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RCPCH news Royal College of Paediatrics and Child Health

Leading the way in children’s health

SUMMER 2009

First National Paediatric Diabetes Survey In December 2008 the Department of Health commissioned the RCPCH Science and Research Department to establish the number of under-18 year olds with diabetes in England. The project received funding from NHS Diabetes and was carried out in collaboration with the main diabetes stakeholder groups including NHS Diabetes, the British Society for Paediatric Endocrinology and Diabetes (BSPED), the Association of Children’s Diabetes Clinicians (ACDC), Diabetes UK, the Royal College of Nursing, the National Diabetes Information Service (NDIS) and the Yorkshire & Humber Public Health Observatory. The project was supported by Dr. Rowan Hillson, the National Clinical Director for Diabetes and

Revalidation update INTRODUCTION This article summarises RCPCH preparations for revalidation and a brief guide on what doctors should be doing to prepare themselves.

Dr. Sheila Shribman, National Clinical Director for Children, Young People and Maternity. The project used web-based software to survey clinicians in every acute hospital in England. The 1st January 2009 was used as a census point in order to obtain numbers of children and young people under the age of 18 with diabetes of any type in England. The survey generated an excellent response from over 95% of paediatricians caring for children and young people with diabetes A report of the survey findings, ‘Growing up with Diabetes: children and young people with diabetes in 2009’ is available from www.rcpch.ac.uk/Research/ResearchActivity/Current-Projects/National-Diabetes-Survey The key findings were: • There are almost 23,000 children and young people in England with diabetes. • 97% of children and young people have Type 1

Revalidation Pathway

Portfolio of Evidence

Appraisal X5

Local Responsible Officer

College/Faculty (Full evidence review)

REVALIDATION – which includes both relicensing and recertification in a five-year cycle – is due to be introduced in 2010 in a phased roll-out. For those undertaking recertification the two elements will form a single process based on largely the same information. A proposed model for revalidation is shown in the box opposite. RELICENSING will be necessary for all doctors (in training and non-training grades) who wish to practise. It will verify that doctors are practising in accordance with generic standards based on the GMC’s Good Medical Practice. The first steps towards relicensing, the issue of licences by the GMC, have begun. For further information on this stage see box B.

College/Faculty LRO General Medical Council

RECERTIFICATION will verify that doctors on the specialist register meet the particular standards set for their medical specialty by their Royal College or Faculty. Recertification will apply to all of those who hold a certificate of completed training (CCT) or CESR – that is consultants and many associate specialists. Although recertification technically only applies to those on the specialist register, those not on the register e.g. locum consultants, SASGs will be required to show they meet specialty standards if working in specialist areas. Continued on page 8

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diabetes; this is in contrast to adults where numbers Type 2 cases far exceed Type 1. A very small number of children and young people have Type 2 diabetes (328). The greatest number of children and young people with diabetes are aged between 10-14 years (just under 9,000). The burden of diabetes in school age children is high. There are at least 15,000 children (age 5-15) in schools in England with diabetes – this has significant implications for schools and families. There are differences in the numbers of cases between Strategic Health Authorities (SHAs). The numbers with Type 1 are higher than would be expected in the North East and South East Coast SHA’s. For Type 2 diabetes, numbers were much higher than average in London, the North East and the West Midlands. Continued on page 6

Spring Meeting In pictures. See page 7


Editorials In the news

From the Registrar

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In my column for the Winter 2008 Newsletter I wrote about current events, including Baby Peter. Part of my reflection was to write “that even the use of Baby P as a descriptor of the child, whose photographs have been widely published, might show a lack of respect to him and his short life? Does he not deserve the dignity of a name?” We now know him as Peter, apparently at the request of his family. This does seem more appropriate, and respectful of him as an individual. His case continues to raise important issues in Safeguarding, and the recent publication of Lord Laming’s Report and the care Quality Commission Report into the NHS Trusts, shed further light on the complexities and difficulties of the case. The Care Quality Commission raise concerns about both training and adequate staffing levels. As Registrar, I am responsible, with David Ennis, Director of Policy and Standards, for our External Clinical Advisory Team (ECAT) work. Trusts who come to us wanting help with issues in relation to either individual doctors or services where there are concerns either about the quality of a service, the level of staffing or the way services are configured. These Trusts have often approached other organisations, especially the National Clinical Assessment Service, prior to contacting us, and are advised that they should seek College support in addressing the issue, rather than using the National Regulatory bodies. The Trusts are usually looking for a paediatrician, or often a team of two, to assist them in understanding the problem, and in devising a solution. That is an ECAT! David and I will initially help the Trust decide what exactly the issues are (and the initial request can vary from the very well thought out to the very general) and developing a clear brief and terms of reference for the Team. Once this is clear, we then look to find individuals who might be able to undertake the task, which typically involves several days work on site, together with preparation and write-up time. The Trust pays for this work, and provides indemnity for the individual doing it. The College acts as a gobetween, but the report belongs to the Trust, and is not endorsed by us. I have undertaken two of these in the past, one on staffing issues and one on a service model. I found both exercises very stimulating, and although I don’t think we were able to come up with easy solutions,

Letters Enduring War and Health Inequality in Sri Lanka

5 Young People’s Health Special Interest Group (YPHSIG) One year on... Media Update

6 First National Paediatric Diabetes Survey continued Fundraising: Leaving a gift to the RCPCH in your Will

7 Spring Meeting 2009

8 Revalidation update continued SPARCDIC

9 The NIHR Paediatrics (nonmedicines) Specialty Group Calling all General Paediatricians and Trainees!

10 Workshop on Child Health in Cuba BPSU Conference Celebrating Recent Achievements IN MEMORIAM: Professor Lucy Wagstaff

11 Trainees’ column SASG news

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in both cases we were able to suggest realistic ways forward. Importantly I came away in both cases with an enhanced understanding of why problems arise, and how to look at systems, which I think was useful for my own service. Finding people to undertake these reviews is never easy. You need to be able to make some time for the process, and probably have some management experience. However if you can do this, it is a good learning experience, and certainly different from the routine of normal clinical practice. David and I tend to ask Speciality Groups and also look to members of the Consultation Panel. However, if you think this sounds like something you might like to do in the future, please get in touch by completing the form on the College website and returning it to David Ennis at the College www.rcpch.ac.uk/consultationpanel (members-only webpage). Although the College doesn’t run the process, we are always willing to support individuals undertaking reviews. Recently retired members may find this an interesting way to use their skills while undertaking a small amount of paid work! Finally, our Policy Conference in June is on EWTD. David Shortland, Vice President for Health Services, has recently produced a paper on this, which is available on the website www.rcpch.ac.uk/Research/Workforce#role At policy conference we aim to continue thinking about possible solutions to this difficult workforce issue, recognising that implementation is almost on us, and that we will not have solutions in place in all parts of the UK in time. It is important to continue to develop our potential solutions – not least because EWTD is only one of many pressures on our workforce – including the need to ensure a well trained and adequately staffed service in response to Safeguarding concerns, as highlighted by the care Quality Commission Report into Baby Peter. We need not only safe, but sustainable solutions to these service pressures.

Dr David Vickers RCPCH REGISTRAR


Editorials

RCPCH news

The President’s page I want to begin by saying that it is an honour and a privilege to take over as President of the RCPCH from Pat Hamilton. She will be a hard act to follow! I hope to use my three years in office to continue to make the College a leading authority on paediatrics – both to help you as members in your work and to improve child health more generally. To do this, of course, I and the team of officers and staff at the College are hugely grateful to all of you who give of your time to help our work, whether as examiners, committee members, or through involvement in our training work. I intend to use this page in the Newsletter to highlight issues or pieces of College work that I think are particularly topical or important. At the moment, top of the College’s agenda are: • The European Working-Time Directive. We know that there are serious concerns across the UK about the EWTD's impact on services; the panel below offers some pointers to helpful resources and how to access funds to alleviate the impact. • Revalidation. This will be a major change in the regulation of doctors over the coming years. The immediate decision that individuals need to make is what kind of licence they require: see the panel below for more details. • Safeguarding children remains a major theme for us all. Our Child Protection Officer Rosalyn Proops has been working to provide you with more tools to help your work in this area, as the panel on the right shows. I want to hear welcome feedback from members, either on issues raised here or on other concerns. This is your College and I and the other Officers are here to help you in your work for children. To strengthen our communications you will also soon begin to receive a new and more regular monthly email bulletin to keep you in touch with our work on your behalf.

With best regards, Professor Terence Stephenson RCPCH PRESIDENT

Revalidation There is a new section on revalidation on the website at www.rcpch.ac.uk/Revalidation - see also the full article on page 1. This will clearly be a major change for the medical profession, and we are working closely with the GMC and other Royal Colleges to ensure the scheme for paediatricians is as comprehensive as possible. The GMC is writing to all doctors to set out the issues around relicensing. From Autumn 2009 doctors will, by law, need to be both registered and hold a licence in order to practise medicine in the UK. The decision should be straightforward but will depend on a doctor’s professional situation and the particular activities they carry out. Legal and contractual issues will require many doctors to hold registration with a licence but there will be an option to be registered without a licence for those requiring an alternative. In the licensing campaign, doctors have ONE of three options: • Option A - Registered with a licence to practise (£410) All registered doctors will be entitled to a licence. This will legally allow doctors to undertake any of the activities for which UK law currently requires GMC registration.

Child Protection The main online home for the RCPCH’s work on Child Protection is: www.rcpch.ac.uk/Policy/Child-Protection Specific resources can be found at the following pages: Training courses www.rcpch.ac.uk/Policy/ChildProtection/Child-Protection-Training Child Protection publications www.rcpch.ac.uk/Policy/ChildProtection/Child-Protection-Publications Resources for Named and Designated Doctors www.rcpch.ac.uk/Policy/ChildProtection/Named-and-Designated-Doctors Details of Child Death Review Processes www.rcpch.ac.uk/Policy/ChildProtection/Child-Death-Review-processes Child Protection links www.rcpch.ac.uk/Policy/ChildProtection/Child-Protection-Links

European Working Time Directive The implementation of the EWTD in August of this year is causing concern for many members. We recognise this and have been working with the Department of Health to mitigate any problems. Resources on EWTD issues can be found on our website at www.rcpch.ac.uk/Research/Workforce

• Option B - Registered without a licence to practise (£145) Those not practising may wish to remain registered without a licence.

Of particular relevance are two statements linked from that page – one on middlegrade rotas and EWTD from January 2009, and a letter from the DH setting out £50m of extra funds to help ensure EWTD compliance.

• Option C - No longer registered (no charge) The GMC also has a leaflet on relicensing, which can be downloaded from the address above.

The College’s Policy Conference in June focused on EWTD issues, and we will feed back further news to you as a result.

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News Enduring War and Health Inequality in Sri Lanka

Letters Dear Editor, Dr Magier (Letters, Newsletter, Spring 2009) is completely right in calling for a sound evidence base to the science of climate change. For example, that evidence lies in studies analysing Antarctic ice cores, which show levels of carbon dioxide and methane in the atmosphere are now higher than they have been for 650,000 years, and that human activity can be the only reason behind such swift greenhouse gas accumulation. Other studies have shown a precise match between the ocean warming and the intensity of manmade carbon dioxide emissions. Dr Magier asserts that scientists are divided. Whilst a very small number challenge the theory, the evidence is supported by the Royal Society and equivalent organisations in fifteen other countries, including the US National Academy of Science and the American Association for the Advancement of Science, whose Board Chair, Dr Jim McCarthy, spoke by video link at the meeting on climate change during the ASM in York this year. The IPCC is accepted as a rigorous and scientific body. According to its website, ‘Its role is to assess on a comprehensive, objective, open and transparent basis the latest scientific, technical and socio-economic literature produced worldwide relevant to the understanding of the risk of human-induced climate change, its observed and projected impacts and options for adaptation and mitigation. IPCC reports should be neutral with respect to policy, although they need to deal objectively with policy relevant scientific, technical and socio economic factors. They should be of high scientific and technical standards, and aim to reflect a range of views, expertise and wide geographical coverage.’ According to its most recent report, accessible at www.ipcc.ch/pdf/assessment-report/ar4/wg1/ar4-wg1-spm.pdf ‘Global atmospheric concentrations of carbon dioxide, methane and nitrous oxide have increased markedly as a result of human activities since 1750 and now far exceed pre-industrial values determined from ice cores spanning many thousands of years (see Figure SPM.1). The global increases in carbon dioxide concentration are due primarily to fossil fuel use and land use change, while those of methane and nitrous oxide are primarily due to agriculture. {2.3, 6.4, 7.3}’ The graphs in the report are startling and I would urge Dr Magier to inspect them in the paper cited above. Similar evidence is available about the rate of warming of the atmosphere: it is accepted by scientists that the recent cool winter is quite within the usual range of fluctuation and does not disprove the warming trend. Climate change misconceptions are common and are addressed by the Royal Society, see http://royalsociety.org/page.asp?id=6229 In short, the evidence that it is happening includes the following: • The increase in temperature in the twentieth century is likely to have been the largest in any century during the past 1000 years (World Meterological Society) • Hurricanes being seen for the first time ever in the Pacific Ocean • In the past year, the Antarctic ice shelf has lost 14% of its size • A consistent 50-year upward trend in major floods in every region of the world except Oceania • Decreasing crop yields and rising food prices • More than 150,000 premature deaths annually due to climate change alone (WHO) We are facing an urgent crisis, and the health impacts will be more greatly borne by children, both now and in the future. Hence the RCPCH has a duty to act now as otherwise climate change will swamp every other issue facing paediatrics today. S.Haroon BSC (HONS), MBCHB (HONS), MRCPCH, MPH, MFPH

Filling the gap in information on child health and the conflict in the North-East of Sri Lanka While Gaza and Darfur have been prominent in the media, the conflict in the north-east of Sri Lanka has only recently received attention. The tragic situation of the estimated 50,000 people trapped in the conflict zone and the 170,000 displaced to camps they cannot leave, has all the recognised characteristics of a situation likely to cause severe mental and physical harm to children. The present situation has deep roots but recent national figures have found it difficult to provide health data for the most affected districts for some years. A recently released report by the Tamil Information Centre is a systematic and evidence-based attempt to fill this gap. Enduring War and Health Inequality in Sri Lanka analyses the effects of the conflict from a human rights and public health perspective. It uses information from an extensive literature review, government sources, health professionals both within and outside Sri Lanka, and local agencies and institutions. Child morbidity as a direct result of the conflict will leave the children who survived dealing with lifelong disabilities. In August 2006 in Mullaitivu 10-12 bombs were dropped by government forces in the vicinity of a compound killing many and injuring up to 100 children and young people. Some of the injured children said they had been attending a 2-day first-aid training course.1 Meanwhile many reports indicate that the Liberation Tigers of Tamil Ealam continue to recruit children into their ranks. Despite Sri Lanka’s historically impressive health indicators the inequalities that have been caused by the conflict are stark. Severe acute malnutrition (SAM) among under-five children in parts of conflictaffected Batticoloa and Jaffna districts was 6% and 6.7% respectively in 2007, while the country prevalence was 2.5%.2 While the national infant mortality rate fell from 24 to 11 deaths per 1000 live births between 1985 and 2003, the trend in the northern district of Jaffna was the opposite – increasing from 11 to more than 22 between 1985 and 2000. UN General Assembly Resolution 61/146 recognizes the importance of incorporating a child-protection perspective across the human rights agenda. This report is a brave attempt to do so. Please see www.tamilinfo.org/aboutreport.php Dr Tony Waterston CHAIR, RCPCH ADVOCACY COMMITTEE

UNICEF (2006) Sri Lankan schoolgirls killed and injured amid escalating violence www.unicef.org/infobycountry/sri_lanka_35357.html accessed 05.05.09

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2

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UNICEF (2008) Humanitarian Action Report: Sri Lanka www.unicef.org/har08/index_sri_lanka.php accessed 05.05.09


RCPCH news

News

Young People’s Health Special Interest Group (YPHSIG)

One year on... Following our official launch at the 2008 Spring Meeting, YPHSIG has had a busy and successful year. We have welcomed new members throughout the year who benefit from reduced fees at YPHSIG events and receive a monthly e-bulletin, packed with useful web-based and other resources (news, research, events) relevant to professionals working with young people. Good practice guidelines on transition and participation have been developed, summarising key points from the large amount of literature on these subjects. These guidelines are available to download from our website (www.yphsig.org.uk). Our first residential conference ‘Improving Paediatric Practice in Young People’s Health’ in October 2008 was very well received, covering the key issues of confidentiality and consent, young people with life-limiting conditions, participation and communication. The first YPHSIG Academic Session and Annual General Meeting in York, April 2009 was well attended (a bigger room needed next year!). Interesting discussion was provoked by the speakers on a range of topics including the current state of young people’s health in the UK, training and the Adolescent Health Project, self management by young people with

Media Update In early February the Health Protection Agency released new figures revealing a rise in the number of measles cases in England and Wales. David Elliman, RCPCH Immunisation spokesperson, appeared on BBC Breakfast, BBC Radio 4, Radio 5 Live and regional radio stations discussing the threat posed to children who had not received the MMR vaccine. The College also re-released its statement urging all children and young people to have the MMR vaccine and was quoted in The Sun and BBC News website. The Child Health Strategy was launched in February and a statement by Simon Lenton, the then Vice President for Health Services, was included in articles by BBC News, PharmaTimes, Children & Young People Now and OnMedica. BBC news website, Independent and Daily Mail gave coverage to the BPSU’s forthcoming Hyperatraemia study and the Guardian quoted paediatrician Julian Shield-Hamilton who led

chronic conditions and the implementation of the You’re Welcome Quality Criteria. YPHSIG will have a joint session with General Paediatrics at next year’s Spring Meeting. Improving research into young people’s health is a key aim of the YPHSIG and we are keen to attract good quality abstracts for presentation. A prize will be offered for the best abstract submitted by a trainee for the 2010 meeting. A ‘top tips’ guide to writing an abstract is available on the website. YPHSIG’s objectives for 2009 – 2011, confirmed at our AGM, can be viewed on our website. They include: • Training - Steering group members are currently working with the RCPCH to develop a competence-based curriculum for trainees aiming to work as consultants with an interest in young people’s health. • Participation – YPHSIG is funding the development of a Participation Toolkit for use by paediatricians. The work is being led by the RCPCH Children and Young People’s Participation Manager working with member of the steering group. • Support and guidance - for consultants with responsibility for young people’s health in either acute or community settings.

the recently completed Type 2 diabetes study. In March, the College hosted the launch of a joint series with the Lancet – ‘Health in the Occupied Palestinian Territory’. A number of journalists attended the press conference and articles about the series appeared in the Guardian and The Times. Child protection was a prominent issue in the news during March. The Healthcare Commission (now Care Quality Commission) released a report about the care of children in hospitals. The Vice President for Training and Assessment, Mary McGraw provided a response to this report and was quoted in the Telegraph and BBC News website. Lord Laming also released his latest report that month, and Officer for Child Protection, Rosalyn Proops spoke to the Times in this respect. In April, the College published the first national survey of children with diabetes. The snapshot survey found that almost 23,000 children and young people have diabetes in England and articles appeared in The Times, Channel 4 website and the professional health press.

The second YPHSIG residential conference will be held on 1st and 2nd October 2009. This year’s theme is Young People with Chronic Conditions, including epilepsy, chronic fatigue and eating disorders. There will be a mixture of facilitated workshops and keynote speakers including international experts. Importantly, we will be joined by young people from “Staying Positive” Expert Patient programme and young researchers. The conference is subsidised enabling the cost to be only £50 for one day and £85 for both days, including accommodation, with a further reduction for YPHSIG members. Information about joining YPHSIG, the 2009 conference programme and booking information are available on our website. We hope to see you there! Dr Naomi Jones SPR PAEDIATRICS, YPHSIG SECRETARY Dr Gill Turner CONSULTANT PAEDIATRICIAN, YPHSIG CHAIR/CONVENOR

Since taking over as President, Terence Stephenson has been a signatory on a letter to the Observer about child poverty that was also signed by 70 other members of the College. He has also appeared on Radio 4’s Today Programme talking about the benefits and science around breastfeeding. And in May he was interviewed by Children & Young People Now magazine about his priorities for the College. In May, the College launched its new growth charts together with the Department of Health. The launch was covered in the Daily Telegraph, Daily Mirror, BBC News website, British Medial Journal and as well as numerous parenting publications. Professor Charlotte Wright, academic lead for the project, carried out 20 local radio interviews and appeared on the Channel 4 lunchtime news talking about the importance of the new charts. www.rcpch.ac.uk/media Ella Wilson MEDIA AFFAIRS ASSISTANT

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News First National Paediatric Diabetes Survey continued from the front page The Department of Health will use the results of the survey to help plan and deliver high quality care for children and young people. This will include the organisation of healthcare, and the accommodation of children’s needs, in schools as well as in

clinical settings. The survey will also inform discussions about the need for a national register of childhood diabetes. RCPCH President, Professor Terence Stephenson concluded that, “the survey is a testament to both the efficiency and the

Fundraising Leaving a gift to the RCPCH in your Will ‘Leaving a gift to the RCPCH means that the College can continue the work you supported during your lifetime.’ Legacies, large & small, left to the College make a significant difference to the College's work Whether you want to ensure your legacy is used for a specific purpose, or for your donation to be remembered at the College, or to support & develop pediatric education & training worldwide, the difference that a gift from your Will can make is tremendous. Who benefits from your legacy? Not only your wishes are carried out after your death, charitable bequests in your Will are free of tax. This will mean that by leaving a legacy to the College, you lower the amount of your estate on which your relatives would be liable to pay Inheritance Tax. This makes charity giving in your Will tax efficient for everyone Your tax benefits If your estate is liable to Inheritance Tax, you could choose to give money to charity to reduce the overall amount of tax due from your estate. Points to note: • The current tax threshold is £312,000 (2008 to 2009) • The amount over the threshold is taxed at 40% • When a legacy is left to a charity, the gift is totally tax free - regardless of the amount. How the tax benefit will work for your estate: • The value of the gift is deducted from the total gross value of your estate. • This may reduce the amount on which tax is payable. For example, if the value of your estate is £10,000 over the tax threshold £4,000 in tax must be paid. • However, if a legacy of £10,000 is left to a charity, no tax is payable on the estate as the legacy is tax exempt and this would bring the estate to below the tax threshold.

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How will my legacy be spent? In the particular case of legacies, the College can guarantee that every penny of the gift you leave to them will be spent on projects that will help improve the lives of children and the training and education of Paediatricians in the UK and developing countries. The following are examples of projects and activities that have received support & funding from legacies: A few of the bequests that have supported Paediatrics & Child Health: The Tony Jackson Memorial Prize – This prize has been established to encourage UK Medical Students & graduates to consider a career in paediatrics. The prize has been funded by a generous bequest to the College by Dr Tony Jackson who was a consultant paediatrician at the Royal London Hospital and Queen Elizabeth Hospital for Children. The prize is awarded annually at the Spring Meeting. Bequest of Dr Harold Everley Jones has helped in the following way – • Has helped develop the learning materials of the ‘Paediatric Mastercourse’, which is a package designed for the core modules to pass the MRCPCH examinations. • Supported the ‘Child in Mind’ project, to design training materials for paediatricians in child mental health in order to understand and recognize the issues surrounding child mental health. • Developed distance learning packages for Safeguarding 2 project – The bequest supported the awareness of child protection issues and equip doctors in training with the knowledge and skills to enable them to recognize and respond to child protection situations competently and confidently at a level appropriate to their stage of training. • Development of the ST7 Assessment that will be piloted this year on 9-10 June. The ST7 will examine managerial and leadership

willingness of paediatricians nationally to collaborate and the ability of the Royal College of Paediatrics and Child Health to conduct important research”. For further information please contact Zaki Kramer at the College at zaki.kramer@rcpch.ac.uk

aspects of training to assess where trainees are competent to embark on independent practice as consultants. Recent projects: The Paul Polani Award - established in 2007 in memory of Professor Paul Polani who was the first director of the Paediatric Research Unit at Guy’s Hospital. The award aims to encourage research and innovation in the field of paediatric neurodisability. Teams of individuals are invited to apply for up to £7,500 to pilot, undertake or complete research projects based in paediatric neurodisability. The Lorber Prize – this prize is an annual competition open to medical practitioners registered in the UK, working in the UK in preconsultant grades at the time that the relevant scientific paper is accepted for publication. The prize is awarded to the author of the best article on any subject related to paediatrics. The prize is in the memory of John Lorber Professor of Paediatrics at Sheffield University, who was a major contributor of medical ethics, childhood tuberculosis and neural tube defects. The David Baum International Foundation - was established in memory of the late Professor David Baum, President of the Royal College of Paediatrics and Child Health, (who died suddenly and tragically whilst on a sponsored bike ride to raise money to help children in the Balkans). The aim is to raise funds to promote high quality training of paediatricians in the most needy and disadvantaged parts of the world. What to do next If you would like to leave a legacy in your Will to the RCPCH, it is essential that certain pieces of information are properly included in your Will. Wills are legal documents and if they are not worded properly then they may not have the effect that you wish. We strongly recommend that you seek independent professional advice from a solicitor when drawing up your Will. For further information, please contact: Pardeep Bhakar, PA to Director of Internal Services Email: pardeep.bhakar@rcpch.ac.uk Tel: 020 7092 6016


RCPCH news

Spring Meeting 2009

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News Revalidation update continued from the front page A recommendation for revalidation every five years will be made by an individual’s Local Responsible Officer to the GMC. The recommendation will be based upon documentation and evidence produced at annual appraisals. Consultation with members RCPCH consulted with 440 members in November 2008 to gain their initial views on revalidation. Members indicated that: • Appraisal could act as one of the pieces of evidence for revalidation (84%) if made more robust (59%); • RCPCH should decide if appraisal was a component of revalidation (72%); • RCPCH should define specialty standards (76%) and evidence (78%) for general and specialist paediatricians and tertiary specialists for recertification; • 49% had used multisource feedback and 95% of these felt it had been beneficial; • A highly significant proportion felt that a wide range of evidence should be used. Examples included: Multi-Source Feedback (MSF); patient surveys (generic and speciality specific); complaints and incidents; CPD and Personal Development Plans; participation in clinical audit; evidence of use of national guidelines; and others e.g. mortality and complication rates. Full results are available on the RCPCH website. A focus group day is planned for 22 July 2009 to further consult with members. Invitations will be sent out over the coming weeks. RCPCH specialty standards for recertification Work to develop specialty standards for recertification is ongoing. These standards will identify acceptable evidence and supporting information to demonstrate acceptable specialist practice.

Revalidation and Recertification Committee (RRDC) This RCPCH Committee continues to work with other Royal Colleges and the AoMRC to develop processes and standards for recertification in addition to advising on wider recommendations for revalidation e.g. role of local Responsible Officers, guidance on quality assured appraisal systems. More information More information on revalidation can be obtained from the RCPCH website at www.rcpch.ac.uk/Revalidation or from Dr Alistair Thomson (clinical lead Revalidation) or Sarah Fellows (project lead Revalidation) at recertification@rcpch.ac.uk

Box A What do I need to do now for revalidation? While work is still underway to finalise the model for revalidation, you are advised to take account of the following: 1. Ensure that your annual appraisal forms are completed, signed off and retained. 2. Ensure that your personal development plan is completed, signed off and retained. 3. Ensure you record 50 CPD credits per year on average and retain evidence of participation in and learning from CPD (read current RCPCH CPD guidelines and use the online CPD system http://www.cpd.rcpch.ac.uk/). For the near future, it may be helpful to: 4. Consider using a 360 degree appraisal tool (MSF) for your generic and specialist practice, as two of these will be required during a 5 year revalidation cycle. 5. Consider using a specialty-specific patient survey tool (see SHEFFPAT pilot above) as feedback from patients/parents & carers will be required during a 5 year revalidation cycle. 6. Gather evidence of your activities in e.g. clinical audits, particularly completed audit cycles. 7. Gather outcome data for your specialty where outcomes are measurable. In other words, the backbone of revalidation will be current procedures. How this evidence is gathered and who will assess it remain to be finalised.

Box B Paediatric parent and carer assessment tool RCPCH has started to modify its patient feedback tool, SHEFFPAT, to validate its use for non-training grade doctors. This work has been funded by the Academy of Medical Royal Colleges (AoMRC). An invitation to be involved in the validation process has been sent to consultant paediatricians. CPD scheme consultation RCPCH is re-examining its CPD scheme and online CPD database to ensure it is appropriate for revalidation. The initial phase will survey a random sample of RCPCH CPD scheme participants to seek their views on improvements prior to making modifications.

SPARCDIC The Report on the Working Party on Sleep and Respiratory Physiology Control Disorders in Childhood. The chaotic state of services for children with sleep-related breathing problems and other disturbances of sleep physiology has been apparent to most clinicians for some time. A few enthusiasts have established services focussing variably on neurophysiology or breathing, amid a stony indifference from commissioners. Other regions have little or no specialised services available in this field. The College commissioned a short-life Working Party to make recommendations for clinicians and commissioners of services about

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GMC begins process to issue Licences to Practise The GMC has started out the next stage of its licensing campaign across the UK. It is writing to all registered doctors to ask whether or not they wish to hold registration with a licence to practise. From Autumn 2009 doctors must be both registered and hold a licence in order to practise medicine in the UK. The decision will depend on a doctor’s professional situation and work, but should be straightforward. Licensing will be the first step towards the introduction of revalidation. Further information on licensing is available from RCPCH at www.rcpch.ac.uk/Revalidation or from the GMC website at www.gmc-uk.org/doctors/licensing/practice/index.asp

sleep services in the UK. The Working Party has produced a report, which is evidence-based and makes recommendations on clinical standards for the diagnosis and treatment of sleep-related pathologies, as well as quality control mechanisms and organisation of services nationally. It has not attempted to address behavioural sleep problems in toddlers. The Working Party has had input from the British Sleep Society, the British Paediatric Neurology Association, the British Paediatric Respiratory Society, Association of Respiratory Physiologists and Therapists, and patient support groups. It is hoped that the report will aid clinicians in making their case for development of services, and inform purchasers or commissioners in how and where they might seek to organise services in their region.

The report can be found on: www.rcpch.ac.uk/Research/CE/Guidelinesfrontpage/Guideline-Appraisals-by-Topic/RCPC H-Summary-and-AppraisalsRespiratory#SleepDisorders_RCPCH Dr Robert Primhak CONSULTANT RESPIRATORY PAEDIATRICIAN


News

RCPCH news

The NIHR Paediatrics (non-medicines) Specialty Group Research into medicines for children has received a significant boost over recent years following the creation of the National Institute for Health Research (NIHR) Medicines for Children Research Network (MCRN). Non-medicines paediatric research will now also receive NIHR support through the NIHR Comprehensive Clinical Research Network. Professor Anne Greenough was appointed Chair of the Paediatrics (nonmedicines) Specialty Group in December 2008, following an open, competitive process and members of the group have been nominated from 18 of the 25 NIHR Comprehensive Local Research Networks (CLRNs) across England (see map). The first meeting of the group will take place on 28 May at the RCPCH and be organised in collaboration with the MCRN. The NIHR Comprehensive Clinical Research Network (CCRN) has established 26 national Specialty Groups to provide the NIHR CCRN with access to a national network of subject specific expertise. Specifically, the national Specialty Groups will provide the NIHR CCRN with feasibility assessment of research protocols

and help to ensure engagement within these clinical areas. They will provide advice on both “do-ability” and more detailed feasibility for commercial and publicly-funded studies, contribute members for adoption committees and provide input into topic specific training within the NIHR Clinical Research Network Coordinating Centre’s national training and education programme. The national Paediatrics Specialty Group will have a key role in overseeing the non-medicines paediatric research portfolio and in assisting with the performance monitoring and delivery of studies within the NIHR Portfolio. The national Specialty Group will be working closely with funders of paediatric research to ensure continuity and communication between portfolio development and delivery and has received additional support from the RCPCH to enable this group to take a more proactive role in study development and prioritisation. Recognising that there is considerable overlap between non-medicines and medicines for children research, the NIHR MCRN will be working closely with the Paediatrics Specialty Group to enable economies of scale to be made, and common

strengths to be shared and maximised. Paediatricians interested in non-medicines research should liaise with their local CLRN or contact Prof Greenough directly on anne.greenough@kcl.ac.uk. Alternatively, please contact info@mcrn.org.uk Figure 1. Map showing location of Paediatrics Specialty Group Chair and Members.

Calling all General Paediatricians and Trainees! In 2008, The British Association of General Paediatrics (BAGP) became formally affiliated to the college. The association has been established to represent General Paediatrics as a speciality within the college and promote General Paediatrics to the wider community. Please consider the following questions: • What is currently concerning you about the way General Paediatric care is structured? • What are your views on the European Working Time Directive? • How should General Paediatrics interact with the college? • How do you make sure that NICE guidelines fully represent General Paediatric views and experience?

RCPCH news Copy deadline for next issue:

1 August 2009

• How can you become involved with the ST7 assessments? • How should General Paediatrics interface between primary care, emergency departments and paediatrics practiced in the community? • How should General Paediatrics interact with the subspecialties? • What should be on the curriculum for trainees who want to become General Paediatricians? • Can the profile of General Paediatric scientific meetings improve? • What should be the research priorities for General Paediatrics and how can you develop your General Paediatric research ideas? • Which specialty group supports your application for Clinical Excellence Awards?

We want to hear from you. The BAGP aims to make sure that the voice of General Paediatrics is heard. This can only be achieved with your support. We want you to join the association and contribute the development of, what should be, the largest subspecialty group affiliated to the college. Please visit our website www.bagp.org.uk and join us. Make your views heard. The more members we have, the louder we can become! Thank you for your support

Managing editor: Graham Sleight Editor: Joanne Ball Email: newsletter@rcpch.ac.uk Editorial services: Chamberlain Dunn Associates

Published by the Royal College of Paediatrics and Child Health, 5-11 Theobalds Road, London WC1X 8SH. Tel: 020 7092 6000, Fax: 020 7092 6001 Website: www.rcpch.ac.uk Email: enquiries@rcpch.ac.uk The College is a registered charity: no. 1057744 and registered in Scotland as SC038299

Dr Colin Powell Senior Lecturer in General Paediatrics and Consultant Paediatrician Chair of the BAGP powellc7@cardiff.ac.uk

© 2009 Royal College of Paediatrics and Child Health. The views expressed in this newsletter do not necessarily reflect the official positions of the RCPCH.

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News Workshop on Child Health in Cuba

The fourth, and most successful to date, International Workshop on Child Health in Cuba was held in Camaguey on 3-5 March 2009. The multidisciplinary meeting involved doctors, nurses, clinical pharmacists and social workers. Nine health professionals from the UK attended and they learnt about health care of children in Cuba. The multidisciplinary group from the UK involved an academic social worker, a trainee in child and adolescent psychiatry, a school nurse, a student in public health, a medical student and several consultant paediatricians. The meeting was held in the San Juan de Dios museum which used to be a children’s hospital. The delegates were welcomed by a local orchestra who both played Cuban music and delighted the British delegates with an excellent version of ‘Yesterday’ by Lennon and McCartney. The main

focus of the first day was child health in the community and two Cuban doctors explained the role of the family practitioner and the polyclinic. The family doctor, working with a nurse, provides medical care for between 120 and 160 families. The health professionals are aware of each member of the family and understand their medical and social problems. The polyclinics provide secondary care but work alongside the family doctor. The group visited the Julio Antonio Mella polyclinic in Camaguey which, like all polyclinics in Cuba, offers 24 hour emergency facilities. Alongside the British and Cuban health professionals, were health professionals from Argentina, Canada and the United States. Dr Marcela Defagó described child health in Argentina and focused on inequalities in health in Argentina. She pointed out that over 40% of children in Argentina live in poverty and that there are wide variations in child mortality rates in different parts of Argentina. There was a threefold variation in infant mortality rates within different parts of Argentina. The problems of malnutrition, drug abuse and street children in Argentina provided a stark contrast to achievements in child health in Cuba. Other contributions on the second day focused on Cuba’s contribution to child health in Latin America where many Cuban health professionals work and Cuba’s role in training doctors from countries throughout Latin America. The workshop provoked extensive discussion

such that the meeting constantly overran. In order to accommodate a visit to the Children’s Hospital, this was arranged early in the morning prior to the lectures. Despite the long working days the delegates still managed to visit the beautiful city of Camaguey alongside visits to several excellent restaurants. The group also visited the house of Dr Carlos Finlay who was the first to develop the theory that mosquitoes were carriers of the organism responsible for yellow fever. He subsequently identified the mosquito responsible for transmitting this disease and recommended controlling the mosquito population to prevent the spread of yellow fever. The group finished off with a free day in Havana and a good understanding of how preventing illnesses is better than treating them once they are established. The workshop was organised by the Director of Camaguey Children’s Hospital (Dr Deybis Sánchez Miranda), the Department of Provincial Health, Camaguey Province, (Dr Nacyra Bonet Lopez), the Department of Child Health, University of Nottingham and the International Institute for the Study of Cuba at London Metropolitan University. There will be a further workshop in March 2010 and individuals interested in attending should contact Professor Imti Choonara (email: imti.choonara@nottingham.ac.uk).

Professor Imti Choonara

British Paediatric Surveillance Unit Conference

Celebrating Recent Achievements

IN MEMORIAM:

On 3rd March 2009, the British Paediatric Surveillance Unit (BPSU) held a successful one-day conference at RIBA London. The event was attended by almost 100 delegates, a mixture of clinicians from a wide range of specialties and BPSU investigators past and present. Feedback from the event was very positive with delegates rating the quality of presentations and choice of speakers highly. The conference provided an opportunity to celebrate some of the recent work of the BPSU. The programme reviewed the contribution which the BPSU has made to the understanding and control of uncommon childhood conditions, its impact on public health policy and its development of partnerships. Speakers presented on the surveillance activities of the unit over the past 5 years. Talks included a keynote lecture by Dr Shelia Shribman, National Clinical Director, Children, Young People and Maternity Services. The BPSU was also delighted to welcome speakers from other surveillance units who have used the model developed by the BPSU to influence the establishment of their own systems. Dr Knight from the UK Obstetric Surveillance System and Dr Nicholls from the very recently established child and adolescent psychiatry reporting scheme both presented at the event If you would like details of any the presentations made at the conference or the BPSU in general please contact Helen Friend at helen.friend@rcpch.ac.uk

Lucy Wagstaff, who died in Johannesburg on 27th March, was nominated by Professor David Baum, the first elected president of our College, as one of our first Honorary Fellows. In his citation David described her as a “Freedom Fighter”, a term which might have both pleased and embarrassed her – but her obituary on the website of the University of the Witwatersrand (“Wits”) perhaps understated her contribution to the struggle against apartheid, as “a champion of the down-trodden, a friend of those in need, and superb teacher and clinician”. Lucy’s career spanned the rise of apartheid and its darkest moments through to the dawn of democracy in 1994. She matriculated in 1946, and graduated from Wits in 1952. She studied in the UK and was then appointed as a paediatrician at Baragwanath Hospital in Soweto, the township on the outskirts of Johannesburg. She was indeed a superb hospital clinician but recognised that much of the pathology treated at the hospital was the result of desperate poverty and social conditions associated with the political system. During the Soweto uprising of 1976 it became too dangerous for White staff to work in township clinics. Lucy had already been exploring nurse-led models of care and she seized the opportunity to introduce this on a wide scale, creating new opportunities for Black nurses and improving access to primary medical care for children. In that same year she became the first Loewenstein Professor of Community Paediatrics at Wits, and held this post until her retirement in 1997. Her publications covered a variety of topics including nutrition and growth, models of care, paraffin ingestion, paediatric consultation skills in community settings and immunisation policies. She was truly a community paediatrician as we would understand the term, at a time in South Africa when clinical excellence and expertise were the norm but preventive work, health promotion and primary care for the Black population were seriously neglected and – with a few notable exceptions - not considered worthy subjects for ambitious paediatricians. All too aware that, in spite of democracy and the end of race – based discrimination, this situation is changing only slowly, she continued to offer her expertise and wisdom until her health deteriorated a few years ago. We are privileged to have known and worked with Lucy Wagstaff and honoured that she was a Fellow of our College. Rest in Peace.

Helen Friend BPSU RESEARCH FACILITATOR

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Professor Lucy Wagstaff (1930-2009)

David & Susan Hall, May 7th 2009 d.hall@sheffield.ac.uk


RCPCH news

News Trainees’ column The foremost subject on every trainees mind appears to be the incoming EWTD regulations. I have therefore decided to use a large proportion of the Trainees’ Column this time to answer some of the questions on EWTD.

The National Trainees’ Forum This year saw the launch of the National Trainees’ Forum at the RCPCH Annual Spring Meeting. The meeting opened with an excellent keynote presentation given by the Chief Executive of PMETB. This was followed by stimulating talks by our new President on the subject of research in paediatrics, and Martin McColgan, the Workforce Information Officer on the recent MMC cohort survey. The highlight of the meeting was a Q & A session with an expert panel including the incoming and outgoing RCPCH Presidents, The Chief Executive of PMETB, the Deputy Chair of the BMA Joint Consultants Committee, The Vice Chair of the Academy Trainees Group, the RCPCH Vice President of Training and Assessment and the incoming Chair of the Trainees’ Committee. The National Trainees’ Forum was a success, attracting approximately 80 delegates. I am sure this will provide a platform for successful meetings in the future, providing trainees an opportunity to converse with leaders representing key professional stakeholders.

EWTD From August 2009, trainees will be legally required to work no more than an average of 48 hours working time each week. In addition, doctors must adhere to New Deal

SASG news I’m delighted to inform you that at the AGM in York it was agreed that there will be a specific seat on RCPCH Council for a SASG doctor. The call for nominations was included in the papers you received with this newsletter. This is something that the SASG committee has being trying to establish for some time but it hasn’t been easy. The constitution of Council forms part of the Byelaws of the RCPCH, and agreement had to be sought from the Privy Council to make this change. As a committee we would like to thanks the senior officers of the College who have supported us in this and

requirements. The Department of Health are closely analysing Trusts to ensure compliance and provide support where reaching compliance has been problematic. Provided that the EC supports the UK’s request, Trusts will be enabled through amendments to the UK Working Time Regulations to plan services with up to a 52 hour week for up to three years. They will have to achieve full compliance with 48 hours by August 2012 at the latest. The WTD cannot be ignored. It is a legal requirement under EU and domestic UK legislation. In 2008/09, £110m was included in PCT allocations to support WTD compliance. This was increased to £310m in 2009/10. To support trusts, the tariff uplift for 2009/10 reflected £150m funding for WTD. As some specialties face particular challenges a further £50m was been allocated to PCTs to support changes needed for trained doctor solutions, particularly in paediatrics and obstetric services. Given the current mismatch between doctors recently acquiring CCT and the number of available consultant posts, there is no plan to increase the number of training posts to meet WTD requirements. The plan is to reconfigure paediatric services to provide a more consultant delivered service. As with other employees, doctors can opt out of the maximum 48 hour working week. However this should be agreed in writing and no employee can be forced to work more than 48 hours. WTD is intended to protect the health and safety of workers. Therefore, there can be no ‘opt-out’ from the rest and leave provisions. Junior doctors’ contracts also limit them to a maximum 56 hours work a week

made our aspiration a reality. In the past, SASG doctors often held one of the Associate Members’ seats on Council and ensured that our issues were still considered. As the name applies the Associate Members’ seat can only be held by Associate Members and as more and more of our group of doctors are becoming full members of RCPCH we were keen to have a seat that could be held by any SASG doctor be they an associate member, a full member or a fellow of the RCPCH. I hope that by the next newsletter I will be able to tell you who has been appointed. Revalidation is looming, and I am delighted that our College is considering the needs of SASG doctors in their discussions

under the New Deal. Training should be delivered within the 48 hour week, and the opt-out should not be used by deaneries or Trusts to achieve the current training requirements. There are still a number of legal issues regarding internal and external locum work. It is vital that doctors check that any task that they perform and the hours they work are indemnified by the Trust. I would strongly recommend that all doctors have membership with a defence union (MDU, MPS). FAQ’s will be released notifying doctors about the EWTD including the relevant legislation.

Enrolment Fees for assessments Following a recent survey conducted by the Trainees’ Committee, we have identified a number of issues regarding the delivery of assessments and the e-portfolio. A proposal has been put forward to the RCPCH Executive Committee to double the enrolment fees by 2011. Given the recent problems, the Trainees’ Committee has released a statement strongly opposing this proposal.

Chair of the Trainees’ Committee Sadly, this is the last time I will be writing the Trainees’ Column as I have stepped down as Chair in May. I would like to congratulate Dr. Damien Roland who has been elected as the New Chair of the Trainees’ Committee. I wish him every success in leading the Trainees’ Committee in the future.

Dr Paul Dimitri CHAIR, TRAINEES’ COMMITTEE pauldimitri@hotmail.com

about this. Please keep referring to the RCPCH website (www.rcpch.ac.uk/revalidation) for more news about this. Finally, may I remind you that we are trying to strengthen the network of SASG regional representatives? Please have a look at the call for nominations flyer with this newsletter to see if there is a vacancy in your region and if there is I would urge you to put yourself forwards. I hope you have the opportunity to take some time off over the summer and I would like to wish you a happy holiday. Dr Natalie Lyth CHAIR, SASG COMMITTEE

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RCPCH Newsletter Summer 09