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Council précis, January 2015

This page contains the précis from the Council meeting which took place on Friday 23 January 2015. 

Global health

Essential gynae skills workshop – 10 modules have been developed and training will be piloted later in 2015. A grant application has been submitted to deliver the training. The prevention of fistula project in Kitovu, Uganda has secured funding from the Tropical Health and Education Trust (THET). It will provide emergency obstetric skills training.

UK affairs

The Saturday Council meeting in September 2014 focussed on the issue of rota gaps in the specialty and the workforce problems encountered in the delivery out-of-hours services. There was acceptance that middle grade doctors were not the solution. Following analysis of the recorded discussions, Vice Presidents Clare McKenzie and Ian Currie summarised the Saturday meeting to Council and spoke about the College’s next steps to address the issues.

Context:

  • There is no good evidence for 24/7 care but there is commitment to achieve this standard.
  • Locums are being used to plug service gaps and there is growing pressure on trainees (many are working beyond the EWTR requirements). Resident on call appointments are working at the level of registrars and not consultants. The specialty may end up with a junior consultant grade if these developments remain unchecked.
  • The focus of attention is on maternity services at the expense of the provision of gynaecological care.
  • Set against these developments is the forthcoming General Election, move to reconfigure maternity services in some parts of the country, implementation of the Five Year Forward View (which makes a case for maintaining local units) and the finite numbers of medical students in the system with the move to focus more on primary care (as recommended in the Shape of Training report). There will be fewer O&G trainees with a projected 5-15% drop over the next years.
  • O&G graduates are also moving away from the UK to work elsewhere (eg Australia).

Potential solutions:

  • RCOG needs to update the Safer Childbirth data to ensure that services are sustainable by focusing on safety and quality.
  • Future recommendations on the running of the service needs to look at the full patient journey including ante and postnatal care. RCOG is currently collating morbidity and outcomes data through its Clinical Indicators Project and Each Baby Counts.
  • There is a need to examine the affordability of seven-day services.
  • Credentialling for consultants needs to be examined. Post CCT training is needed to help progress the consultant portfolio. CPD and a formal training programme are needed for middle grade doctors in order to enable better job planning and career prospects. Clear and attractive career pathways are needed to attract the best doctors.
  • RCOG needs to provide sustainable models of care – collaboration is needed within the healthcare system. If the focus is too much on maternity, other services will suffer. Gynaecological services need to be protected.
  • RCOG needs to demonstrate leadership in pushing for greater consultant presence in the specialty.
  • There is also the need to address issues around reconfiguration which are often skirted over because this is a politically-sensitive topic.

Solutions will be expensive since senior doctors are needed in the service to support trainees and midwives. RCOG should not shy away from this political debate – RCOG should argue that women’s health services need increased resourcing because of the population/demographic changes and an ageing medical workforce.

Strategic development

  • The Chief Medical Officer project on Women’s Health – the CMO’s Annual Review is set to be published in early summer 2015. RCOG is providing assistance in policy recommendations.
  • UN International Women’s Day meeting – preparations for this have been going well and the event is now fully booked
  • Family Planning Project – this was approved at the end of 2014 and funding has been received. Professor Alison Fiander has been appointed the clinical lead and will be based at the RCOG and starts in May. RCOG will be working very closely with the ministries of health in South Africa and Tanzania who have been very supportive of the project. RCOG will developed best practice guidelines on abortion care and IUD insertion. A training manuals workshop is being planned to include representatives from UNFPA, WHO and FIGO.

Ethics Committee

This committee is being reconstituted. The new group will be more responsive than previously in order to produce timely opinion.

Education

  • RCOG has submitted its MRCOG Part 3 examinations to the GMC for approval. The subspeciality training programme will also been submitted.
  • The Centre for Workforce Intelligence (CfWI) report has been published. RCOG contributed to the report but was not involved in the recommendations on workforce planning. RCOG is concerned that the report’s finding that the specialty is overproducing trainees may destabilise the speciality. This implies a reduction in O&G trainee numbers in years to come and needs to be balanced by the move to enable greater consultant presence in trusts, the changing demographic of the O&G workforce (eg. numbers of doctors retiring and those looking to work part-time) and the changing needs of the female population (eg. increase in the incidence of older mothers and maternal obesity).