BOTA/ASiT Position Statement: Winter Pressures Affecting Surgeons In Training
The Association of Surgeons in Training (ASiT) and the British Orthopaedic Trainees’ Association (BOTA) are independent professional organisations that work to promote excellence in surgical training for the benefit of surgeons in training and patients alike.
Providing excellent and safe care is the absolute priority of all trainees. ASiT and BOTA believe strongly that this is achieved through the provision of excellent training for all doctors. The National Health Service (NHS) is under increasing pressure to deliver safe and cost-effective care all year round. However, in recent years the winter period has become especially challenging for both patients and staff, with these ‘winter pressures’ presenting predictable challenges.1 The combined impact of staff shortages with a reliance on locum recruitment, in-patient capacity pressures, low staff morale2 and the suspension of elective operating represent an absolute failure of long-term planning in an already overstretched system.
ASiT and BOTA acknowledge the challenges that organisations face when responding to these pressures. Recently published winter pressure guidance aims to minimise the effects of removing trainees from their training. ASiT and BOTA represent surgeons in training, as the Consultant Surgeons of the future, and advocate that the highest quality surgical training will deliver excellent patient care.
ASiT and BOTA do not support the movement of surgical trainees from their surgical training. Moving surgeons in training from a surgical training environment not only reduces their opportunities to develop clinical and technical skills, but also poses a risk to existing surgical in-patients. ASiT and BOTA do not support any position where training is lost and where no explicit agreement is made for it to be replaced. Surgeons in training must not be pressurised to work outside of their expertise or curriculum. Allowing this to occur is short sighted and will be to the detriment of patient safety in the future. Individuals who miss training opportunities are encouraged to raise their concerns through the established channels.
Winter pressures present unique challenges for surgical training, as acknowledged by the Royal College of Surgeons.3 The seasonal variation in acute admissions is here to stay; however, stretching the current workforce thinner is not a long-term solution. Elective surgical training is often the first to be affected when such pressures occur. In response to the pressures of winter 2017/18, 62,000 fewer operations were performed, compared to the previous year.4
Surgeons in training have a duty of care to patients and to support their colleagues. ASiT and BOTA are proud of the efforts that surgeons in training make to mitigate the pressures within their working environments. Surgical trainees would not knowingly harm a patient by act or omission; and they respond to calls for assistance to provide emergency care when required. These are standards which are upheld throughout the year.
ASiT and BOTA encourage trainees to continue to seek the highest quality training in order to deliver safe surgical care for the patients of today and tomorrow.
NHS Improvement (2018). NHS Review of Winter 2017/18. London: NHS Improvement. Available at: https://improvement.nhs.uk/resources/nhs-review-winter-201718/NHS Accessed 12th December 2018.
General Medical Council (2018). National Trainee Survey. London: GMC. Available at: https://www.gmc-uk.org/about/what-we-do-and-why/data-and-research/national-training-surveys-reports Accessed 12th December 2018.
Royal College of Surgeons of England (2018). ARCP Guidance to Trainees, Trainers and Assessment Panels. London: RCS. Available at: https://www.rcseng.ac.uk/news-and-events/news/archive/arcp-guidance-to-trainees-trainers-and-assessment-panels/ Accessed 12th December 2018.
Royal College of Surgeons of England (2018). Press release. Available at: https://www.rcseng.ac.uk/news-and-events/media-centre/press-releases/more-patients-wait-longer-for-elective-surgery/ Accessed 12th December 2018.