"Ladies and gentlemen, members of BAUS, guests and invited speakers, it has been an extraordinary honour and privilege to serve as your President and I welcome you all to our new venue - Liverpool. I am very grateful to our secretary Tim Terry, the BAUS Events’ team and the Sections for the strong programme ahead of us this week and I especially welcome our national and international speakers and guests whose contribution makes this meeting so valued. A key feature of our meeting, compared with the EAU and AUA, is the level of interaction it allows between speakers and delegates and the consistent feedback over the past few years has been that the delegates greatly appreciate your input. So BAUS has made a positive effort to incorporate many overseas speakers into the programme and we thank you for your efforts to join us in 2011.
Urology UK
Over the past year, and with the Trustees and Council, I have been keen to build on the programme of change instigated by our two most recent past Presidents, Derek Fawcett and Tony Mundy. I am very grateful to them both for the strong platform on which we are now able to develop our future. Every organisation needs to have a clear vision and direction, and we are now actively discussing our future strategy for the next 3-5 years but I have felt for some time that BAUS should have a higher profile in relation to government as well as to patients, NHS managers and the public in general. It is important that we seek to increase the BAUS brand identity amongst these groups and this links with our mission. British urology needs to speak with a unified voice and by developing closer working relationships with related bodies such as BJUI, TUF, BAUN, SURG and other urological charities under the umbrella concept of “Urology UK”, I feel there is the real opportunity to become much more influential. I believe we will have a greater impact when we are speaking with one voice about the issues that affect the standards of practice and urological care for our patients. There is no doubt that, to survive in the future, organisations may need to adopt new ways of working but by forging a strategic alliance through Urology UK I am sure we will be in a stronger position to achieve our objectives, without necessarily compromising our ideals. In the light of discussions last year about future BAUS strategy, and following deliberations at BAUS Council, I think the time has come to pursue these options in greater detail over the next year.
One early initiative is Blue September, which is an international men’s cancer awareness campaign founded in 2008 and currently delivered in Australia, New Zealand and California. It will be launched in England and Wales in September 2011 by MWC Media on behalf of the Men's Health Forum, the campaign’s UK charity partner. Blue September is an engaging way of delivering a serious message – tackling the cancer inequalities that affect men and I think it is very important that BAUS is seen to be an active player in this campaign. We will be e-mailing all members with further details and I strongly encourage you to engage in the various local activities.
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I am also very pleased to announce that last Thursday TUF awarded 5 Fellowships for Preceptor training in Robotic surgery:
- Mr Khurshid Ghani – Trainee Fellowship
- Two Consultant Fellowships - Mr Justin Collins & Mr Pardeep Kumar
- Two Team Fellowships - Mr Ben Eddy & Mr Peter Cooke
This is the start of a series of joint BAUS and TUF proposals to enhance the Urology UK concept.
Revalidation
The General Medical Council (GMC) is currently completing a major review of its approach to revalidation. The key principle that BAUS has reiterated, time and again, is that the process must be simple and achievable; I am very grateful to John Anderson and Sam Liu, our Revalidation leads, for their assistance in what has been a very changing field over the last year. In essence, we now believe revalidation will mean an annual appraisal supported by information relating to:
- health and probity
- CPD
- feedback (both peer and patient)
- "quality improvement activity" (including audit, case note reviews and, in the case of surgical specialties, outcome data, MDT data,and evidence of compliance with best practice).
We see the data and audit system as a valuable tool to help BAUS members meet the “Quality Improvement Activity” criteria by entering their audit data.At the moment, this is voluntary but the long-term implications of revalidation mean this will become a regular part of our daily practice. As doctors, our primary concern is to treat patients to the best of our ability. Accurate and comprehensive data collection is the basis of meaningful clinical audit which in turn, informs best practice for both urologists and patients.As such, it is important for BAUS to take a lead on co-ordinated national data collection and audit so the Section of Endourology have announced the launch of the national stent registry. I would urge Members to participate in the audits relevant to their practice.
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Commissioning for Value
Further to my previous newsletters on Procedures of Lower Clinical Value / Effectiveness, the process is now termed Commissioning for Value. There are significant challenges ahead and we will be exploring them in more detail in the session on “The White Paper” on Thursday afternoon.
The latest progress is that, on 14 April 2011, the FSSA met with Phil da Silva of the Right Care Team to try and understand where the process was currently going in relation to the previous list of procedures deemed of low clinical value, (published in September 2010). Although Sir Bruce Keogh (NHS Medical Director) had confirmed that there were no nationally-recognised lists, there are, undoubtedly, PCT lists in existence which have impacted on patients and their quality of care, often, seemingly, without evidence and contrary to NICE guidance.
The situation was compounded by the publication that day of the Audit Commission’s Health Briefing entitled “Reducing Spending on Low Clinical Value Treatments – Health Briefing, April 2011” which was based on the ”Croydon list”. This PCT list has been in existence the longest but actually has little of urological import. However, the Audit Commission briefing looked at PCT spending on low clinical value treatments and showed how some PCTs have successfully made significant cost savings in this area with the message that others could, similarly, achieve the same.
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BAUS and the FSSA, which represents all the surgical specialty associations, garnered appropriate media support culminating in our front page headline in the Daily Telegraph and the Guardian, a first for BAUS. Consequently Sir Bruce Keogh has asked the SHA Medical Directors and the Specialty Associations to agree a process for evaluating such lower value clinical interventions. Nigel Beasley, deputy medical director for the East Midlands has been tasked to work with Urology with the aim of developing commissioning guidance for high priority areas based on care Pathways rather than single procedures. BAUS and the FSSA have repeatedly stated that:
- It is important to recognise that absence of evidence of effectiveness is not the same as evidence of absent effectiveness
- Rationing is a political decision not a clinical one and Ministers must take responsibility for decisions about rationing not doctors. I am, therefore, keen to hear from any member who is aware of such processes ongoing locally as we have to take a national stand.
The NHS Commissioning Board will be established in September 2011, subject to the outcome of the “listening exercise” and the passage of the bill through parliament. This will establish standards and guidelines for commissioners, the full remit of which has yet to be determined, but BAUS in conjunction with the FSSA is keen to develop a national process based around evidence, relevant NICE guidance and Quality Standards, with the aim of trying to avoid a post code lottery of healthcare funding.
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BAUS Website
BAUS invested in the development of a new website which was launched at our Annual Meeting last year. Our aim was to make it user-friendly for urologists and, for the first time, to provide patients with access to high-quality information in relation to urological conditions and interventional procedures. The goal is for the BAUS website to become the home of UK urology. We are extremely fortunate to have Nigel Bullock as our web editor and he has done a phenomenal job in terms of getting a wealth of good quality patient information posted on our site.
We are now seeking to link more effectively with the other urological charities and patient groups in order to raise awareness of BAUS and the information on the website. However, we are not complacent and recognize that maintaining and improving communication is an ongoing task and one that is never complete. I want as many BAUS members as possible to engage in this process as I hope you will see the site as being your professional resource; if you feel that you have any comments then please direct them to Nigel so that we can enhance the process. There is a BAUS stand in the exhibition area where Nigel and the BAUS staff will be happy to discuss any suggestions.
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Training & Workforce
I am very grateful to Kieran O’Flynn, for his work leading the SAC in Urology, and to Neil Burgess, as BAUS and the SAC Lead for Urological Workforce data collection.
Education is a crucial part of BAUS and I recognise the threat of competing organisations such as the EAU, so I propose to set up a BAUS Educational Working Group, under the Chair of the SAC Lead, to co-ordinate the activities of all the interested parties, the Office of Education, The Raven Tutor, the ICB Chair and a deanery representative, so that BAUS can continue to deliver education of the highest quality and relevance to both trainees and consultants for their CPD.
Simulation is seen as a growing opportunity in Surgical training and I have taken the decision that Urology should be at the forefront of such developments and, to that end, BAUS has asked Prokar Dasgupta to be our Lead for Simulation, to look at both skills and non-skills acquisition in urological training and to harness those that are already active locally/regionally in this field. It is very apparent that we have to look at developing a National Strategy for the development of simulation in Urological training, both pre and post CCT. Recently, the Urology SAC decided to include elements of simulation into the Urology Syllabus and curriculum.
Contemporary urology training is moving out of clinical practice and simulation is increasingly used to provide a safe and supportive learning environment for learning and maintaining skills. However, controversy remains over its efficacy for training and in predicting future outcomes. As a consequence, Full and Trainee Members were sent details of a national survey to assess current thoughts and opinions about simulation and urological training; we are grateful to the 171 consultants and 86 trainees who responded. There was an overwhelming recommendation for integrating simulation into training and, together with the SAC, we will come up with several further recommendations over this coming year.
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I am increasingly concerned at the level of medical student exposure to Urology and, if we want to attract the best students into our specialty, then we have to increase our profile in relation to medical students. I am, therefore, very grateful to Ian Pearce from Manchester for progressing a study programme in Urology on the website, accessible to all medical students. In addition to a comprehensive series of didactic lectures focussing on the more common aspects of urology and those pertinent to Foundation Year training, it is anticipated that the website would also play host a variety of interactive clinical scenarios and PBL cases, to further underpin and promote undergraduate urological education.
In March, a delegation from BAUS went to the Centre for Workforce Intelligence to share our data in relation to numbers of consultants and workforce activity. Last year, the Centre for Workforce Intelligence (CfWI) made recommendations by specialty and geography for the following year’s medical training recruitment numbers. This year the CfWI has agreed with the Department of Health (DH) that, in England, instead of making annual recommendations on recruitment numbers, it will make recommendations for the medium to long term by specialty and geography. At present it has not recommended any reduction in the number of specialist registrars in urology. The DH will then charge Medical Education England, SHA workforce directors and postgraduate deans, through the Joint Working Group, to agree a plan towards implementing the recommendations. There are several benefits to this new approach:
- It provides employers, postgraduate deans and the profession with an opportunity to plan more effectively and manage change over a longer period of time
- It will help reduce risk and offer a degree of stability as developments in the workforce planning education and training system in England get underway
- It will allow the CfWI to target resources each year into a deeper analysis into those specialties where significant change or concerns have been identified over future requirements.
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It is very apparent that BAUS has one of the largest resources, in relation to workforce, of any surgical specialty and this is due to the sterling efforts of Neil and Margaret Joyce in the BAUS office in collating this data and keeping the database live. A new, national survey will be undertaken in the autumn. Two years ago, we were predicting serious issues in relation to trainee unemployment, due to a potential bulge in trainees coming out with their CCT. I am pleased to report that, to date, we have not seen such problems although some have had to take locum positions “with a view” as trusts determine the balance of need against their financial status.
There is no doubt that, with people living longer, there is going to be an increasing need for Urologists and urological intervention. However, the new Commissioning Plans mean that we must wake up to the challenges facing us in the new world. The result is the broad recognition that the NHS needs to make unprecedented efficiency gains if it is to meet the rising demand for healthcare experienced in most first world systems. The government’s key to achieving these gains is more effective commissioning of healthcare and I have no doubt that future urologists in the UK will have an increasing role in primary care, and with their local commissioning group,s to deliver diagnostic and medical services in the community. However, I feel very strongly that urology must be delivered by urologists, working in multidisciplinary teams to agreed pathways, in order to ensure the maintenance of the highest standards of urological care for our patients.
Thanks
This year would not have been possible without the support and efforts of a strong team of trustees but I just want to place on record my heartfelt thanks to Nick George and Tim Terry for their commitment, advice and humour as they demit office as Honorary Treasurer and Secretary respectively at the end of the meeting, and to the staff in the BAUS Office who have really shown how teamwork can deliver results. BAUS is in excellent shape and all credit is due to the efforts of our Chief Executive, Anne Bishop, and her deputy Tricia Hagan whose thoughtful counsel and managerial skills have protected me from, in the immortal words of "Yes Minister", making too many “courageous decisions”.
Finally BAUS is an organization that can only progress if you the membership feel that you can have a say; this is done either through your regionally elected council member or direct to me. I am, therefore, very keen to hear from members with respect to any issues in relation to the delivery of urological services or how we can help you in your practice. Communication is paramount so do get in touch by e-mail."
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Adrian Joyce
President of BAUS
