The Confederation of British Surgery has said that the withdrawal of funding for specialist surgical training could have dangerous consequences.
The Confederation of British Surgery (CBS) has warned that an NHS England decision to withdraw funding for specialist surgical training without national oversight and standard setting will have “inevitable consequences” and make a recurrence of the recent Great Ormond Street Hospital scandal, which affected just under 100 children, more likely than ever.
Training interface group (TIG) fellowships, the only nationally quality-assured, GMC-regulated supra-specialist fellowships, have effectively been axed by NHS England. They have been removed as quality-assured training opportunities for surgeons.
“The decision to make the cuts by the Postgraduate Medicine and Dental Education Oversight group in NHS England (NHSE) effectively dismantles a regulated pipeline into complex sub-specialist surgery at the same time as high-profile failures in paediatric orthopaedics are exposing the dangers of poorly governed, siloed complex practice,” said CBS board member and president of the Association of Surgeons in Training, Raiyyan Aftab.
“The withdrawal of funding will have inevitable consequences for future patient safety,” he added.
A patient safety issue
TIG fellowships were curriculum-based in complex sub-specialist surgical practice, which requires additional training such as cleft lip and palate, hand surgery, head and neck oncology, spinal, oncoplastic breast surgery and major trauma. Their aim, as described by the Joint Committee on Surgical Training (JCST), is to ensure “excellence in a selected group of talented trainees” over a minimum of 12 months, reaching defined competencies for formal certificates of completion.
“In practice, the cuts mean the loss of the single, regulated, UK-wide pathway for specialist competence in these fields, to be replaced by a patchwork of ad-hoc, locally employed posts of variable oversight and quality,” said Aftab.
“Removing TIG’s creates a patient safety issue in that without quality assurance, patients and commissioners cannot reliably know what training a surgeon has actually received in supra-specialist procedures or whether their unit has met any nationally agreed threshold for case-mix, supervision, and governance,” he added.
The confederation points to evidence on siloed and poorly coordinated care, for example, a UK perioperative care review which describes how multidisciplinary working can improve outcomes but also warns that “less well-organised” multidisciplinary models are associated with worse survival than conventional care, highlighting how fragmented, poorly structured practice can be.
Other examples of the value of coordinated training with close national oversight include cleft palate surgery, which historically was a fragmented service with the worst speech, growth and appearance outcomes in Europe. This scandal led to a central government push to centralise services, as well as setting clear, measurable and quality assured standards for training and practice, which has transformed cleft lip and palate surgery in the UK.
