WINTER 2012 NEWSLETTER
Notes email@example.com @RCPCHtweets www.facebook.com/rcpch
RCPCH Christmas Lecture: Inequalities in child health
RCPCH parent/carer feedback tool Photo: Richard Wilkinson delivers the inaugural RCPCH Christmas Lecture
For paediatricians who have outpatient consultations you can use the RCPCH parent/ carer feedback tool as part of your revalidation: • Validated by RCPCH • Meets GMC requirements • Easy to use • Only 20 responses required • We will do your analysis report for you • You only need to complete once every 5 years For more information contact Sarah Fellows: Revalidation@rcpch.ac.uk http://www.rcpch.ac.uk/paedccf
Delegates from across the children’s sector joined members and staff in the London office on 9 December to hear Richard Wilkinson, author of the critically acclaimed The Spirit Level, deliver the inaugural RCPCH Christmas Lecture. Introducing the lecture, College President Dr Hilary Cass described how Richard and his co-writer Kate Pickett had performed a remarkable task through the publication of the book in achieving plaudits from across the political spectrum, including from both David Cameron and Ed Miliband. Drawing heavily on the data in The Spirit Level, Richard outlined the extent to which, across a range of health and social problems, outcomes are worse in more unequal countries. He used startling evidence which showed that
overall child wellbeing is unrelated to national income per head of population; in other words, across most of the developed world it doesn’t matter how rich a country is but how big the gap is between the top and bottom. In areas including life expectancy, infant mortality, teenage births, obesity and mental illness he demonstrated powerfully how children do significantly worse in more unequal countries. Viewpoints on the lecture are available at @RCPCHtweets along with a video presentation on the RCPCH website, www.rcpch.ac.uk. Given the enthusiasm from delegates and members, the lecture will now become an annual fixture on the College calendar. BRIAN DOW Director of Communications
Revalidation: supporting you – Page 5
News RCPCH Christmas Lecture: Inequalities in child health RCPCH Annual Conference 2013, continued p.6 RCPCH parent/carer feedback tool
2 From the President 4 Your views
From the President
Membership survey RCPCH in the Twittersphere Join the discussion on Facebook
5 Training and support
The road less travelled
Revalidation - supporting you National Trainees’ Survey results
6 Your RCPCH RCPCH Annual Conference 2013 RCPCH events and courses 2013 Time to ‘turn the tide’ on myths of child health research RCPCH promotes obesity campaign at party conferences Workforce - working towards the right balance Membership subscription fees 2013 International news Medicines for Children Research Network
10 Committee news Nutrition update SSASG news Training matters Annual General Meeting Your chance to get involved with the RCPCH
Editors: Jo Ball Sarah Quinlan Brian Dow Email: firstname.lastname@example.org Supplier services: Work Communications www.workcomms.com Published by: The Royal College of Paediatrics and Child Health, 5-11 Theobalds Road, London WC1X 8SH. Tel: 020 7092 6000 Fax: 020 7092 6001 Website: www.rcpch.ac.uk Email: email@example.com The College is a registered charity: no. 1057744 and registered in Scotland as SC038299
‘‘‘Cheshire Puss,’’ she began timidly, ‘‘Would you tell me, please, which way I ought to go from here?’’ ‘‘That depends a good deal on where you want to get to’’ said the cat.’ Alice’s Adventures in Wonderland, Lewis Carroll Every one of us must learn to own up to our weaknesses and vices; after all, if you’ve been following the revalidation debate, you will know that self-knowledge and reflection are everything. So here’s the denouement. My crashing weakness is that I am seriously directionally challenged; that bit of my parietal lobe just isn’t there. Few other people could leave a hotel in Land’s End, with the sea to the left and the whole of the rest of England to the right, and turn the wrong way. Christine Turner, who as Executive Assistant has spent nearly a decade getting successive College Presidents to the right place at the right time, has risen to this challenge with maps, post-it notes and helpful travel hints... but on rare occasions some independent planning is required on my part. Enter my vice and my downfall; electronic gadgets and gizmos. As a ‘techno-chick’ I just have to have the latest tablet, smartphone, or computer, so felt compelled to trade in my perfectly serviceable iPhone 4 for the new iPhone 5. Alas they have ditched Google Maps and replaced it with the much hated Apple Map App which has cunningly eradicated the Department of Health, the GMC, several Medical Royal Colleges, and all transport routes between them, leaving me lost, late and muttering about conspiracy theory.
The Road If we think about the direction of travel for children’s services, it’s fair to say we wouldn’t start from here. We all recognise that specialist services have evolved serendipitously, sometimes through creativity and innovation, and sometimes following adult services. We know that general and community services are spread too thin, and that primary care is struggling to meet contemporary demands. We know that children’s services are often unprofitable and financial incentives work against best practice. But more important than all these issues is the real impact of the financial climate. The web presentation by Anita Charlesworth, Chief Economist of the Nuffield Trust, paints a grim picture of the realities of the next ten years1, which makes sober but essential viewing. Her conclusion is that only a long-term freeze in other public service budgets or massive tax increases would allow NHS funding to grow at historic levels. The latter would not be politically achievable, and the former would not only be undesirable but would also lead to catastrophic indirect effects on health. So what are the implications for children’s services? The hard reality is that we have to start to plan a fundamentally different way of delivering children’s healthcare, which isn’t just about tweaking around the edges; and we have to do that while the rest of the health service is worrying – with some justification – about a completely different agenda related to demographic 1. http://www.nuffieldtrust.org.uk/live/how-canhospitals-do-more-less
President’s webinars Dr Hilary Cass is keen to talk to members about some of the biggest issues facing paediatrics and the RCPCH today. Dr Cass is holding a series of webinars to discuss these issues in depth and gather member feedback and opinions. The webinars will take place via GoToWebinar, which will allow you to ask questions and vote on questions posed by Dr Cass. The first webinar took place on 27 November on ‘Future Consultant Working’ and is available to view at www.rcpch.ac.uk/have-your-say. Look out for the invitation emails nearer the time as places are limited. If you are unable to attend, we will be making all webinars available for members to view on the RCPCH website shortly after the event.
pressures and care of the elderly. Because one thing is for sure; if we can’t plan a vision and direction of travel together, no-one else is going to be able to do it better. To this end the RCPCH, in partnership with the Royal College of Nursing and Royal Society of Medicine, is hosting a two-day conference in Manchester on 11-12 April 2013 (see Events and Courses page 6). The aim of the conference is to start on the journey of how we could radically redesign children’s services, and what we have to do in terms of training and workforce to deliver a new model of care. So please do register your interest, and pass on the information to colleagues in other disciplines, as well as in management roles, commissioning and primary care. The Travellers I now want to turn attention from the road to the people on it – i.e. you. I’ve been doing quite a bit of travelling myself over the last few months, so have had a chance to talk to many people around the country. I did get a bit fixated for two weeks on places beginning with B – Bristol, Bath, Birmingham, Bolton and Berkshire – but managed to break out into other parts of the alphabet including Manchester, Nottingham, Glasgow and Cardiff. The other chance to speak to people – albeit using a less familiar medium – was through the first of a series of webinars which tackled the question of consultant delivered care. One message has come through clearly from all these encounters: you want more support from the College throughout your
FUTURE WEBINARS: ‘The Impact of NHS Reforms’ •
Wednesday 06 February 17:30 – 18:30
‘Coalition of Services’ •
Thursday 14 February 17:30 – 18:30
‘Membership Engagement’ •
Wednesday 20 February 17:30 – 18:30
careers, not just during training and first consultant posts. On page 5 of this newsletter you will find an article from Sarah Fellows and Alistair Thomson about the launch of the revalidation process, and the resources available to you. There is also a piece from Martin McColgan on page 8 outlining the latest information on our College workforce strategy. Within the SSASG news section (page 10) you will get a flavour of the range of topics that the SSASG Committee is grappling with, and as part of the Turning the Tide launch (page 7) you will see that a key plank of our research strategy is to support those embarking on academic careers. However, despite the fact that there is a lot going on, members still feel there is a vacuum, so I have spent some time reflecting on what we need to do to fill that. The big issue for everyone seems to be summed up by the immortal words of Benjamin (Dustin Hoffman) in The Graduate; ‘I’m a little worried about my future’. That doesn’t just apply at 21, or even 31, but at 41, 51 and 61. Some of you are gloomy about the prospect of being able to step down from the most acute roles in later life, and about getting the time and support to develop new clinical and/or non-clinical roles. Others are dealing with incredibly difficult practical, ethical and personal dilemmas in your roles as clinical directors, often managing tensions between senior management and colleagues, and with loyalties to both. Still others are dealing with the stresses of referral
to the GMC, or an unmanageable workload, or intra-departmental conflict. Burnout is never discussed, but is a reality for some senior staff, and the health service seems too busy to notice. Finally there is the group that is winding down to retirement, but still wanting to contribute to paediatrics, and asking about ways to remain involved. Across this diverse range of issues, many of you have told me that you want more practical advice, support and mentoring from the College on all these topics. You want us to help work out how to make portfolio careers a reality not a possibility. You sometimes want confidential paediatrician-topaediatrician advice, which is external to your trust. I am taking all these concerns very seriously and with senior staff at the College am exploring what we could provide by way of longer term career support for all those outside of the training grades. Of course, we have to recognise the limits of our resources, and we have to recognise the difference between a college and a union, but within those limitations we will develop proposals for how to take this important piece of work forward. Your suggestions and comments, as always, are very welcome. Web: www.rcpch.ac.uk/have-your-say Twitter: @RCPCH_President DR HILARY CASS President
Membership survey In June 2012 we launched our membership survey to find out a bit more about how you felt, not only about the benefits you receive but also about how we communicate with you and how to improve ways to get involved in College work. In total there were 2,085 responses, equalling a 15.4% response rate, which is a 5% increase on a similar survey performed in 2010. The survey formed
part of a wider ‘evidence-gathering’ project between March and September that also looked at qualitative data from focus groups and telephone interviews to give us an insight into how you view the College and discover tangible changes that could be made in order to help us reach our target of increasing membership satisfaction. The full results of the survey and recommendations will be announced
early in 2013, but in the meantime below is an infographic showing the main themes of discussion with the largest, most prominent words highlighting the issues that matter to you most. Thank you again to everyone who took the time take part in our research. LAMYA HACHICHO Marketing Manager
Photo: RCPCH member survey infographic
RCPCH in the Twittersphere RCPCH members have been tweeting on a range of topics this quarter – from the first START assessment through to the rotavirus vaccination introduced in November. Our top tweets and re-tweets of the period came during the RCPCH’s events on obesity at the political party conferences and the College’s latest publication Turning the Tide outlining
the need for more child health research. Several tweeters were keen to nominate @rcpchPresident Dr Hilary Cass for the Woman’s Hour Power List – and a number also retweeted and commented on her recent HSJ article outlining the case for health service reconfiguration. Several members engaged the President in a discussion about the value of an RCPCH smartphone app;
something the College is exploring. Dr Cass tweeted live from a number of conferences and events, including the Who Cares Trust Conference and the WACP Conference in Ghana. MELISSA MILNER Media and Campaigns Manager
Join the discussion on Facebook Did you know that we are now on Facebook? ‘Like’ our pages to keep up to date with the latest news, events and resources as well as to discuss the latest in child health stories and advances. www.facebook.com/RCPCH www.facebook.com/RCPCHAnnualconference www.facebook.com/RCPCHGlobalChildHealth
Training and support
Revalidation: supporting you Revalidation began in December 2012. Paediatricians will need to collect evidence for their appraisals to demonstrate how they are meeting the requirements outlined by the GMC and their specialty. Most paediatricians will already be undertaking all the necessary activities. To help and support you, RCPCH has produced or developed a number of tools and guidelines: Revalidation Portfolio – NEW! Launching end of January 2013, the portfolio (www.rcpch.ac.uk/ revalidation) provides doctors with a secure online tool to collate and review supporting information for appraisal and revalidation. It is linked to the College’s CPD diary and ASSET system to allow transfer of relevant files into the revalidation portfolio. Available to career grade members only. CPD Diary The diary (www.cpd.rcpch.ac.uk)
links to the Revalidation Portfolio and generates a number of documents, including a CPD certificate, a CPD activities log and a GMC ‘revalidation domains and attributes report’ for any chosen time period.
These documents outline specialtyspecific expectations (www.rcpch. ac.uk/revalidation) and should be used in conjunction with the GMC guidance on supporting information and revalidation.
Revalidation Specialty Advisers
The trainee ePortfolio (www.nhsepor tfolios.org) continues to support trainees to gather information for their specialty training requirements which are also used to meet revalidation requirements.
This group of clinicians provides expert advice to doctors, appraisers and Responsible Officers on paediatric requirements for revalidation via the central College revalidation team (firstname.lastname@example.org).
Paediatric Parent and Carer Feedback (PaedCCF) tool
1. McGraw M et al. [E-publication ahead of print] Feedback on doctors’ performance from parents and carers of children: a national pilot study Archives of Disease in Childhood 26 May 2011
Available to career grades (www.rcpch. ac.uk/paedccf) and validated for use in outpatient settings 1, it is the only RCPCH-approved parent and carer feedback tool which meets GMC criteria. Paediatric-specific supporting information and revalidation guides
SARAH FELLOWS CPD and Revalidation Manager DR ALISTAIR THOMSON Revalidation Lead and Vice President (Education)
National Trainees’ Survey results Improving the training experience During winter 2011-12 the RCPCH Trainees’ Committee performed its first National Trainees’ Survey. The aim was simple: to discover the views of the broader trainee body on a range of issues that had been brought to the attention of the Trainees’ Committee the preceding year. These issues included:
The response to the survey was astounding, with 2,037 paediatric trainees (approximately 56% of all trainees currently registered with the College) providing us with a large amount of information to help the committee do what it’s meant to do better – represent the views of trainees in the work of the College.
difficulty applying for time Out of Programme (OOP)
difficulty applying for study leave
Less Than Full Time (LTFT) training issues
problems with time allocation in sub-specialty training and academic/research training
The full report of the results of the survey is now available online, including a brief executive summary. It’s very important to the Trainees’ Committee that the results of the survey are put to use to begin to change the training experience.
trainee doctors carrying out unsuitable tasks
current trainees seriously considering leaving paediatric training
We have already started to do this. Information from the survey was presented to the RCPCH Commission on Child Health Research, which fed into the Turning the Tide report and provided the basis for the recommendations it makes regarding trainees. Other findings (such as 50% of current trainees would like to work LTFT as a consultant) will be used in the College’s workforce strategy.
Plans are also underway to establish a database of trainees OOP - a resource to help trainees across the country plan their OOP experience. Given this year’s success we will be making the survey an annual event. Some of the questions we are planning for next year will build upon what this year’s survey told us, eg if such a high proportion of trainees are keen to get involved with research, what are the barriers to this? Other questions will be completely new, concerning the role of the consultant and consultant delivered care, and issues around leadership and management training. If there are any questions that any trainee or trainer feels we should include then please let me know. The more relevant we can make the survey to members of the College, the more use it can be to drive changes in training. DANIEL E LUMSDEN Chair RCPCH Trainees’ Committee email@example.com
The RCPCH Annual Conference
Bringing European Paediatricians Together
JOINTLY HELD WITH
6 Europaediatrics th
5-8 JUNE 2013, GLASGOW, UK Be part of the UK’s largest paediatric conference: Register now! We are pleased to announce the 2013 RCPCH Annual Conference will be held jointly with the 6th Europaediatrics, the biennial conference of the European Paediatric Association. A must-attend conference for people working within child health that will attract 3,500 attendees from the UK and Europe to discuss and debate key clinical issues, latest paediatric science and share innovation and best practice. 96% of those who attended in 2012 would recommend the conference to a colleague. •
Prestigious keynote speakers
Clinical guideline sessions
Peer reviewed abstracts
Child protection symposium
7 symposiums covering a wide range of topics
Over 30 specialty group sessions
15 personal practice sessions
For a full programme and to register visit: www.rcpch.ac.uk/conference2013
RCPCH events and courses 2013 EVENTS TEAM:
tel: 0207 092 6000
How to Manage: Paediatric Nutrition
14 January 2013 Oxford
12 March RCPCH, London
..................................................................... President’s Roadshow 24 January 2013 Liverpool
..................................................................... Child Health in Developing Countries 11 – 13 February 2013 RCPCH, London
..................................................................... President’s Roadshow 22 Feb 2013 Bristol
..................................................................... Women and the Changing Face of Paediatrics 08 March 2013 ICC Birmingham
..................................................................... Child Protection: From Examination to Court 18 – 19 March 2013 RCPCH, London .............................................................................
How to Manage: Paediatric Allergy 29 April RCPCH, London
..................................................................... How to Manage: Paediatric Pain
How to Manage: Mental Health in General Paediatrics 14 October RCPCH, London
..................................................................... Paediatric Educators Programme 21-22 November RCPCH, London
16 May RCPCH, London
..................................................................... How to Manage: Paediatric Oncology 16 September RCPCH, London
Child Health in the UK – The Future: Conference 11 – 12 April 2013, Manchester At a time of major financial constraint, the NHS is undergoing some of the biggest changes since its inception. For those of us working in children’s services, these challenges are compounded by increasing problems of sustainability, and the realisation that some of our key health outcomes are slipping down the league tables when
compared to the rest of Europe. In response to these serious concerns, the RCPCH is delighted to announce that we will be hosting a two-day conference in partnership with the Royal College of Nursing and the Royal Society of Medicine to explore these issues. The conference will provoke new thinking on how we can build a better
and more sustainable health service for children. It is aimed at all those working in children’s health, as well as those who are responsible for the provision, commissioning and planning of services and the workforce. Register your interest now: www.rcpch.ac.uk/events
Time to ‘turn the tide’ on myths of child health research A new report launched by the Royal College of Paediatrics and Child Health has called for a collaborative, national vision to boost UK research into childhood diseases. The report was launched at an event attended by the College’s patron, HRH Princess Anne, held at the RCPCH in November, and attracted press coverage in several outlets including The Times and ITV’s Daybreak.
and a fragile funding base are just some of the barriers blocking effective child health research – leading to the UK’s high childhood mortality rate and too many premature deaths in adults. The report states that despite the commitment made by successive governments and progress in research, a reluctance to involve children in research has left the UK with a dearth of understanding around the major adult diseases, such as heart disease and diabetes, that have their origins in early life. The report argues that it will take collective action from Medical Royal Colleges, Government, children’s charities and funding bodies, as well as a change in culture, if the UK is to improve its standing as one of the worst countries in Europe for child mortality.
with the RCPCH pledging to improve research training for all paediatricians and clear routes into research careers •
Strengthen the infrastructure for children’s biomedical research in the UK by supporting the establishment of a children’s trials network for nonmedicines as well as medicines studies, and children’s health sciences networks to share resources, and promote crossinstitutional collaboration researching the early life origins of adult diseases
The launch marks the start of a campaign, led by the RCPCH, which sets out to: •
Debunk the myths surrounding clinical trials – and push for the introduction of a system of ‘opting out’ of studies designed to reduce uncertainties in treatments, rather than ‘opting in’
Bring organisations together in a UK ‘Children’s Research Collaboration’ to optimise use of funding for research and raise awareness of the need to strengthen children’s involvement
Improve education, research training and guidance for paediatricians
Photo: HRH Princess Anne greeting Thines Ganeshamoorthy of the RCPCH Youth Advisory Panel at the launch Turning the Tide: Harnessing the power of children’s research is authored by the RCPCH’s Commission for Child Health Research led by the College’s Vice President for Science and Research, Professor Neena Modi. It says myths around clinical trials, fewer doctors involved in research
The full report and executive summary are available to download at www.rcpch.ac.uk/ harnessing-the-power-of-child-healthresearch. For more information email firstname.lastname@example.org JYOTSNA VOHRA Science and Research Coordinator
RCPCH promotes obesity campaign at party conferences RCPCH members and staff attended a number of other health-related events at the party conferences, engaging with politicians from across the political spectrum on a range of child health issues, focusing on the College’s policy priorities of obesity, child protection, mental health, child mortality and a better NHS for children.
The RCPCH hosted its first events at each of the main political party conferences in England this year which proved a real success. The events focused on the emerging findings from the Academy of Medical Royal College’s (AoMRC) obesity campaign, for which the RCPCH is leading the communications work, tying in with the College’s policy priority of ‘tackling obesity’. The round table events profiled evidence gathered from the inquiry stage of the obesity campaign and included lively debate on how best to tackle obesity. Keynote political speakers were Conservative Dr Sarah Wollaston MP and Liberal Democrat Andrew George MP, both of the Health Select Committee and Diane Abbott MP, Shadow Minister for Public Health. Deputy Mayor of London, Victoria Borwick, also attended the Conservative event.
Photo: Stakeholders engaging in lively debate at the Conservative Party Conference There was a diverse audience at each session including politicians, RCPCH members and representatives from the food and drink industry, public health leads, weight management programmes, charities and campaign groups.
Several positive results came from the events which will work to further raise the profile and influence of the College. These include an invitation to present on obesity to the All Party Parliamentary Group on School Food and numerous meetings with politicians from across the parties with a view to gaining support for the report launch in January. The AoMRC report on obesity is due to launch in February 2013. KARMJIT KAUR Public Affairs Coordinator
Workforce – working towards the right balance Facing the Future (2011) highlighted the service and workforce issues facing acute paediatrics, and provides a sustainable solution for the service. College officers and members can use this information to influence the Centre for Workforce Intelligence and the new commissioning landscape for England, and national workforce planning bodies for Scotland, Wales and Northern Ireland. There are still not enough staff to support current acute rotas. Comparison of the EWTR 2010/11 and 2011/12 compliance surveys found middle grade rota vacancies and gaps had fallen from 20.4% to 16.3%, but 78% of Clinical Directors were very or moderately concerned about sustaining the service.
The 2010 new CCT holder survey recorded that 90% had consultant posts, but posts were not always substantive. Preliminary results of the 2011 workforce census indicate annual consultant growth slowing to 2.3% a year which raises concern for current trainees. There were 252 new CCTs in paediatrics in 2011 who will also be followed up, and with over 1,300 ST1, 2 and 3 trainees currently registered with the College, CCTs will continue to rise.
The College has advocated an expansion of consultant delivered care models. Our report of April 2012 shows that some form of consultant delivered care exists in 96.4% of acute units and is seen as a good service model by clinical directors, consultants, trainees and nurses. College surveys indicate substantial growth in this model, but it is not a ‘one-size-fits-all’ solution and staged career planning must be progressed.
The 2007 MMC cohort study showed that attrition from paediatric training is approximately 15% by ST3, and 52% wish to work Less Than Full Time (LTFT). There is a higher demand for specialist posts and a low demand for community paediatric posts.
Visit www.rcpch.ac.uk/workforce to read the project reports and census findings. MARTIN MCCOLGAN Workforce Information Officer
Membership subscription fees 2013 The College aims to keep subscription increases in line with, or below, RPI inflation. Despite a difficult financial climate and reductions in funding this aim has been met for all recent years. Council have agreed to freeze the membership subscriptions for Ordinary, Associate, Junior Members and Foundation Affiliates resident in the UK. This will mean all UK trainees and the majority of SSASG doctors will not see a rise in their membership
subscription in 2013, this takes into consideration increased costs associated with assessments and examinations. The College, like most organisations, will be affected by inflation and therefore all other membership subscriptions need to rise by 2%, this is still expected to be less than RPI inflation, which at September 2012 was 2.6%. Members who are having difficulty in paying their subscription due to financial hardship can apply for a concession by
contacting the Member Services Team on 0207 092 6060 or via email@example.com. All requests are treated confidentially. The main subscription rates for 2013 are outlined below (as membership subscriptions are fully tax deductible UK tax payers can claim up to 40% back from the Inland Revenue). DR DAVID VICKERS Honorary Treasurer
2013 annual subscription
Rate shown – includes Archives?
Fellow UK* and Republic of Ireland
Fellow rest of EU and North America
Ordinary UK* and Republic of Ireland
Ordinary rest of EU and North America
Associate UK*, EU and North America
Junior (UK only)
Medical Student Affiliates
*as in previous years, UK residents pay additional levies and payment surcharges may apply for some payment methods.
INTERNATIONAL NEWS RCPCH International MA in Child Health – a first for the RCPCH In January 2013 teaching will commence on a course in East Jerusalem which will, in two years’ time, lead to the award of an MA in Child Health (MACH). This is a partnership between the RCPCH and Al Quds University and will be the first Masters under the aegis of the College, succeeding the Diploma in Palestinian Child Health. Accreditation for the new course was obtained during a visit to Palestine by Tony Waterston, Jean Bowyer and Justin Thacker in October 2012, where the process of changing from a diploma to a Masters was discussed and the Partnership Agreement with the RCPCH finalised. Under this agreement, the College will fund paediatrician visits, tapered over the next four years. We also have a two-year programme funded by the Tropical Health Education Trust to strengthen the Palestinian faculty and develop outcome measures for the course. Like the diploma, the MACH will be taken by doctors and nurses taught in small groups using self-directed learning, the materials developed by UK and Palestinian paediatricians and public health specialists. Moving
Building on successes to date, the future looks bright for paediatric research within the National Institute of Health Research (NIHR).
Photo: Representatives of Al Quds University and RCPCH with the signed MACH agreement to a Masters means that the overall standard of the course will increase – there will be additional ‘electives’, including adolescent health and research methodology, the teaching hours will be longer (though the course will remain part-time), and there will be a dissertation at the end. Overall, the partnership is strengthening and we are proud of the RCPCH contribution at this difficult time in the region. For further information about the Palestinian child health programme visit our website at: http://www.rcpch. ac.uk/international JUSTIN THACKER Head of International Operations
Training success for ETAT+ Uganda As reported in autumn’s Notes, the ETAT+ Partnership is a £1 million project funded by the Department for International Development which aims to improve paediatric emergency and immediate admission care in 18 hospitals in Kenya, Uganda and Rwanda. The Partnership conducted a highly successful three-day instructors training course in Kampala in September for 22 paediatricians, medical officers and nurses working in public and university hospitals throughout Uganda. The training was delivered by instructors from the Kenya Paediatric Association. The practically-based course used the National Resuscitation Council of Kenya guidelines and covered the principles of training using a variety of approaches including lectures, skills teaching, small group work and simulation assessments. Each participant conducted a number of At the time of writing, Justin Thacker is leaving his post as Head of International Operations. On behalf of the College we would like to thank
Medicines for Children Research Network
practice sessions for each learning technique. It represents a huge advance for ETAT+ training in Uganda, producing three fully-qualified ETAT+ instructors and 22 instructor candidates who will continue to be mentored and supervised while they conduct at least two training courses before becoming full instructors. The Kenyan team will continue to provide support with the intention of Ugandan instructors having sole responsibility for further training in Uganda by mid-2013. This successful course will significantly contribute to the project’s aim of rolling out ETAT+ training to district hospitals across East Africa. For further information about ETAT+ please see our website: www.rcpch.ac.uk/international.
Paediatric research is well supported within the NIHR by the Medicines for Children Research Network (MCRN) and the Paediatric Specialty Group (PSG). NIHR is planning to reconfigure the clinical research infrastructure across England and it is possible that these two groups will be brought together, removing the distinction between medicines and non-medicines work and enabling more equal support across the whole country. This will bring further opportunities to paediatricians, children and families to get involved in research. At a recent annual review by NIHR, the MCRN was commended for outstanding activity and performance achieved over the past year. Equally, at their review, the PSG received a ‘green’ rating for the second time running, having been congratulated for its excellent performance. Professor Anne Greenough, Chair of the PSG, said ‘In 2011/2012, more than 39,000 children were recruited into paediatric (non-medicines) portfolio studies, a 55% increase on the previous year’s activity. Bringing together MCRN and PSG will build on this success by increasing local support’. Professor Michael Beresford and Dr William van’t Hoff are acting as joint interim directors of MCRN following the departure of Professor Rosalind Smyth who recently started as Director of the Institute of Child Health, UCL. They both welcome this opportunity for MCRN and PSG to work more closely together. Michael said ‘We have always enjoyed strong linkages with Anne and the PSG, having had a role in coordinating the group since it was established and through close integration with our Clinical Studies Groups’. William reflected that ‘close alignment of support for medicines and non-medicines research will make it easier for paediatricians and network staff to work across all studies involving children which in turn will help families to become involved’. DR VANESSA POUSTIE Assistant Director, NIHR Medicines for Children Research Network
CATHERINE FAGAN International Coordinator Justin for all his hard work during his time at RCPCH and to wish him well for the future.
Nutrition update Vitamin D deficiency: the hidden dangers Vitamin D deficiency as a public health concern is a topic of increasing importance amongst our members – with a growing number of abstracts on the issue presented at the College’s Annual Conference and numerous media enquiries the College has received. Low vitamin D levels in the general population have been linked to a range of diseases, including osteoporosis, several forms of cancer, type I and type II diabetes, cardiovascular disease, tuberculosis, multiple sclerosis and mental health issues. Vitamin D deficiency has also been proposed as a cause of unexplained fractures in a number of controversial and high-profile cases and therefore has implications for the College’s child protection work. Although there are no national figures on trends of vitamin D deficiency within the UK population, local studies, research from abroad and anecdotal evidence from RCPCH members suggests it is a serious hidden problem, not least amongst children and young people. Indeed there has been a fourfold increase in the number of admissions for rickets in the last 15 years (HES) .
The College has already done a significant amount of advocacy and media work relating to vitamin D, including the Nutrition Committee’s letter alongside NHS London to the Medicines and Healthcare Products Regulatory Agency – calling for an urgent review of applications for licensed vitamin D products. There is also ongoing work by the British Paediatric and Adolescent Bone Group, an RCPCH special interest group, to clarify the causal mechanisms explaining vitamin D deficiency and bone disease. The British Paediatric Surveillance Unit recently undertook a study on hypoglaecemic seizures in relation with vitamin D deficiency. Members of the RCPCH Nutrition Committee, working closely with College staff in the Health Policy and Media and Campaigns teams, have recently developed a position statement which calls for: • Professional guidelines for paediatricians and other healthcare professions on how to identify and treat vitamin D deficiency in patients which are both easily accessible and authoritative
• Increased awareness amongst the public as to the health implications of vitamin D deficiency – particularly in children – and provision of advice on how to prevent and treat it • Further research into a single vitamin D supplement and their quality assurance, and exploring the pros and cons of foods fortification to ensure that the whole population has access to affordable vitamin D supplements • Better surveillance of vitamin D-related diseases to establish their current prevalence and trends in incidence over time The campaign was launched in December 2012 and future campaigning activity will be rolled out in 2013. The RCPCH’s vitamin D position statement can be viewed at www.rcpch.ac.uk/positionstatements PROFESSOR MITCH BLAIR Officer for Health Promotion PEDER CLARK, ANNE RUSINAK Health Policy Team MELISSA MILNER Media and Campaigns Manager
SSASG news BACCH representation British Association for Community Child Health (BACCH) representative member of the SSASG Committee
• contributing an article to the BACCH newsletter to address current topics of interest and concern
Dr Thérèse Bennett, an Associate Specialist working in Manchester, describes her role as BACCH representative member of the SSASG Committee. Like the majority of SSASG paediatricians, Thérèse works in community child health where over 60% of the career grade workforce are SSASGs. Thérèse states:
• providing a voice for the SSASG members of BACCH
‘Did you know that the largest number of SSASG paediatricians across the UK work in community child health and that BACCH, one of the specialty groups of RCPCH, “represents professionals working in paediatrics and child health in the community”?
From updates on the new contract to reflections on the route to CESR and the latest on revalidation, there is never any shortage of topics of interest to put in the BACCH newsletter. Future articles will include the results of the SSASG survey and information on training and development. There is work in progress to develop training and development guidance for SSASGs, so do keep a look out for this.
The BACCH role includes: • responding to queries about issues specific to SSASG
The role has recently been redesigned and now includes being a member of the SSASG Committee. This is brilliant as I am given first-hand access to current topics of interest and concern and am able to keep the SSASG members of BACCH as up to date as possible.
Finally, you can find out more about BACCH at www.bacch.org.uk.’ In addition to Thérèse, given that so many SSASG paediatricians work within community child health and a significant number fulfil lead roles, Dr Christine Arnold on the Community Child Health CSAC, is also a representative member of the SSASG Committee. RCPCH Annual Conference June 2013: SSASG update meeting We would like to hear your views on the format and the topics you would like to hear about at the update meeting to be held at the conference in Glasgow next year. Please get in touch with me through our Committee Administrator: firstname.lastname@example.org DR JANE D WILKINSON Chair SSASG Committee
Performance measuring – effective assessment Measuring herself with a tape measure ‘Mary Poppins, practically perfect in every way’. We doctors are pretty used to the idea of being tested. There’s a lot of exams to pass to get into medical school, more to get through medical school, and yet more to continue in your training. One thing these exams have in common is that they were ‘passed’ or ‘failed’. You have to be ‘good enough’ to progress and coming up short usually comes with a price tag – missing out on opportunities and having to put yourself through the test again. A lot of your time as a trainee is spent having your performance measured in some way, by your peers, by your seniors and, perhaps too often, by yourself. We’re all so used to exams that it’s very easy to apply this mindset to assessments in the workplace, and
to concentrate on ‘passing’ them to progress. It’s obviously important to demonstrate that you are able to perform some essential skills, such as cannulation or intubation, because these are the things we need to have mastered to deliver care safely. The difficulty is that if all our assessments are approached with the ‘pass’ or ‘fail’ mindset, we are limiting the potential to benefit from a much more formative experience. Formative assessments are for learning, rather than assessments of learning, such as the MRCPCH. They focus on how you undertake tasks and approach problems, and how this can be improved, rather than ticking a box that says ‘good enough’. I’m writing this about a week since the first group of trainees sat the START assessment. START has been designed to be a formative experience providing
personalised feedback to each trainee, which can help guide their training. This has been a deliberate move away from the exit exams other Colleges run. With input from a large number of trainees, the College has been reviewing and revising the Work Based Assessment strategy. One of the main aims of this has been to take the emphasis off the summative and place it on the formative. Whilst it can be nice to see the phrase ‘keep up the good work!’ on a feedback form, we need to be giving more guidance than that for our assessments to be effective. Let’s hope in the future our assessments can be less about ticking boxes and more about talking points. DR DANIEL E LUMSDEN Chair, Trainees’ Committee email@example.com.
ANNUAL GENERAL MEETING RCPCH Annual Conference 2013 The College’s Annual General Meeting for 2013 will be held as part of its Annual Conference in Glasgow this June.
weeks before the date of the meeting, accompanied by the signatures of 15 persons being Ordinary Members or Fellows.’
In accordance with Bye Law 6 viii e), the AGM will consider motions ‘submitted in writing to the College not less than 10
Such motions should be submitted to the Registrar, Dr Ian Maconochie, c/o the College. The deadline for receipt of
motions is 28 March 2013. The agenda for the AGM will be made available to members via the website, and publicised via the email bulletin, nearer the time. GRAHAM SLEIGHT Head of Governance and Contracts
Your chance to get involved with the RCPCH Enclosed with this edition of Notes is a list of College member posts for which members can nominate themselves. The College is keen to encourage as many members as possible to apply and there are many benefits that can be gained.
meet and network with peers
participate in RCPCH strategy and direction
determine the quality and nature of sub-specialist training
You will be able to:
use your clinical expertise to support RCPCH work
make a contribution to child health at national level build skills and learn in areas where you might not otherwise have experience
Job descriptions and the online application process can be found at www.rcpch.ac.uk/nominations Closing date: 24 FEBRUARY 2013
BNF for Children 2012-2013 New Edition
Guiding health professionals on all aspect of paediatric drug therapy. Significant content updates for latest edition ✓ Updated guidance on the prevention of secondary case of Haemophilus influenzae type b disease ✓ New guidance on the prescribing of Controlled Drugs by Independent Prescribers ✓ Revised guidance on the use and monitoring of warfarin ✓ Updated advice on the prescribing of antipsychotics ✓ Updated advice on the risk of osteonecrosis of the jaw with bisphosphonates
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