newsRCPCHAUTUMN 2007

Royal College of Paediatrics and Child Health

The future of children’s health services:Modelling the Future 9

6Sleep Course report

7Windsor to HamptonCourt Walk for DBIF

13The Research Division’sstrategy

Leading the way in children’s health

Page 2

‘Cheshire Puss,’ she began timidly, ‘Would

you tell me, please, which way I ought to

go from here?’

‘That depends a good deal on where

you want to get to’ said the Cat.

LEWIS CARROLL (1865)

When I was a child, our next doorneighbour was headmistress of a smalllocal secondary school. The bane of hersummer was the construction of thefollowing year’s timetable. For weeks shewould pore over a 4ft x 3ft board filledwith scores of square recesses - graduallyfilling it with multi-coloured pegsrepresenting staff, pupils and lessons. Nopupil of hers would ever be precludedfrom the most bizarre combinations ofsubjects because of a mere timetablingclash! On the first day of term we wouldwatch with horrified anticipation as sheloaded three children, assorted hockeysticks and musical instruments, and therevered timetable into her miniscule Fiat – knowing that the only uncertainty waswhether the pegs would fall out before orafter she rounded the first corner.

Each summer the Senior Officers –and for the first time this year, theDirectors of the College – spend 21/2 daysengaged in an equally challengingexercise, brainstorming issues andstrategy for the following year. I’m surePat Hamilton never met my neighbour,but couldn’t help the nasty feeling of déjàvu when she produced a 4ft x 3ft board,pieces of Velcro, and multi-coloured cardsand pens. However, the task was actuallyto map our progress against the Vision andValues launched at the beginning of herPresidency (www.rcpch.ac.uk/doc.aspx?id_Resource=1998). There were no lessthan 75 targets in 11 key areas – not anagenda for the faint-hearted! Wedistributed each target along a horizontalred-amber-green continuum, dependingon whether we were behind schedule,making progress, or well on the way tocompletion. We also had a vertical axis tohelp us assign priority levels tooutstanding tasks. So what are our mid-term highlights?

Despite the traumas of MTAS, thereare some real achievements in training,assessment and education. Our curricula

have been approved by PMETB, and weare well on the way to a comprehensiveassessment strategy. We have secured anumber of Academic Clinical Fellowshipsand Lectureships, and established a newAcademic CSAC. Our Safeguardingcourses are widely rolled out, and wehave successfully launched Masterclassin Paediatrics and our PaediatricEducators Programme. We know weneed a more proactive approach torecruitment into paediatrics, ensuringthat we continue to offer flexible andenticing career options. We also face amajor challenge in developing standardsand an assessment framework forrecertification, as outlined in Pat’scolumn opposite.

We now have an excellent ChildProtection Officer, and are promoting amore positive image of the College as aprotector of children rather than ofpaediatricians. Our Child ParticipationManager is working with our Patientsand Carers Advisory Group on ourobesity campaign. We have published animportant document on the crucial roleof clinical networks, and are about tolaunch our Modelling the Future work.We continue to lobby actively andwidely on a range of issues, includingour pressing workforce problems, thelack of adequate investment in children’sservices, the need for more integratedcommissioning, and persistinginequalities. Despite all our efforts, weknow we need to exert even morepolitical pressure to push children to thecentre of government thinking. We donot yet have comprehensive andsustainable paediatric services in allareas, particularly as we approach 2009.

To celebrate our achievements, mostof the team repaired to the hotel croquetpitch. After a few Poirot movies, Iconcluded that the combination ofcompetitive paediatricians and croquetmallets constituted an extreme andpotentially lethal sport, and opted for a

quiet walk with theHonorary Treasurer.

Hilary CassRCPCH REGISTRAR

Editorials

From the Registrar4Media update

College Budget 2007/8 and MembershipSubscriptions 2008

5SASG news

Message fo Named anddesignated Doctors

6Improving musculoskeletalclinical skills – there is aneed and help is at hand...

Sleep Course report

7Windsor to Hampton CourtWalk for DBIF

8 & 9The future of children’shealth services: Modellingthe Future

12Medact and the RCPCH –mutual benefits?

13The Research Division’sstrategy

14Trainees’ column

15Meetings

The Tony Jackson Prize

Photographs on front cover and p.7 reproduced by kind permission of George Bodnar, www.gbevents.co.uk

In the newsAutumn 2007

Page 3

The ether is a mystery to me. How is it, forexample, that they can get colour picturesfrom Mars but they can’t get Radio 3 into yourcar? I was particularly frustrated on a trainjourney to Edinburgh when the wirelessconnection was not functioning and I neededto do my emails from my laptop. I phoned thehelpline from my mobile (now how does thatwork?), and a nice man asked me what timethe train had left London, where it was going,and what carriage I was in. He then proceededto restore the connection. It takes a plumberthree days and a king’s ransom to fix adripping tap – I am on a speeding train in oneparticular carriage and am reconnected to theworld – how on earth did he do this?Obviously he wasn’t on earth at all, but on asatellite somewhere with a good telescope, asteady hand and a very long spanner.

However he did it I bet he was a certificatedexpert. Soon you and I will need to be re-certificated under the new plans for revalidation.

It is almost 10 years since appraisal forconsultants was proposed. In 2005, DameJanet Smith in her 5th report of the ShipmanEnquiry was highly critical of the so-calledrevalidation process and the “cosy chat”appraisal. Revalidation plans had gone intoabeyance waiting for this report and for theCMO’s response. The latter came in 2006 withGood doctors, safer patients, which proposed a2-phase revalidation consisting of relicensurefor all doctors and recertification for doctors onGP or specialist registers.

In 2007 the Government’s white paper,Trust, assurance and safety endorsed most ofthe CMO’s proposals, and the profession has toadjust to another upheaval – in more waysthan one this is further modernising of medicalcareers – and we must learn from thatexperience accordingly.

Will revalidation stop dangerous doctors?Many have commented that appraisal wouldnot have stopped Harold Shipman – thoughDame Janet Smith’s response was that analysisof his patient outcomes would have done so.Is the aim to reassure the public that doctorsare up to date and fit to practise or to driveindividual improvement? The GMC saysrevalidation has “….2 distinct but complementarypurposes – ensuring patient safety andimproving the quality of patient care”.

The Department of Health is rather sternerand says “…appraisal no longer remains a...formative exercise but becomes a vehiclefor…the evaluation of a doctor’s practice”.

Relicensure will be based on thedemonstration of meeting agreed genericstandards of practice set by the GMC,following a revised appraisal process and“standardised workplace multisourcefeedback”.

The Royal Colleges will be responsible forrecertification. The GMC says it expects theColleges to deliver a statement of assuranceabout each doctor's practice to them. This isclearly a great deal more serious than a cosy chat.

Recertification will mean demonstration ofmeeting specialty specific standards - in ourcase being a paediatrician and being, for example,a generalist or a specialist. It is expected thatthe process will be undergone at 5 yearlyintervals and will coincide with relicensing.

The Colleges will be responsible forrecertification of all paediatricians on thespecialist register i.e. consultants, some SASGdoctors and other career grades –whether ornot they are members of the College. We willbe expected to draw up relevant standards forspecialist practice and will need to develop upto date and consistent guidance on the natureand the content of the evidence to be provided.And somehow we have to deliver a statementof assurance about each doctor's practice tothe GMC – knowing that failure to do so havevery severe consequences for that doctor.

Whatever process we put in place must befair, transparent and externally quality assured.It must be positive and not arduous fordoctors. It must be an important principle thatthere should be no surprises in this process.Doctors who are struggling should beidentified well before they “fail” theirrecertification and mechanisms put in place todo our best to rescue them.

We need to decide how the evidence willbe defined, gathered and assessed and how toformulate the criteria that will be used to makedecisions. We have already piloted MSF forconsultants, with the Academy of Medical RoyalColleges (AoMRC). It is clearly a different matterto the SPRAT process for SpRs. Peer reviewersmay respond very differently if they know thattheir comments have a bearing on the livelihoodof the consultant whom they are reviewing.

Clearly we will need to work with ourspecialty groups to define standards, kite-markrelevant courses and CPD activities and theevidence we expect to receive. We need tocontinue developing e-learning packages andto build self-assessment into them with ways ofrecording the evidence that this work has been

usefully undertaken. We will develop e-portfolios, from the ones currently piloted fortrainees, to make it easier for doctors topresent their evidence.

We must look at data collection and waysof auditing and assessing patient outcomes.Local and central IT systems will be key incollecting these data.

Our CPD scheme has already moved toinclude personal records, audit and reflectivenotes as better evidence of learning thancertificates of attendance at meetings. Jointward rounds or shared procedures are usefulways of confirming or re-evaluating ones longstanding habits. We will need to ensure thatpaediatricians obtain time and fundingallocated for CPD, appraisal and other activitiesrelevant to revalidation.

The recent experience of MTAS has taughtus not to introduce a new concept with a newprocess – especially with a “big bang”.Whatever schemes are developed should bepiloted and evaluated so that whereverpossible their effectiveness is evidence-basedand their feasibility is proven.

The College will need appropriateinfrastructure in terms of suitable staff and ITexpertise and equipment. There is fundingfrom the DH via the AoMRC but clearly thereis an expectation from the Government thatindividual doctors will have to bear at leastsome of the cost. This will be an additionaland inevitably unpopular additional levy onindividual doctors.

The white paper has shifted the emphasisfrom declaring doctors to the GMC when theirpractice has been called into question to apositive affirmation to the GMC that theirpractice meets required standards.Recertification is a major challenge for theColleges. It will be a statutory duty – perhapsthe only one we will have left – and we mustrise to the challenge.

The College needs to make this easy anduseful for paediatricians. The process must beequitable, effective and feasible – and shownto be beneficial for patients and not furtherdetrimental to the morale of the service.

Patricia HamiltonRCPCH PRESIDENT

RCPCH newsEditorials

From the President

With more journalists contacting the College every day, it has beena busy few months for the President and other spokespeople.

Most recently, Patricia Hamilton spoke to the Daily Telegraphabout the pressures on A&E departments due to the rise in childadmissions. The President warned that, with the increasing workloadand new European Working Time Directive, there will be ashortage of consultant paediatricians. The article also provokedcomment and debate on Radio 4 and Radio 5 Live that day.

In May, Chris Verity, Vice President for Education, spoke toThe Times about a new brain scan that may be able to predictmental illness or personality disorders in children. We were alsoinvolved in Breastfeeding Awareness Week and, as one of thesupporters of the Breastfeeding Manifesto Coaltion, we wentalong to the parlimanetary launch where Jemima Khan spokeabout the benefits of breastfeeding on behalf of UNICEF. DrColin Michie, a consultant paediatrician from Ealing Hospitalrepresented the College on the panel. We also got involved inthe debate on the Food Standards Agency recommendations toadd folic acid to bread or flour and comments were included inseveral of the nationals.

'Childhood obesity is primarily a public health problem, nota child protection issue' was our message to the public in mid-June, after the BBC carried out a survey through a number ofCollege members about childhood obesity. Their news itemsthroughout the day looked at whether in some cases obesity is achild protection issue and how young some children are whoare being classed as obese. This generated widespread mediacoverage and Penny Gibson, the College obesity spokesperson,was interviewed on BBC News 24, Channel 5 News and tookpart in a live debate on Radio 5 Live. Terence Stephenson, VicePresident for Science and Research covered the local BBC radiointerviews and BBC World Service radio too.

MMR and Andrew Wakefield's GMC hearing dominatedmuch of the health news in July. The College was instrumentalin drafting a strong position statement and was at the top of thelist of organisations and medical institutions that signed up toshow a united voice on the subject.

A new paper was published in the BMJ on SuddenUnexpected Death in Infancy (SUDI), by two retiredpaediatricians. Terence Stephenson went on Channel 4 Newsthat lunchtime to support its findings. The Royal College ofSurgeons published their recommendations for children's surgeryin late July and the College commented to BBC Onlinesupporting the need for a network of children's surgical services,so that care is delivered safely as close to home as possible.

To keep up-to- date with news articles that mention orquote the RCPCH, or to stay informed about what is going onwithin paediatrics and child health, visit the website for aregular summary of articles - www.rcpch.ac.uk

Claire BrunertHEAD OF MEDIA AFFAIRS

Media update

When setting the budget for 2007/8, Council noted that theCollege’s finances have reached a financial equilibrium whereincome and expenditure are finely balanced. Previously, theCollege has continuously grown in every year since its formation.

In particular there has been an income loss and increased costsassociated with recent changes in the assessment and monitoringof training. The income loss is approximately £200,000 andrelates to a Department of Health grant that is now received byPMETB. Council felt it is unfair to expect trainees to bear thesefinancial burdens, particularly in the current climate.

Council resolved that the cost of the monitoring of trainingshould be reviewed over the coming year as the new regimeestablishes itself and that this review should be done in conjunctionwith more vigorous lobbying of PMETB and the Department ofHealth over the loss of income for work done by the College.

Council therefore agreed that Membership subscriptionswould increase by 4% on 1 January 2008. It considered that thisincrease was essential to maintain the College’s current activitiesand to ensure the budget has some increase in general fundsbuilt-in as a sensible “safety margin” that is likely to be achievedeven if the overall actual result is not as good as budgeted. Anyincrease in general funds should also eventually further helpestablish the level of reserves needed to purchase a new building.Council also reflected that subscription increases for the pastfour years had not kept up with the RPI measure of inflation.

The main subscription rates for 2008 will therefore be as follows:Rate shown

Membership Type 2007 2008 includes Archives?

Fellow UK & Republic of Ireland £404 £420* YesFellow rest of EU & Nth America £303 £315 YesFellow Elsewhere £194 £202 YesOrdinary UK & Republic of Ireland £339 £352* YesOrdinary rest of EU & Nth America £256 £263 YesOrdinary Elsewhere £162 £168 YesAssociate UK, EU & Nth America £172 £179* NoAssociate Elsewhere £166 £173 NoJunior (UK only) £67 £70 NoHonorary Fellow £75 £75 YesSenior Fellow / Member £67 £70 No

* as in previous years, those resident in the UK and Ireland pay additional leviesNote also that payment surcharges may apply to those resident in the UK.

As usual, members will receive a personalised statement inDecember of the amount due in advance of the due date forpayment together with details of standard concessions. Membersare reminded that those who are in financial difficulty and thusfinding it hard to pay their membership subscription can apply for a non - standard concession. For more information onsubscriptions please contact the Membership Section on 020 73075623/5620/5619 or e-mail membership@rcpch.ac.uk

Dr Sue HobbinsHONORARY TREASURER

College Budget 2007/8and MembershipSubscriptions 2008

News

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News RCPCH news

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I hope you all have had a good summer, andthe memories from it don’t seem too distant.The hottest topic for doctors over thesummer has to be MMC and whilst ourtrainee colleagues have been most greatlyaffected by this there are implications for theSASG workforce. The guidance suggests thatdoctors can only make applications for RunThrough Grade Training at ST1-ST3 if theyhave less than 48 months training andexperience in the speciality they are applyingfor. To apply at ST4 or above applicants haveto show they have the competencies for thislevel. For many SASG doctors this is a Catch-22 situation. Often, we have worked at a senior level for a long period of timeand gained expertise in a specific area ofpaediatrics. So we have greater than 48months’ experience but have not necessarilygained the whole range competencies toapply for a ST4 post. Dr Mary McGraw (VicePresident RCPCH, Training and Assessment)has assured me that senior officers at theRCPCH are well aware of this issue and theyhave brought this up in the Tooke Reviewand will fight very hard to have themaximum time criteria removed from theentry eligibility. As always I am very gratefulfor the support our College gives to the SASGworkforce. I have also discussed this issuewith Dr Paul Dimitri (Chair of the RCPCHTrainees’ Committee). He has spoken to Dr.

Shelley Heard , past MMC National ClinicalAdvisor and has been advised that doctorsin this situation should make it clear in theirapplication for run through training that theposts they have worked in have not enabledthem to gain the required competencies.Therefore, applicants should request thatthese posts are excluded from theirexperience. I will come back to this topic asI find out more for you.

Colleagues have told me that there seemsto be confusion over the application processto PMETB for a Certificate for Eligibility forthe Specialist Register. Please can I draw yourattention to both the Speciality SpecificGuidance for Paediatrics which is availableon the RCPCH website and the PMETBwebsite, and the Additional Guidance forArticle 14(4) Applicants available on theRCPCH website. I hope you will find boththese resources helpful.

Please put 31 October 2007 in yourdiary. This is the SASG informationday at the RCPCH. Please contactJohn.Pettitt@rcpch.ac.uk for anapplication form.

Dr Natalie LythCHAIR OF THE SASG COMMITTEE OF THE RCPCH

A message forNamed andDesignated DoctorsThis is a reminder of a child protectionresearch that the College isundertaking, funded by DfES and DH.The title of the project is:

Understanding the informationneeds and experiences ofparents where professionalconcerns of non-accidentalinjury were not substantiated

The project involves confidentialqualitative interviews with parents whohave been in this situation. The study aimsto contribute to paediatric training andgenerate public information for parents.

We urgently need more help inapproaching families through NHSTrusts. Please be assured that theresearch is being carried out in a mostsensitive fashion.

Please do not hesitate to contact Dr Sirkka Komulainen atSirkka.Komulainen@rcpch.ac.uk ortelephone 0207 323 7909 for furtherinformation and to discuss any questionsyou may have.

SASG news

The College was saddened to learn of the death of Prof Tom Oppe, adistinguished neonatologist and pastHonorary Secretary of the BPA, on 25 June. We send our sincerecondolences to his family.

ProfessorRichardMoxonThe College is extremelypleased to record thatProfessor RichardMoxon, Action ResearchProfessor and Head ofDepartment ofPaediatrics at Oxford,was elected to aFellowship of the RoyalSociety earlier in theyear. To our knowledge,he is only the secondpaediatrician to receivethis honour.

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Assessing the musculoskeletal system is not anuncommon event in the MRCPCH clinicalexamination but often causes candidatesconsiderable anxiety. Evidence shows thattrainees in paediatrics rate their confidence inassessing the musculoskeletal system as beingmuch lower than the “mainstream” systems ofcardiovascular, respiratory and abdomenexams – in fact joints rank last equal toneurology and eyes! Furthermore, consultants,to whom trainees look to for guidance andtraining, are also under confident inmusculoskeletal assessment. Theseobservations reflect a real problem in clinicalpractice where musculoskeletal complaints inchildren are common but may be thepresenting features of serious illnesses andcompetent clinical assessment is important.

This situation is to hopefully change in thenear future and an important driver for changeis the General Competency Framework forPaediatricians which states that trainees needto be able to perform a competentmusculoskeletal screening examination and beable to interpret the findings appropriately.

This short article focusses on resourcescurrently being developed to help the traineepreparing for MRCPCH and those involved inclinical teaching. A recently publishedmusculoskeletal screening examination hasbeen developed and validated for use inschool aged children (Foster HE et al ArthritisCare & Research 2006 55(5):709). This is calledpGALS (which stands for paediatric Gait,Arms, Legs and Spine) and is simple, quick(takes about 2 minutes to do) and is aneffective screen that children even as young as3 find acceptable (even fun!) to do. ThepGALS screen is now being taught in manymedical schools and students find this veryeasy to learn as it is similar to an adultscreening exam called GALS which is routinelytaught at undergraduate level.

To help teaching and learning of pGALS, aDVD has been produced and this is a free resourceavailable from Arthritis Research Campaign(www.arc.org.uk/arthinfo/emedia.asp). Manychild health departments and medical schoolsare ordering supplies of the DVD to give totheir students and trainees. pGALS is soon to

be followed by production of pREMS (apaediatric Regional Examination of theMusculoskeletal System) which is an approachto a more detailed examination after thescreening examination. pGALS (and pREMSwhen ready) is evidence based and consensusbased incorporating views of doctors andtherapists in the British Society Paediatric andAdolescent Rheumatology (www.bspar.org.uk)

So please take a look at pGALS and orderthe DVD – we hope you find it helpful as aneducational resource and boost your clinicalskills in clinical practice. You may also find ithelpful to know that we are currently workingon an educational “tool-kit”, which will includepGALS and pREMS, and provide resources tohelp teach paediatric musculoskeletal medicine– if you want further information, pleasecontact us (sharmila.jandial@ncl.ac.uk orh.e.foster@ncl.ac.uk )

Dr Sharmila JandialDr Helen Foster

Improving musculoskeletal clinical skills – there is a need and help is at hand…

The inaugural course on Sleep and Long TermVentilation in Children was held in Bristol overthree days and was generally acknowledgedto be a huge success. The course wasorganised by Dr Tom Hilliard, Dr JohnHenderson, Professor Peter Fleming and sleepstudy nurse specialist Jennie Shine. This wasthe first course of its kind in Europe and wasa major landmark in the progress of paediatricsleep medicine in the UK. We sometimes lag alittle behind the likes of North America andAustralasia in this field but with this course

have hopefully made some inroads into theirdominance. A superb faculty of 22,representing national and internationalexpertise in sleep medicine, taught theirsubjects enthusiastically and the courseprovided the perfect blend of cutting edgescience with practical clinical advice. Wewere especially fortunate to have aninternational guest in Assistant Professor AnnHalbower from Johns Hopkins, Baltimore.

The course was set in the stunninggrounds of Burwalls in Bristol (a universityowned institute overlooking the Avon gorgenext to Brunel’s Clifton Suspension Bridge)and reflected a little of the history of this city.

The content of the three day coursecovered a broad range of sleep topics throughthe function and structure of sleep, sleepproblems and sleep disordered breathing topractical investigation and management ofsleep related breathing disturbances, includingthe institution of non-invasive ventilation. Thecourse blended a mixture of lectures withsmall group seminars and workshops.

A highlight of the first day was the

evening event, dinner on the SS Great Britain(another of Brunel’s great Bristol landmarks).This gave the delegates and faculty a chanceto network and relax in gloriously restoredVictorian surroundings. Indeed one of thebenefits of attending the course was theopportunity to meet a range of clinicians andtechnical staff involved in the study of sleepand breathing in children, to share ideas andto discuss how to develop services locally,aided by contributions for the faculty oncommunity provision of care for children onlong term ventilation and how to set up andrun a sleep service for children. I wouldhighly recommend this course for anyonewith an interest in this field from nursespecialists to physiotherapists and juniordoctors to consultants with establishedinterests in paediatric sleep medicine. Afantastic time was had by all 48 delegatesfrom around the UK with plenty of time fornetworking as well as the obviousassimilation of invaluable knowledge. Welldone to the organisers and I’m sure there willbe more to come.

Dr Dave BartleREGISTRAR, BRISTOL

Sleep Course report

Organisers and attendees at the 3-day course in Bristol.

News RCPCH news

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As mentioned in previous newsletters, a sponsored walktook place over the weekend of 29-30 June from WindsorCastle to Hampton Court in aid of the David BaumInternational Foundation (DBIF). The walkers were greetedat Windsor Castle by HRH The Princess Royal, the College’sPatron, and then set off along the Thames Path for the firstof two days’ walking to Hampton Court.

The DBIF (website: www.dbif.org) works to sponsor projectsoverseas that advance the cause of child health, in memory ofProfessor David Baum (RCPCH President from 1997 until histragically early death in 1999.)

Windsor to Hampton CourtWalk for David BaumInternational Foundation

HRH The Princess Royal greeting walkers at Windsor Castle.

RCPCH staff members.

With this newsletter you will find a documentwhich is purple on the outside and has avision for the future for children’s healthservices on the inside. It has been written bypaediatricians for paediatricians and is aboutyour service, so is a subject where youropinion really does count.

There is now central acknowledgementthat children’s services have “missed out” inthe countless NHS changes of recent years, but there may now be an unprecedentedopportunity for that all that to change.Undoubtedly, we face enormous challengesboth in scope and scale so we all need to be fully engaged in helping shapechildren’s services.

By definition there is no simple answerto what is the right configuration, appropriateto all locations - however there are somebasic principles that have universal

application which can be used to shape thefuture direction of service development.

Modelling the Future is an aspirationaldocument setting out what we believechildren’s health services could look like.Some of what you read will look familiar,some will be common-sense, but some will look challenging and possibly overlyidealistic. We have tried to engage a widespectrum of paediatrians in its production,and where there is uncertainty we haveincluded questions along the way.

There are two discrete parts. Enclosedhere is part one which provides a strategicvision of how children’s health services couldbe provided to ensure best outcomes forchildren. A second part, due for publicationearly in 2008, will incorporate your feedbackand consider the more detailed implicationsfor services and workforce.

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The future of children’s healthservices: Modelling the Future

Clinical leads meeting Thursday 15 November 2007There will be a meeting in the autumn looking at future modelsfor children’s services. Dr Simon Lenton will be discussing hispaper “Modelling the Future” and there will be the opportunityto discuss some of the issues raised around the future ofchildren’s services. This will be of interest to all clinical leadersin paediatrics and those involved in service reform. More detailswill follow on the RCPCH website (www.rcpch.ac.uk/Health-Services/Clinical-Management)

Survey for Named & Designated Doctors in Child Protection

The College has produced a brief online survey for named &designated doctors to determine the amount of time spent on childprotection activities as the named and/or designated lead.

The basis for this particular survey is to obtain accurate informationfor the College on demographics, workload and support for named &designated doctors within UK. A summary report will be produced in late2007 outlining key findings and make recommendations on appropriateworkload expectations. All responses will remain strictly confidential.

If you are a named or designated doctor, you have until 31October 2007 to complete the survey online at;www.rcpch.ac.uk/named_and_designated_doctors

SOME QUESTIONS:

Current modelling suggests that a minimum of eight consultant paediatricians are required in an acute rota for a balanced mix ofdirect clinical commitments and supporting professional activities. For what size unit/level of activity is this the correct number?

Would you support the proposal to release specialists from acute general paediatric on call rotas?

Should we be training some paediatricians to predominantly work in urgent care services, and others to work in planned careservices, particularly in medium and large places?

What models of service delivery work well for behaviour problems in school-aged children?

Which children with long-term conditions need to be seen regularly in a hospital setting? What prevents more community-basedpaediatric provision?

News RCPCH news

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Given the scale of this piece of work, what doyou see as the key areas on which the RCPCHshould focus? There is widespread supportamongst paediatricians for greater co-operationbetween teams, services and organisationsworking in a given geographical area. It is clear

that greater joint working between professionalgroups will play an increasingly important rolein service design and delivery. This includessharing clinical protocols, working in managednetworks, rotating staff between services, and joint training. A whole-systems approachto planning change will help to ensure thatunintended consequences are avoided.

Having digested the report, what happensnext? This is the start of a consultation processlasting until the end of the year. Councilmembers will be hosting regional meetings todiscuss the proposals and seek your ideas.Find out the date and put it in your diary now!

The RCPCH website (www.rcpch.ac.uk/modellingthefuture) will also offer additionalresources and contain an online facility for youto give your views. Alternatively feel free to emailus directly at modellingthefuture@rcpch.ac.uk

Simon LentonVICE PRESIDENT HEALTH SERVICES

Susan MitchellHEAD OF HEALTH SERVICES

While not wanting to repeatwhat you can read in thereport, the key ideas can besummarised as;

• Acceptance that current services arenot always achieving the best outcomesfor all children in the UK.

• Improvement comes for smallincremental innovations as well as stepchanges such as reconfiguration.

• The key values that form the basis ofdecision-making, as shown in figure 1,are that: - children and families are involved in

decision-making at all levels, - delivery of services is based on

pathways of care delivered by teams, working in networks,

- all services work within a system of continuous learning and improvement.

• Recognition that there are considerablechallenges facing services such asEWTD, Payment by Results, competitionbetween Trusts and changinghealthcare policy.

• Need to consider developing andassessing competencies of teams as well as defining individualprofessional roles.

• There is a need to support andstrengthen both current commissioningcapacity and skills and the regulation and inspection of services.

The report proposes suggestions and poses questions that could havesignificant implications for paediatricians, for example:

• Acute on-call. Should all paediatriciansparticipate in acute on-call in the earlypart of their consultant careers? Is thisappropriate in all places?

• How should specialist on-call services be organised? How many tertiary centresare needed?

• Which specialists should participate in the acute general on-call rota?

• Should there be separate child protectionrotas? Over what geographical area?

Needs driven Outcome orientated

Pathway components

Prevention Identification Assessment Management Long term support

Managed network

Statement on the duties of doctorsand other professionals ininvestigations of child abuse fromDepartment of Children, Schools and Families

DCSF released their statement on the duties ofdoctors and other professionals in investigationsof child abuse in July 2007.

The College welcomes this statement andwill continue to work with the GMC to producea similar statement for their complaints handlingprocess. Further details can be found at:www.rcpch.ac.uk/Health-Services/Child-Protection

WHO Growth ChartsIn April 2006 the WHO published new child growth standards for infants and children up to theage of 5 years. This is based on a study of the growth of infants in good health, exclusively orpredominantly breastfed for at least four months, in Brazil, Ghana, India, Norway, Oman and theUSA. They are applicable to all infants, whether breastfed or formula-fed.

The Department of Health asked the Scientific Advisory Committee on Nutrition (SACN) for anopinion on the relevance of the WHO standards to growth monitoring and population surveillancein the UK. A joint expert group of SACN and RCPCH representatives was set up for this purpose. It has produced recommendations favouring the use of the WHO growth data for children up totwo years, while using existing UK reference data for older children. This would mean creatingnew UK growth charts, combining the WHO charts with current UK charts.

The DH is looking at the expert group’s recommendations and will decide whether to acceptand act on them in full or part. The report is thus not yet policy or practice. The report can beaccessed at: www.rcpch.ac.uk/Health-Services/Nutrition-and-Growth

Fig 1: Schematic diagram of components of service design

PurposeImprove health

Reduce inequalitiesBe sustainable

ValuesFamily friendlyPathway based

Continually improving

PracticeProcess (evidence)

People (competence)Place (environment)

Support Services

News

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Medact is an organisation of health professionalswhich tackles the roots of conflict, nationallyand globally. Members use their health expertiseto highlight the awful effects of conflict, and theabsolute need for prevention. The group’soriginal focus (as the Medical Campaign againstNuclear Weapons) was nuclear war and nuclearweapons, and these are still a major part of thecampaign. Since 2002, Medact has carried outin-depth work in relation to the health effects ofthe Iraq war and has produced four reports todate, which have received wide publicity. Asthe UK affiliate of International Physicians forthe Prevention of Nuclear War (IPPNW: NobelPeace prize winner 1985), Medact works closelywith other affiliates in Europe and across theworld to highlight the dangers of weapons ofmass destruction, and regularly takes groups ofphysicians to meet decision makers in nuclear

states to describe the health outcomes of violent conflict.

A second area of work is the North-Southhealth divide, the role of the developedcountries in damaging health in poor countriesand the effects of medical migration (the ‘skillsdrain’). The report ‘Global Health Watch’ wasproduced in 2005 and is recognised for itsauthority. This links with the third area ofwork, on health issues of asylum seekers andrefugees in the UK. The fourth area ofMedact’s work, also of interest to the RCPCH atpresent, is the health consequences of climatechange and how to promote sustainabledevelopment, especially in the health service.

Medact can be of assistance to the RCPCHby its experience of education and advocacy ininternational health. Its publications GlobalHealth Watch and the Iraq Health reports will

be of much value to medical students andpaediatric trainees. Medact has experience inlobbying in relation to conflict and the armstrade through its close links with LandmineAction and the Campaign against the ArmsTrade, and regularly takes delegations to meetthe Ministry of Defence and Foreign andCommonwealth Office. Medact also hasexpertise in relation to the health aspects ofclimate change; former Medact President RobinStott is now Chair of the BMJ Carbon Council .

RCPCH can contribute to the aims ofMedact by providing data in relation to theeffects of conflict and violence on children, byjoining campaigns in relation to the healthcare of asylum seekers, and by mounting acampaign to reduce its carbon footprint.

Information on all the above can be foundon the Medact website, www.medact.org

Frank Boulton CHAIR OF MEDACT

Tony Waterston CHAIR OF RCPCH ADVOCACY

COMMITTEE

Managing editor: Graham Sleight

Editor: Joanne Ball

Email: newsletter@rcpch.ac.uk

Editorial services: Chamberlain Dunn Associates

Advertisements: British Medical Journal

Published by the Royal College of Paediatrics andChild Health, 50 Hallam Street, London W1W 6DE Tel: 020 7307 5600, Fax: 020 7307 5601 Website: www.rcpch.ac.uk Email: enquiries@rcpch.ac.ukThe College is a registered charity: no. 1057744

© 2006 Royal College of Paediatrics and Child Health. The views expressed inthis newsletter do not necessarily reflect the official positions of the RCPCH.

RCPCH newsCopy deadline for next issue:

1 November 2007

Medact and the RCPCH – mutual benefits?

In November 2006, RCPCH Council agreed to affiliate to Medact,

(Medical Action for Global Security). What can Medact offer to the

College, and how can the College contribute to the objectives of Medact?

Research RCPCH news

‘Helping paediatricianspractise evidence basedpaediatrics’

Since taking over from Neil McIntosh as Vice-President for Science & Research in Aprilthis year, I have been seeking the opinions ofmembers and officers on what research theCollege should do. I have offered to meet withall CSAC chairs and regional reps on Council toexplore their views. I have met with a numberof CSACs already and have accepted invitationsto further CSAC meetings along with visits toYorkshire, the Northern Region, Wessex, NWThames, Ireland, Scotland and Wales. I will bespeaking at the annual meetings of BACCH andthe Medicines for Children Research Network. I have also met with the Trainees’ Committee,the Paediatric Research Society and theAssociation of Clinical Professors of Paediatrics(now reconstituted as the more inclusiveAcademic Paediatrics Association of GreatBritain & Ireland). However, there is a broadconsensus forming already.

The College has never had a formalresearch strategy before – some might suggestthis is no bad thing as there have been manysuccess stories since David Baum formed theBPA’s Research Division in 1994 (see below fora recent selection of publications and reports).However, as part of the good governance of acharitable organisation, the College Trustees(Council) now require that the ResearchDivision produce a strategy, partly to indicateforward planning of how money will be spent.This has to be indicative because the verynature of research is that we don’t knowwhere research will lead, what calls for bidsthere will be, what funding will be availablefor different topics, and how we will fare in anincreasingly competitive environment. Aresearch organisation has to be flexible andfleet of foot and it is these very qualities whichhave led to many of the successes of previousyears, under the stewardship of previous Vice-Presidents and with the continuity provided byour Principal Research Officer Linda Haines.

In David Baum’s original Terms of Referencefor a Research Division there were some ideasthat have since been overtaken by other eventsor agencies (eg. the Data Protection Act, theMedicines for Children Research Network, ClinicalTrials Units) but there were other aspirationswhich endure, the first two of which were:i) “research of particular relevance to the British

Paediatric Association and its membership”

ii) “research of immediate relevance toclinical practice”

In the light of my consultations, we mightnow incorporate these tenets into threepriority areas for the College:• Research which requires access to many

paediatricians. For example:– Surveys– Rare disorders (British Paediatric

Surveillance Unit)• Under-researched areas important to children

but unattractive to funding bodies. For example:– child protection– Medicines for children– Obesity

• Dissemination and implementation of bestpractice:If we do not pay attention to guidelinedissemination and implementation, we cannotensure benefit to users – in our case children.Whether children do benefit from guidelinescan only be answered by carrying out auditsof practice, ideally auditing objective, measurableaudit points against guideline standards. The Quality of Practice Committee, underthe chairmanship of Sabine Maguire, will beaddressing this important area of work.

In addition, one of the issues I havediscussed with many colleagues iswhether we should undertake research tounderpin RCPCH policy. For example:– Recertification/CME– Reconfiguration of services– Workforce and working patterns

The College is invited to comment on manypolicy documents every week, and it wouldbe preferable if our opinions could be moresystematically evidence based. However, thedeadlines are invariably short and goodprimary research takes months or years. Acompromise might be to consider what isalready out there, sometimes in other countries.One option might beto have a roving researcherwithin the division who could carry outrelevant searches to underpin policy work.

I have been asked to provide a morecomprehensive overview of our research workin the Winter newsletter. I intend to use thatopportunity to showcase in detail perhaps fourtopical projects so that you can see the range ofwhat we do on your behalf. I hope this brieferintroduction gives you some idea of thedirection of travel and I would be interestedto hear your views – you can contact me atterence.stephenson@nottingham.ac.uk

Recent reports and publications involvingthe Research Division1. Haines LC, Wan K, Lynn RL, Barrett T, ShieldJP. Rising Incidence of type 2 diabetes inchildren in the UK. Diabetes Care 2007: 30; 1-5.

2. Boulton M, Haines LC, Smyth D, FielderAF. Health-related quality of life of childrenwith vision impairment or blindness.Developmental Medicine and Child Neurology2006: 206; 656-661

3. Knowles RL, Smith A, Lynn R, Rahi JS onbehalf of the British Paediatric SurveillanceUnit (BPSU). Using multiple sources to improveand measure case ascertainment in surveillancestudies: 20 years of the British PaediatricSurveillance Unit. Journal of Public Health2006: Jun 28(2); 157-65. Epub 2006 Apr 26.

4. Grenier D, Elliott EJ, Zurynski Y, RodriguesPereira R, Reece M, Lynn R, Kries R von.Beyond counting cases – public healthimpacts of national paediatric surveillanceunits. Arch Dis Child 2006 Dec 11doi:10.1136/adc.097451.

5. An investigation into the nature and impact ofcomplaints made against paediatricians involvedin child protection procedures. Dr Jackie Turton& Linda Haines. RCPCH November 2006

Terence StephensonVICE-PRESIDENT, RESEARCH & SCIENCE

The Research Division’s Strategy

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Trainees

MMC – Independent InquiryThe former Secretary of State for Health,Patricia Hewitt, has invited Professor Sir JohnTooke, Chair of the Council of Heads ofMedical Schools, supported by an independentpanel and secretariat, to lead an IndependentInquiry into Modernising Medical Careers(MMC) in the wake of the debacle surroundingMTAS. The inquiry has called on a multitude ofstakeholders to give opinion and evidence ontheir input and experience during the evolutionof MMC. All trainees have had had theopportunity to provide their opinions throughan online questionnaire. This e-consultationclosed on 31st July. The panel received 370,127answers to the questions posed. The aims ofthe inquiry are to assess the degree to whichthe background to and principles of MMCwere understood and embraced by theprofession, evaluate the extent to which theproposed structure really would deliver worldclass training and identify alternative solutions,grounded in evidence, which will deliver theeducational opportunities our junior doctorsrightly expect and deserve. The preliminaryreport will be available by the end of September.

MMC Programme BoardA new MMC programme board has beenestablished by the Department of Health(DH), led by Professor Martin Marshall,Deputy CMO for England. The Board hasbeen established to address the issues ofapplication to training posts and ongoingtraining for 2008 and beyond. The board haswide stakeholder input including theAcademy of the Medical Royal Colleges, withPaul Dimitri as the trainee representative, theBMA with two further trainee representatives,the Deans, and the DH.

Exit examsThe RCPCH is currently discussing thepotential idea of an exit exam prior to thecompletion of medical training. This hasprovoked a lot of discussion within theTrainees’ Committee. We are very keen togain widespread trainee opinion on thismatter and have set up an onlinequestionnaire for trainees to provide theirviews. This is available atwww.questionpro.com/akira/TakeSurvey?id=750128

AssessmentsThe Trainees’ Committee is involved with the working group for assessments to helpimplement assessment strategies. All traineesare now required to enrol with the RCPCH,and will inevitably move to using the new e-portfolio. Many other Royal Colleges areasking trainees to pay for assessments.Following a long consultation, Trainees are not being asked to pay for assessmentsthis year.

GMC and the abolition of limited registrationThe GMC is due to abolish limitedregistration on 19th October 2007. Limitedregistration currently applies to InternationalMedical Graduates (IMGs). In future IMGswill be able to apply directly for provisionalor full registration. They will still need tosatisfy a number of criteria before this isgranted, but will no longer need an offer ofemployment beforehand. IMGs applying forprovisional registration will be limited toworking in foundation posts. UK graduatesand IMGs granted full registration for thefirst time, and starting new jobs or thosereturning to the register after a prolongedperiod out of UK practice, will be requiredto work initially within an approved practicesetting (APS). An APS is an organisationwhich has effective clinical governancesystems, providing a suitable environmentfor newly registered doctors. For moreinformation please go to pages 9 and 10 of -www.gmc-uk.org/publications/gmc_today/gmctoday0707.pdf

New Vice ChairI would like to congratulate and welcomeMo Gnanalingham to the Trainees’ Committeeas the New Vice Chair.

Trainees’ column

Paul Dimitri pauldimitri@hotmail.com

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MMC and MTAS have been the major topics of discussionfor trainees and senior colleagues this year. Many arebattle worn from the confusion and chaos created byMTAS. The MTAS review has now closed and a report willavailable in the public domain shortly. In the short term,Round 2 applications will continue until early November,although the intention by deaneries is to have mosttrainees in post well before this date. We wouldencourage those trainees who are applying to posts toclosely watch deanery websites, NHS Jobs (all posts willbe advertised here for a minimum of 72 hours) and BMJCareers. Further updates will also be available on theMMC website. Information regarding further trainingopportunities and career support in 2007 are availableon the MMC website applicants guide.

Meetings RCPCH news

UK meetings and courses200720-21 September Paediatric Cardiology for PaediatriciansVenue: University of ExeterTel: 01392 490470Email: david.mabin@rdeft.nhs.ukor Jessica.bedford@rdeft.nhs.uk

20-21 September Paediatric acute sexual assault examinationand aftercare (two days)Venue: St. Mary’s Hospital, London Contact: Aidan Moss, Training co-ordinatorTel: 020 7886 1101Email: havenseducation@st-marys.nhs.ukWebsite: www.thehavens.co.uk

21 September Masterclass 2007 - 'Comparative KeywordAnalysis: A Computer-Assisted Method forthe Qualitative Analysis of Text'Venue: School of Medicine, Swansea UniversityContact: Ms Vicky DaviesTel: 01792 513407Email: v.i.davies@swansea.ac.ukWebsite: www.swansea.ac.uk/chiral/events

25-26 September The Autumn Meeting of APEM Call for abstracts: closing date 1 June 2007

Venue: Sheffield Town HallContact: Dr Eileen ByrneTel: 0151 228 4811Email: Eileen.Byrne@rlc.nhs.uk (abstracts);julie.underwood@emergencymedicine.uk.netWebsite: www.apem.me.uk

27 September RCPE/RCPCH Joint symposium: Paediatrics- things you don't grow out of (managing chronic disorders)Venue: Royal College of Physicians of EdinburghContact: Eileen StrawnTel: 0131 225 7324 Email: e.strawn@rcpe.ac.ukRegistration: www.rcpe.ac.uk/education/events/pediatrics-flyer-reg-sept-07.pdfInformation: www.rcpe.ac.uk/education/events/pediatrics-flyer-sept-07.pdf

4 October Hot Topics in Paediatric EducationVenue: Stirling Management Centre, StirlingUniversityContact: Claire BurnettTel: 0131 247 3644Email: claire.burnett@rcpch.ac.uk

11-12 October British Society for Paediatric andAdolescent Rheumatology (BSPAR) Annualgeneral MeetingVenue: Aston University Busines Park, Birmingham

Contact: Barbara MooreTel: 0121 333 8730Email: b.g.moore@bham.ac.uk

16 October How relevant are NICE guidelines to yourclinical practice?Joint meeting between the RSM and RCPCHVenue: The Royal Society of Medicine, LondonContact: Andrea TörökTel: 020 7290 2986 Fax: 020 7290 2989 Email: paediatrics@rsm.ac.ukWebsite: www.rsm.ac.uk/paediatrics

22-23 November Paediatric Educators Programme (PEP)Venue: RCPCH LondonContact: Aaron BarhamTel: 020 7307 5633 Fax: 020 7290 2989 Email: aaron.barham@rcpch.ac.ukWebsite: www.rcpch.ac.uk/Education/Education-Courses-and-Programmes/Paediatric-Educators-Programme

28 November SPS Annual General Meeting and St Andrew'sDay Paediatric SymposiumVenue: Royal College of Physicians EdinburghContact: Claire BurnettTel: 0131 247 3644Email: claire.burnett@rcpch.ac.uk

RCPCH meetings

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One of the key challenges for paediatricians overthe next few years is to encourage UK graduatesto enter the specialty, and this is a task which theCollege will be addressing. There are already anumber of initiatives in place, such as the prizesawarded to enable promising medical students toattend the Spring meeting, but now we are able tointroduce a new prize, made possible by a verygenerous bequest by Dr Tony Jackson.

The prize is worth £500 and will be awardedannually. It is for a written report between 2,500and 3,000 words in length and is open toundergraduate medical students at any universityin the United Kingdom or Ireland and graduates intheir first Foundation post. The brief isdeliberately wide ranging: applicants can submit awritten personal reflection upon any aspect ofpaediatrics or child health, experienced in the UKor abroad. The reports may include a maximum

of three photographs or other figures and shouldbe accompanied by a brief abstract of not morethan 500 words. In addition to the prize itselfthere will be a system of commendations for highstandard entries and all abstracts will beconsidered for publication in the Collegenewsletter, at the editor’s discretion.

Details of the prize have been circulated tomedical school deans but I would urge you toencourage entries from potential prize winners youcome across. The closing date for entries this yearis 31 October. They should be addressed to TheTony Jackson Prize in the Training department atthe College.

Dr Wilson BolsoverASSISTANT TO THE OFFICER FOR TRAINING

The Tony Jackson Prize

Tony Jackson was a Consultant Paediatrician atthe Royal London Hospital and Queen ElizabethHospital for Children. He was an active supporterof the Cystic Fibrosis Trust which awarded himits’ John Panchaud Medal. He was well knownand highly regarded for his teaching of medicalstudents and paediatricians in training.