President's Dec 2019 Newsletter

As promised, the joint BAUS/GIRFT document “Provision of Out of Hours & Emergency Urological Care: Guiding Principles for Clinicians” was published in May 2019.  

I am indebted to all BAUS members who fed back, through their Regional Reps or directly to me, during visits to several Regional and Section Meetings. I am grateful to every Regional Rep and, in particular, to Matt Hayes (South Central), Simon Williams (East Midlands) and Sri Sriprasad (KSS) who helped write the numerous drafts and iterations.  This document provides a framework for how this much-debated issue should be taken forwards and, although it cannot be applicable to all individual areas, it should be used to negotiate, for example, how much elective work is done whilst on-call, how hospitals might want to arrange their networks, and optimise working patterns.  

I recognise that some Consultant Urologists feel uncomfortable about providing assistance with ureteric injuries or the traumatised kidney, and BAUS (in conjunction with the SAC) will be looking, in the future, about how best to train for these situations initially, and how to provide ongoing / refresher training to help with this.

I would commend reading these guidelines which BAUS has endorsed, together with three other surgical societies.

They aim to protect patients from harm and also to reduce the likelihood of criticism against surgeons involved in treating patients at risk of developing this relatively uncommon, but potentially devastating condition. WLCS potentially results in loss of limb and/or life following otherwise uncomplicated pelvic surgery.

A vital piece of work is ongoing to improve recruitment and retention in urology.  Competition ratios into higher urological training currently stands at about 2.8:1, having been 9:1 a decade ago. In General Surgery, this is less than 1:1, but is as high as 6:1 in Neurosurgery.  This might start at the very beginning in Medical Schoo,l and BURST have been asked by our Undergraduate Educational lead, Toby Page (Newcastle), to find out how much exposure to and teaching in Urology is given in all of our Medical Schools. He is also refreshing the role of Medical School Champions and has already sent out a message to that effect.

In Europe, it seems that the countries which have the most undergraduate time given to urology, have the least problems in recruiting to our specialty.  I am also going to write, on behalf of the Federation of Surgical Speciality Associations (FSSA), to each Medical School Dean and ask how much surgical teaching and, indeed, surgical specialty exposure they feel their students receive. The triangulation of these responses should be interesting. There are several Medical School surgical, and even urological societies, so we are exploring closer links with these as well as the more difficult task of trying to reach the students who might not have considered a surgical career at all.

Dominic Hodgson (Portsmouth) has been leading the Education Committee since the start of 2019, and we have appointed Anna O’Riordan (Newcastle) as the FY/CT lead, Sunjay Jain (Leeds) as the Consultants and AUS lead, and more recently (last week) Hari Ratan (Nottingham) to take over from Owen Hughes (Cardiff) who has been a very committed and successful Higher Trainee lead for 4 years  – we are very grateful to him.  It was very pleasing to have such a strong field of candidates apply for these roles.  

A very successful Consultant’s Boot Camp was held in Leeds in November and this will be further developed according to need.

I am also particularly concerned at how the NHS structures job plans for consultants in the latter stages of their careers.  We will be taking a look at the variance in how colleagues are managed, in terms of their roles such as mentorship, on-call commitments, teaching etc and how they can be encouraged not to retire as early as the current pattern would seem to suggest.

Congratulations to Caroline Moore (UCLH) who has been appointed as the Urology Surgical Speciality Lead to the RCS England Research Board in September 2019  and to Abhay Rane (Redhill) on his election to Vice President  of the RCPS Glasgow (November 2019) – it is always good to have urological friends in influential places.

We are very fortunate to have quite detailed workforce data.  The intelligence for this comes from our Regional Reps who are now able to update their data via the website, to keep it more current. I am very grateful to Mike Palmer (Glasgow) for his many years running this - he has now handed over to Gurminder Mann (Nottingham)

GIRFT continues to progress and, after the very comprehensive first report in June 2018, there will soon be a document available concentrating on Innovations, good practice and guidelines for establishing a Urology Area Network which will be essential reading.  

We will have a link to the document on the BAUS website when it is published.  

Simon Harrison, after his hugely successful time at the helm will be handing over to Kieran O’Flynn (Salford) and John McGrath (Exeter) in the New Year – we wish them well.

Quality improvement is becoming increasingly important and visible in our daily activities.  

The Education Quality Improvement Programme (EQUIP), started in 2015 and, funded by TUF, has steadily grown to deliver teaching in this to 3/5 of all UK trainees which is very satisfying. Under the leadership of James Green (St Bartholomew’s / Whipps Cross) and Nick Sevdalis (King’s College London) there is a scheme to appoint regional QI champions who could either be a Consultant or a Trainee.

In response to an issue raised at the AGM in the summer, BAUS has conducted an analysis of gender representation on BAUS committees and elections. Whilst it is reassuring to know that this did not reveal any cause for concern, work is ongoing to develop and further embed equality and diversity throughout the organisation.

BAUS take this responsibility very seriously and is committed to ensuring that all members are treated with respect and free of prejudice.

It has been a great pleasure to attend many of the Section and Regional meetings (Oncology, Endourology, Wales, Scotland, North East, Yorkshire and Humber, East Midlands, East of England, North London in the last year or so) and to find out the issues that are most relevant to you. 

Myself, or one of the Officers of BAUS will usually manage, given enough notice, to come along and hear from you and give the BAUS perspective or answer any questions you might have.

Thank you for the tremendous enthusiasm and hospitality and it is reassuring to see, on the whole, that urology is still a cohesive and satisfying specialty - despite the pressures of life within the NHS.

FNUU - Sheilagh Reid (Sheffield) has been elected to succeed Chris Harding (Newcastle) as Section Chair in January 2020. Chris will continue to lead on the very time-consuming mesh issue. I am most grateful to all those from FNUU who are helping to navigate a way through this complex and emotive issue, and especially to Chris for a very successful tenure as Chair.

AGUS – I am pleased to report that, finally, in August, NHSE reversed their intention to centralise all penile implants in England to only four centres mainly due to pressure exerted by almost all implanters, led by Rowland Rees (Southampton) who demits as Chair in January, to be replaced by Maj Shabbir (Guy's and St Thomas’ Hospital). Thank you both.

Oncology – had their most successful ever Section meeting with 235 delegates in Brighton in November, and have launched a first targeted Section audit on cytoreductive nephrectomy. Thety have also linked with our colleagues in general surgery and gynaecology to form UKPEN, the UKs pelvic exenteration group.

Endourology –  Daron Smith (UCLH) succeeded Jonathan Glass (Guy's and St Thomas’ Hospital) as Chairman of the Section at the Section meeting in Sheffield in September; this meeting also attracted record numbers with 162 delegates.  The Section engaged in the consultations on the NICE Renal Stones Guidelines and the soon-to-be-published Quality Standard.

BAUS Section of Trainees (BSoT) - is now over a year old, and Luke Forster (Royal Free) and his executive team are going to hold what looks like an excellent meeting in February 2020 in Leeds. I am very pleased that our trainees are now much more formally embedded in the wider BAUS, and they often provide invaluable insight as to how we should develop initiatives.

As you will be aware from the regular updates sent to members about the BAUS Data & Audit Programme, a lot of work is underway to ensure that BAUS audit is focused on collection of data that addresses clinically relevant questions and cuts duplication of data that already exist.  

This work is being led by the BAUS Audit Steering Group, chaired by Andrew Dickinson (Plymouth).  With the intention of reducing the burden of surgeon-entered data, BAUS has been one of the vanguard specialties working with NCIP to improve the accuracy  of the HES data. The NCIP pilots are in progress, at Salford Royal Hospital, Kingston Hospital, University College Hospital London and the Royal Free Hospital.  The NCIP portal will provide access to HES data not only for specialised urological procedures but also for general urology procedures; circumcision, hydrocele and male bladder outflow obstruction surgery.  This is exciting because we have not had sight of data for these procedures before.  

NCIP only covers England and so we will continue to support data submission from urologists  in Wales, Scotland and Northern Ireland until the end of 2020.  There is a list of FAQs covering the closure of the current BAUS registries and future arrangements on the BAUS website – please click here – you will need to log in as a member.  I would like to stress that  2017 - 2019 outcomes data will be analysed and made available to members and the public on the BAUS website  in 2020.   We will also provide summary 'benchmarking data' from the registries to give an audit standard for those procedures.

For obvious reasons the MESH and Penile Implant databases will continue for the time being to inform the future shape of services and commissioning, etc.

There will be a UK-wide BAUS snapshot audit of all men who underwent intervention for bladder outflow obstruction in November 2019, with data submission in March 2020 – see link to the  BAUS website (you will need to log in as a member).  Data will be collected using JotForm.  Data for each patient can only be entered into JotForm once. It is, therefore, essential that you have all the information for each patient (including follow-up, if your unit does follow-up) when you create the online form for each patient. The results will be presented in Birmingham at the 2020 Annual Meeting.  I do hope that you engage with this audit.  All units should have an identified lead for this project who will coordinate the process for data submission locally.

The BAUS Research Committee (BRC) led by John McGrath (Exeter) has now met twice and is working closely with the ASG to help support the development of research projects by the Sections.

We are currently looking at all our incomings and outgoings and thinking about new ways of income generation, led by our Honorary Treasurer, Olly Wiseman (Cambridge) and Honorary Treasurer Elect, Nick Watkin (St George’s) with the aid of an external agency – Eastside Primetimers – with whom we have worked on the 2020 strategy document.  This is likely to help direct our refreshing of that strategy – to ensure that BAUS continues to evolve and stay relevant to our members for the benefit of our patients.

You will have probably noticed that the re-vamped Barry Building is now accelerating skywards and the seventh floor has been added.

Anne Bishop (CEO), Tricia Hagan (DCEO) and I had a “hard hat tour” around the building site and have seen our new home next to the circular windows at the front of the building on the fourth floor. They will be smaller premises than the current space we enjoy in the Nuffield building, but we are looking at how to work slightly differently with this and the shared committee and meeting rooms.  

We have been told by the RCS that we are due to move into our new home in early 2021 – which is a little later than had been originally thought.

There are several significant anniversaries during 2020. BAUS will be a mature 75 years old, the Royal Society of Medicine Section of Urology will be a venerable 100 and both TUF and BAUN a youthful 25.  

We have been having regular meetings on how best to mark this year and 2020 will culminate in a scientific meeting at the RSM followed by a celebratory dinner at the Drapers’ Hall on Friday 16 October 2020.  Please do put this in your diary now.

Discussions are underway about a “legacy fund” to support training for excellence in urology – both in individuals and (perhaps more regionally distributed) research projects and initiatives. TUF and BAUS have recently started to see the value and opportunities to work more closely together, and 2020 will be an excellent chance to see how we can do that practically – watch this space.

We aim to increase the profile of urology throughout this year and into the future. Partnering with Media Planet - BAUS, TUF, and BAUN have already been involved in the production of two National Press supplements – click here - as part of the 2019 Urological Health Awareness campaign; we should hopefully see the momentum, and funds, increase throughout the year.  

Obviously, this theme will be highly visible at the 2020 Annual Meeting, and Jonathan Goddard (Leicester), Anne Bishop and Nicola Quinlan (BJUI) are in the advanced stages of producing a hardback book on the History of British Urology, which will be launched in June.

Preparations for BAUS 2020 are well ahead of schedule, lead by our Honorary Secretary, Asif Muneer (UCLH), and Honorary Secretary Elect, Ian Pearce (Manchester).  There has been tremendous excitement around the meeting with a return to Birmingham after 20 years. The venue will be the ICC in the very centre of the city which has excellent transport links and has undergone extensive refurbishment in recent years. The area surrounding the conference centre is bustling with numerous hotels, restaurants, coffee shops, cafes and bars. The meeting will start on Monday 15 June with plenary sessions commencing on the same day.

Each BAUS Section will be running their own teaching course which will provide either updates or new training for both trainees and consultants. As usual, there will be a number of sponsored symposia throughout the three days – almost all of these have already been sold to our industry partners.

The Monday evening social programme will include an evening reception which will include an informal buffet to allow delegates to meet old friends and make some new ones.

Abstract submission is open and I would encourage you all to submit your work before the closing date which is 23.59 hours (GMT) on Thursday 9 January 2020. Look out for the BAUS TV feeds on #BAUS20 and for "early-bird" registration.

I am very pleased to announce that after a strong field of nominees, the Medals and Awards committee decided that the recipients in 2020 are as follows:

• St Peter’s Medal – Prokar Dasgupta (Guy’s and St Thomas’ Hospital)
• St Paul’s Medal – Margaret (Peggy) Pearle (UTSW, Dallas, USA)
• Gold Medal – Simon Harrison (Wakefield)
• Karl Storz Harold Hopkins Golden Cystoscope Award – Chris Harding (Newcastle)
• John Anderson Award – Tamsin Greenwell (UCLH)

The above will all be presented with their awards at the meeting in Birmingham, and are so wholeheartedly deserved.  Many congratulations.

Over the last year many BAUS members have been involved in meeting with other societies (urological and more general) both at home and away, and the links have really strengthened as a result.

We have interacted with, for example the USI, USANZ, EAU, AUA, SLAUS, and SIU. We are in discussion with the BMA, the four Royal Surgical Colleges and the CBS - mainly via the FSSA. At the AUA in Washington, I am delighted to announce that our Scandinavian Colleagues will be joining us, for the first time, as partners in the traditional BJUI/BAUS/USANZ session which will take place on the Sunday afternoon and be followed by the BJUI reception – a good place to meet, socialise and perhaps discuss future joint initiatives.

You are warmly invited to come along if you are intending to go to the AUA next year.

In preparation for the election of a new Vice POresident to replace Tim O’Brien in June 2020, the call for nominations will be circulated on 14 January 2020; nominations should be received by 12 noon on 11 February. We have increasing numbers of members voting for elections, made very much easier by one-click voting, and I would strongly urge you all to vote and ensure that the best candidate is chosen. 

I hope that you will find this update useful and that you can see there is a common desire to make BAUS ever more relevant to our patients and members. If there is anything that you wish to comment upon, or seek guidance with, please contact your Regional Rep, Section executive committee, any of the Trustees, the permanent BAUS staff or myself.

Please do continue with the enthusiasm and engagement in this, your organisation.  As you will appreciate, there have been, and continues to be, many initiatives and work in several areas and I haven’t, by necessity, mentioned every workstream.

It is an honour to have served as your President over the last 18 months, and I sincerely appreciate the support I have received from members, sections, Trustees, Officers and permanent staff.

I shall write again in the early Summer before the Annual Meeting.

All that remains is to wish you a very peaceful festive season, especially if you are on-call, and a happy & prosperous New Year.