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AUTUMN 2012 newsletter

Notes Improving communications with members – page 4

RCPCH releases the results of two major national audits

Members for media The RCPCH is always keen to hear from members who are willing to speak to the media on behalf of the College, either as part of our proactive campaigning work, or reactively in response to research findings or news articles. To find out more: email: tel: 020 7092 6067

Epilepsy12 launch – from left to right: Professor Helen Cross, Professor Neena Modi, Dr Hilary Cass, Valerie Vaz MP, Jhon Bateman, Dr Colin Dunkley

Join the RCPCH events mailing list Be the first to hear about events and courses near you. Sign up to our events e-newsletter at: www. and view our complete events calendar, including: •

Paediatric Educators Programme Obesity Assessment and Management in Children and Young People

The results of two major national audits led by the RCPCH launched last month in-line with the College’s aim of raising standards and reducing childhood morbidity and mortality. •

EPILEPSY12 AUDIT UK’s first national audit of epilepsy care for children and young people

NATIONAL PAEDIATRIC DIABETES AUDIT Largest ever paediatric diabetes audit of England and Wales

Child Health in Developing Countries

Child Protection Study Day (Scotland)


Welsh Paediatric Society Autumn Meeting

About 1 in 200 children in the UK are affected by an epilepsy – yet the standard of care they receive remains

variable, according to the results of the UK’s first national audit of epilepsy care for children and young people. The Epilepsy12 National Audit examines the provision of healthcare for children and young people with suspected epileptic seizures against 12 standard measures derived from NICE and SIGN Standards. It was largely undertaken by local paediatricians and nurses keen to find ways to continue improving the services they provide – and 98% of relevant children’s NHS Services took part. It also captured parent’s and young people’s experience of their service. The audit found marked variation in the quality of care for children and young people with epilepsy and their families. Some figures were encouraging; including over three-quarters of children and young people with epilepsy seeing a paediatrician with expertise in childhood epilepsies and 95% given carbamazepine appropriately – a medicine for controlling epilepsy. Continued on page 6


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1 News

RCPCH releases two major national audits. (cont. p6)

Members for media

Join the RCPCH events mailing list

2 From the President 4 Your views

Improving communications with members

5 Training and support

Revalidation – preparation for launch

START Assessment – November 2012

From the President Behind the scenes at the College

New guidelines standards New e-learning materials

6 Your RCPCH RCPCH releases two major national audits

Child Health Reviews – UK case notifications

Turning the Tide: harnessing the power of child health research Youth Advisory Panel Working together to safeguard children

E-learning for child mental health

Obesity campaign and RCPCH

College Governance review

RCPCH International

10 Committee News

SSASG news

Training matters

Your chance to get involved in College work

Editors: Jo Ball Sarah Quinlan Brian Dow Email: Editorial services: Work Communications 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: Email: The College is a registered charity: no. 1057744 and registered in Scotland as SC038299


‘Today is the tomorrow you worried about yesterday’ Proverb It’s 15 minutes before the Membership Ceremony is about to start. New Members, Fellows and their families are filing into the magnificent Church House Assembly Hall in Westminster, and there is an air of expectation and excitement. Meanwhile, outside the Hall, the members of the platform party are each dealing with their own personal anxieties. Kevin Windebank, our Examinations Officer, has rushed straight down from his clinic in Newcastle, but during his hasty departure has become separated from his tie, and is hence awaiting the arrival of an ‘emergency’ College tie. Daniel Lumsden, Chair of the Trainees’ Committee, is waiting with some trepidation for the padlock to be removed from the wooden mace box; this is to be his first appearance as mace-bearer, and he has yet to discover whether the object in question is heavy enough to make mace-bearing a future Olympic sport. And I have just realised, as I don the College gown, that it clashes rather horribly with my turquoise blouse, and that this sartorial error is about to be photographed over 100 times. It strikes me that this scenario sums up how we live most of our lives. All around us are the ‘big print’ issues; economic recession, major health service reform, and the cycle of life and death in our professional, as well as our day-to-day lives. But for 90% of the time we can only worry about the issues we have to get through in the next hour, we ‘sweat the small stuff’ because the big stuff is too

difficult, and regardless of anyone else’s problems, we inevitably fret about our own. For example, right now on a Sunday evening, my big problem is getting this column written by the copy deadline (tomorrow morning!) so I don’t incur the wrath of the publications team. So for the next few minutes while you flick through this restructured edition of Notes, I’m asking you to live in the other 10% of your day; the moments when you draw breath to think about the strategic issues, the shape of paediatrics, your career development opportunities, and how the College can evolve to help with all these challenges. Some thoughts on children’s healthcare Over the last few weeks I’ve gone on record in the press to say that all is not well with children’s healthcare in the UK. Whether or not you live in England, I would urge you to read the Report of the Children and Young People’s Health Outcome Forum ( files/2012/07/CYP-report.pdf) because many of the identified problems apply to our children’s healthcare system across the UK. If we look at acute care, we already know that our all-cause mortality for children under 14 is amongst the worst in Western Europe. Turning to long term condition management, in this edition of Notes you will see the results of two major national audits – the Epilepsy12 Audit and the National Paediatric Diabetes Audit. Both of these audits identify wide variations in care, as well as some disappointing figures about how we are doing compared to best practice guidelines and to other parts of Europe.


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President’s roadshow In order to launch her new vision for RCPCH and paediatrics, Dr Hilary Cass will be speaking at a number of locations around the UK over the forthcoming months. Dr Cass will speak about her six priorities for paediatrics and the session will provide an opportunity to discuss issues surrounding sustainability, workforce development and education provision. Further information about Dr Cass’ six priorities can be found at:

None of this means we should be wringing our hands or beating ourselves with nettles. The first take home message is that variation is both good and bad; it means that there are some really good areas of practice that we can build on and learn from to improve practice more broadly. But perhaps the most important message from these audits is the massive contribution that paediatricians have made to collecting this incredibly powerful data set. Literally hundreds of you have taken time out at the end of busy days – doubtless beset by overrunning clinics and missing notes – to contribute to this common purpose. For Epilepsy12 that meant 186 units providing data about nearly 5,000 children. And that’s just one example of what is being achieved in the ‘10% time’ which almost inevitably happens outside of working hours. Of course, another reason not to beat ourselves up is that we know paediatricians are just one link in the chain when it comes to producing good outcomes for children. Deficits in care have much broader implications for all systems, services and professionals, so the responsibility now sits on my shoulders and those of everyone in a leadership role to use the information wisely. That may mean lobbying for more resources in a tight economy, working out how to develop better designed and integrated services or implementing changes to the way we train professionals across primary and secondary care.


26 October Nottingham

12 December Oxford

13 February Bristol

28 February Cardiff

For further information about these events, please email:

Of course, you have to allow me one small ‘nag’, and that is about Child Health Reviews–UK (see p. 6). We need you to engage with that as effectively as you have with these audits, and ensure that you respond to the monthly emails or opt out of them if you don’t see children with epilepsy. It should take less than a minute a month, and will make a massive difference to the data. A few words about the College Also in this newsletter, you will find an article by Chris Hanvey, our CEO, about the planned governance review. As Chris explains in his article, one key intended outcome is that we should have a Board and governance structure that is fit for the 21st century. That has to be just the start of more accountability and streamlining throughout our College activities. I know many of you feel frustrated by how opaque College processes can be, and that is a fair criticism. At present we have over 100 College committees – almost one for every member of staff. If we are going to ask Trusts to release paediatricians to do College work we have to make sure it is being done in the most streamlined way, with clear outputs and no duplication of effort. We have to use paediatricians’ time to best effect, and that has become ever more possible because we have such a strong staff team. If you scan through this newsletter you will see many more articles authored by members of staff, not just by paediatricians. Our staff have skills that are different and

complementary to our own, and on which I rely heavily every day. A paediatrician recently came to see me to talk about how we could do more for undergraduates to encourage them into paediatrics. She had many excellent new ideas, which we will be exploring, but some of her suggestions were for things we are doing already in terms of profiling paediatrics at career fairs around the country, with staff giving up their weekends to support these events. The same was true of suggestions that came in when I put out a Twitter call to ask how we could evolve the College to serve members better. It has always been a challenge to demonstrate to members just how much is going on behind the scenes at the College, and to help everyone access what is available. I will be continuing to look at ways of making what we do more visible. We are already developing and growing our communication approaches, and exploring new options including smartphone apps and more creative uses of our website. As ever, I would ask you to carry on sending in your suggestions for how we can improve our communication with you in the coming months, as well as telling me about other ways in which we can improve what the College has to offer.

Dr Hilary Cass President



Your Views

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Improving communications with members NHS structures Diagram:

We’re keen to make sure that the College communicates effectively with members – and that members have the chance to feedback on College activity and input into our key areas of work. So we’ve recently developed a range of tools designed to promote two-way communications, including: • A toolkit – Health Reforms: Your Say, providing a one-stop shop for information relating to the new NHS reform structures. The toolkit also acts as a mechanism for feedback on what’s working and what isn’t now the Health and Social Care Act in England is in place: health-reforms-your-say • Utilising social media channels – Twitter (@rcpchtweets) and Facebook to promote events and news • Delivering a programme of road shows which will get key RCPCH Officers out into your community • Developing an extensive calendar of policy, education and training events. All comments are welcome, and we’ll be highlighting some of your feedback in future editions of Notes.

Health reforms – your say In March 2012, the Health and Social Care Bill received Royal Assent to become the Health and Social Care Act (2012). Now that this Bill is an Act of law, our focus as a College is not only on shaping the content of the legislation but also on how it will be implemented by healthcare professionals, local authorities and others. The Act aims to: •


devolve power to clinicians through Clinical Commissioning Groups. Primary Care Trusts and Strategic Health Authorities will be abolished devolve commissioning of public health services to local authorities

Adapted from Department of Health 2012

introduce consumer champions for health service users through HealthWatch

introduce Health and Wellbeing Boards to analyse the local needs of a community and to promote integration of health and social care services.

The RCPCH has designed a toolkit to help paediatricians make sense of the NHS reforms. It acts as a one-stop shop for our information regarding the Act, what it means in practice for paediatricians and how we can support members during and following the transition of services. The RCPCH wants to gather information from members on what is happening locally, so we can identify where things are working well and where they’re not as the NHS reforms are rolled out. We want to hear examples of best practice, innovations and new ideas being implemented in your area so that we can champion the work of members and spread good practice further. We also want to hear if you feel that relevant services and structures are not being implemented in your area, and if there are inefficiencies when it comes to child health. We want to support all paediatricians  so that they can continue to deliver the best possible healthcare for children within the new system. By members identifying areas of support, we can signpost members to guidance, training programmes and other supportive services to aid you in the implementation of the reforms. The strength of the RCPCH is its members. We will use the information you provide us to lobby policy makers to ensure that any changes to the health

system are to the benefit of children and young people. Some of the areas we want your views on include: •

your views on the recommendations of the Children and Young People’s Outcomes Forum

consultations that you wish to advise on evidence of innovations and problems you have encountered as the Health and Social Care Act is being implemented in your area.

Consultations – your view RCPCH is responding to the statutory safeguarding guidance Working Together, the Secretary of State’s draft mandate to the NHS Commissioning Board, the draft guidance on Joint Strategic Needs Assessments (JSNAs) and Joint Health and Wellbeing Strategies (JHWSs) and the consultation on shared decision making, ‘No Decision About Me Without Me’. The latter response has been drafted in partnership with the RCPCH Youth Advisory Panel. We’re always keen for members to feed into the College’s consultation responses. View current consultations and RCPCH responses at: consultations Karmjit Kuar Public Affairs Coordinator


Training and Support

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Revalidation: preparation for launch Revalidation is expected to begin in December 2012. The majority of doctors will be revalidated by end March 2016. Paediatricians must prepare for launch – How?

• Undertake and retain evidence of your CPD in-line with your PDP and College guidelines – cpd – gaining at least 250 CPD credits over a five-year revalidation cycle

• Read the RCPCH and GMC guidance on supporting information for revalidation and the GMC framework for appraisal and assessment. See revalidation and doctors/revalidation.asp

• Obtain feedback from colleagues using a validated colleague feedback tool – at least one is required during a revalidation cycle

• Ensure you have an annual appraisal using the latest appraisal forms. Ensure complete, signed off, printed and retained • Appraisal guidance specific to the UK can be accessed from revalidation/prepare • Keep a written statement about your whole scope of practice to inform your appraisal discussion

• Obtain feedback from patients using a validated patient or parent feedback tool – at least one is required during a cycle. The PaedCCF tool is recommended: • Gather evidence of involvement in quality improvement activities (eg completed audit cycles, reflection on clinical cases and benchmarking against clinical outcomes) • Gather evidence of other activities relevant to practice (eg engagement

in research, education and management roles) • Ensure documentation is in place for any significant incidents and complaints that you may have been involved with • Complete statements on probity and health annually • Ensure the GMC knows which is your designated body (automatic if you work in an NHS Trust) and local Responsible Officer (RO). How to find your designated body (and RO) is available via Email: Sarah Fellows CPD and Revalidation Manager ALISTAIR THOMSON Vice President (Education)

START – November 2012 The Specialty Trainee Assessment of Readiness for Tenure (START) START, formerly ST7, is designed to assess a trainee’s readiness for consultant practice and evaluates clinical decision making based on adequate knowledge and communication with the family and clinical team. On the basis of experience during the pilots, it was decided that the assessment should be completed using an electronic marking system. This idea was then integrated into the ASSET workplace based assessment website.

START is made up of a 12-station circuit each lasting 12 minutes, split into four minutes of preparation and eight minutes of assessment. Each station will test the different skills a consultant is required to use on a day-to-day basis. Assessment areas include hand-over to a colleague, safe prescribing, decision making in a clinical situation where the diagnosis is unclear, leading a team on the ward, safeguarding children and critical appraisal. The feedback from each assessor is then collated into a report that is generated via the ASSET website, which

New guidelines standards resource for paediatricians Are you developing a guideline? Do you want to: •

ensure it is developed to a high standard?

used in practice?

considered for endorsement by RCPCH and accreditation by NHS Evidence?

The RCPCH has revised its 2006 publication, Standards for Guideline Development, which sets out the key characteristics of high-quality guidelines and describes the methodology for development to ensure the College’s standards for endorsement are met. It outlines the endorsement process, provides advice about dissemination and implementation, as well as a list of useful resources. The document, which will be available in November, will be of value to specialist and expert groups seeking to develop high-quality standards and guidelines. Rita ramnal Clinical Standards Coordinator

is available for education supervisors and programme directors to view through ePortfolio. The assessment needs to be taken before application for CCT for those trainees who started Level 3 training after 1 August 2011. The first assessment will be on 9 and 10 November 2012, followed by the 14 and 15 March 2013. It will be held in the RCGP in Euston, London. JOanne Hatton Support Administrator

New e-learning materials for child protection training and support Every paediatrician should be competent in child protection. RCPCH offers a range of education and training courses to help you meet the requirements for your role. As a paediatrician you must be able to identify and act on concerns and fulfil your duty to protect children who are suffering, or at risk of suffering, harm. If you are a consultant, you should be Level 3 competent. If you are a trainee, you should be working towards Level 3. We would recommend that you attain Level 1 training between ST1-3, Level 2 for ST4-5 and Level 3 during ST6-8. RCPCH, in conjunction with E-learning for Healthcare, have published new e-learning materials for Level 1 and Level 2. These modules are available to all NHS staff and include material for other specialties such as such as GPs, anaesthetists, midwives, health visitors and nurses. New Level 3 materials will be launched in October 2012. Visit to find out the competences you need, the range of material the College provides and to complete the e-learning modules. nick libell, Child Protection Policy Lead




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Epilepsy12 audit continued from page 1 Others were more concerning; less than half of children and young people with epilepsy are seeing an epilepsy specialist nurse; developmental and learning assessments are often not undertaken; about a third of children and young people are not having an MRI or referral to a paediatric neurologist where indicated, for example. For more information, visit

previous audits, with data collected on 23,676 patients under the age of 25 years across England and Wales. This represents the largest number of participating centres ever with 180/185 centres submitting data from units where paediatric diabetes care is delivered.

About 1 in 500 children under the age of 17 years are affected by diabetes, with about 95% having Type 1 diabetes.

The quality of care for infants, children and young people with diabetes is at an eight-year high with year-onyear improvement in the number of individuals receiving the care processes and better HbA1c. But despite these improvements they remain significantly worse than those for adults in the UK and still remain poor in comparison to some other European countries.

The NPDA has examined the healthcare provision for infants, children and young people with diabetes by measuring participation in eight care processes recommended by NICE. For 2010-11, there has been a 22.3% increase in patient record returns from

The audit found that the percentage of patients with diabetes whose HbA1c levels are <7.5% (the NICE recommended target) is nearly 16%, up from 14.5% in the 2009-10 audit, with great variation across the 180 participating units. However, only 6%

National Paediatric Diabetes Audit (NPDA)

of patients received all eight care processes (compared to over 50% of adults) and the <7.5% HbA1c figure remains short of results from the German and Austrian Audit where nearly 34% achieve such a level. There is also concern at the increase in the number of children with diabetes being admitted with DKA – a potentially life-threatening complication that can lead to death if untreated. The incidence per 100,000 has almost doubled since 2005 from 8.5 to 15. For more information, visit: The National Paediatric Diabetes Audit is funded by the Health Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP). Rita ramnal Clinical Standards Coordinator

Child Health Reviews – UK: Paediatricians and case notifications The CHR-UK case review is looking at the care received by children and young people with a diagnosis of epilepsy, who have either died of any cause or been admitted for intensive or high dependency care following a prolonged seizure. The CHR-UK team is sending monthly emails to consultant paediatricians, asking them whether they have seen

a case meeting the inclusion criteria during the previous month. Unfortunately response rates to these monthly emails have been lower than hoped, so the CHR-UK team is keen to draw consultants’ attention to several points: •

the process has been designed so that responding to monthly emails takes no longer than a minute

clinicians who do not see children or young people with epilepsy are able to opt out of emails by following the instructions provided

Look out for monthly emails, and for more information about CHR-UK visit: karina pall Research Administrator

Turning the Tide: harnessing the power of child health research On 20 November we will be launching Turning the Tide, a major new report on the importance of child health research to paediatrics as a profession, and to patients. The report is led by Science and Research Vice-President, Professor Neena Modi. Many major health problems have their origins in early development and investment in early years’ research has the potential to reverse or minimise the effects of health problems such as obesity and high blood pressure. This is particularly important in the UK, where we see more child deaths from preventable illnesses than countries such as Germany, France, the Netherlands, Sweden and Italy.  However, children are ten times less likely than adults to be given


the opportunity to enter a clinical trial, whilst children’s research only represents 3% of all studies in the UK Clinical Research Network Study Portfolio. Further, only one-third of consultant paediatricians have any time allocated for research and only a small number are leaders in research for children. The report will stress that children are not small adults; they need research that takes into account their changing physiology, addressing their problems directly, and research that is not merely extrapolating results from adult based research. To achieve this we need: • a national spotlight on the importance of child health research

for the benefit of the population as a whole • all trainee paediatricians to have the confidence to carry out research if they wish to do so and are aware of the opportunities that are available  • parents, young people and the public are engaging and playing a role in improving and advocating the benefits of participating in good quality research into child health • to initiate a collaborative approach to tackling child health research including all relevant parties from the third sector and healthcare professionals. Jyotsna VOHRA Science and Research Coordinator



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Obesity campaign and RCPCH

College Governance Review

With nearly a third of 2-15 year olds in the UK overweight or obese, tackling what is fast becoming the biggest global public health threat is high on the RCPCH’s agenda.

Winston Churchill famously said that democracy is the worst form of government, apart from all the others that have been tried. Democracy has been one of the foundations of the College since it was established in 1996: we have always had a representative Council acting as our Board of Trustees and taking overall legal responsibility for what the College does. But – as with all our other activities – we should always look for improvement in what we do and how we do it. We should also seek out best practice in other organisations and see whether we can use such techniques in our own work.

Earlier this year, the healthcare profession came together under the umbrella of the Academy of Medical Royal Colleges (AoMRC) to launch a major campaign to tackle the pandemic. The RCPCH, in coordination with the Academy, is leading on the policy and communications activities in order to achieve our wider goal of reducing levels of childhood obesity. The campaign got off to a strong start back in March with significant media coverage and political interest as we invited organisations to submit evidence on what works and what doesn’t in combating obesity across the life course. With more than 100 submissions, plus feedback from the public via a separate questionnaire and a number of organisations invited to give oral evidence, the report is due to be launched publicly in January. At the time of writing, the College is preparing for events at each of the main political party conferences in England. With keynote political speakers including Dr Sarah Wollaston MP, member of the Health Select Committee, Diane Abbott, Shadow Minister for Public Health and Andrew George, liberal democrat member of the Health Select Committee, the round table events are set to profile the evidence gathered from the AoMRC obesity campaign and gauge political appetite for taking forward interim recommendations. Other invitees include representatives from the food and drink industry, local councillors and public health leads, weight management programmes, charities and campaign groups. Following report launch, the RCPCH and others on the steering group will lead campaigning activity on each of the recommendations. To keep up to date on obesity campaign developments, including related education and training opportunities, visit: PEDER CLARK Health Policy Lead Melissa Milner Media and Campaigns Manager

When Dr Cass took office as President, she made it clear that she wanted to review the structures by which the College is governed. (You may recall that there was some discussion of this in her message to RCPCH members which was mailed out in June.) A further debate on the issue was held at the meeting of Council on 11 July that saw the Council meeting give the go-ahead for a review of the College’s governance structures to be undertaken over the coming months. This review has two goals: •

To give the College a governance structure in-line with best practice in the charity sector, and fit for the legal requirements placed on charities in the 21st century.

The need to have a governance structure which enables more engagement with our members and increases our democracy.

Together with the President and other colleagues, I am beginning to take forward this process. We hope to have some proposals to share with you at the AGM in Glasgow next June. We are acutely aware of the need to preserve accountability in how the College is run and to ensure that we maintain a democratic structure that allows members’ voices to be heard. The challenge is to balance this with the various requirements and recommendations made by the Charity Commission and similar bodies. In addition, there are a number of technical pieces of work to be done to accomplish this: whatever changes are ultimately decided, we will probably need to seek amendments to the College’s Royal Charter and ByeLaws. This will require negotiation on matters of detail with the Privy Council. At this stage, it would be premature to judge the results of this review. We will of course be doing extensive consultation work over the autumn and winter. But in the meantime, we are very eager to have members’ views on this subject. We have established a web-page at on which we will post updates as our work proceeds. There is also an email address,, to which members can send any comments. This, of course, is only logical. If we are aiming to reform the College’s democracy, we should be as democratic as possible about how we do it. Dr Chris Hanvey Chief Executive Officer




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Youth Advisory Panel Working with paediatricians to improve child health In light of the NHS reforms, the RCPCH has been instrumental in creating platforms to ensure the insights and experiences of children and young people help shape paediatric services and child health. This year, we have worked collaboratively with children and young people by: • advising the Future Forum and the Children and Young People’s Health Outcomes Forum/Strategy

• launching key resources for young people and health professionals on ‘Consent, Confidentiality and Having Your Say’, developed with the YPHSIG. You can read more at: www.rcpch. Thank you for your continued support to improve the healthcare children and young people receive. Young people in the media

• shaping RCPCH responses to key consultations such as ‘No Decision About Me Without Me’ and ‘The Office of the Children’s Rights Commissioner for England’

Outspoken children and young people have been hitting the headlines over the last few months, speaking out through the media on health issues that are important to them.

• engaging in the debates surrounding the Health and Social Care Act • facilitating and presenting at highprofile advocacy events such as the RCPCH Annual Conference and the London Tertiary Paediatrics Project

The RCPCH has been continuing to work with a group from the College’s Youth Advisory Panel to get their views on public health issues (such as smoking), reconfiguration, the health and social care reforms and their own personal health experiences.

• blogging opinions on the RCPCH website

By using young peoples’ opinions, experiences and voices through the

Thank you, for giving us the opportunity to highlight concerns that adults may not necessarily think of and influence services before decisions are made and the window of opportunity closes. Thines Ganeshamoorthy, 18, Youth Advisory Panel, RCPCH media we can help influence decision makers to ensure children and young people receive the best healthcare possible. Get involved with the e-consultation This year, the first RCPCH e-consultation went live, launched by the College’s former President, Professor Terence Stephenson. Please share the following link: www.rcpch. so we can hear from as many children and young people across the UK, about their health service and ways we can work together to continue to shape and improve it. bharti mepani Children and Young Persons Participation and Advocacy Manager LAUREN SNAITH Media and Campaigns Officer

Working together to safeguard children It’s not just the leaves on the trees that are changing this Autumn, but also the entire operating framework for safeguarding children. Later this year the Department for Education for England will publish revised statutory guidance for safeguarding that you as a paediatrician must abide by. The guidance is likely to impact on your day-to-day practice; frameworks for assessment may well be changed in your local area and it will be incumbent upon you to keep abreast of local

developments. The guidance seeks to reduce bureaucracy and provide a launch pad for local innovation. You will not have 400 pages of guidance anymore – the government will be producing a markedly slimmeddown version and it will be up to you to know your role, your responsibilities, and those of others. RCPCH can support you. Visit for our latest child protection news, publications

and resources. And keep an eye out for future developments – for example, in the new year we will be launching our new Child Protection Companion; which is your handbook for everything you need to know about child protection – from the clinical evidence base through to assessment and ultimately legal proceedings. nick libell Child Protection Policy Lead

New e-portal set to transform knowledge, skills and attitudes towards child mental health The RCPCH is heading a pioneering e-learning programme giving more than a million people working with children and young people access to advice on child and adolescent mental health. The £2.2m interactive hub, funded by the Department of Health, will help identify children and young people who have mental health issues and ensure messages given to them are concise and consistent with other professionals working with them. The e-portal, which will be live in Spring 2014 and accessible


from anywhere in the world, will provide:

of this unique programme by end 2012.

The two-year programme is supported by a Consortium which includes: the Royal College of Psychiatry Faculty of Child Psychiatrists, Royal College of Nursing, Royal College of General Practitioners, the British Psychological Society, National Children’s Bureau and children’s charity Young Minds.

A suite of e-training resources tailored specifically at health professionals and non health professionals Assessment and outcomes evaluations aids throughout the programme E-enabled therapies

We will be asking for member and stake holder involvement in the development

Jo lawton Education Projects Leader



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RCPCH International Volunteer overseas with the new Global Links programme The College’s international strategy focuses on the improved health and wellbeing of children across the globe by working with and learning from partners overseas. After successfully securing funds from DfID, RCPCH International has developed its own overseas exchange programme to work with paediatric associations in East and West Africa. Over the next three years the Global Links volunteer programme is recruiting UK registrars and consultants to undertake 6–12 month placements in poorly resourced African hospitals. The volunteers work collaboratively with African doctors and nurses on agreed objectives to address what is most needed in these

hospitals. The programme also invites African paediatricians to visit the UK on training and quality improvement programmes. Through this exchange we hope to create strong and lasting links between the UK and African partner hospitals. If you are looking to broaden your experience as a paediatrician, interested in sharing your knowledge and expertise with African partners or fancy the challenge of living and working overseas, please contact Peter Nash at or visit the RCPCH website for more information: global-links Peter Nash Global Links Manager

ETAT+ Uganda In early July a meeting was held in Kampala, Uganda to formulate local clinical guidelines for the emergency management of sick children. The meeting forms part of the RCPCHled ETAT+ project in East Africa. ETAT+ is an extension of the WHO ETAT (Emergency Triage, Assessment and Treatment) training programme through which six district hospitals in each of Kenya, Uganda and Rwanda will receive an 18-month intervention aimed at improving emergency and immediate admission care for babies and children. The programme is relatively new to Uganda and has been implemented in only two hospitals to date. The purpose of the meeting was to discuss the wider introduction of ETAT+ into Ugandan hospitals and to review the evidence based clinical practice guidelines for care of newborns and sick children in Uganda with reference to the ETAT+ approach. Led by Dr Bob Opoka (Makerere University), Dr Ambrose Agweyu (KEMRI-Wellcome Trust) and Dr John Wachira (Kenya Paediatric Association/RCPCH), the group reviewed the evidence for treatment of the most commonly presenting

Child health in developing countries

paediatric conditions and modified the Kenyan protocols for use in Uganda, mainly focusing on the most appropriate antibiotic treatment for infections in the Ugandan setting. The recommendations from the meeting will be incorporated into the Basic Paediatric Protocols for Uganda and presented to the Ministry of Health for endorsement prior to printing and distribution. Participants included officials from the Ministry of Health, WHO, consultant and trainee paediatricians, medical officers and nurses from regional referral and district hospitals and lecturers from the training institutions. All were enthusiastic about the introduction of ETAT+ in Uganda and agreed that the first training course for instructors will take place in September. For further information about ETAT+ please see our website: international catherine fagan International Coordinator

In June, RCPCH International ran its first Child Health in Developing Countries course. Aimed at paediatric trainees with an interest in global child health or who intend to work in low-income countries, the course included: •

practical guidance on how to manage the most common conditions of children presenting in low resource settings

an insight into the nature of working overseas

sessions delivered by senior paediatricians with extensive overseas experience, RCPCH Visiting Fellows and former RCPCH/VSO Fellows who gave personal accounts of the issues facing paediatricians in low-income countries

We received excellent feedback from delegates, with 100% stating they would recommend it. Delegates felt the course improved their understanding of the role of an overseas volunteer, and motivated them in considering their potential contribution to global child health: ‘The course was inspiring. It opened up my eyes to some of the problems of practicing paediatrics in a low resource setting and, more importantly, some practical ways to deal with those.’ (Clare, ST1) The dates for the next course have just been announced as 29 November to 1 December. This second diet of the course will encompass all of the material from the first, plus additional sessions such as burns/injuries in children and how to build international work into your paediatric career. More information is available at: The course complements the launch of the College’s new volunteering programmes, details of which can be found at: justin thacker Head of International Operations



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SSASG NEWS SSASG careers – a positive choice

RCPCH remains committed to supporting and developing the roles of SSASG paediatricians. To do this effectively, it is important that your views about your career aims and educational needs are heard. Results from the SSASG survey show: •

the majority (75%) of SSASG paediatricians who responded have made a positive choice to opt for a SSASG post at some point in their career; the majority remain satisfied with their current appointment over half of those responding to the survey seek to progress their careers either by application for entry to the Specialist Register via CESR, by re-entering formal training or by development of a skills portfolio within their SSASG post expansion of access for non-CCT CESR application for those trained wholly in the UK, particularly those working in Community Child Health and Neonatology, would attract over 70% to apply for CESR 90% of SSASGs who responded seek to enhance their skills by accessing formal training and assessment tools.

These same paediatricians, however, report a perception that significant barriers exist for SSASGs wishing to compete for re-entry to higher specialist training. The SSASG Committee is looking at this and other issues concerning career development for SSASGs and is examining ways in which SSASG paediatricians can be better supported in enhancing their skills portfolio. The full report of findings from the survey will be published on the RCPCH website shortly. While the survey has provided an extremely valuable forum for voicing


your views , the SSASG Committee are keen to hear from you at any time about what you would like to see RCPCH doing to support SSASG paediatricians. Email our committee administrator: Serean.Williamson@ RCPCH Membership Communications Survey As shown on page 4 of this issue of Notes, the College is starting to look at what it can provide in terms of improved communication, further membership benefits and particularly developing a better experience for SSASG members. To be able to do this, we would like to get your views on what your experience is like at the moment as well as testing out some future ideas. The survey itself should take no longer than 10 minutes and will ensure that we can make improvements in the right places:

postgraduate qualifications which may be certificates/diplomas/ masters in clinical areas or others such as leadership, education, ethics, etc

short-term clinical secondments which are of relevance to the individual and the NHS

other training and development opportunities which are considered to enhance the development of that individual doctor and the service they can provide.’

This is very good news for SSASGs in Scotland who have not previously benefited from designated funding of this sort. There will also be a National Managed Educational Network of SAS Educational Advisers who will offer advice and support to those wishing to apply to this central fund. Details can be found on the NES website: education-and-training/by-discipline/ medicine/about-medical-training/ supporting-specialty-doctors.aspx

SSASG professional development funding: Scotland

GMC consultation ‘Recognition and Approval of Trainers’ update

NHS Education for Scotland has announced new funding for SSASGs:

This consultation outlined the GMC plans for recognition and approval of trainers such as Educational and Clinical Supervisors and the final Implementation Plan is now available on the GMC website SAS doctors’ roles are specifically mentioned:

‘The Scottish Government has made available funding for SAS doctors’ and dentists’ training and development needs. This is not to support routine CPD, which should be funded as normal via your employer’s study leave budget, but is rather to provide assistance to individuals by way of a contribution towards the cost of carrying out a course of study or project, for the purpose of meeting a specific aim.  ‘Applications may be considered for: •

short-term top-up training already prescribed by GMC

‘60 Recognised or approved trainers may be GPs, consultants or staff, associate specialist or specialty (SAS) doctors. Recognition and approval will underline their essential contribution and contribute to the fair and equitable appreciation of training responsibilities.’ Dr JANE D WILKINSON Chair SSASG Committee


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Training matters What you’ve told us about training Last winter the Trainees’ Committee undertook a survey of paediatric trainees in the UK. Our intention was simple – to ensure that what we think is important is what you think is important, and that our committee is concentrating on issues that are a concern out in the ‘real’ world. We were staggered to receive 2,037 responses to the survey. Thank you for taking the time to complete this and for all your thoughts about the issues raised. The last few months have been spent reviewing and analysing your responses. This is the first time the Trainees’ Committee has carried out a national survey, and it’s fair to say it’s taught me as much about questionnaire writing as it has about training. We’ve spent time thinking about what we do with your answers and how we can use them to shape our future work and improve paediatric training in the UK.

As I write, the report is just passing through the final stages before it is made available to all members. As part of the report we’ve made 10 recommendations for training, which we hope will help to address the issues you’ve raised. For example, less than one in five of you told us that you thought there were sufficient mechanisms in place in your region to identify and support trainees struggling to pass the MRCPCH, so we have recommended that each paediatric school has a designated lead tutor with responsibility for developing such support. I hope when you’ve read the report you’ll feel that the time you spent completing the survey wasn’t wasted. We plan to carry out a survey annually and you can help us ensure we are asking questions that are relevant to training needs by giving us feedback on the report (good or bad!) and

suggestions for questions we should be asking. The better the questions we ask, the better the answers will be for driving change. Vice Chair appointment After an election over the summer I am pleased to announce that Emma Webb has been appointed Vice Chair of the Trainees’ Committee. Emma has been a member of the Trainees’ Committee for the last three years and has represented trainees on the Academic Board, which organises the RCPCH’s Annual Meeting. Emma will be taking a lead with improving communication between trainees and the College so I’m sure you’ll be hearing a lot from her in the coming months. DR DANIEL E LUMSDEN Chair Trainees’ Committee

Your chance to get involved in College work 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. You will be able to: • make a contribution to child health at national level • build skills and learn in areas where you might not otherwise have experience • meet and network with peers • partcipate in RCPCH strategy and direction • determine the quality and nature of sub-specialist training • use your clinical expertise to support RCPCH work Job descriptions and the online application process can be found at Closing date: 02 DECEMBER 2012


RCPCH NOTES Autumn 2012  

Royal College of Paediatrics and Child Health quarterly newsletter