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RCPCH news Royal College of Paediatrics and Child Health


Draw to win RCPCH 10th Birthday Drawing Competition ‘Me and My Doctor’


Future Child Health Services: Modelling the Future 8

‘Child in Mind’ project update 13

Trainees meeting, Cardiff

Editorials Winter 2006

In the news 4&5 Future Child Health Services: Modelling the Future

6 The British National Formulary for Children 2006

7 Draw to win

8 ’Child in Mind’ update Safeguarding Children Training Programmes

9 Continuing Professional Development & Revalidation SASG News

12 New Clinical Effectiveness website United Kingdom Paediatric Chronic ITP Registry

13 Regional Sub-Committees in Scotland

14 Trainees Committee report

15 Meetings

Front page photo: RCPCH 10th Anniversary Drawing Competition Awards Ceremony. Jamie Smith with his prize-winning picture.

From the Registrar Trust no one unless you have eaten much salt with him. CICERO (106-43 BC)

For several years we have been running multi-disciplinary Rett syndrome clinics around the country, as a partnership venture between Great Ormond Street Hospital and the RSAUK. So it was that we awoke in a slightly seedy hotel in readiness for one such clinic, only to discover that my car keys had vanished. Our hopes were raised briefly when the barman confirmed that some car keys had been handed in – and immediately dashed when it transpired that he had done as directed on the emergency tag, and posted them in a nearby letter box. An advance party set off in the 2nd car, whilst my colleague Vicky accompanied me to the sorting office to plead our case. Thankfully the Guardians of the Royal Mail took pity on us, retrieved the keys…..and within minutes we were hopelessly lost in a country lane, having failed to ascertain the exact clinic location from our team-mates. Vicky was reluctant to phone RSAUK headquarters for directions, lest they discover that “we’re a bunch of plonkers”. Her discretion was futile. We had a senior member of the RSAUK in the advance car – our cover was already blown. A crucially important issue for all doctors – and arguably even more so for paediatricians in the current climate – is the need to inspire public confidence. Fortunately, having been ‘on the road’ with us, the RSAUK team knew we were a competent bunch of plonkers. But as far as the wider public is concerned, it’s no longer enough to be competent – we need be able to evidence-base our competence. In the last few weeks, the College has responded to two important consultations which address these themes in differing ways. The first – Confidence and confidentiality; improving transparency and privacy in the family courts – is based on the assertion that there is widespread lack of confidence in the family justice system. It proposes greater openness and public scrutiny, through allowing the media to 1

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Rett Syndrome Association UK

attend proceedings on behalf of the public. Whilst recognising the need for transparency, there are difficult questions to address about the balance between confidence and confidentiality, and the harm to children and their families which might accrue if reporting restrictions are breached. As paediatricians, we must not be seen to be defensive about identification of expert or clinical witnesses who act honestly and in good faith, but we also know that campaigns against individuals have had an untoward effect on the willingness of paediatricians to become involved in child protection cases. Clearly implementation of these proposals must take account of these complex dilemmas. We have also responded to the CMO’s report Good Doctors, Safer Patients. What is required is a revalidation/recertification process that will firstly generate the best clinical outcomes for children, secondly satisfy the public in terms of its transparency and robustness, and last but by no means least, be feasible for paediatricians to undertake. Alistair Thomson’s article, on page 9 in this edition outlines some of the challenges that lie ahead for us in achieving these outcomes. The CMO’s proposals regarding local management of fitness to practice procedures present further challenges, and I would urge members to read his report, as well as our responses to both the above consultations. These can be found at Finally, I would like to thank all those who have joined the College Consultation Panel, and hope that this article will encourage even more of you to sign up! Meanwhile, do look out for our revitalised website, which will be launched in January ‘07, and enable you to participate more actively in these important debates.


RCPCH news

Editorials From the President At this time of year my neighbours are duly impressed when a tall muscular blond man is seen on my doorstep at 06.30. He is in fact Sven the gardener, who is, surprisingly, South African, and who comes once a year to hack back the overgrown shrubs and trees in my small London garden. He is there because I am incapable of standing on top of a tall ladder without becoming hypoxic, and he is there at 06.30 because it is the only time I am there to let in the steady stream of plumbers, builders and electricians who troop through my house in an effort to prevent it from flooding, subsiding, bursting into flames etc. This is by way of saying I am busy – like all of us – and what follows is an attempt to say how we are implementing the College Vision. Health Services We have discussed with ministers the impact of current reforms on children’s services. We have regular meetings with Sheila Shribman, our National Clinical Director, and with the Department of Health. We have now identified localities where we will be involved in pilots of practice based commissioning and we involving local paediatricians with this. Sheila has convened a multidisciplinary group looking at implementing the standards of the NSF and I represent you there. We are picking issues such as urgent care, obesity and adolescent health where there is current concern and a door already ajar on which we can push. We are planning the numbers and shape of the workforce we will require in the future and have received funding to progress this with the RCOG. Reconfiguration is now on the political agenda in a major way. We have been campaigning for planned configuration of services not reconfiguration by crisis. The drivers and the outcome must be improved, safe and sustainable services for patients. We are involved in a reconfiguration project with the Academy of Medical Royal Colleges and are working jointly with the RCOG and the College of Emergency Medicine on this. Elsewhere in this newsletter is our work on modelling service configuration and effective pathway and network commissioning which will feed into this group project. Key to successful reconfiguration is effective, noncompeting organisation of planned and unplanned calls on paediatric services.

Child Protection We are rolling out the Basic Child Protection course that all SHOs should undertake and are progressing Advanced Child Protection training for SpRs. We plan to adapt the basic course for current consultants who want training in child protection or who feel in need of a refresher. The DVD, Companion and Reader are now all nearly complete. The Family Justice Training scheme starts with a 2 day course early next year. We have issued guidance on managing complaints and are working with lay organisations to improve mutual understanding of these difficult issues. Education, Training and Assessment We are as ready for the start of the runthrough grade as we can be and feel we have selection criteria and the numbers of training places that we need. We will soon pilot a new assessment tool to complement the very successful e-SPRAT. Our curriculum is approved by PMETB and soon we should have approval of a subspecialty in paediatric and adolescent mental health. We will define the resources needed for teaching by providing evidence of the time this takes. The Paediatric Mastercourse textbook is nearing completion. This will equip trainees with the knowledge needed to pass the membership examination and help them acquire competences in our basic specialty training framework. It is accompanied by a DVD and an interactive website. Whatever the response to the Donaldson report, we will need to be able to show that we are up to date in our chosen specialties. The College plans to develop or kite-mark elearning packages and real time courses for specialty “good medical practice” as well as generic professional skills. We are progressing an “educating the educators” course. Academic and Research Our curriculum accommodates academic trainees in accordance with the Walport report. We should produce model special study modules in academic paediatrics for undergraduates. I have met the NHS R&D lead to try to ensure that paediatric research is not ignored. We need more women academic role models to encourage female trainees into academic careers. The Research Division is defining the evidence-base underpinning practice in child protection.

Advocacy The Advocacy committee is developing a course in children’s rights and equity of access to health and health care. Our College press officer and newly structured policy division enable us to get our messages across more effectively. Our child participation manager and our lay committee are working with children, young people and other agencies to strengthen the impact of those messages. We are discussing developing a subspecialty in paediatric public health. International Our projects concentrate on Africa, the Middle East and the Indian subcontinent, with directors for these areas, and built-in sustainability. We are planning to develop a course on malnutrition. We run our exam overseas where it helps standards according to criteria in our overseas examination strategy. We have had discussions with paediatricians and ministers for health in countries affected by the loss of international paediatric training schemes and are planning to develop fellowship schemes compatible with the new Home Office rules. College Structure and Function I have been to a number of meetings with national and regional committees. This has been very useful for me in hearing about problems and learning from solutions. Feedback to councillors is finding its way to Council meetings and informs our debates. Our new IT team and web designers have produced a modern looking and user friendly website that will go live in January and eventually will have areas for members, international members and the public. The newsletter will be more substantial and useful to members. You will find more detail in this and subsequent newsletters. We welcome hearing from you and assure you we are all working hard on your behalf.

Patricia Hamilton RCPCH PRESIDENT

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Health Services Future Child Health Services: Modelling the Future Background The challenges facing us include factors that limit the availability of paediatricians – such as the EWTD, feminisation of the workforce, and expectations of a better career-life balance. These need to be reconciled with increasing demands secondary to greater patient expectations, the drive to deliver better quality of training, increasing numbers of children with complex healthcare needs, changing technologies, and changes in urgent care provision. Then add the impact of payment by results, choice, plurality and contestability, a general lack of priority for children’s health services and fragmented commissioning. The RCPCH vision is for high quality and sustainable services, delivered to an agreed standard as close to home as possible, but with this degree of complexity can there be any solutions? Nine months ago we started work to propose new models for the delivery of children’s health services and consider their impact on workforce and configuration of services. This article is an update on progress and asks for your opinions on the issues that are emerging. Six working parties considered specific issues ranging from acute care to neonatal services and care of the vulnerable child. Their preliminary findings were presented to the RCPCH Policy Conference in March 2006, and the majority of people acknowledged the need for improvement. The basis for better services Some important themes are emerging. The importance of a clarity of purpose -what is the service there to provide, who are the beneficiaries and further clarity about what is it not there for and how that part should be provided. Next how is this to be achieved? A family-friendly approach – involve and use the expertise of children and families in making decisions about individual treatment as well as in service development.

RCPCH news Copy deadline for next issue:

1 February 2006

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Strive for joined-up services – services structured around patient journeys, based on pathways starting with prevention, including early detection, assessment, treatment, and long-term support. These components are then delivered by individuals and teams working within networks, with the child and family experiencing a seamless journey to their destination. Continually learn from practice – consider whether the right things happened to the right children, at the right time, with the right people, in the right place with the right outcome; and then work to improve the care at an individual, a pathway and a network level. Finally, attend to detail in the delivery of the components of the pathway. In particular what needs to be done, translated into guidelines and protocols, who needs to do it, focusing on people and their competence, where it needs to be done, and with what support (everything from management structures, record systems and the roles of other professions and agencies). Focus on sustainability and try to predict any unintended consequences. Involve families, professionals, managers, other agencies, commissioners, local politicians and use their support to drive change for better services. Emerging ideas Clearly no one model will fit all situations. Two complementary strands of ideas are emerging, one based on whole-systems thinking, the other on local innovation. There is widespread support for greater cooperation between teams in a geographical area, including sharing protocols, rotating staff, joint training and developing managed networks. Local innovation includes improvements such as “consultant of the week” working, the use of assessment units to reduce admissions, better handover practice, single point of referral systems, electronic records, automated discharge summaries, electronic prescribing and a better

Honorary editor: Rashmin Tahmne Managing editor: Graham Sleight Editor: Joanne Ball Email: Editorial services: Chamberlain Dunn Associates Advertisements: British Medical Journal

skill mix in the team. All are being implemented, but not always successfully; we need to learn, share and support their implementation. Implications for configuration and workforce In remote and isolated places, all paediatricians may need to participate in the on-call rota and also provide non-urgent care. Active links with larger centres for acute consultations (telemedicine) and rotations should maintain safety and competence. Where volumes are very small, skill-mixing with other professional groups will be essential. In large and medium-sized places, two models of service provision are emerging. One team of paediatricians offering acute and urgent care across a ward, an assessment unit and an emergency department working closely with a team of paediatricians providing nonurgent care delivered in more community settings. The alternative model is that all paediatricians provide acute care as “consultant of the week” and all then provide non-urgent care in the community. Whether a separate neonatal on-call rota is required depends on the designation of the neonatal unit. Clearly a separate rota is required for a level 3 unit, but a level 2 unit should be able to be cross-covered at night from the general paediatric rota. The issue of adequate level 3 neonatal capacity still needs to be resolved. In large tertiary centres, there should probably be a separate general acute on-call rota, not involving specialists. Their time is better spent delivering specialist care, and supporting DGH based paediatricians locally. Acute provision in “small but close” places still requires further evaluation, but the linking of an urgent care centre, emergency department, with an observation and assessment unit (open for peak hours) appears to be a viable option. Paediatricians might then cover such a unit a week at a time, similar to the consultant of the week approach.

Published by the Royal College of Paediatrics and Child Health, 50 Hallam Street, London W1W 6DE Tel: 020 7307 5600, Fax: 020 7307 5601 Website: Email: The College is a registered charity: no. 1057744 © 2006 Royal College of Paediatrics and Child Health. The views expressed in this newsletter do not necessarily reflect the official positions of the RCPCH.

Health Services Issues requiring discussion and consensus The more important workforce questions seem to be: • When should consultants consider being resident on-call? • Are SHOs and registrars essential in every rota? What other skill mixes should be considered? • When is a separate consultant neonatal rota required? • Should tertiary centres have a separate general paediatric rota and not rely on specialists? • Which specialists need to offer a 24 hour hands-on service? • Which specialists could offer a networked telephone service from number of centres? • When should there be a separate child protection on-call rota? The important configuration issues hinge around: • What is the optimal size of DGH in patient children’s unit? • How far is it reasonable for children to travel to access “APLS equivalent” resuscitation skills? • Is further centralisation of neonatal skills in level 3 units the right direction of travel? • What is the contribution of paediatricians to the child mental health team? • Should acute general paediatric teams consider providing more out of hours first-contact urgent care to meet the increasing demands by families? • How many tertiary centres are needed? • What might be the impact of telemedicine? We need you… The new College website will be operational in January and we will then be consulting you more formally. In the mean-time, please think about these initial proposals. Please tell us the changes your services facing and the solutions that you consider would offer a better service for children than those proposed. Have you developed a practice you would like to share? Do please let us know. Email responses to Susan Mitchell, Head of Health Services: Simon Lenton VICE PRESIDENT HEALTH SERVICES

RCPCH news

Workforce census 2005 This excellent reference document provides you with all the information on national workforce numbers, regional workforce patterns and trends since the last census. Key findings include a considerable slowing in the growth rate of career grade paediatricians, a decline in the number of academic paediatricians and a decrease in the number of community paediatricians. Do read the discussion (pg 45). publications/research _division_workforce _docs/Census2005.pdf

A guide to understanding pathways and implementing networks This document complements existing DH policy and the Children’s NSF and will be of interest to all and of particular relevance to those planning to develop managed clinical networks.

Competences for Clinical Directors A team led by David Shortland have developed a set of competencies and skills for paediatricians leading services. These competences will be used as a basis to create a management development programme for paediatricians.

New RCPCH Health Services department Health Services has now been recognised as a separate department within the College and Susan Mitchell has been appointed as the Head of Health Services. Its remit is both to develop, share and influence policy and support paediatricians in improving their services. Contact point is Susan Mitchell, Head of Health Services

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News The British National Formulary for Children 2006 The Charter founding the Royal College of Paediatrics and Child Health contains a number of elements relevant to the joint production of the BNF for Children. The Charter gave the College power to encourage the publication by paediatricians and others of original work of medical or scientific value in the chosen field of Child Health; to disseminate information about paediatrics; to raise the standard of medical care provided to children; to educate those concerned with the health of children and to advance the education of the public and in particular medical practitioners in child health. Medicines for Children was first published in 1999 and quickly became the authoritative reference book for prescribing, dispensing and administering medicines to children. I was involved with that first edition as a contributor and to a greater extent with the second edition of Medicines for Children as Chairman of the Joint Standing Committee on Medicines between the Royal College of Paediatrics and Health and the Neonatal and Paediatrics Pharmacists Group. In the introduction, I cautioned that “much more still needs to be done”. The second edition was carefully guided to fruition by Dennis Carson who worked tirelessly as Chair of the Editorial Board. In his preface he concluded “in keeping with the first edition, we invite feedback to correct our mistakes, share ideas, offer criticism and, when deserved, words of encouragement”. It is in that spirit that I am appealing to you via the College Newsletter. The two editions of Medicines of Children were written with a grant from The Nuffield Foundation and immense goodwill from paediatricians and pharmacists throughout the country. However, it was difficult to see that this would be a sustainable model. The College and the Neonatal and Paediatric Pharmacists Group therefore negotiated with the Royal Pharmaceutical Society and BMJ

Publishing who had for many years produced the British National Formulary. The BNF relies on a full time editorial staff and this capacity, not dependent on charitable funding, was seen as a way of securing a long term solution for the need to provide easily accessible and readily updated information on prescribing for children to all of those involved in the care of children. The first BNF for Children (BNF-C) was published in 2005. By uniting the information contained in the previous editions of Medicines for Children, in particular the consensus recommendations around off-label and unlicensed medicines, and the experience and knowledge of its contributors and other national experts with the editorial and publishing skills of the BNF team, this publication was a landmark in paediatric prescribing. The second edition was published in July 2006. The UK Health Departments have ordered and paid for sufficient copies to ensure that all NHS staff that treat children with drugs have a copy. The information in BNF-C is still arranged in the very familiar order of the Standard BNF and although many paediatricians have found this less accessible than the alphabetical format of Medicines for Children, the alignment with the Standard BNF is useful because many of those who prescribe and dispense for children (e.g. General Practitioners and many pharmacists), also refer to the Standard BNF in their daily work. Several changes have been made to the presentation compared to the first edition. Doses are now more clearly identified and each does is linked to its indication. Tinted panels have been added to highlight safety concerns and practical information on administering drugs is now easier to pick out. In addition, emerging new information is also presented in the new edition, for example, the value of a single dose of Dexamethasone in

the management of even mild cases of croup is noted. Perhaps one of the most important revisions is the presentation of drugs and doses used in paediatric emergencies set out clearly for ease and speed of access on the glossy pages at the back of the book. There are also useful algorithms for basic and advanced paediatric life support and newborn life support and conversion tables and nomograms to assist with prescribing. BNF-C 2006 is certainly an improvement on the first edition but we would all wish for BNF-C 2007 to be even better. The success of BNF for Children is thanks to the Paediatric Formulary Committee which has produced it, under the chairmanship of George Rylance and with a membership drawn from paediatricians, children’s pharmacists, clinical pharmacologists and representatives of the BNF staff. However, to assist them in making BNF-C 2007 even better, the BNF team need feedback from practising paediatricians, general practitioners, paediatric pharmacists, children’s nurses and other healthcare workers. If like me, you found that your Athens username did not allow you on-line access, or you too found the section on compound preparations for treatment of chronic asthma confusing, then take those constructive criticisms to the BNF so that the next version can be even better. Please do not send your criticisms to me or to George Rylance but to the Executive Editor, e-mail: Things are rarely perfect the first time round and most publishers reckon the second edition is always better than the first. Perhaps together we can make the Third Edition of the BNF for Children even better. Professor Terence J Stephenson VICE PRESIDENT ELECT, SCIENCE AND RESEARCH

Membership fees 2007

The Main Subscriptions Rates for 2007 will be as follows (Inclusive of Archives of Disease in Childhood)

Council has agreed that subscriptions for 2007 for those resident in the UK, Republic of Ireland, the EU and North America will only increase by 2%, which is below the rate of inflation. There will be no increase in subscriptions during 2007 for those resident in the rest of the world. A personalised statement informing you of your 2007 subscription amount and all the concessions available will be sent to you in mid December.

Fellow (UK and Republic of Ireland) Fellow (rest of EU and North America) Fellow (elsewhere) Ordinary Member (UK and Republic of Ireland) Ordinary Member (rest of EU and North America) Ordinary Member (elsewhere) Associate Member (worldwide) Junior Member (UK only) Senior Fellow/Member Honorary Fellow

l l l

In addition those resident in the UK and Ireland pay levies and possibly surcharges. Standard concessions will continue to be available. Those suffering from financial hardship may be eligible (depending on their circumstances) for a non-standard concession. For further information please contact the membership section email or telephone 0207 307 5619)

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£404 £303 £194 £339 £256 £162 £247 £144 £144 £75


RCPCH news

Draw to win RCPCH 10th Birthday Drawing Competition ‘Me and My Doctor ’ Following the huge number of entries received for the RCPCH 10th Birthday Drawing Competition ‘Me and My Doctor’, the winners received their prizes at a special event held at the Merchant Taylors’ Hall in London on Wednesday 25th October. According to all the feedback we received, the day was a resounding success and helped to raise the profile of the College with patients and families. Artist Credit: Tracey Kusi, age 12-17 category.

Christa Woodman, Trustee of AYME (The Association of Young People with M.E.) and judge for the 5 to 11 age group, said: I recently became the Members’ Rep on the Board of Trustees at AYME. I heard about the opportunity to be a judge for a day and thought it sounded really intriguing. All the winning pictures had been blown up, printed and displayed on boards. Each winner was presented with a certificate and a framed copy of their drawing plus either vouchers, or for the first prizes a bike, or art equipment. The venue was beautiful and added to the atmosphere. It was an amazing day and I was delighted to be invited to be part of the prize-giving ceremony. The winners with framed copies of their pictures to take home. From left: Emma Arnold,Tracey Kusi, Isobel Jackson, Jamie Smith, Alanah Davies-Brown, Stephanie Copeland, Ryan Wilkins.

Chris Verity, the College’s Vice President (Education), said: I was really pleased to judge the pictures in the older age group and meet the artists themselves at the prize-giving. The judges agreed that the entries were excellent and we had a lot of fun looking at them all. I hope the children and young people who attended the prize-giving enjoyed themselves as much as I did. Our thanks to WellChild for allowing us to share the venue at Merchant Taylors’ Hall and to all colleagues who helped to make the day a success.

Sophie Auckland CHILDREN AND YOUNG PEOPLE PARTICIPATION MANAGER The drawing competition judges, clockwise from left: Deni Kadirov, Chris Verity, Sally Sweeney Carroll , Saskia Ottignon, Christa Woodman, Purvangi Dave.

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Education ‘Child in Mind’ project update The ‘Child in Mind’ Project is an initiative of the RCPCH with support from the Royal College of Psychiatrists and the British Psychological Society. It is funded by the RCPCH and the Department of Health. The remit of the project is to design training materials for paediatricians in child mental health as it relates to paediatrics (paediatric mental heath). The materials cover most of the child mental competences found in the RCPCH’s A Framework of Competences for Basic Specialist Training in Paediatrics. Courses for SHOs (STs 1 - 3) are designed to be run alongside or be integrated into the regular departmental teaching programme, delivered by a lead senior paediatric trainer with a child mental health co-trainer. At the heart of each course are two or three seminars, which are interactive and multi-media. Evaluation rates them highly with very positive feedback from trainers and trainees. Self-directed learning activities with mentoring reinforce the seminars. The teaching materials for stage 1 & 2 are located on ‘Child in Mind’ Web Works - a password protected web forum linked to the RCPCH website. Usernames and passwords

are issued following attendance at a ‘Training the Trainers’ workshop, which teaches senior paediatricians how to make best use of the training materials. Workshops will be held in May and November of each year for each stage (stage 3 to commence in 2007). STAGE 1: Early Paediatric Training A course designed for trainees new to Paediatrics and GP trainees. Communication is a theme that runs throughout this course. It includes three interactive multi-media seminars as outlined below plus self-directed learning activities: 1. Communicating with Children 2. Children Talking with their Bodies 3. Paediatric Assessment of Deliberate Self-harm STAGE 2: Paediatric Assessment of Behaviour A course for ‘community based/focused’ pre-membership trainees which follows a similar format to stage 1. There are two seminars: 1. Paediatric Assessment of Behaviour: (1) Pre-school 2. Paediatric Assessment of Behaviour: (2) Primary school

STAGE 3: Neonatal Cognitive and Emotional Development A similar course for neonatal pre-membership trainees. The seminars are: 1. The Competent Newborn 2. Promoting Positive Relationships Stage 3 is currently piloting in six sites across the UK. Piloting will finish at the end of January 2007. After analysing the feedback and making any modifications necessary, the course will be added to Web Works. For further information and to download application forms for ‘Training the Trainers’ workshops please see: child_in_mind.html


Safeguarding Children Training Programmes: An Update Level 1: Recognition & Response in Child Protection educational programme for doctors in training: A collaboration between the RCPCH, NSPCC and ALSG Following the launch of this programme at the college in January 2006 and the inaugural course in Newcastle in March 2006, we are pleased to report that there have been 17 courses across the UK training approximately 300 candidates. There are 15 course centres established, representing all four countries in the UK and many of these have already run a course. The trainer training has produced a group of 150 recognised trainers, which is enough to sustain 100 training courses each year. There are also many potential trainers who will be attending a three-day trainer course or a one-day masterclass in the near future. We are really grateful for the support and positive feedback we have already received for this programme – we would like to encourage anyone else who is interested to contact us. Potential trainers can get further details about eligibility and the training process on the ALSG website

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If you are interested in setting up a course centre, please contact Jenny Antrobus . If you have any general queries or feedback, please contact Neela Shabde, Project Director or Sue Wieteska, Project Manager on; Level 2: A collaboration between the RCPCH and ALSG We are pleased to report that, following wide consultation amongst designated and named doctors, college members including trainees and college committees, development work for the Level 2 programme for specialty trainees, career grade doctors and consultants is underway. The project schedule is due to complete at the end of 2007 and we are currently on track to achieve this deadline. The programme will build on the Level 1 Recognition & Response course and will predominantly be delivered in the virtual learning environment (VLE) with some face-to-face training. Based on the consultation, six core modules have been identified and the learning

outcomes defined, these are epidemiology, underpinning principles, legislative framework and systems, clinical topics, special circumstances and communication. Communication being a common thread throughout all of the modules. Development teams have been recruited and trained, each of the development teams has a trainee representative. The development site is up and running and material is being sourced and generated. In many situations, where there is excellent existing material this is being signposted rather than reinvented. We are also taking into account other existing programmes and aiming to ensure that, where possible, these are acknowledged or signposted appropriately. If you are interested in becoming involved in this development we are looking for potential expert reviewers and also potential facilitators. If you are interested in becoming an expert reviewer could you please contact Neela Shabde Potential facilitators can learn more about the selection criteria and details of the training involved on the ALSG website


RCPCH news

Continuing Professional Development and Revalidation Since the last CPD item in the newsletter, the consultation period on the CMO’s report Good Doctors, Safer Patients has been and gone. Amongst its 44 recommendations were a number that impinged on CPD. This is not surprising, given the close relationship between CPD, appraisal and revalidation. In the document RCPCH Vision and Values (distributed with the last newsletter), our President sets out the current and future position of CPD and Revalidation. The vision for CPD is that it needs to develop from the current framework and monitoring process towards a system that will support professional development through Collegeapproved credentials and assist appraisal and revalidation/recertification. The RCPCH should be able to satisfy the public and the GMC that we have effective ways of enabling paediatricians to demonstrate continuing competence, perhaps including (for example) video assessment of professional skills. The Education Department is examining aspects of post-CCT learning, including e-learning and website-based facilities for CPD and acquisition of specialist credentials. Are paediatricians themselves ready for this? The latest CPD audit suggests not. In 2005, 147 doctors’ 2004 CPD documentation was audited (5% of the CPD participants). The majority (94%) were able to produce

sufficient evidence to satisfy the audit criteria. However, full documentary evidence for all points claimed was only provided by 21% of auditees. This is a significant decrease in standards of documentation over the three years of the audit process. It suggests that stringent attention is not paid to CPD at appraisal, and that a revalidation system that relies on CPD evidence may pose difficulties. The quality of evidence submitted was also examined. Auditees were asked to produce ‘evidence of learning or attendance at an event’. The majority of evidence provided related to attendance rather than learning (i.e. chiefly certificates, as well as participant lists, invoices and other relevant correspondence). Perhaps worryingly, given Donaldson’s recommendations, only 19% were able to provide documentation to substantiate actual learning, in the form of personal note-taking or reflective notes. Many paediatricians are therefore not yet up-to-speed in keeping and collating the evidence of their lifelong learning in a way that would pass a revalidation inspection. However, I am encouraged by the participation of paediatricians in a number of initiatives that are being taken in anticipation of plans for revalidation. For example, there is a project being run by the Academy of Medical Royal Colleges on 360-degree appraisal - similar to

the SPRAT tool already developed and used in the RCPCH. This Academy project aims to use 360-degree appraisal as a ‘formative’ process (that is, as a development tool), rather than a summative one (i.e. not as an assessment tool). Another joint Medical Royal College project on CPD is in the final stages of design. If any of you wish to know more about, or participate in these projects please contact me. Finally, the 2007 CPD guidelines should be with you soon. These guidelines remain similar to previous versions and comply with the Academy of Medical Royal Colleges document The 10 Principles of CPD ( Don’t forget that the CPD scheme can work for you2, and that you can make returns online (at If you have any problems please let the RCPCH CPD office know (via Anna Emerson at 020 7307 5600) or correspond with me. 1. RCPCH Vision and Values. RCPCH 2006. 2. Thomson A P J. How to make the RCPCH CPD Guidelines work for you. Arch Dis Child 2005;91:65-67.

Alistair Thomson CPD OFFICER


Anne Diamond received the first College Medal from the President at a dinner held at Tate Modern on 1 November to mark the College's 10th Anniversary. Anne Diamond received this honour in recognition of her tireless work and advocacy around the issue of cot deaths.

At the time of writing, the SASG committee is busy preparing for our Annual SASG information day to be held at the College on 1 December 2006. Topics include Making the Most of the SASG Role, PMETB Applications, Modelling the Future and Child Protection work. So it should be a very interesting day. We hope to put summaries of the presentations on the RCPCH website. As you are aware there is now a new route by which Associate Specialists can gain Membership to the RCPCH: membership by election. So far, two candidates have been successful and a further three will be considered at the RCPCH Council meeting on 1 November 2006. Details of this route are available from the Membership Department of the RCPCH. The College has been busy assessing applications to the Specialist Register under Article 14 and making recommendations to the Post-graduate Medical Education and Training Board. The RCPCH recommendations on the type of evidence to use to support an application are available on the PMETB website. Natalie Lyth CHAIR OF THE SASG COMMITTEE

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Research New Clinical Effectiveness website This last area is one of high importance. As a stakeholder, the College is regularly invited to comment on the development of a particular guideline by national bodies such as NICE or SIGN. This could involve commenting on a draft document or nominating College members to join the guideline development group. It is essential that paediatricians are involved in the process to help influence the content of the guideline to ensure that the needs of children and young people are considered and that the end product will help improve practice and ultimately help improve health outcomes for children. See the ‘get involved’ page of the website for more information. The website will be regularly updated to keep you up-to-date. If you have any comments or suggestions for improvement, the team would be pleased to hear from you. So save the web address in your favourites today: and email your comments to

• Do you want to know how to develop guidelines to College standards? • Do you want to know what paediatric guidelines are available? • Do you wish that you had a chance to comment on the content of guidelines before they landed on your desk? • Do you need to improve your knowledge and skills in evidence based medicine? If the answer to any of these questions is yes, then read on! The College’s Clinical Effectiveness team, overseen by the Quality of Practice Committee, has launched a new website to replace the quarterly publication CHERUB as part of the College’s wider aim to promote evidencebased practice amongst paediatricians. The website, which can be found at, includes more resources than could be included in CHERUB such as information on national guidelines relating to paediatric practice, advice on developing and implementing guidelines, useful resources,

courses and events, information about the Quality of Practice Committee’s appraisal and endorsement programme, and ways in which paediatricians can get involved.


United Kingdom Paediatric Chronic ITP Registry In 1997 and 2001 the RCPCH supported two audits on childhood immune thrombocytopenic purpura (ITP). These audits allowed us to establish the incidence of acute ITP and the frequency of bleeding complications, and also aided development of national guidelines. We are now pleased to announce the development of the UK Paediatric ITP Registry The Registry’s primary objective will be to establish the consequences of ITP on the frequency and severity of bleeding symptoms and on the requirement for treatment. Secondary objectives include the collection of data on the long-term outcomes of ITP, on the frequency and outcome of intracranial and other significant haemorrhage, and on the various treatment strategies used to increase patients’ platelet counts. We anticipate that information collected through the Registry will subsequently be used to identify children at high or low risk of

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significant haemorrhage so that interventional treatment could be offered appropriately. Children aged between two months and sixteen years diagnosed with acute ITP in the last 12 months are eligible for recruitment now. What work is involved for data collection? MREC has agreed that all sites participating in this study are exempt from site-specific assessment. There is no need to inform Local Research Ethics Committees about the research. You will need to notify your local R&D department about the research and provide copies of REC application and approval letter, both of which can be downloaded from the website Data requested will consist of standard information stored in the medical notes such as bleeding episodes, therapy required and blood counts. Follow up information will be requested six months after

registration: no further information will then be collected on those children whose ITP has resolved whereas data will continue to be collected annually on children with ongoing chronic ITP.



RCPCH news

Regional Sub-Committees in Scotland Call for nominations to North, North East & East of Scotland Regional Sub-Committee Scotland is in the process of setting up 3 Regional Committees (N, NE & E; South East and West) and has essentially followed the model for England and Wales. The intention is to have these operational by the beginning of 2007. There is a vacancy for a Deputy Regional Representative for the North, North East & East. The Regional Representative, Dr Donald Macgregor, would like to hear from any member in that region who is interested in becoming a member of this group and with suggestions on how the sub-committee might

be modified to suit local needs. For more information on the membership and remit of this sub-committee please contact Deanne Tomasino, or 0131 247 3644. Suggestions to Dr Donald Macgregor at

Videoconferencing facilities in Scotland - new ways of working Videoconferening facilities should be up and running in the Edinburgh office and in London during November. New technology often leads to new, and hopefully improved, working practices. Sometimes the uses and benefits are obvious, such as reducing

Contributions sought for anecdotal review to mark WellChild’s 30th Birthday in 2007. In 2007, WellChild (formerly Children Nationwide Medical Research Fund) will be 30 years old. Initially set up as research organisation, ‘Kidney’, in response to a young child dying of kidney disease, the charity has developed over the years to support any area of paediatric research and well as providing care and support to chronically sick children and their families. WellChild is proud of having supported many pioneering young researchers whose work has led to significant changes and benefits to children’s health covering many areas including kidney disease, prematurity, liver disease, genetic epidemiology, pain and cancer. As we mark our 30th birthday milestone, we are looking to produce an anecdotal publication/review of the major changes across all areas of children’s health, wellbeing and treatment over that period as well as looking forward to the next 30 years with a glimpse into the future of possible child health concerns in 2037 and beyond. We are gathering

contributions from a wide range of medical professionals, opinion leaders, healthcare practitioners, charity professionals as well as parents and children from the different ages. As a member of the RCPCH, we would be most interested to hear your thoughts, in short, personal, layman’s narrative (no more than 300) words on your particular area of interest and if possible your thoughts on what general achievements, breakthroughs have had the greatest impact over this period. We are also keen to gather your thoughts and views on what, in an ideal world, could and should be done to bring the maximum benefit to children’s health (generally or your particular area) in the next 30 years. We do hope you will be able to contribute to this publication which will be launched at a high profile event in mid 2007. All contributions will be fully credited. Please email contributions to or post via Freepost to Wellchild, Freepost NAT3575, Cheltenham, GL50 1BR.

travelling time of busy paediatricians to meetings in London - making it resource efficient, assisting decision-making which includes the views of all concerned, and at times it is used in ways that could not have been predicted. Scotland, in spite of being the most likely beneficiary in the UK for videoconferencing and telemedicine, has lagged behind somewhat. Tele-education.will continue to develop and the College hopes to facilitate such developments and help widen its application. The up-to-date equipment has excellent image quality and should have little or no difficulty connecting to older NHS systems. For availability of this facility in the Edinburgh office please contact Claire Burnett on 0131 247 3644 or

LETTER TO THE EDITOR Dear Sir, I read, with interest, the obituary of Professor June Lloyd [Newsletter Autumn 2006, p6]. I felt it clearly outlined her career and her strengths and weaknesses but made her sound like quite a forbidding person. She was formidable but, behind the stern and brisk manner, I think she was a very warm and caring person. I worked with her for a year on a Fellowship supported by the British Council, when she was very encouraging and supportive, and continued to support me in various ways as I built my career over a period of time. I did not, therefore, experience the comment “women did not find her so easy”! She fostered a very happy atmosphere at the Institute of Child Health within staff who worked on the same floor, and sent a Christmas card each year to May, the laboratory instrument cleaner, even after May had retired and up until her death a few years later. It was good to see her talking to children in her own way, paying careful attention to them and never talking down to them. She once said, “Don’t you think paediatricians are much nicer than other doctors? You can’t sit on the edge of the bed and have a chat with adults as you can with children! It is difficult to be pompous around children, isn’t it?” This is how I like to remember June, not as the perfect and somewhat glacial person who appears in the obituary. Yours sincerely, Dr Meher Pocha CONSULTANT PAEDIATRICIAN, BEDFORD We welcome letters on subjects raised by the newsletter. They can either be sent by post to the Newsletter Editor, c/o the College address or via email to

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Trainees column We thought a few pictures would add a little more interest to this column. We have a meeting once a year outside London. This year a very successful meeting was held at Cardiff. These meetings are followed by a trainees’ forum where any trainee can come and ask questions. Our meeting next September is to be held in Leeds. However, prior to this the trainees’ forum will take place at the York meeting. This will be followed by a trainees’ dinner on the Wednesday night – purely to enhance the social opportunities at York at a trainee level. We all have friends who have moved to different regions – why not use York as the excuse to meet up?

competency based curriculum in a new period of transition. Study leave budgets: Many of us have found study leave is becoming increasingly difficult to take both in terms of time and money. There has been a central reduction of funds allocated to doctors for study leave just as the costs of courses increases. We have joined the BMA JDC in expressing our disapproval of this. In the context of “more significant” NHS cuts, we may not be heard. Donaldson report: A report from the Chief Medical Officer (see also Registrar’s Column page 2) is currently out for consultation, to the College among other bodies. It is called Good Doctors, Safer Patients. It is seeking to entirely overhaul the way that the GMC works and disciplinary matters are dealt with. It has been born out of the disasters of Shipman and the Bristol cardiac cases. We believe that some of the changes proposed are extremely worrying. We would encourage you to have a look at this document on the DH website.

The Trainees Committee in Cardiff.

Onto trainees’ issues:

Ari Kannivelu, Trainee Representative for West Midlands region.

Jess Oldfield, Trainee Representative for Yorkshire region.

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MMC: Implementation of MMC is gathering momentum. There have been calls for delay to this process. However, the start date of August 2007 remains and it will affect everyone. There has been a huge amount of uncertainty and unanswered questions on MMC, but great effort is being made to improve communication to trainees to help allay some of the concerns. The advice for the anxious SHO is to keep checking the MMC website ( and the deanery websites for up-to-date information. The most recent and significant change is to the ST application process. You may now apply to 4 areas for one specialty or two areas for two specialties. It is important to get someone to look at your application prior to submitting it. It can make a massive difference and will ensure that you are applying at your correct level of experience. SpRs will also be affected by MMC. Almost all jobs including SpR posts that were due to finish in September 2007 are now moving to changeover in August 2007. Eventually, SpRs will move over to the new

IMG’s: Negotiations are still taking place with the DH over how the new work permit rules will affect IMG’s in MMC. Website: The college website is undergoing a major overhaul including the trainees’ section. It will be more user friendly and more informative. It contains contact details of all regional trainee representatives, so please feel free to email us if you have a query. As ever, we are looking for people to join our committee – there are calls for nominations in this pack. Martha Wyles

Paul Dimitri

RCPCH news


RCPCH meetings Advanced Course in Paediatric Bone and Calcium Metabolism The Centre for Ethics in Public Policy and Corporate Governance at Glasgow Caledonian University is currently developing an MSc in Bioethics and International Health Law. This is a unique, intensive postgraduate programme which provides a sound knowledge of ethical and legal concepts and their application to issues in biomedicine and health care delivery. The programme covers a wide variety of contemporary ethical, legal and social issues relating to biomedical science and health law, including: common ethical theories and their application; professionalism and proper conduct; beginning and end of life issues; research ethics; developing world issues; reproductive health; genetics; resource allocation; human rights; informed consent; confidentiality; and research involving underage participants. The first intake of students is intended to be early 2007. We would value input from the profession with regard to the likely interest in such a programme. Any feedback would be greatly appreciated. Professor Udo Schuklenk, Head of the Centre for Ethics in Public Policy and Corporate Governance, Glasgow Caledonian University. Professor Schuklenk can be contacted on 0141 273 1422 or at

RCPCH meeting 20 February 2007 Diabetes in the Young joint between the RCPCH/RSM Venue: The Royal Society of Medicine, London Contact: Andrea Torok Tel: 020 7290 2986 Fax: 020 7290 2989 Email: Website: To guarantee your place please register by Friday 9 February 2007.

UK meetings 12 December 2006 How to be a success as a new consultant Venue: The Royal College of Physicians, London Tel: 020 7935 1174 (extension 252) Fax: 020 7224 0719 Email: 14-15 December 2006 Clinical Genetics Venue: University of Warwick, Coventry Contact: Dr Charlotte Moonan Tel: 024 7652 3540 Email: 9 January 2007 Neonatal Cranial Ultrasound Course – 4 full day modules Venue: Birmingham Women’s Hospital, Edgbaston Contact: Sharon Kerr Tel: 0121 623 6893 E-mail:

11 January 2007 Symposium on gastro-oesophageal reflux Venue: The Royal Society of Medicine, London Contact: Andrea Torok Tel: 020 7290 2986 Fax: 020 7290 2989 Email: Website: To guarantee your place at this meeting please register by Tuesday 2 January 2007.

16 February 2007 Working with Interpreters Venue: University College London, London Contact: Dr Alexandra Argenti-Pillen Tel: 020 7679 8641 (ext. 28641) Email: Working%20with%20Interpreters/main.htm Friday 9 March 2007 British Academy of Childhood Disability Annual Conference 2007 Autism spectrum disorder: the evidence Venue: Assembly Rooms, Derby Contact: BACD Administrator, Royal College of Paediatrics and Child Health Tel: 0207 307 5625 E-mail:

Worldwide meetings 11-14 January 2007 Pedicon 2007 Venue: Renaissance Mumbai Hotel & Convention Centre, India Web:

25-26 January 2007 A Third Update in Genetics for Paediatricians Venue: Wales Gene Park, The Medicentre, Heath Park, Cardiff Contact: Angela Burgess Tel: 029 2068 2140 Email: Website:

14-16 March 2007 Perinatal brain damage: from pathogenesis to neuroprotection Venue: Auditorium San Romano, Lucca, Italy Contact: Elena Fanari Tel: +39 02 795458 Email: Website:

6 February 2007 Female Genital Mutilation in a Globalized Age - International Zero Tolerance Day Venue: RCOG, London Tel: 020 7772 6245 Email: Website:

22-26 January 2007 21st Annual San Diego International Conference on Child and Family Maltreatment Location: Town and Country Resort & Convention Center, 500 Hotel Circle N, San Diego, CA, 92108 Tel: 858-966-4972 Fax: 858-966-8018 E-mail: Web:

10 February 2007 Interview Skills Training (Sponsored by PULSE Academy) Venue: Central London Contact: 01992 305 792 Email: Website: Cost: £160 + VAT

25-30 August 2007 25th International Congress of Paediatrics Location: Athens, Greece Tel: 02-2-106-889-100 Fax: 30-2-106-844-777 E-mail: Web:

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RCPCH Newsletter 06 Winter  

Newsletter from the Royal College of Paediatrics and Child health

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