery, Congenital Surgery and a representative for NIHR
Academic Clinical Fellows and Lecturers.
2.9. The committee will normally meet twice a year. The chairman may convene
extraordinary meetings with the approval of the SCTS President. One of the two
meetings of the committee will normally take place during the annual scientific
meeting of the Society. The second will normally take place at the Society’s offices
at the Royal College of Surgeons of England but an alternative venue, if more
convenient to the committee members, may be used at the discretion of the
chairman and with the agreement of the SCTS Secretary.
2.10. Facilities for meetings at the Society’s offices or during the annual conference will be
arranged by the Secretary of the Society in consultation with the Chairman of the
committee.
2.11. The Chairman of committee will be responsible for ensuring that minutes of every
meeting are recorded and submitted to the Executive via the SCTS President.
2.12. The Society will provide secretarial services for the typing of minutes,
correspondence and reports.
2.13. The Society will reimburse travelling and subsistence expenses from within the
United Kingdom for members of committee for meetings not held at the time of the
annual conference. Members meeting at the annual conference will be expected to
meet their own expenses.
2.14. No financial arrangements with any organisation may be enacted without the
approval of the SCTS Executive.
GJM Sept 2015
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7. Specific Issues
RCS AAC
Meeting summary
Royal College of Surgeons of England 7th August 2015
Agenda:
1. Review of SCTS role and contribution to reviewing and approving Consultant job
descriptions.
2. Review of SCTS role and contribution to supporting AACs for Consultant posts.
Attendees:
Andrew Chukwuemeka (AC) - SCTS
Tim Graham - President (TG) - SCTS
Lee Honeyball - Professional Support Manager – RCS(Eng)
Justine Clarke - Assistant Director of Professional and Business Support – RCS(Eng)
• The RCS has recently published new guidelines and a checklist for Consultant JDs. This
deliberately leaves little flexibility and is designed so that minimum standards are
maintained across all surgical specialties.
• It was agreed that in contrast to many specialty associations, the SCTS is engaged and
provides effective assistance to the RCS in reviewing and approving JDs.
• It was agreed that all SCTS JD reviewers will be sent an updated list of outstanding JDs
on the first Monday of every month. An updated list of recent Consultant appointees will
be included in the same email.
• RSPAs and DPAs will not to be copied into the original JD review request – the original
request will only go to either TG, AC, Richard Page, David Barron or Simon Kendall –
with AC copied into them all.
• AC (or relevant reviewer) will then copy the local RSPA into the reply – or if not, the RCS
will forward to the RSPA for information. Any Trust comments will only be forwarded to
the reviewer.
• All Senior Lecturer requests – for both JDs and AAC assessors – will be sent to AC who
will recommend someone to review and to sit on the AAC as an assessor.
• AC will be informed of who is sitting on each AAC by copy of the confirmatory email.
• The RCS is responsible for training College Assessors for AACs. The SCTS can continue to
assist by ensuring that there are sufficient numbers of appropriate assessors for each of
cardiac, cardiothoracic, congenital and thoracic AACs.
• The current list of assessors was reviewed and updated. A need for more assessors in
thoracic and congenital surgery was identified.
• The next College Assessor training days are on 13/11/15 and 26/02/16 and 24/06/16.
The SCTS will seek volunteers to attend these courses.
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• Refresher training for current assessors who have not had training in the last five years
will be investigated by the RCS.