Dr Eddie Morris writes to the membership…
Having spoken to many of you in the past weeks it’s very clear that things are starting to get challenging again and some areas of the UK are pretty much close to shutting down their elective work, if they have not already done so.
I totally appreciate that if this is happening in your area it may well be as tough as it was over the Spring. Earlier this week, in recognition of the demands that the second wave will – and indeed, already is – placing on healthcare professionals, the four UK CMOs, the Medical Directors of NHS England and the GMC, and the Chair of the Academy of Medical Royal Colleges wrote to all doctors across the UK reiterating the guidance and support available in the challenging times ahead.
In many ways the situation is similar to how it was in the Spring, but where we are now we have not only learnt a lot about how best to restrict the spread of the virus at home and in our workplace, we have also seen many ways in which the impact of the virus can be reduced. In our specialty the collection of data performed by UKOSS has shown us that most women who contracted the virus whilst pregnant are doing well, as are their babies, and this many find very reassuring.
What we have learnt about and what I have previously written to you about are the unforeseen consequences of the way in which our patients have reacted to and how our health system has managed COVID-19. These consequences range from women presenting late with non-COVID obstetric problems, late presentations of women with red flag gynaecological symptoms and, more recently, the unavoidable fact that waiting lists for elective surgery are reaching previously unseen proportions. Knowing these issues has enabled all Medical Royal Colleges and Specialist Societies to work together to try to help us all mitigate these problems. Waiting lists are, however, something that I believe we will need greater help with over a long period of time.
Another unforeseen consequence of all of this is the significant loss of training opportunities for all doctors in training, as well as trained doctors who need to perform a certain number of procedures per year to keep their skills up. We have been increasingly aware of this as a problem and we feel that it is an absolute priority that those of us who are trainers need to ensure that all teaching opportunities are fully utilised. A good example of this is the use of the private sector as additional NHS capacity. This vital service has provided not only more capacity but also COVID protected pathways and kept some elements of elective work moving. Much of the regulatory blocks have been removed to allow trainees to work in the private sector on NHS patients and we should be encouraging and supporting their attendance.
Last week I did an NHS operating list at my local private hospital. I was assisted by a senior trainee which of course was great but I was disappointed that the paperwork was slow such that whilst she could assist, she was not allowed to be the primary surgeon. Whilst we were able to have a very educational morning I am now on a mission to try to speed up the processing of this paperwork!
The loss of training opportunities has already resulted in delayed progress through our training grades during the most recent series of ARCPs. Our recent, extremely difficult decision to postpone the November Part 3 exams, will undoubtedly have added to the stress felt by candidates, and I would like to take this opportunity to say again how sorry I am to everyone who was affected, and to thank all those of you who have supported your colleagues who were due to sit the exams last week. Our decision was the only safe option for all those concerned with delivering the exam, and the GMC are fully supportive of the need to ensure these difficult circumstances do not adversely affect progression through the training programme.
As you will know from my previous updates, a key priority for the College since the start of the pandemic has been to get the MRCOG exam into a digital format that is fully pandemic-proof. We had already planned to turn the MRCOG Part 1 and 2 fully digital by the end of 2021, and I am so proud of the collective efforts of everyone involved to actually launch our first computer-based testing examinations with our new digital exam partner, Pearson VUE, this autumn. We had candidates sitting in a record 48 countries, all in appropriately socially distanced venues, and every candidate who took our survey ‘agreed or strongly agreed’ that computer-based testing is an improvement on the traditional paper-based format. While the Part 3 OSCE is a much more complex proposition to turn fully remote, I have immediately started work to find a solution that enables our trainees to sit the exam in a way that is COVID-safe for everyone involved, and again would like to thank everyone who is working so hard to get this right for our future members.
To finish, on a completely different note, I wanted to share my excitement about what I hope will become a real breakthrough in antenatal and intrapartum shared decision making. Anyone who knows me will know I have an absolute passion to drive up the highest standards of information giving to women and records around taking consent for all that we do. 'iDecide' is a new digital tool being developed by NHSE/I, with input from RCOG, to help front-line staff with communication, decision-making and consent processes, when obstetric interventions are recommended. The first iteration is due to be feasibility tested in the coming months, with formal piloting planned for 2021. The team are keen to understand more about what obstetricians want and need from a digital tool and we would be very grateful if you could help by completing this short survey. Another resource that you may be aware of is the new GMC guidance on decision making and consent. This is an excellent summary of our duties in this area and please be aware it came into effect on 9 November.
Finally, with a potentially tough few months ahead of us it is imperative that we look after ourselves and each other. I realise that, several months in to the pandemic, there are more things that we understand about COVID-19 and what it does, but it still has huge potential to harm our own health and those around us. There are rules for our domestic life that we must follow but, in the workplace, where we mix with patients and other staff, often closer than the 2m or 1m+ rules, it is imperative that we don’t let our guard down.