British Orthopaedic Directors Society (BODS) network: Reporting the state of the nation

Mike Reed

Mike Reed is a Consultant Orthopaedic Surgeon for Northumbria Healthcare NHS Trust He is President of the British Orthopaedic Directors and sits on Council of the British Orthopaedic Association.

In 2004 the original constitution named the group British Association of Clinical Directors and Lead Clinicians in Trauma and Orthopaedics. This was then shortened to the British Orthopaedic Directors Society or BODS. The initial objective of the Association was to provide a forum for discussion of the issues facing Clinical Directors and Lead Clinicians in Trauma and Orthopaedics across the United Kingdom. The society was seeking to support the BOA in influencing government health policy in a process of dialogue and engagement.

Over the years, key topics have been discussed and debated via e-mail and in face-to-face meetings. The current medium is WhatsApp and Zoom – in an ‘open mike’ format rather than a webinar. All are encouraged to join in.

Clinical Directors or Lead Clinicians may join. There are some exceptions, for instance the BOA Executive are keen to hear what’s happening on the ground.

Julian Owens was president of BODS as COVID hit and he led at a vital time as Clinical Directors grappled for information on how to reconfigure. It was a crucial lifeline with live discussions every day on WhatsApp and regular briefings from senior NHS leaders, with mutual feedback to them about what it was like on the ground.

Clinical Directors or Lead Clinicians can join by e-mailing mike.reed@nhs.net, or ask another Clinical Director to propose them.

Posts on WhatsApp are wide and varied. There is normally someone in the UK having a problem and usually someone within the network to propose a solution or at least offer a show of support. Examples in recent months have been job plans, medical teams moving into our beds, the Emergency Department, pension tax, COVID rules and science, virtual fracture clinics, trauma waits, NHS payment structures for Trusts and Health Boards, leave rules. The list goes on...

The pandemic appears to have hit trauma hard although it is less well publicised. Theatres are less efficient and have been undermined by COVID rules and inefficiencies. Staff have been absent and have been moved to support other teams in the hospital. According to the National Hip Fracture Database, prompt surgery rates (within 36 hours) are the lowest they have been in the last 10 years. Teams have reported long waits for ‘cold’ trauma that is waiting at home.

There is a mountain to climb. Orthopaedic patients in England have fared badly from the pandemic, and the devolved nations have arguably fared even worse. As clinical leaders of their respective departments the members are well placed to plan and deliver the elective recovery plans from the various governments that oversee the NHS in the UK. At the moment, most units are struggling to deliver their pre-pandemic levels of clinics and surgery. Some are running slightly more operating sessions but universally we have become less efficient. The NHS recovery plan has us delivering 30% more elective activity by 2024/25 than before the pandemic – and this seems difficult to achieve. Some Trusts are better placed with staff and investment. Returning to a version of ‘payment by results’ funding in England, and payments for Trust activity rather than whole System activity (i.e. the surrounding group of trusts as a whole) should help planning and investment. Specific challenges are a lack of nurses and other staff, although in some areas we are short of theatre and ward estate. The latter is being addressed by a huge investment in new and refurbished estate. The former is harder to solve and it is hard to see clearly if this being addressed. We work in teams with huge skill sets and training requirements – and they are years in the making.

Many units are getting ahead and are willing to share information such as protocols and contracts. BODs have led specific sessions on Limited Liability Partnerships formation as a way of delivering the large volume of NHS work required over the next few years.

There is a management committee elected from the members. This group designs the Zoom meetings, run any surveys of what’s happening on the ground, and invites the speakers and runs a session at congress.

The members decide the discussion topics every day. The President and Vice President are elected by the management committee. The President is in post for two years and is followed by the vice president. The president sits on BOA Council and the past president on the Orthopaedic Committee. BODS has no accounts and no employees which keeps it simple.

This depends very much upon the members and we are keen to have volunteers to join the management committee. We aim to remain agile and able to respond quickly to demand. The group is bigger and more active than ever in discussions, although there is little need for national Zoom calls in this period of relative stability.

• Mike Reed – President • Julian Owen – Past President • Alan Middleton – Vice President • Bibhas Roy • Ajit Shetty • Vinay Takwale