NHS Education for Scotland
Meeting of the Surgical Specialties Training Board held at 10.30am on Wednesday 7 January 2015
in Meeting Room 5, 2 Central Quay, 89 Hydepark Street, Glasgow
Present: Dominique Byrne (DB) Chair, John Anderson (JA), Helen Biggins (HB), Angus Cain (AC),
Jonathan Dearing (JD), Tracey Gillies (TG), Gareth Griffiths (GG), Douglas Orr (DO) part meeting, Ian
Holland (IH), Mike Palmer (MP), Rowan Parks (RP), William Reid (WR), Andrew Renwick (AR), Ian
Ritchie (IR) part meeting, Hamish Simpson (HS), Satheesh Yalamarthi (SY).
By Videoconference: Aberdeen (1) – Gillian Needham (GN); Aberdeen (2) – Chris Driver; Edinburgh
(1) –-James Garden (JG); Edinburgh (2) – Anne Dickson (AD), Kenneth Stewart (KS); Inverness –
Kenneth Walker (KW).
In attendance: David Arnot (DA), Helen McIntosh (HM).
Apologies: Alison Graham (AG), Brian Howieson (BH), Lorna Marson (LM), Sai Prasad (SP), Rachel
Thomas (RT).
Action
1.
Welcome and apologies
The Chair welcomed all to the meeting and in particular:




Dr Tracey Gillies, SAMD representative, attending her first meeting.
Dr David Arnot, Clinical Leadership Fellow working with the Scottish
Government on modelling workforce supply and demand, observing today’s
meeting.
Professor Kenneth Walker, now Simulation representative.
Professor Gillian Needham, interim North of Scotland representative.
The Chair also congratulated Mr Gareth Griffiths on his appointment as ISCP
Surgical Director and he will represent ISCP on the STB. His appointment has
resulted in a vacancy in representation for East of Scotland and a replacement was
awaited.
The Chair noted that Mr Laurence Dunn has demitted office and confirmation of a
replacement Neurosurgery representative was awaited.
Apologies were noted.
2.
Minutes of meeting held on2 October 2014
The following amendments were noted:
Page 1, List of apologies, to add ‘Ian Ritchie (IR)’.
Page 5, Item 4.2, second paragraph, second sentence to read ‘…whose expected
CCT date falls after 31 December 2018 will be well advised to move to the new
Vascular training programme …’
Page 7, Item 7.2, General Surgery update, second paragraph, first sentence to read
‘…the new guidelines for the indicative numbers of …’
Addendum to item to read ‘The statement was being reviewed.’
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With these amendments the minutes were accepted as a correct record of the
meeting and will be posted on the NES website.
3.
3.1
Matters arising
HR support for 2nd round Core recruitment
Formal HR support has been secured for a 2nd round of recruitment to Core
Surgery in Scotland if required.
3.2
Trauma & Orthopaedics recruitment
Jackie Sutherland has confirmed she will provide HR support for T & O recruitment.
3.3
Inter Regional Transfer (IRT) policy
The policy has been circulated and it was noted that conditions were clearly
described and similar to that of IDT while the process differed slightly.
3.4
Transfer of Vascular trainees to the new Vascular Curriculum
DO drew the Board’s attention to a modification of the statement on the date by
which General Surgery trainees with an interest in Vascular Surgery would have to
declare their intention to transfer to the new Vascular Curriculum. This date has
now been amended from 31 December 2014 to 28 February 2015.
3.5
SAC Guidelines on indicative numbers of procedures
GG indicated that the earlier statement on the need for relevant procedures to
have been undertaken only within the six formal years of specialty training was
currently being reviewed.
4.
4.1
Single Scottish Deanery
Medical Educational Leads (MELs)
RP confirmed much work has been taking place on processes since the move to the
single Deanery model and some changes to administrative staff roles. The STB role
was being developed in relation to Training and Quality Management and each
allocated a senior Medical Education Lead (MEL); Professor Reid remained the MEL
allocated to this STB. The aim was to achieve single system working and
consistency across Scotland and will result over time in changes in the various
reporting lines. The main driver for this work was the GMC visit in 2017 when NES
will demonstrate single system processes were in place or that it was working
towards this. WR added that much operational detail was still to evolve for some
aspects and that there will be crucial work coming to the STB to ensure
standard/equivalent experience for trainees across Scotland. Regional teams will
continue to look after the trainees in their regions and it would be good practice
during the transitional period to ensure that communications are circulated to
both the regional team and the Scotland-wide team allowing overlap of the old
and new systems.
4.2
Flexibility
JA raised the issue of flexibility in trainee distribution across programmes. Some
specialties offered Scotland-wide national programmes while others delivered
training programmes on a regional basis. Some regions were unable to provide all
training and the new IRT process did not take account of the potentially beneficial
movement of trainees between regions for training/career aspirations ( eg
Transplantation Surgery). At present the PG Deans discussed any such requests
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received. DB said it was not always possible to provide all possible subspecialty
training preferences within single programmes, most notably in the specialties
which are registered with GMC as 4 regional programmes, since the service is not
configured in that way; one possible solution would be for 4 regional programmes
to apply to become a single programme. JA also noted that a recent request for an
exchange between Cambridge and South East Scotland would be badged as an
OOP period for the Scottish trainee involved; he also noted the recent suggestion
that STs could only apply for one OOP period within the period of their training and
that exchanges such as this one therefore imposed significant restrictions on
trainees’ training. WR confirmed that while the Gold Guide states that trainees
should normally only have one OOP period (and this guidance has largely been
followed), Deans do have some latitude to allow additional OOP opportunities.
OOP arrangements were currently the subject discussion designed to allow the
development of a process which would not stifle opportunities. It was likely that
OOP might ultimately become a post-CCT opportunity, but in the meantime
requests for OOP submitted with appropriate TPD support and a clear
identification of career opportunity were likely to be approved if feasible. He
stressed the need for an honest assessment of the career prospects of applicants.
AD said there should me more options available within the single Deanery to add
new geographical placements to programmes subject to GMC approval.
5.
Overseas Advanced Medical Training Fellowships
The chair introduced this Scottish Government initiative. Six applications from
surgical specialties had been received and circulated to the STB. The STB was
asked to judge these but not to rank them and to provide NES with its view on
whether it supported each application or not.
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
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Application 1 – Colorectal Surgery at Western General Hospital, Edinburgh;
Application 2 – Transplant Surgery at Royal Infirmary of Edinburgh;
Application 3 – Pelvic Floor Surgery at Ninewells Hospital.
JA considered that each post offered educational value and that their creation
would not jeopardise current trainees. In terms of bringing benefit to current
training, he acknowledged that this would be provided indirectly by increasing (or
maintaining) the pool of doctors on a given rota and that the greater benefit would
be to the service. However, he felt that all three posts and in particular the Pelvic
Floor post could potentially have been useful for post-CCT UK trainees; JA queried
whether funding could be an issue.

Application 4 – Head and Neck Cancer Ablative and Reconstructive Surgery at
St John’s Hospital.
IH confirmed the educational value of the post There would be no detriment to
existing trainees and he could anticipate a benefit to them as the presence of a
senior Fellow could release trainers to work more closely with junior trainees and
provide greater flexibility.
 Application 5 – Plastic and Reconstructive Surgery within NHS Lothian.
KS confirmed educational benefit of this proposed Fellowship which would provide
experience in various areas of Plastic and Reconstructive Surgery (eg breastoncoplastic/hand/paediatric burns). They would not specify in advance what the
appointed Fellow would do but would instead focus on the individuals’ area of
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interest. They were in the process of appointing 2 new consultants and so would
have an increased number of educational opportunities; there would also be
benefit to existing trainees and to the programme in general as a result of cross
fertilisation of ideas from across the world. Interest had apparently been noted
from Australia/North America. On-call experience would also be improved.

Application 6 – Vascular and Endovascular Surgery at Ninewells and Victoria
Hospital.
DO confirmed the educational value of this proposed Fellowship and agreed that
current trainees would not be disadvantaged. In terms of benefits, Ninewells was
unable at the moment to provide a separate Vascular rota so this post could help
trainees to gain experience in the emergency aspects of Vascular Surgery by
increasing the number of people available to contribute to such a rota. There
would be no competition with other trainees as this post would cover high end and
complex cases using post-CCT type skills.
The STB agreed its support for each application.
STB members expressed some reservations concerning the posts:
 Selection and recruitment for posts, and training aspects. This must be at a
level to ensure training and educational benefit. Person specifications could
stipulate the need for evidence of having already completed training to a level
equivalent at least to that of ST6, perhaps using way points/markers at that
level for equivalence for overseas applicants, or using FRCS which should have
defined criteria for overseas doctors. The College MTI programme insists that
applicants meet Faculty standards and that those in post are placed there
primarily for training and not simply to support workforce. Similar assurances
should be sought for the proposed new Fellowships. . IR noted the initiative
was a Scottish Government response to problems in recruiting to Acute and
Emergency Medicine. Although he had concerns he felt there was potential
for good training in these posts for overseas doctors and this was something
the NHS has always provided. The initiative differed from the MTI programme
previously discussed. This would be an opportunity for the College to support
the process via its established links.
 Potential to deprive local trainees of opportunities for high level experience.
JA had earlier alluded to the possibility that these Fellowships would offer
high-level training to overseas doctors which might also have benefited
Scottish trainees at the peri-CCT or post-CCT stage of their career. Thus while
not directly detrimental to current training, they might nevertheless have the
effect of diminishing the expertise of locally-trained surgeons by depriving
them of this experience
 Global health responsibility. JG felt that there should be an obligation to
support opportunities more widely across the world although he
acknowledged these posts might not be the most appropriate for a wide pool
of people. There was general agreement among STB members of the need to
provide opportunities to overseas trainees. AD noted the Government will
want to adhere to the WHO code of practice. The question of responsibility for
provision of Tier 2 visas and sponsorship was also raised.

Certification of experience and from which body.
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RP stressed that responsibility for the posts lay with Health Boards and that as
these were not NTN posts, NES had not committed itself to Quality Assuring them.
NES will report back to the Scottish Government which will then consider its
timetable for advertising and recruitment.
In addition to responding to Jean Allan confirming the STB’s support for the
individual applications received, DB will note the STB’s reservations on certain
aspects of this initiative, in particular (i) the potential conflict between home and
overseas trainees, (ii) the recruitment process and selection criteria, (iii) global
distribution of the recruitment process, and (iv) certification and from which body.
6.
DB
Regional teaching programmes – study leave applications
KS confirmed that the specific issue precipitating his enquiry to the Board had been
resolved with agreement on advance bulk application for trainees in programme.
The STB discussed the provision of study leave for regional teaching days. Variable
practice was reported, some specialties insisting on the submission of Study Leave
applications for release to attend (usually as a block application) while others did
not insist on formally recording this as Study Leave. OMFS and Urology did not
insist on study leave but expected all trainees to attend; ENT had 10 days per year
for which there was a formal block application process; in Core Surgery the
majority in WoS did not request study leave and there was no formal process in
EoS; T & O did not insist on formal Study Leave application for normal routine
teaching but did ask trainees to submit applications for some other Scottish wide
meetings and events; Vascular Surgery held a 2 day residential course twice per
year for which it did not require study leave requests, although it was possible that
some applications might be made via General Surgery TPDs; General Surgery also
did not require study leave forms to be submitted and the onus was on trainees to
inform service of their planned absence.
WR confirmed that study leave applications should be required and approved even
for courses where no funding was requested. Recording study leave provided an
audit trail and allowed trainees protected time and official recognition that they
did not need to be present for service on the relevant day. The Training
Management workstream was considering study leave and AD noted it was hoped
TURAS would include a process by the end of March for applications to be made
and signed off online. It should be possible to set up a template for bulk
applications for regional training days. The recording process would be for all
Scotland.
7.
8.
Recruitment 2015 – Round 1 and Round 2
The latest Oriel monthly update compared application numbers between 2013 and
2015. This showed that Core Surgery has experienced a slight increase; there had
been a sizeable increase in applications to ST1 runthrough programme in T & O –
the latter was also reflected in competition ratios. The updates contained little
information for surgical specialties at present as there was very limited
involvement in Round 1 recruitment. However monthly updates will be circulated
to the STB for information and tabled at future STB meetings.
DB
Agenda
Selection for Surgical specialty training
KS highlighted concerns regarding Plastic Surgery recruitment via the UK national
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process. He questioned the effectiveness of the current selection process in
identifying the most appropriate candidates for training in Plastic Surgery. He felt
a Scottish process would make Scotland more attractive and help to retain people.
He noted that trainees used the system to get a post but that after being
appointed to Scotland, a number of them reapplied the following year to obtain a
post elsewhere in the UK. There was also a feeling that Scottish trainees were
mostly unsuccessful at National recruitment to Plastic Surgery.
Discussion highlighted:
 Every Surgical specialty has moved to UK national recruitment over the last
few years apart from T & O. The Scottish programme remains the only one
offering run-through training in this specialty in the UK.
 As trainees from elsewhere must be scoring higher in the recruitment process,
consideration should be given to ways of helping Scottish trainees to improve
their performance.
 The issue of dissatisfaction with the recruitment process was thought to be
one which was not confined to Scotland but which applied to most LETBs in
England, in contradistinction to London. It was suggested that the SAC
representative should be made aware of the issue; consideration should also
be given to how much input there was from Scotland to the definition of
person specifications and involvement in national recruitment. The Scottish
training programme would need to ensure that posts in Scotland were
attractive.
 MP emphasised that Urology has participated in UK national recruitment since
2010 and in that time has seen an improvement in the quality of candidates
and had no desire to return to Scottish recruitment.
 Previously, under Scottish recruitment, trainees did make multiple applications
and pulled out before the start of programmes as Scotland was seen as a backup option; there was no appetite to return to this.
 AC highlighted that because of a perception that Scottish trainees were
unsuccessful at National recruitment, ENT has worked to improve candidate
applications to ensure no-one was disadvantaged. H also indicated that ENT
had numerous trainees appointed from elsewhere who chose to stay in
Scotland.
 CD felt that if there was a genuine issue in Plastic Surgery training in Scotland
this should be investigated – DB pointed out that the StART Alliance led by
Professor McLellan was focused on the retention of trainees once appointed in
Scotland and suggested KS could liaise with him.
DB suggested that it would be a matter for the specialty to decide whether a
return to Scotland-only recruitment was desirable and that this should be raised at
the STC and discussed with the SAC before then consulting with NES if necessary.
9.
9.1
Updates
Service
No update was received.
9.2
Specialties
 Core Surgery
ARe summarised Paper 2015.05, highlighting some discussion at the recent Core
Surgical Training Committee (CSTC) meeting in London. He noted that the Chair of
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the Committee was keen to redefine what Core training was delivering and to
assess whether it was successful; she favoured redesign of rotations and
introducing themed training. ARe felt Core training was successful as it produced
trainees who completed their training before moving into specialties including
non-surgical specialties taking with them their surgical skills. He was not
supportive of wholesale redesign of rotations. DB confirmed the Department of
Health in England saw the 40% rate of progression from Core into Surgical
specialties as a failure – a view which was not shared by the CSTC, and one which
seemed to be at variance with the move towards generalism proposed by Shape of
Training.
 OMFS
IH noted there was a new Chair of SAC. He also noted an approach by Irish
Colleges to re-establish programmes.
 ENT
Noted: recruitment will take place at end of March.
 Urology
MP noted that the number of female incontinence procedures in trainees’
logbooks have dropped significantly following the cessation of these procedures,
casting doubt over trainees’ ability to achieve the indicative numbers in these
procedures; however he felt this should not adversely affect trainees in the long
term as the expectation was that these procedures would be reinstated in the
coming months. He was also seeking clarity with regard to the configuration of the
urological service after the opening of the new South Glasgow University Hospital.
National recruitment is scheduled to take place at the end of April.
 Trauma & Orthopaedics
Noted: ST1 recruitment will take place in Glasgow in March.
 General Surgery
JA noted recruitment will take place April – May and will cover all GMC domains;
communication between SAC and TPDs was very good. The Remote and Rural
working group report has been submitted and recommended proleptic and
bespoke post CCT Fellowships.
 Paediatric Surgery
CD noted new SAC Chair; national recruitment was likely to take place in March.
 Plastic Surgery
KS noted that he was working in cooperation with the Royal College of Surgeons of
Edinburgh to recruit Omani trainees to Scotland under the MTI initiative.
9.3
SAC update
No update was received.
9.4
Academic
JG collated information which showed that there are currently 20 Clinical Lecturers
in Surgery and a further 58 trainees engaged in academic activity across Scotland.
The majority are within General Surgery and are OOP or OOPR. He will circulate
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the data and the issue will be discussed as an agenda item at the March meeting.
WR noted the SCREDS Annual Report will be available in the next fortnight and will
provide a full picture.
9.5
MDET
No additional update was received.
9.6
Colleges
IR reported the Edinburgh and Glasgow Colleges were stressing the health benefits
of exercise to patients and to doctors and information was on its website. He
asked all to highlight.
9.7
Trainees
JD reported the main trainee concern was around Shape of Training and a joint
letter from the co-Chairs of the BMA Junior Doctors Committee on behalf of 15
organisations has been sent to Dr Dan Poulter MP, Parliamentary Under Secretary
of State for Health. The letter will be circulated to the STB. IR noted a similar
letter has been sent from Scottish Academy Groups.
9.8
JG
Agenda
HM
Simulation
KW noted that the strategy for Core surgery had been implemented from August
2014, and validation studies of the boot camp and Incentivised Laparoscopy
Practice project were under way. He noted work this year will concentrate on
Urology, General Surgery, Vascular Surgery and Paediatric Surgery, as well as nontechnical skills and faculty development.
He noted the JCST letter on the JCST trainee survey 2013-14 and the responses
around simulation. Responses were disappointing in that only 40-50% recorded
experience of simulation training. This may be a fault of the survey question and
they were working on the assumption that trainees did experience simulation but
not necessarily within training. DB has responded to the letter as Head of School.
His view was that the wording of the question posed was a factor in the
disappointing response and he has responded on 3 points – formal introduction of
this training was in its early stages and as more elements are rolled out to the
trainee cohort the positive response would increase; greater clarity in the wording
of the question would be likely to produce a more informative response
(questioning the validity of a “not applicable” response option to a question asked
of clinical trainees about training in clinical skills).
9.9
JCST
GG noted that the review of SAC Terms of Reference was out for consultation with
recommendations due in March.
9.10
CoPSS
DB will report at the next meeting.
Agenda
SCCCSS
DB noted receipt of an email from Rod Duncan concerning difficulties experienced
across Scotland as a whole in recruiting Consultant Ophthalmologists with a
declared interest in Paediatric Ophthalmology. The issue seemed to be about
Ophthalmology trainees’ preferences and choices rather than selection. DB will
DB
9.11
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discuss this further with EK.
Agenda
10.
10.1
AOCB
Aberdeen Royal Infirmary
GN noted the issues around scrutiny in Aberdeen Royal Infirmary which centred on
General Surgery services. An extraordinary visit by two GMC Directors is scheduled
to take place on 29 January 2015; this will be an informal meeting and is being held
at NHS Grampian’s invitation. A triggered HIS visit to General Surgery will then
take place on 30 January 2015 to look at Foundation, Core and Higher Specialty
Training. She asked the STB to be aware and supportive of the processes
underway. She did not believe there were implications for other Surgery
specialties; however the whole Aberdeen site was under scrutiny. TG reported she
has been invited to attend the visit on 30 January but is unable to go and is
therefore seeking the support of a Consultant General Surgeon to attend in her
All
place. Suggestions to be sent to TG.
11.
Dates of next meetings
Meetings in 2015 were arranged for:

10.30 am on Thursday 26 March 2015 in Room 3, Westport, Edinburgh

10.30 am on Thursday 18 June 2015 in Room 5, 2 Central Quay, Glasgow

10.30 am on Friday 9 October 2015 in Rooms 3/4, Westport, Edinburgh.
Actions arising from the meeting
Item no
5.
9.
9.4
Item name
Overseas Advanced Medical Training
Fellowships
Recruitment 2015 – Round 1 and
Round 2
Updates
Academic
9.7
Trainees
9.10
9.11
CoPSS
SCCCSS
10.
10.1
AOCB
Aberdeen Royal Infirmary
7.
Action
To confirm support for applications
received; to note STB reservations.
To circulate monthly Oriel updates.
Who
DB
To circulate data; agenda item for
March meeting.
To circulate joint letter from the coChairs of the BMA Junior Doctors
Committee to Dr Dan Poulter to STB.
To report at next STB meeting.
To discuss recruitment to Paediatric
Ophthalmology with EK.
JG
Agenda
HM
Suggestions of Consultant General
Surgeon to attend GMC visit to TG.
All
DB/
Agenda
DB
DB
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