newsRCPCHAUTUMN 2008

Royal College of Paediatrics and Child Health

The RCPCH and the Media 8-9

Modelling the Future II 4

In memoriam: Spence Galbraith 5

ACCEA/SACDA: when and how to apply 6

Leading the way in children’s health

Education news – upcomingcourses 10-11

Page 2

“What is a Registrar”, I was asked, by theyoung person sitting next to me at dinnerafter an MRCPCH Admission ceremony, “andis it the same as my Mum” (who had earlierreceived her diploma)?

I had been on surer ground with the earlierquestion about the College mace, beingfairly confident with its function as a symbolof authority. So after a few rather non-specific comments, I neatly turned theconversation to how she had managed to getoff school to come to the ceremony! But itwas a good question, and although there is ajob description, it is probably best answeredby looking at definitions in education, wherein the UK the role relates to administrationand outside relates to student records entry.My role has an amalgam of both, with aclose involvement in the internal running ofthe College as well as responsibility forAdvisory Appointment Committees (AAC).

The latter are an important part of thework of the College, and Collegerepresentation on them helps to ensure thatstandards are maintained in those appointedby Trusts, both in terms of the personappointed, and the quality of the posts. I amgrateful to those of you who makeyourselves available to serve on thesecommittees. Sometimes it is difficult to findpeople for an AAC – we can all help byboth volunteering to take part, and mostimportantly, by ensuring that when we aredeveloping a new post in our own Trust, weadvise our medical staffing department of theimportance of making early contact with theCollege when setting up interview panels.The main reason it can be difficult to findpeople is short notice!

Internally, we are looking at how theCollege structures itself, and in particularhow departments work together. The newbuilding, bringing everyone under one roof,supports this, but like most organisations, weneed to continue to encourage an approachwhich takes a broad perspective. Sometimesit is easy to focus on the narrow andspecific, rather than seeing widerimplications (for example not thinking abouthow an issue needs to be reflected in all ourwork, from education for all doctors, totraining for future doctors, considering if ithas an impact on the way we organiseservices and whether it generates a research

or clinical effectiveness question). TheRegistrar, because of the broad remit, alsohas a role in supporting such thinking.Council, and Regional Advisers, are critical inhelping steer the College in this direction.They bring an external and broadperspective, often seeing things not apparentto those more closely involved in the detail.Recently we have begun to consider howthese two groups will work in the future,given the development of Heads of Schools(although as ever this does not apply acrossall parts of the UK), which has resulted in areduction in the role of Regional Adviser. Weare setting up a working party to considerthis further, and to ensure that we continueto benefit from the current strong regionalrepresentation currently existing in Counciland Regional Advisers. Discussion at bothmeetings has suggested it is an appropriatetime to look at this further, not least becauseof a feeling that the current arrangementsmay not make best use of precious time, norresult in the clearest relationship betweenindividual members and their representationon College bodies.

I also have responsibility for Policy.Thank you to all of you who comment ondocuments for us. We are asked to provideour thoughts on a huge number ofdocuments, and this is only possible becauseof your involvement. Our Policy Conferencethis year was on the issue of first contactcare (GP’s, paramedics, emergencydepartments). The conclusions of this can befound on our website atwww.rcpch.ac.uk/Policy/College-Policy-Conference-2008. We will continue to workon this, with a particular emphasis on furthercollaboration with the RCGP. I welcome anycomments you have on this topic. And if youhave an idea for an important topic weshould consider at Policy Conference 2009,please let me know.

Dr David VickersRCPCH REGISTRAR

Editorials

From the Registrar4Media Update

Modelling the Future II

5Death of BPSU founding father:Dr Nicol Spence Galbraith

NIHR Medicines for ChildrenResearch Network – ClinicalStudies Groups

6College Budget 2008/9 andmembership Subscriptions 2009

Clinical Excellence Awards(ACCEA/SACDA) – 2009 Round

7Workforce Census Results

International Paediatric TrainingSceme (IPTS) Fellowships

8-9RCPCH and the media – a report

10-11RCPCH Education News

12SASG news

BPSU Update

14Trainees column

UK Retinopathy of PrematurityGuideline for Screening andTreatment 2008

15RCPCH meetings

In the news

Page 3

Once a fortnight, the proverbial Martian lookingdown at my house will observe me dashingaround in a whirl of tidying and cleaning. Thisis not my daily behaviour and he/she mightdeduce that an important visitor is coming andhe/she would be right. That visitor is of coursemy cleaning lady. I feel guilty enough abouthaving a cleaning lady at all without the addedanguish of having her find the house uncleanand untidy – hence the frenzied activity.

I suspect that you might think this odd butI would defend myself by saying that having acleaning lady achieves the desired outcome –once a fortnight my house is tidied and cleaned.You might reasonably enough counter with theobservation that this is not the most efficient orindeed cost-effective way of achieving thisoutcome. I would in turn point out that with themoney I pay her, my cleaning lady and I arecontributing to the wider economy and fightingthe credit crunch; but I recognise that I am noton a strong wicket here.

As ever my home life seems not sodifferent from that of our own dear NHS. LordDarzi’s Next Steps Review has made a welcomeshift away from targets expressed in weeks orhours to patient outcomes in terms of qualityand improvement. Paediatricians will welcomethis as we feel this is more relevant to us aswaiting times and payment by results havenever served us - or children - well. Howeverthere are pitfalls here too as outcomes couldstill be interpreted along the lines of the “hipoperation” model and be defined in easilymeasured criteria which may return to timebased ones such as time in hospital or repeatout patient visits. Whilst these may make sensefor orthopaedic surgeons, defining outcomecriteria is more of a challenge for paediatricians.

However it is possible to define desirableoutcome criteria in partnership with parents andchildren and young people themselves. TheCollege can help by working with the generalistsand specialists to define some key indicators thatwould reflect a good outcome for our patientsand hence a good outcome for us. In order toavoid a plethora of goals and an intolerableburden of measurement, we will be askingspecialty groups and the general paediatric groupto help us identify those measurable factors thatare good indicators of wider good practice. Thatis, if these “marker” outcomes are achieved, it islikely that a good team is practising well andother goals are also likely to be met. We shouldnot fall into the cleaning lady trap which means

that the outcomes are only achieved in ways thatare not efficient or depend solely on doctors toachieve them. We should define our outcomesalong pathways with multidisciplinary teams eachpaying their part – each doing what they do bestand most efficiently. We need to find outcomesthat are measurable - but not fall into the trap ofmaking it important to measure things but tomeasure those things that are important and areamenable to improvement.

One of the issues we are currentlyworking on is the concept of “care bundles”and we are doing a project on this with theNational Patient Safety Agency. There isevidence to show that where a pathway for,say, reducing nosocomial infection involves 5different steps or actions you will only be trulyeffective if all 5 steps are taken – 3 or 4 is notenough. We are piloting this work in aneonatal context and if this proves to bereliable and feasible we could introduce this aspart of one of our index patient outcomes.

Our paediatric workforce is already woefullyoverstretched and we must not add to theadministrative burden we already bear.Revalidation will require us to capture more dataabout our own outcomes but since these willmap with patient outcomes this is an opportunityto make sure we do not duplicate effort. The ITchallenge has not yet been met but we certainlywill need it if we are to carry on practisingmedicine rather than being data collectors.

August and September presented hugechallenges to paediatric and child health serviceswith the change-over period and the gaps inrotas. I sent out an email bulletin in Augustwhich contained links to various documentswhich we hope will help those trying toredesign services or be innovative aboutcovering acute services and also routine clinics. Ihope you saw these links – if not do check onthe website. Some relate to reconfiguration,some to schemes for international medicalgraduates and some to ways of recruiting toprogrammes in a way that allows for gapsdeveloping later. Sadly none of these are veryhelpful for this year but may be for next time.

We also were made aware of the problemspresented by delays in getting Criminal RecordBureau checks and the difficulty in gettingportable checks which enable trainees to movefrom one part of a training rotation to anotherwithout waiting for a repeat check. Portabilityis difficult under the protection of children actand we are still working on trying to clarify

what can be done about this. We have madeprogress and will let you know when we havea definitive answer and appropriate guidance.

Last year the AGM asked us to continue totalk with the GMC about their processes inregard to child protection and expert orprofessional witnesses. We have been doing soand the GMC has now published guidance onacting as an expert witness. We in turn havedeveloped our court skills training and issuedguidance on the conduct of home visits as partof a child death review team. We have talked tothe Family Justice Council, to CAFCASS (Childrenand Family Court Advisory Support Service) andalso the GMC about trying to ensure thattranscripts of family court proceedings are takenand are available in case of a challenge as towhat a witness did or did not say. The problemremains the small number of occasions onwhich these transcripts will be needed but wehave pointed out that paediatricians are not theonly witnesses in this position and that socialworkers, psychiatrists and others might also findthis useful if called to account by their regulators.

Finally I return to Lord Darzi and the NextSteps Review. The chairs of the Children’sClinical Pathway groups – one for each StrategicHealth Authority – met recently in London tosee how implementation is progressing. There issome progress but mainly it seems at SHA level– albeit with some welcome appointments ofkey people to ensure that the issues facingchildren and young people are not forgotten inthe general schemes being put in place. This iskey as we wait with anticipation for theChildren’s Health Strategy due to be releasedsoon – hopefully by the time you read this. Wehope it will address acute health as well asissues for children and young people with longterm conditions, we hope it will address theproblems facing the workforce and we hopethat, whilst it will address the very importantissues of education and social services it will notlose its all important focus on health.

We have tried to get this message across,helped as always by our National ClinicalDirector Sheila Shribman and we await to seeif we have succeeded.

Dr Patricia HamiltonRCPCH PRESIDENT

RCPCH newsEditorials

From the President

Expert witnesses and child protection continue to be written about, andthe College is always keen to express its views. In May, TerenceStephenson, Vice President for Science and Research, took part in a livediscussion on BBC Radio 5 Live with the Minister responsible forFamily Courts, Bridget Prentice, and the NSPCC in-house lawyerBarbara Esam. Also that month, Penny Gibson, RCPCH obesityspokesperson, spoke to Chemist and Druggist Magazine aboutchildhood obesity and the difficulties in treating children, saying “it’snot as simple as eating too much or being less active; there is arecognisable genetic tendency, which may influence your metabolismand how you deal with food... even simple obesity is multi-factorial.”

In June the College hosted a very successful conference on carbonreduction and health which looked at the role the health sector canplay in reducing its impact on the environment. British Satellite Newsattended the conference. Lord Darzi launched his report High QualityCare for All: Next Stage Review in June too. The College found much towelcome in its response, particularly “the specific references to the needfor children’s services to be effectively designed around the needs ofchildren and their families.”

In July, we were involved in the launch of the fourth edition of theBNF for Children and launched a joint report with the RCOG –Children’s and Maternity Services in 2009: Working Time Solutions.Also, the National Health Service mark its 60th birthday and PatriciaHamilton said in a statement that “children have benefited greatly fromthe NHS” and that “routine immunisation and regular screening areparticular achievements to be acknowledged.”

The Times published a series of articles in mid-July on familyjustice, by Camilla Cavendish, to which Patricia Hamilton and RosalynProops, Officer for Child Protection, responded with a letter to thenewspaper. They raised the issue of the difficulties professionals facewhen involved in child protection cases and wrote: “Of course childcare professionals should be properly accountable for their decisions butsome have been pursued by the media in a way which only deters themfrom welcoming a more transparent process.”

The Adolescent Health Project was launched by Health MinisterAlan Johnson at the College in July. The project aims to improve thecare young people receive by health professionals and attracted a largeamount of press interest – it was covered by the Guardian, EveningStandard, Press Association and Telegraph as well as a number ofprofessional publications including HSJ, Nursing in Practice, Managementin Practice and Children and Young People Now magazine.

In late July, articles in the BMJ about child protection cases and theGMC’s new guidance for expert witnesses led Patricia Hamilton andRosalyn Proops to respond with a letter. It welcomed the guidanceand stressed that paediatricians contribute to the protection of childrenby following clearly laid out procedures detailed in the Government’sdocument Working Together to Safeguard Children and “they must feelsafe from unnecessary referral to the GMC or from protracted procedures.”

To keep up-to-date with news article that mention or quote theRCPCH, or to stay informed about what is going on within paediatricsand child health, visit the website for a regular summary of articles –www.rcpch.ac.uk

Claire BrunertHEAD OF MEDIA

Media UpdateAt the time of writing this article in late July, I am already hearing concernsthat a substantial number of middle grade training posts will not be filledover August and September. Both consultants and trainees are concernedabout having to do additional night shifts. Trainees worry about theimpact that this will have on their training, and consultants are worriedabout the affect on their daytime work. It feels like a no-win situation.

The origins of this problem go back to 2002 when there was anexpansion of the number of trainees in order to meet the limitation ondoctors hours set by the Working Time Directive (WTD). This led to amismatch between trainee numbers and consultant numbers, and nowalmost five years later, we are expecting up to 400 trainees to receivetheir CCTs each year and yet only around 100 consultant retirements.

So we have a dual dilemma - too many trainees for consultantposts available, and too few for the number of rotas that requiremiddle grade trainees.

Modelling the Future II is the second of three papers looking at the futureconfigurations and workforcerequirements for children’s health servicesin the UK. It examines the variousoptions that are open to paediatriciansand service planners to achieve highquality care with a sustainable medicalworkforce, whilst meeting WTDrequirements. The report proposes thatconsultant numbers need to expandconsiderably, and that once this is

achieved, trainee numbers will need to be reduced. In addition, itproposes that services need to be reconfigured to improve the qualityof care delivered.

However, it’s not all bad news! The Department of Health(England) has set aside £100m for consultant expansion in 2008/09with further substantial allocations planned for 2009/10 and 2010/11.The DH recognises that paediatrics is in a particularly difficult positionand that the shortages it faces cannot be covered from adult servicemiddle grade rotas. However, this new money will come with stringsattached - improvements in patient experience and outcomes willneed to be demonstrated and WTD compliance must be achieved.Exactly how the money will be distributed between specialties iscurrently under negotiation – as soon as we know, you will know!

For more information about Modelling the Future, visitwww.rcpch.ac.uk/Health-Services/ServiceReconfiguration/Modelling-the-Future

RCPCH has produced a number of briefings to help with staff shortages:1. Solutions for the medical staffing of acute units

(www.rcpch.ac.uk/Health-Services)2. Proposals for Dealing with the Crisis in Filling Short-term Vacancies

in Training Programmes (www.rcpch.ac.uk/Training)3. International Paediatric Training Fellowship Scheme

(www.rcpch.ac.uk/Training)4. Long-term workforce briefing (www.rcpch.ac.uk/Health-Services)

Bee BrookeHEAD OF HEALTH SERVICES

Modelling the Future II

Page 4

News

News RCPCH news

Page 5

The Medicines for Children Research Network(MCRN) Clinical Studies Groups (CSGs) wereestablished to facilitate the development of aportfolio of high quality randomised controlledtrials and other studies of medicines for children.

At present, 12 MCRN CSGs exist covering mostpaediatric specialty areas: • Allergy, Infection and Immunity (Chair: Dr

Mike Sharland)• Anaesthesia, Intensive Care, Pain and

Cardiology (Chair: Dr Robert Tasker)• Diabetes, Endocrinology and Metabolic

Medicine (Chair: Professor David Dunger)• Gastroenterology, Hepatology and Nutrition

(Chair: Dr Stephen Murphy)

• General Paediatrics (Chair: Dr Colin Powell)• MCRN/ARC Paediatric Rheumatology (Chair:

Dr Michael Beresford)• MCRN/BAPN Nephrology (Chair: Dr Moin

Saleem)• Methodology (Chair: Professor Peter

Brocklehurst)• Neonatal (Chair: Professor David Field)• Neurosciences (Chair: Dr William Whitehouse)• Pharmacy and Pharmacology (Chair:

Professor Ian Wong)• Respiratory and Cystic Fibrosis (Chair:

Professor Jonathan Grigg)

The remit of all CSGs is to: be responsible fordeveloping and overseeing a comprehensiveportfolio of studies; propose and support thedevelopment of protocols for new trials andother well-designed studies; review studyprotocols and advise the MCRN Study AdoptionCommittee; provide robust scientific evaluation,expert advice and support to investigators;ensure consumer involvement in all activities.

The MCRN has attracted external funding

from charitable bodies (Arthritis ResearchCampaign; Kids Kidney Research) to supportthe development and funding of new CSGs(MCRN/ARC Paediatric Rheumatology andMCRN/BAPN Nephrology). We hope tocontinue to work closely with funding bodiesand specialty groups to facilitate thedevelopment of more CSGs in the future.

Further information on the CSGs can be foundat http://www.mcrn.org.uk or by contactingthe CSG Administrator atlaura.pilkington@liverpool.ac.uk.

ERA-NET PRIOMEDCHILD

During 2008, the MCRN has been conductingthe UK work package of the ERA-NETPRIOMEDCHILD Programme on Medicines forChildren, in partnership with the MRC.PRIOMEDCHILD is a European researchprogramme, funded through the EU sixth

Continued on p15

The NIHR Medicines for Children Research

Network – Clinical Studies Groups

As a fellow parent ofthe BPSU, it was withgreat sadness that I learned of the deathof Spence Galbraithon August 8th. When I joined theCommunicable DiseaseSurveillance Centre ofthe Public Health

Laboratory Service in 1980, Spence was Director.At the time he envisioned the need for clinicalreporting schemes to identify and monitorconditions of public health importance, whichwere possibly, but not necessarily, caused byinfection and which might be newly emergingor changing in incidence. In 1980 we were inthe shadow of the thalidomide and Spanish toxicoil disasters in which the signs and symptomsfirst manifested themselves in children.

The methodology of the BPSU is based on thatused by the National Childhood EncephalopathyStudy and it was typical of Spence that, when

approached by the NCES to take on surveillanceof Reyes Syndrome (RS), he agreed with enthusiasm,even though it would be a departure from theusual remit of CDSC. Spence was looking fornew projects for me to take on, so that was thebeginning of my 20 year association with RS forwhich I am profoundly grateful to “the boss” aswe all affectionately called him..

Initially we didn’t have the resources toundertake an “active” monthly card reportingscheme like the NCES used, so decided on a“passive” scheme, recognising that we wouldneed to ascertain cases of RS via paediatricians.Spence and I took the proposal to the (then)British Paediatric Association. It was approved bythe BPA Executive and we launched it inAugust 1981.

In 1982 we added Kawasaki disease,haemorrhagic shock encephalopathy syndromeand haemolytic uraemic syndrome. All hadappeared as outbreaks in this country duringthat year and all were thought to be associatedwith an infection although microbiological

investigations were inconclusive. They appearedto be new and alarming and fitted with Spence’snotion of the need for a clinical surveillancescheme for emerging new paediatric disorderswhich might have public health implications.

In the early 1980s, there was increasinggeneral interest in studying rare disorders andtalk of the need to improve and unify casereporting for rare disease research. After muchnegotiation between the upper echelons of theBPA and the PHLS in which Spence played amajor role, a joint steering committee was setup to take forward a proposal for a BritishPaediatric Surveillance Unit, whose remit wouldbe the surveillance of less common illness inchildren. It would use an “active”, monthly, nilreturn card reporting system.

In July 1986 the first card went out and theunit has gone from strength to strength to thisday. There were of course other key figures butwithout the vision, imagination and sheerpersistence of Spence Galbraith it is probablethat the BPSU would never have happened. Inacknowledgement of this, the College awardedhim an Honorary Fellowship in 2006.

Dr Susan Hall

Death of a founding father of the BPSU: Dr Nicol Spence Galbraith

National Institute forHealth Research

News

Page 6

Council has set the College’s budget for2008/9. The budget achieves a £192,000increase on general funds, which exceedsthe break-even recommended by FinancialGovernance & Audit Committee. As a resultthere is a small “safety margin” and/or some scope for inclusion of furtherdevelopments. This is a significantachievement as there was no growthbudgeted (compared with the previous year)and this is the first full year following themove to Theobalds Road. It therefore bodeswell for the College’s long-term viability inits new headquarters.

Membership subscriptions income of£3,134,000 accounts for 36.5% of the totalCollege income of just over £8.5 million.Council agreed that most membershipsubscriptions would increase by 4% on 1January 2009. It considered that this increasewas essential to maintain the College’sactivities. Council was satisfied that such alevel of increase was unlikely to exceed theRPI measure of inflation which has alreadyreached 5.0% for the year to 31 July 2008. A £20 reduction from £70 to £50 has beenagreed for Senior Fellows and Senior Members so as to encourage them to retaintheir membership.

Previous years, Subscription increases comparedwith RPI and Exam fee increases

The main subscription rates for 2009 willtherefore be as follows:

Members will continue to receive apersonalised statement of the amount due inadvance of the due date for payment togetherwith details of standard concessions. Membersare reminded that those who are in financialdifficulty and thus finding it hard to pay theirmembership subscription can apply for a non- standard concession. For more informationon subscriptions please contact theMembership Department on 020 7092 6060 or e-mail membership@rcpch.ac.uk

Dr Sue HobbinsHONORARY TREASURER

College Budget 2008/9 and MembershipSubscriptions 2009

The clinical excellence awards process kicksoff a month earlier than usual. ACCEA hasannounced that the deadline for submissionfor the 2009 round of awards will be inDecember rather than in January as in thepast. As usual the College has been invited tosubmit nominations and as usual we will beasking Regional Reps on Council andconveners of specialty groups to send theirshort-lists for Gold, Silver and Bronze awardsto us. Members in England and Wales eligiblefor awards should therefore expect to hearfrom their region shortly about local deadlinesfor submitting CVQs. These will need to besome time in October, in order to allow us tocomplete our processes and prepare a finalCollege list. The timetable for Scotland ishowever unchanged, and members in

Scotland should have an extra month.One further change to the ACCEA system

this year concerns the submission ofsupplementary forms. In previous years nationalapplicants have been afforded the opportunity tosubmit a supplementary option along with theirapplication; they have been able to choosebetween the Research option and theTeaching/Training option (with the Managementoption included for Platinum applicants only).For the 2009 round, the Management option hasbeen extended to all national applicants. Underthe revised scheme Bronze and Silver applicantsmay choose to submit one out of the followingoptions: Research, Management,Teaching/Training. Gold applicants may chooseto submit up to two of the options. Platinumapplicants may submit all three.

We try each year to make our processesmore open and to ensure that all eligiblemembers – regardless of their specialty orbackground - have a fair chance of obtainingan award. Please contact us at the College ifyou have any questions about the process.

More information is available on the Collegeweb-site: www.rcpch.ac.uk/About-the-College/Clinical-Excellence-Awards-2009

ACCEA guidance for 2009 has been publishedand is available on the ACCEA web-site -www.advisorybodies.doh.gov.uk/accea/. The on-line national awards applicationInformation from the Scottish AdvisoryCommittee on Distinction Awards can befound on: www.sacda.scot.nhs.uk/

Len TylerCHIEF EXECUTIVE

Clinical Excellence Awards (ACCEA/SACDA) 2009 Round

Membership Type 2009 rate Rate shown includes Archives?Fellow UK & Republic of Ireland £437* YesFellow rest of EU & Nth America £328 YesFellow Elsewhere £210 YesOrdinary UK & Republic of Ireland £366* YesOrdinary rest of EU & Nth America £274 YesOrdinary Elsewhere £175 YesJunior (UK only) £73 NoHonorary Fellow £85 YesSenior Fellow / Member £50 NoAssociate UK, EU & Nth America £186* NoAssociate Elsewhere £180 No

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

5.0

4.0

3.0

2.0

1.0

02003 2004 2005 2006 2007 2008

Incr

ease

(%

)

Year

Subscriptions RPI

News RCPCH news

Page 7

The RCPCH offers the following advice to help overseas doctors to achievepostgraduate training in the UK for aspecific period of time.

BackgroundAll overseas doctors seeking clinical training inthe UK are managed by the Royal Colleges.The International Paediatric Training Scheme(IPTS) depends entirely on trust between thoseinvolved: the sponsors, the College and thetrainees. The scheme enables suitably qualifiedpaediatricians to obtain registration with theGMC. The scheme is of mutual advantage to allparties when it works well. The sponsors fromoverseas receive good training in UK for theirtrainees, the UK training scheme can expecttrainees of high calibre and motivation, linksbetween UK and overseas institutions arestrengthened and the trainee is exposed to ahigh standard of postgraduate medical education.

AimsIPTS aims to foster links between the UnitedKingdom (UK) and countries overseas. TheIPTS fellowship provides a variety and depthof training and clinical experience in UKwhich is likely to complement that obtainedin the overseas fellow’s home country.Moreover, training in UK provides overseasfellows an opportunity to experience a newculture and to see how cultural differencesaffect the presentation of illnesses. It alsoprovides exposure to the organisation andmanagement of health care within a NationalHealth Service.

IPTS FellowshipWe have established a number offellowships, which are links between variousPaediatric departments in UK, overseasinstitutions (e.g. Sri Lanka, Pakistan, Libyaand Myanmar) and the RCPCH. IPTS trainees

in these posts will be eligible for 2 years’sponsorship under the scheme. This timelimit is due to the new immigration rules.Overseas doctors wishing to come and trainin the UK need TWES (MTI) work permitwhich is only for up to 2 years.

Development of new fellowshipsThe College has been looking at differentways to broaden the scope of the IPTSFellowship scheme. At the moment we arecurrently in the process of setting up newfellowships, but are still in the very earlystages. The establishment of new fellowshipswill be mutually beneficial for UK hospitalsand the links overseas.

For further information and in order to set upIPTS fellowship scheme, please contact: Maria Kirk (IPTS Administrator) atmaria.kirk@rcpch.ac.uk or Dr Mansoor Ahmed (IPTS Liaison Officer) atmansoor.ahmed@burtonh-tr.wmids.nhs.uk

Dr Mansoor Ahmed and Maria Kirk

A statistical summary of the RCPCH 2007Workforce Census is now available on theCollege website www.rcpch.ac.uk/workforce,and the full report will be published laterduring the autumn. The 2007 census is the5th biennial census of the paediatric careergrade workforce and once again achieved anexcellent response rate of 97.9%. The Collegeis extremely grateful to ClinicalDirectors/Leads and their staff for supplyingthe data, and mindful of the extra workloadthis imposes. Although some workforce datais available from other sources, undertakingour own surveys allows the College to bemore flexible to produce data reflecting, forexample, the introduction of the consultantcontract or the WTD. 2007 census informationhas already been incorporated in theconsultation for Modelling the Future and hasbeen shared with DH and NHS WorkforceReview Team.

The census shows the total number of UKconsultants in post growing steadily to 3011in 2007 with 10.6% (5.2% growth per annum)from 2005. The career grade workforce

overall however, increased by only 4.3% inthe same period and the number of SASGdoctors continues to fall, by 4.2% per annum.

The census also records a fourthsuccessive decline in the size of the paediatricacademic workforce and a fall in thecommunity career grade workforce, althoughconsultant numbers rose from 462 to 500between 2005 and 2007. The numbers andproportions of tertiary specialists increasedfrom 973 (22%) to 1134 (25.4%). 993 of thesedoctors worked in tertiary centres, an increaseof 13.3% since 2005, and a further 141 wererecorded in DGHs or other centres workingas part of a specialist network.

Trainee data were not collected as part ofthe census, but information gathered from theCollege’s enrolment process and othersources indicate that, given current trends, theexpected number of new CCT holders willoutstrip growth in jobs available.

The proportion of female consultantsgrew to 45.8% in 2007 from 43.6% in 2005,although the proportion of women in thetotal career grade workforce fell marginally.

53.5% of Community consultants are nowaged over 50 years compared to 51.7% in2005 and to 35.4% in general acutepaediatrics.

The average number of PAs contracted byall consultants (including those working part-time) was 10.5 per week compared to 10.8 in2005. 18.3% of consultants for whom PAinformation is available are contracted forfewer than 10 PAs per week. This compareswith 17.5% who worked part time ormaximum part time in 2005. Individualconsultants were also surveyed and thisrevealed that they work on average 1.24 PAsmore than contracted - the equivalent of theover 370 consultants on a 10 PA contract.

Workforce pressures perceived by ClinicalDirectors and Leads were similar to thoserecorded in 2005 with staff shortages beingthe greatest pressure reported by 90 (32%)trusts. Policy issues, especially WTDimplementation, excessive workload and aninability to recruit were all also mentioned byat least a quarter of respondents. Issuesrelating to care, continuity and safety weremore noticeably prominent in 2007 than 2005being raised by 40 clinical directors.

Martin McColganWORKFORCE INFORMATION OFFICER

Workforce Census Results

International Paediatric Training Scheme (IPTS) Fellowships

News

Page 8

Feedback from journalists A number of journalists were asked forfeedback on the ‘service’ we provide, withmost commenting favourably.

Some did say that the College could bemore outspoken. Many commented on theswift response to queries and that Collegespokespeople were accessible. The BBChealth team said specifically that theyappreciate our ongoing advice on topicalissues and that they get an informativeresponse to their queries.

Building relationships with journalists isvery important to us. We recently invitedBBC Social Affairs correspondent, AlisonHolt, into the College to meet some of theOfficers and representatives. Childprotection, MMR, end of life decisions andeducating the public about science werecovered and feedback afterwards was verypositive from both sides.

Collaborative working is also a majorpart of our media strategy. A recentexample is the child protection briefingearlier this year with the Science MediaCentre (SMC). Held at the SMC, a panel ofpaediatricians and child psychiatrists took arange of questions from national health andsocial affairs journalists about this area ofwork, resulting in national newspaperarticles the following day.

RCPCH Press PanelIf the College does not have a position or policyon a particular subject or childhood illness forexample, then the Press Office has a PressPanel to field these types of media enquiries to.The Press Panel is made up of over a hundredpaediatricians and the Press Office puts them indirect contact with journalists to provide‘independent’ expert comment and advice. Ifyou would like more information on the PressPanel, please email press.office@rcpch.ac.uk

The futureThe College is clearly getting more publicity,especially with the national press. It is alsoclear that increases in media activity are linkedto specific news, events, and topical issues ofthe time. Working closely with the Presidentand Officers, the Press Office will continue topromote College work where it can and scopeout opportunities to be proactive as well asreactive. We need to continue to recognisethe increasing need to be more outspoken,but only where we feel we have the expertiseand are the best - and most appropriate -organisation to give it. The regularity of ourpress releases and statements is in line withmost similar organisations, so we feel that thebalance is right here. We will carry onassessing risk and becoming moreopportunistic where possible.

Broadcast InterviewsThere has also been a significant increase inthe number of broadcast interviews. Thenumbers below are for television and radiointerviews with the President, PatriciaHamilton, Officers or College representatives– such as the Officer for Child Protection,Rosalyn Proops.

Claire BrunertHEAD OF MEDIA AFFAIRS

Ella WilsonMEDIA AFFAIRS ASSISTANT

RCPCH and the media – a reportThe RCPCH press office recently carried out an analysis of the College’s mediacoverage. There is a genuine feeling that the RCPCH is gaining a higher profile in the media and with journalists, both nationally and with the specialistprofessional press.

Increasingly the first port of call for many journalists who are looking for anexpert view, quote, and explanation of a condition or issue – the College is alsoregularly called for background research to inform programmes and articles.

It is difficult to measure overall public relations successes. Many calls that comethrough to the press office don’t result in actual visible coverage. General awarenessand column inches have increased over the past few years though and a large partof this also includes educating journalists about paediatrics. In addition, wesometimes successfully keep things out of the media – as well as putting storiesout proactively.

Interviews

April 2006-March 2007 = 12 interviews

April 2007-March 2008 = 29 interviews

RCPCH news

Page 9

Media coverage - overviewWe looked at a six month period, from October 2007 toMarch 2008 – and compared this with the same period theprevious year to see what paediatric and child health relatedstories and topics we were commenting on – but also otherpaediatrics stories that were in the media at that time, whichwe did not comment on.

Month RCPCH stories Paediatrics stories

October Childhood obesity Hospital care of IVF guidelines premature babies

GMC case - paediatricianIVF guidelines

November Premature baby Premature baby survival rates survival rates

December Expert witness work GMC case - paediatricianPaediatric services Maternity unit shakeup

Vaccinations

January A&E reform Children’s medicinesChild protection work Child protection workInterview with RCPCH President

February Child asylum seekers & Breastfeedingx-rays to determine age Child protection workHospitals failing children MMR

Childhood obesityPremature babiesGMC case - paediatrician

March Child asylum seekers Teenage health& x-rays Junior doctors and MMCChildren’s surgery Expert witnessesA&E reform BPSU study – early onset eating disorders

Month RCPCH stories Paediatrics stories

October NHS maternity services Childhood obesity Childhood obesity NHS maternity servicesBringing up Baby Breastfeeding(Channel 4 programme) Child protection work

November Bringing up Baby Chickenpox vaccineChickenpox vaccine GMC case - paediatricianChild asylum seekers Childhood obesity& x-rays BreastfeedingRCPCH in Middle East MMRNeonatal care Child protection workFormula milkChildhood obesity

December GMC case - paediatrician GMC case - paediatricianChild protection work MMRNeonatal care Child protection work

Cot deathShaken baby syndromePremature babies (BAPM)

January Shortage of paediatric Vitamin D deficiencypathologists Children’s cough medicinesPrescription of Abortion debatechildren’s medicines Neonatal unitsBringing up BabyGMC case - paediatricianChild protection work

February Bringing up Baby Premature babies Faulty hospital scales survival rates (BAPM)Child protection Child protection Smacking MMR

Childhood obesity

March Child protection Childhood obesityNew RCPCH careers MMRbooklet Foetal alcohol syndromePremature babies Premature babies

– long term effectsChildren’s cough medicines

Summary of main stories October 2006 to March 2007

Articles printed and onlineWe also looked at how many times the RCPCH was mentioned in print and online articles for both periods and how manytimes paediatrics was in the news.

October 2007 to March 2008

80

70

60

50

40

30

20

10

0Oct Nov Dec Jan Feb Mar TOTAL

Num

ber

of a

rtic

les

Month

Comparison of “RCPCH” mentions in media

Month

2006/2007

2007/2008

80

70

60

50

40

30

20

10

0Oct Nov Dec Jan Feb Mar TOTAL

Num

ber

of a

rtic

les

Month

Comparison of “Paediatrics” mentions in media

Month

2006/2007

2007/2008

Comparison of “RCPCH” mentions in media

Page 10

Education

1. Spring Meeting 200913th Spring Meeting30 March-2 April 2009University of York

New format for 2009 Have you not been to the Spring Meeting before? If not, why not give us a try in 2009?

The Spring Meeting is the College’s main forum for the presentation of basic and clinical science, together withupdates in clinical practice. It is attended by over 1800 participants, including paediatricians, trainees and thoseinvolved in child health.

Do you have some research work to submit to the RCPCH Spring Meeting? We will be accepting abstracts fromSeptember 2008. Submissions will be accepted via our website www.rcpch.ac.uk

2. Paediatric Educators Programme (PEP)27-28 November 2008 PEP has been designed by paediatricians who have an active interest in education, many of whom hold appointmentswith educational components.

This course is intended for paediatricians who have either been on a generic/basic teaching course and/or those witha reasonable level of experience who teach on the job.

The programme has 3 compulsory components:1. Two-day “core” delivered centrally (RCPCH London) for all participants on November 27 -28 November 2008. 2. Two locally based Learning Group meetings to follow in January and March 2009. 3. A Learning Development Portfolio, which is designed to facilitate personal development as an educator through

work for each meeting, and provide a wide range of resources both for use in the programme and your futureeducational practice.

Website: www.rcpch.ac.uk/Education/Education-Courses-and-Programmes/Paediatric-Educators-Programme

3. Child in Mind WorkshopsThe ‘Child in Mind’ project is funded by the RCPCH, and the Department of Health, to design training materials forpaediatricians in child mental health as it relates to paediatrics (paediatric mental health).

Whilst the workshops were designed for paediatric trainers and child mental health co-trainers (e.g. childpsychiatrists, senior nurses and psychologists), the course materials are aimed at SHOs (STs 1-3) and are designed tobe run alongside, or be integrated into, your regular departmental teaching programme.

‘Child in Mind’ London

Stages 1 & 2 Thursday, 13 November 2008

Stage 3 Wednesday, 19 November 2008

‘Child in Mind’ Liverpool

Stage 1 & 2 Thursday, 6 November 2008

Stage 3 Friday, 7 November 2008

Website: www.rcpch.ac.uk/cim for more information

RCPCH Education Update

RCPCH news

Page 11

4. Other CoursesAdolescent Health ProjectThis project aims to improve the health outcomes of the UK’s young people by providing e-learning materials to healthprofessionals at all levels and across all health professions. The initiative is funded by the DH and supported by e-learningfor healthcare. The project was launched on the 14th of July this summer and is free to all registered users.

The curriculum for the Adolescent Health Project maps across the competences for all the relevant Royal Colleges and consists of14 modules covering a broad spectrum of key topics. Topics range from health promotion and youth friendly services to self-harmand obesity. As well as trainee focused pathways, learners and educators have the ability to create individual learning pathwaysthrough the materials. The resources include high resolution images and video clips capturing the voices and opinions of youngpeople and health professionals. This project is now launched and is available via the project’s website www.rcpch.ac.uk/AHP

Court Skills in Child ProtectionA two-day course about family and criminal law in England and Wales, evidence gathering, receiving instructions,report writing and preparing for court. Dates for the next course will be advertised on our website soon.

Diploma in Paediatric NutritionThe aim of the Diploma is to help paediatricians develop an understanding of what nutrition is and how it impacts ontheir work. Dates for the 2009 course will be advertised on our website soon.

Safeguarding Children: Recognition and Response in Child ProtecctionAn educational programme, for doctors in training, to, “raise awareness of child protection issues and equip doctors intraining with the knowledge and skills to enable them to recognise and respond to child protection (CP) situationscompetently and confidently at a level appropriate to their stage of training”. Website: www.rcpch.ac.uk/Education/Education-Courses-and-Programmes/Safeguarding-Children

Palestine Child Health DiplomaA new programme aimed at GPs and nurses working in primary care was established, in collaboration withpaediatricians in the West Bank and using a pilot site in Ramallah where a group of 10 is currently undergoing a yearlong child health course which will lead (for those successful) to a Palestinian Certificate in Child Health.Website: www.rcpch.ac.uk/Education/Education-Courses-and-Programmes/Teaching-Child-Health-in-Palestine

IraqFor 5 years now the College has run an educational programme for paediatricians in Iraq. This programme is run incollaboration with The Jordan Paediatric Society. The programme is held in Jordan and includes doctors from Jordan,the West Bank and Iraq. For more information on this programme please contact rosalind.topping@rcpch.ac.uk.

FellowshipsThe College is very proud of its Fellowships. They have enabled many colleagues from overseas to visit the UK tolearn some techniques and methods from UK paediatricians. We have always had excellent feedback from thosevisiting the UK and are told time and time again how much the programme helps to shape services and save livesback home. If you have any contact overseas who would be interested in our Fellowships, please pass the details of ourwebsite onto them. If you are interested in hosting a Fellow, please contact aaron.barham@rcpch.ac.uk.

All Fellowships cover all associated costs, including economy travel and subsistence whilst in the UK. The Collegealso administers and organises the entire visit for each Fellow.

5. Continuing Professional Development (CPD)Still sending in your returns by card? You can save time, paper and money by making your submissions online at:www.cpd.rcpch.ac.uk (you can, of course, continue to send your returns in the mail if you wish, but please do not do both!)

All you need to register for the online system is your surname, GMC number and an email address. You canregister at: www.cpd.rcpch.ac.uk/register.php

Did you know... If you use the online system, you can print an up-to-date certificate at anytime. An update to thesystem will be coming soon – adding new features and making it even more interactive.

Effectiveness of CPD QuestionnaireWe would be grateful if as many paediatricians as possible could complete the questionnaire at the following link:Website: www.xeoxeo.com/cpdsurvey/ This is a GMC funded project to evaluate the perception of CPD.

News

Page 12

Well, I’m writing this just prior to going onholiday. Over the last couple of weeks, theSASG committee has had more direct contactfrom SASG members of RCPCH than we havehad throughout the year. Many of thequestions are around terms and conditions ofservice, and official advice should be soughtfrom the BMA or other trade unions. Themost asked question is different versions of“I’ve heard this is a funded contract but mytrust doesn’t know how to get the money toimplement the contract?”

NHS Employers have explained that thesum of money for the implementation was inthe general uplift that trusts receive rather

than a ring-fenced pot of money. So themessage to feed back to your trust is thatthey have received the money already. Thenext question is around the PA allocation forsupporting activities. Some SASG doctorswere under the impression that we would allbe paid an additional PA on top of what wecurrently receive to do clinical governanceactivities and CPD. It’s correct that we areentitled to an SPA for these activities but ifthis can be incorporated within your job planwithin existing hours this is acceptable. AsI’ve said previously, I feel it is really goodnews that the importance of time to carry outthese professional activities has been

recognised. Lets just make sure we use theSPA productively for these activities and keepgood records of the outcomes we achievefrom this, rather than letting the time getswallowed up by clinical administration,which should be done in a clinical PA.

We are trying to refresh our network ofRegional SASG representatives. Severalpositions are advertised with thisnewsletter. Why not see if there is avacancy in your region?

Don’t forget our SASG information day atthe College on 14th November 2008 – it’ssuch a good opportunity to find out what theCollege offers to support us. I look forward to meeting you then.

Dr Nataile LythCHAIR OF THE RCPCH SASG COMMITTEE

BPSU annual reportSeptember sees the publication of the 2007-08BPSU annual report. In attempt to reduceour carbon footprint we are only circulatingcopies to those currently receiving the orangecard. However, the report can be found inPDF form on the College’s website atwww.rcpch.ac.uk/publications or via theBPSU website at www.bpsu.inopsu.com

Also we do have a limited number ofcopies available in the office so if you wouldprefer to receive this please contact the BPSU office at helen.friend@rcpch.ac.uk. The report highlights the current studiesundertaken including data on MRSA, anupdate on the newer studies idiopathicintracranial hypertension and genital herpesas well as the status of long term studies suchas HIV, congenital rubella and PIND. Asalways a big thank you for all those whohave returned your cards, over 94% in 2007,and completed questionnaires after reportinga case.

Call for nominationProfessor Adam Finn and Dr Donal Manninghave recently stepped down from the BPSUExecutive. The BPSU is therefore seekingnominations for their replacement. If you areinterested in contributing to this national andinternationally respected activity please visitwww.rcpch.ac.uk/About-the-College/RCPCH-Officers/nominations and complete anomination form. In the meantime, if you wish to know more, do not hesitate toemail the chairman Professor Allan Colver atallan.colver@ncl.ac.uk or Richard Lynn,scientific coordinator at bpsu@rcpch.ac.uk.

BPSU Scientific meetingAn early notice of a conference that BPSU willbe holding on the 3rd March 2009 at the RoyalInstitute of British Architecture. The day willconsist of presentations around the themes ofinfectious disease; informing policy andpractice; and developing partnerships. If youare interested in knowing more or wish to pre-reserve a place contact the BPSU office orvisit www.rcpch.ac.uk/Education/Events

Richard LynnBPSU SCIENTIFIC COORDINATOR

SASG news

BPSU Update

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, 5-11 Theobalds Road, London WC1X 8SH. Tel: 020 7092 6000, Fax: 020 7092 6001 Website: www.rcpch.ac.uk Email: enquiries@rcpch.ac.ukThe College is a registered charity: no. 1057744

© 2008 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 2008

BPSU Annual Report 2008.

®

1,2

References: 1. Simons FER, Roberts JR, Gu X, Simons KJ. Epinephrine absorption in children with a history of anaphylaxis. J Allergy Clin Immunol 1998; 101: 33–7. 2. Simons FER, Gu X, Simons KJ. Intramuscular (IM) injection of epinephrine in adults. What is the optimal interval between doses? J Allergy Clin Immunol 2004; 113: S259. 3. Lee JM, Greenes DS. Biphasic anaphylactic reactions in pediatrics. Pediatrics 2000; 160: 762–6.

Information about adverse event reporting can be found at www.yellowcard.gov.ukAdverse events should also be reported to ALK-Abelló Ltd. (tel: 01488 686016)

–

3

www.epipen.co.uk www.alk-abello.co.uk

EpiPen® Auto-Injector abbreviated prescribing information. Please refer to the Summary of Product Characteristics before prescribing. Presentation:EpiPen delivers a single dose of 0.3mg of adrenaline BP 1:1000 (0.3ml) in a sterile solution. EpiPen Jr. delivers a single dose of 0.15mg adrenaline BP 1:2000 (0.3ml) in a sterile solution. 1.7ml of adrenaline remains in the auto-injector after activation. Uses: Intramuscular adrenaline is considered the first-line drug of choice for allergic emergencies. Adrenaline effectively reverses the symptoms of rhinitis, urticaria, bronchospasm and hypotension. The strong vasoconstrictor action of adrenaline, through its effect on alpha adrenergic receptors, acts quickly to counter vasodilation and increased vascular permeability which can lead to loss of intravascular fluid volume and hypotension during anaphylactic reactions. Adrenaline, through its action on beta receptors on bronchial smooth muscles, causes relaxation which alleviates wheezing and dyspnoea. Adrenaline also alleviates pruritus, urticaria and angioedema and may be effective in relieving gastrointestinal and genitourinary symptoms associated with anaphylaxis. Indication: EpiPen is intended for immediate self administration in the emergency treatment of allergic anaphylactic reactions. Anaphylaxis may be caused by insect stings or bites, foods, drugs and other allergens as well as idiopathic or exercise-induced anaphylaxis. Reactions may

occur within minutes of exposure and consist of flushing, syncope, tachycardia, faint or unobtainable pulse associated with a fall in blood pressure, convulsions, vomiting, diarrhoea and abdominal cramps, involuntary voiding, wheezing, dyspnoea due to laryngeal spasm, pruritus, rashes, urticaria or angioedema. Dosage and Administration: ADULTS: Self administration of 0.3mg adrenaline (EpiPen ) intramuscularly. CHILDREN: The appropriate dosage may be 0.15mg (EpiPen Jr.) for children 15-30kg body weight and 0.3mg (EpiPen) adrenaline for children >30kg body weight, or at the discretion of the physician. EpiPen should only be injected into the anterolateral aspect of the thigh through clothing if necessary. In the absence of clinical improvement or if deterioration occurs after the initial treatment, a second injection with an additional EpiPen Auto-Injector may be necessary. The repeated injection may be administered after about 5 – 15 minutes. As EpiPen is designed for emergency treatment, the patient should always seek immediate medical attention even if symptoms have disappeared. Contra-indications: There are no absolute contra-indications to the use of adrenaline in a life threatening situation. Warnings: Avoid the risk of inadvertent intravascular injection. DO NOT INJECT INTO THE BUTTOCKS. Accidental injection into the hands or feet may result in loss of blood flow to the affected areas. Precautions: Patients must be instructed

in the proper use of EpiPen. Use with extreme caution in patients with heart disease and those taking digitalis, mercurial diuretic or quinidine. The effects of adrenaline may be potentiated by tricyclic antidepressants and monoamine oxidase inhibitors. Adrenaline should be used in pregnancy only if the potential benefit justifies any potential risk to the foetus. Adverse events: May include palpitations, tachycardia, sweating, nausea and vomiting, respiratory difficulty, pallor, dizziness, nervousness and anxiety. Cardiac arrhythmias may follow administration of adrenaline. Overdoses of adrenaline may cause cerebral haemorrhage or arrhythmias. Legal Category: POM. Basic NHS Cost:EpiPen and EpiPen Jr. are available as single unit doses at £28.05 each. EpiPen and EpiPen Jr. are also available as twin packs; two single unit doses at £56.10. Marketing Authorisation Numbers: EpiPen Auto Injector 10085/0012. EpiPen Jr. Auto-Injector 10085/0013. Marketing Authorisation holder:ALK-Abelló A/S, Bøge Alle 6-8, DK-2970, Hørsholm, Denmark. Telephone: (+45) 45 74 74 45 Date of last revision: March 2008. Item code 196E. Customer contact: ALK-Abelló Ltd, 1 Tealgate, Hungerford, Berkshire, RG17 0YT, United Kingdom. Telephone: (01488) 686016 Website www.epipen.co.uk

Date of preparation: March 2008. Code No. 197E

TWINPACK

TWINPACK

Epi 280x210 BMJ Ad 62709.indd 1 7/4/08 12:28:20

®

1,2

References: 1. Simons FER, Roberts JR, Gu X, Simons KJ. Epinephrine absorption in children with a history of anaphylaxis. J Allergy Clin Immunol 1998; 101: 33–7. 2. Simons FER, Gu X, Simons KJ. Intramuscular (IM) injection of epinephrine in adults. What is the optimal interval between doses? J Allergy Clin Immunol 2004; 113: S259. 3. Lee JM, Greenes DS. Biphasic anaphylactic reactions in pediatrics. Pediatrics 2000; 160: 762–6.

Information about adverse event reporting can be found at www.yellowcard.gov.ukAdverse events should also be reported to ALK-Abelló Ltd. (tel: 01488 686016)

–

3

www.epipen.co.uk www.alk-abello.co.uk

EpiPen® Auto-Injector abbreviated prescribing information. Please refer to the Summary of Product Characteristics before prescribing. Presentation:EpiPen delivers a single dose of 0.3mg of adrenaline BP 1:1000 (0.3ml) in a sterile solution. EpiPen Jr. delivers a single dose of 0.15mg adrenaline BP 1:2000 (0.3ml) in a sterile solution. 1.7ml of adrenaline remains in the auto-injector after activation. Uses: Intramuscular adrenaline is considered the first-line drug of choice for allergic emergencies. Adrenaline effectively reverses the symptoms of rhinitis, urticaria, bronchospasm and hypotension. The strong vasoconstrictor action of adrenaline, through its effect on alpha adrenergic receptors, acts quickly to counter vasodilation and increased vascular permeability which can lead to loss of intravascular fluid volume and hypotension during anaphylactic reactions. Adrenaline, through its action on beta receptors on bronchial smooth muscles, causes relaxation which alleviates wheezing and dyspnoea. Adrenaline also alleviates pruritus, urticaria and angioedema and may be effective in relieving gastrointestinal and genitourinary symptoms associated with anaphylaxis. Indication: EpiPen is intended for immediate self administration in the emergency treatment of allergic anaphylactic reactions. Anaphylaxis may be caused by insect stings or bites, foods, drugs and other allergens as well as idiopathic or exercise-induced anaphylaxis. Reactions may

occur within minutes of exposure and consist of flushing, syncope, tachycardia, faint or unobtainable pulse associated with a fall in blood pressure, convulsions, vomiting, diarrhoea and abdominal cramps, involuntary voiding, wheezing, dyspnoea due to laryngeal spasm, pruritus, rashes, urticaria or angioedema. Dosage and Administration: ADULTS: Self administration of 0.3mg adrenaline (EpiPen ) intramuscularly. CHILDREN: The appropriate dosage may be 0.15mg (EpiPen Jr.) for children 15-30kg body weight and 0.3mg (EpiPen) adrenaline for children >30kg body weight, or at the discretion of the physician. EpiPen should only be injected into the anterolateral aspect of the thigh through clothing if necessary. In the absence of clinical improvement or if deterioration occurs after the initial treatment, a second injection with an additional EpiPen Auto-Injector may be necessary. The repeated injection may be administered after about 5 – 15 minutes. As EpiPen is designed for emergency treatment, the patient should always seek immediate medical attention even if symptoms have disappeared. Contra-indications: There are no absolute contra-indications to the use of adrenaline in a life threatening situation. Warnings: Avoid the risk of inadvertent intravascular injection. DO NOT INJECT INTO THE BUTTOCKS. Accidental injection into the hands or feet may result in loss of blood flow to the affected areas. Precautions: Patients must be instructed

in the proper use of EpiPen. Use with extreme caution in patients with heart disease and those taking digitalis, mercurial diuretic or quinidine. The effects of adrenaline may be potentiated by tricyclic antidepressants and monoamine oxidase inhibitors. Adrenaline should be used in pregnancy only if the potential benefit justifies any potential risk to the foetus. Adverse events: May include palpitations, tachycardia, sweating, nausea and vomiting, respiratory difficulty, pallor, dizziness, nervousness and anxiety. Cardiac arrhythmias may follow administration of adrenaline. Overdoses of adrenaline may cause cerebral haemorrhage or arrhythmias. Legal Category: POM. Basic NHS Cost:EpiPen and EpiPen Jr. are available as single unit doses at £28.05 each. EpiPen and EpiPen Jr. are also available as twin packs; two single unit doses at £56.10. Marketing Authorisation Numbers: EpiPen Auto Injector 10085/0012. EpiPen Jr. Auto-Injector 10085/0013. Marketing Authorisation holder:ALK-Abelló A/S, Bøge Alle 6-8, DK-2970, Hørsholm, Denmark. Telephone: (+45) 45 74 74 45 Date of last revision: March 2008. Item code 196E. Customer contact: ALK-Abelló Ltd, 1 Tealgate, Hungerford, Berkshire, RG17 0YT, United Kingdom. Telephone: (01488) 686016 Website www.epipen.co.uk

Date of preparation: March 2008. Code No. 197E

TWINPACK

TWINPACK

Epi 280x210 BMJ Ad 62709.indd 1 7/4/08 12:28:20

Trainees

Over the last few months, a numberof contentious issues have kept theTrainees’ Committee very busy.

Funding for Assessments The issue of charging trainees forassessment has been the subject that hasdominated discussions within theTrainees’ Committee over the last fewmonths. Following a suspension of thislevy last year, we have remained stronglyopposed to the introduction of a newcharge for assessments. However, ourcase of opposition was overruled byCollege Council in June 2008. TheTrainees’ Committee is not opposed tothe introduction of the assessmentsprocess, but to the tariff attached. TheCommittee has raised significant concernsthat the assessments system remainsinequitable around the country despitethe imminent introduction of this charge.Furthermore, given that PMETB currentlygoverns training and assessments, theCommittee feels that there should besome degree of financial support fromPMETB for this mandatory process.Trainees in specialty training are requiredto enrol for training and pay a cost of£70 to undergo assessments and receivethe e-portfolio. Current SpRs may enrolwith the College and either choose toreceive the whole package or to undergoe-sprat at a reduced cost. I wouldencourage Trainees to write to me atpauldimitri@hotmail.com with youropinions regarding this issue.

MMC and Recruitment Following the MTAS debacle of 2007, thenewly introduced national recruitmentsystem for Paediatrics has been moresuccessful. Recruitment to ST posts has beenin excess of 80%. Any remaining posts willhave been advertised locally. The future ofthe FTSTA is currently the subject ofdiscussion at the RCPCH and MMCprogramme board. Progression from FTSTAto ST posts is becoming increasinglyrestricted. The Trainees’ Committee arecurrently in favour of a reduction in thenumber of FTSTAs in favour of an increasein ST posts to provide a progressivepathway for UK paediatric trainees.

Four MMC roadshows have taken placein June and July in England. The MMCprogramme board is keen to seek the viewsof all stakeholders including trainees onhow MMC progresses in 2009 and beyond.

Recruitment Concerns Following issues raised at the SpringMeeting over recruitment difficulties in someregions leading to low morale, the Trainees’Committee has performed a survey toidentify key concerns. 450 trainees followedthe survey from start to finish. Over 50% oftrainees responded that there were gaps ontheir current rota with 10% of respondentsstating the rota was more than three doctorsshort. Trainees in subspecialties are oftensupporting general rotas. This issue hasbeen taken very seriously and our Presidentis currently discussing these issues withMinisters to try and resolve these problems.

National Trainees Meeting A working group has been establishedwithin the Trainees’ Committee to establish aNational Trainees Meeting in York for 2009.We are hoping to provide a new forum forTrainees to voice opinions and discusscurrent training issues. We are also planningto have keynote speakers. I wouldencourage all trainees interested in the waytheir training is developed to contact us withideas they have for this forum and to attendin 2009.

Vice Chair of the Trainees’Committee Nominations have been received and wecurrently have two candidates running forthe post of Vice Chair. I would encourageall trainees to use their vote. Members of theTrainees’ Committee represent your voice inpolitical matters, consultation with otherstakeholders and in the decisions that aremade in training and education.

Your Opinion Counts!We are a body established to representtrainees. The Trainees’ Committee alwaysvalues your views. Please contact the Chair,Vice Chair or your regional representatives ifyou have any issue you would like todiscuss. Contact details are available on theTrainees section of the website.

Trainees’ column

Dr Paul Dimitri CHAIR, TRAINEES’ COMMITTEE

pauldimitri@hotmail.com

Page 14

The new UK Retinopathy of PrematurityGuideline for Screening and Treatment was published in May. This is a jointpublication by the RCPCH, RCOphth, BAPM and the charity BLISS and wasproduced according to the RCPCHstandards for guideline development.

Professors Andrew Wilkinson (RCPCH)and Alistair Fielder (RCOphth) were thejoint chairs of the Guideline Development

Group. The 23 members gave widerepresentation that contributed to thedocument which has now been endorsedby the Council of all the organisationsinvolved. A copy has been sent to the Lead clinician in every Neonatal Unit and Network.

The Executive Summary has gone toevery Medical Director and Chief Executive.Of particular relevance to them will be the

recommendations with respect to theorganisation of services and the workcommitment of screening consultantophthalmologists.

The executive summary has also beenpublished in Early Human Development.Wilkinson AR, Haines L, Head K, FielderAR. UK Retinopathy of PrematurityGuideline. 2008; 84:71-74.and the full guideline and appendices isavailable at www.rcpch.ac.uk/ROP.

Linda HainesHEAD OF RESEARCH

UK Retinopathy of Prematurity Guidelinefor Screening and Treatment 2008

Meetings RCPCH news

UK meetings and courses200825-27 September 2008RCPCH/RCPE joint symposiumNew Approcahes to Paediatric EpilepsyVenue: Royal College of Physicians of EdinburghContact: Eileen StrawnTel: 0131 225 7324Email: e.strawn@rcpe.ac.ukWebsite: www.rcpe.ac.uk/education/events/paediatric-epilepsy-sep-08.php

26 September 2008Nutrition in Childhood - Meeting the Challenge- CPD conferenceVenue: The Newton Hotel, Nairn, ScotlandContact: Fiona O’FeeTel: 01463 258837Email: admin@fabresearch.orgWebsite: www.fabresearch.org

29 September 2008 (5 days)Annual Scottish Advanced PaediatricDermatology CourseVenue: Ninewells Hospital, Dundee, ScotlandContact: Jill LamontTel: 01382 632821Email: jill.lamont@nhs.netWebsite: www.dundee.ac.uk/dermatology/derm/dermintro_files/dermintro.htm

30 September 2008Ronnie MacKeith: his contribution topaediatrics yesterday and todayVenue: RCPCH, 5-11 Theobalds Road, London Tel: 020 7092 6105Email: aaron.barham@rcpch.ac.ukWebsite: rcpch.ac.uk

1-2 October 2008Brazelton Centre in Great BritainVenue: The Royal Free Hospital, LondonContact: Helen WellsTelephone: 01223 245791Email: info@brazelton.co.ukWebsite: www.brazelton.co.uk

1 October 2008Gender Identity Disorder in AdolescentsVenue: The Royal Society of Medicine, LondonContact: Chandni KoharTelephone: 020 7290 2965Email: chandni.kohar@rsm.ac.ukWebsite: www.rsm.ac.uk/academ/gid08.php

2 October 2008The Safety of Birth - new and emerging evidenceOrganised by the NPEUVenue: Martin Wood Lecture Theatre, University of OxfordContact: Lynne RobertsTel: 01865 289719Email: lynne.roberts@npeu.ox.ac.ukWebsite: www.npeu.ox.ac.uk/conference

2-3 October 2008Gastroenterology for General Paediatrics 2008Venue: Institute of Child Health, LondonContact: Colin D'CruzTel: 020 7829 8692Email: info@ichevents.comWebsite: www.ichevents.com

3 October 2008GSF ADHD Study Day: A NICE AwakeningVenue: RCPCH, LondonContact: Dr Somnath BanerjeeTel: 07941156519Email: somnath.b@doctors.org.ukWebsite: www.georgestillforum.co.uk

3-5 October 2008Omega-3 for behaviour, learning and mood;science, policy and practice - CPD conferenceVenue: Said Business School, OxfordContact: Fiona O’FeeTel: 01463 258837Email: admin@fabresearch.orgWebsite: www.fabresearch.org

6 October 2008Family health legacy - Ethical dilemmas inpromoting health for children separated fromtheir genetic rootsVenue: LondonTelephone: 020 7421 2637Website: www.baaf.org.uk

6 October 2008RCPCH Annual Tutors MeetingVenue: Wellcome Collection, Euston Rd, LondonContact: Aaron BarhamTel: 020 7092 6105Email: aaron.barham@rcpch.ac.ukWebsite: rcpch.ac.uk

8 October 2008Immunisation and Vaccination Study DayVenue: Stockport Medical Education Centre,Pinewood House, CheshireTel: 0161 419 4684

9-10 October 2007Young People’s Health Special Interest GroupConference: Improving paediatric practice inyoung people’s healthVenue: Harborne Hall, BirminghamContact: Diane BurgessTelephone: 01661867749Email:diane.burgess@northumberlandcaretrust.nhs.ukWebsite: www.yphsig.org.uk

13-14 October 2008Paediatric and Infant Critical Care TransportCourse (PICCTS)Venue: Glenfield Hospital, LeicesterContact: Sam ThurlowTelephone: 0116 2502305Email: sam.thurlow@uhl-tr.nhs.uk

14 October 2008Do you use or abuse NICE guidelines in yourclinical practice?Joint Meeting of the Paediatrics and ChildHealth section, RSM and the RCPCHVenue: Royal Society of Medicine, LondonContact: Andrea TörökTelephone: 020 7290 2986 Email: paediatrics@rsm.ac.uk

RCPCH meetings

Page 15

22-23 January 2009Paediatric and Adolescent Obesity Course forPaediatriciansVenue: RCPCH Office, LondonContact: Aaron BarhamTel: 020 7092 6105 Email: aaron.barham@rcpch.ac.ukWebsite: www.rcpch.ac.uk

Continued from p5

Framework and aims to improve thecoordination of paediatric research acrossEurope by fostering trans-national researchcooperation, establishing best practice andidentifying barriers for children’s medicinesresearch and developing European research priority setting and fundingstrategies in cooperation with stakeholdergroups. The UK work package focuses onconducting a pan-European priority settingexercise to inform the common researchagenda, and identifying key medicines for children research priorities to be fed into a subsequent funding call. Results ofPRIOMEDCHILD will be presented at aEuropean Conference in November and will be published in a report at the end of the year.

For more information, contact the UKPRIOMEDCHILD Programme Manager atJennifer.Blakeburn@mcrn.org.uk or visitwww.priomedchild.eu

(The NIHR Medicines for Children ResearchNetwork is part of the National Institute for Health Research and the UK ClinicalResearch Network)

Sign up to our free e-newsletter designed to alert you to the latest changes that are influencing clinical practice.

Want to keep up to date with the BNF and BNF for Children?

Newsletters will be sent to you by email, several times a year, and will include:

• Details of significant updates• Tips for using the BNF and BNFC effectively• Latest developments on BNF publications• Links to examples of prescribing

excellence and case studies

If you would like to receive this essential information, please register now at bnfc.org or bnf.org

A5_paed_ad.indd 1 7/2/08 16:56:47