The PPC met this month with a number of high profile points for discussion. The first was the Beford Care Commissioning Group and their contract with Circle. There is a concern that this contract takes simples primary joints and first ray surgery away from trainees, and that this could lead to lack of indicative numbers and the potential to delay CCT for those trainees. The PPC will contact the local TPD to enquire whether there has been a change in number of index procedures performed.
Consent issues with the Montgomery ruling were again discussed. There is a general feeling the Bolam concept is no longer likely to stand up in court. The courts are now asked to decide whether a patient was given appropriate information to make a decision, as well as warned of risks. The clinic letter detailing a discussion of the management options will become more and more relevant.
The use of pre-distributed information sheets was discussed, and recommended. Attention was also drawn to the NHS Choices website to which patients can be directed, which already has relevant information on operative and non-operative management options for common conditions. There will be two sessions at BOA on consent which are likely to be very popular.
The GIRFT roll-out was discussed and attention drawn to a podcast on the BOA website with input from Tim Wilton and Mike Kimmons explaining how it will work. Of note CCGs may now use GIRFT for ‘elimination of variance’. This data is being sent directly to clinical directors, although there were some calls for individual surgeons to be able to access their own data which is not currently available publically.
Commissioning guidance is going through for common conditions including the ‘painful knee’, ‘painful deformed toe’ and ‘painful tingling finger’. These are now in the public consultation phase, and are likely to be in clinical use soon. Additionally there was input on Bruce Keogh’s audit points for seven day working which may be less relevant in T+O: especially the need for every patient to be seen by a consultant within 14 hours of admission.