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Time to reconnect. Thursday 31 March – Friday 1 April 2022 Medicine 2022 RCP annual conference Med22 February 2022 Issue 1 Membership magazine of the Royal College of PhysiciansThe RCP Archive and Museum are recording the experiences of physicians and of those close to them during the COVID-19 pandemic. Tell us your experiences and add to the 500-year history of physicians told in the RCP’s collections. www.surveymonkey.co.uk/r/RZRW96WFebruary 2022 Commentary 1 ANDREW GODDARD PRESIDENT During the course of this pandemic, many emotive words have been used to describe the situation by the media, the NHS, government and health professionals themselves. Does the use of such language help? In our most recent COVID-19 survey of members, we asked a question we have not asked before: ‘During the past 3 weeks, have you felt overwhelmed at work?’ This was asked, in part, as a response to the government line that services were not being overwhelmed, and the many personal communications that I had received which suggested this was not how it felt on the wards. Our recent census of trainees (see page 10) was one such source of concern. We also worried about the personal toll the pandemic and staff shortages were having on physicians. The results showed we were right to be worried – 69% said they had felt overwhelmed in those 3 weeks; 21% said they had felt overwhelmed almost every day. To be ‘overwhelmed’ has a few meanings in the Cambridge Dictionary (other dictionaries are available to the west), but all convey the way it feels in health services at the moment. The first is the military use: to defeat someone by using a lot of force. The second definition is to cause someone to feel sudden strong emotion and, lastly, if something overwhelms someone or something, it is too much or almost too much for them to manage. I certainly relate to the latter definition, and the second one. It certainly described how I felt on a couple of occasions over the past few weeks. There was some wry humour expressed when some NHS leaders said that services were not overwhelmed in the latter stages of 2021. ‘We may not be overwhelmed, but we are feeling as whelmed as ever at the moment’ was one colleague’s comment. Humour is one coping mechanism when faced with difficult situations or the feeling that leaders are not particularly aware of how it feels on the wards. However, the impact that sustained feelings of this type have on our wellbeing is no laughing matter and I really worry what we will reap from the emotional seeds being sown at the moment. Retention issues, mental health issues and burnout are all circling like vultures over the medical workforce this winter. The first definition of overwhelmed raises the use of military language in a healthcare setting. This is commonplace, with ‘frontline’ and ‘in the trenches’ being used often, and more recently the NHS has been described as being ‘on a war footing’. I’m not sure this analogy is particularly useful, as it implies we are at war with patients and the diseases they are affected by – it does not reflect the importance of healthcare as a way of improving health. Many of our politicians like military analogies and have used them during the pandemic with frequent abandon. My least favourite was the description of vaccine development as ‘morale-boosting bugle-blasting excitement of Wellington’s Prussian allies coming through the woods on the afternoon of Waterloo’. No prizes for guessing who said that. I am not blameless in the use of metaphor to try to convey the reality of the pandemic to the press and politicians. Earlier this month, I said that there were no immediate fixes to the staffing crisis and we had no choice but to ‘ride out the storm’ of this wave of the pandemic. To me, this is very different from the notion of ‘riding the wave’ that has recently been used by some to describe how we get through the next few weeks. If we are riding a wave, it is not in the Bondi Beach surfing way, but on a plank of wood in rough seas with neither beach nor barbie in obvious sight. Given all of these thoughts, should we avoid all such ‘sensationalist’ language and any metaphor that may be misinterpreted? The nature of headlines is that they capture the attention and maybe the imagination of readers and we, as a profession, do need to ensure we engage with as much of the public as we can. Professor Sir Van-Tam has done this better than most in the pandemic and his language, especially using sporting references, has engaged with many to convey the importance of public health measures in controlling infection. In the right hands such language can be a powerful tool. Words, if used carefully, can be a powerful ally in our communication with the public and we have the advantage that we are not politicians. Unfortunately, we have plenty of time to practise. There is a long way to go in this pandemic and we may have only played one half, Brian. President’s perceptions: what’s in a word?Contributors Featuring our expert contributors this issue who have written articles or helped create the content for this issue. They share their experiences, knowledge and stories with you. Professor Namita Kumar Namita is a postgraduate dean, consultant physician and rheumatologist. She was made an honorary clinical professor by Durham University in 2014, and both Newcastle University and the University of Central Lancashire in 2017. She has been a council member of the Academy of Medical Educators since 2014, and was elected to the RCP Council in 2017. Professor Mala Rao Mala is director of the Ethnicity and Health Unit at the Department of Primary Care and Public Health, Imperial College London. She was awarded an OBE in 2013 for her contribution to public health and included in the Top 50 of the most influential ethnic minority people in health announced by NHS England and the Health Service Journal in 2020. 2 Commentary February 2022 CONTENTS FEBRUARY 2022 Time to reconnect. Thursday 31 March – Friday 1 April 2022 Medicine 2022 RCP annual conference Med22 February 2022 Issue 1 Membership magazine of the Royal College of Physicians Commentary Membership magazine of the Royal College of Physicians (RCP) Editor Maxwell Baker Editor-in-chief Professor Anton Emmanuel Head of Corporate Communications and Publishing Natalie Wilder Production Adam Pierce Articles published in Commentary reflect the opinions of the authors and do not necessarily represent the view of the RCP. Images copyright of RCP unless otherwise stated. Contact us Please email: commentary@rcp.ac.uk Registered charity no 210508 © Royal College of Physicians Printed: Warners (Midlands) Plc 5 1 President’s message Andrew Goddard reflects on the role of language during the pandemic, and how our choice of words can help to promote public understanding – and set expectations – about COVID-19. 4 News and comment An update on our commitment to equality and diversity; reflecting on the success of our recent physician associate conference; the new year’s honours list, and an update to our fellowship process. 8 VITT update Following a popular session on haematology at the Med+ conference last October, we provide an update on vaccine-induced thrombocytopaenia and its clinical features. 10 HST census As the NHS continues to deal with the pressures caused by the COVID-19 pandemic, our census of higher specialty trainees reveals the pressures on this part of the workforce. Professor Cheng- Hock Toh Cheng-Hock is an academic haematologist at Liverpool who has won awards for his services to patients with bleeding and thrombotic conditions. He has held diverse leadership roles, including as RCP academic vice president, president of the British Society for Haematology and national specialty lead of the NIHR Clinical Research Network. 22February 2022 Commentary 3 Editor’s letter On behalf of the whole RCP publishing team, it is my privilege to wish you a healthy and productive 2022. We hope you continue to find the publications a source of valuable, practical knowledge, both in relation to the pandemic – and in relation to Commentary in particular – for engaging with the multi-faceted work of the college. Our first edition this year is testament to the latter. Dr Mumtaz Patel describes the reach of the RCP global strategy, 1 year after it was launched. With one-in-five members/fellows being international, this is a key issue in building networks and reflecting the RCP’s pluralist ambitions. It is timely, and an honour, that this edition’s interview is with Professor Devi Sridhar, chair of global public health at the University of Edinburgh and adviser to the UK Cabinet Office. Public health professionals have never been more in the spotlight than in the past 2 years, and Devi speaks openly about her views of the national responses to the pandemic, as well as the challenges of being in that spotlight. The need for a global response to the pandemic – in terms of vaccination and future planning – comes through in every line of her interview. Another prolific public health professional, and friend of the RCP journals, is Professor Mala Rao. She offers her views on the importance of physicians being active participants in tackling the climate emergency. As it becomes clear that technological solutions alone will not remedy the situation, the role of doctors in behaviour and system change on a global scale is crucial. There is a complementary piece on the work being done by Health Education England in the north-east of England, part of a wider national programme working towards achieving a net zero NHS carbon footprint for emissions by 2040. Professor Namita Kumar describes the establishment of the Faculty of Sustainable Healthcare, a multidisciplinary collaborative of primary and secondary care healthcare professionals. One other key feature in this edition is the higher specialist training census. As we face up to the workforce needs in the recovery from the pandemic, understanding the needs for flexibility and appropriate support of trainees are key to all readers. Anton Emmanuel Editor-in-chief 16 Medicine 2022 A sneak preview of our annual conference, which will take place on 31 March and 1 April. 19 The new global strategy Twelve months ago, the RCP launched its new global strategy. The Global vice president gives an update on how the strategy has underpinned our activity over the past year. 20 Faculty for Sustainable Healthcare Health Education England North East has launched the Faculty for Sustainable Healthcare in their region, and Commentary speaks to the postgraduate dean who helped establish the new body. 22 Mala Rao on sustainability What are the health co-benefits to tackling climate change, and what is a doctor’s role in working to mitigate the effects we are already seeing of a more volatile climate? 24 Interview: Devi Sridhar The chair of global public health at Edinburgh University on the global response to the pandemic, tackling media and social media misinformation, and her role in advising the Scottish government. 28 New course for consultants Find out more about the RCP’s Six-step course for the new consultant. Dr Amanda Sara Amanda is senior educationalist (lead) at the RCP. She is an education specialist, fellow of the Royal Society of Arts and author of The Literacy Toolkit. Amanda is passionate about medical education and has significant interest in digital learning, an area which her team has daily involvement. Amanda currently leads the RCP’s Emerging Women Leaders programme and the master’s level RCP/UCL MSc in Medical Education. Londo Royal College of Physicians global strategy 2021–24 19 Professor Devi Sridhar Devi is a professor at the University of Edinburgh Medical School and holds a personal chair in Global Public Health. She is the founding director of the Global Health Governance Programme and holds a Wellcome Trust Investigator Award. She was previously associate professor in global health politics and a fellow at Wolfson College, Oxford University and a postdoctoral research fellow at All Souls College, Oxford University. She was also a visiting associate professor at LMU– Munich and guest lecturer at the Harvard School of Public Health. She served on the board of Save the Children UK, on the World Economic Forum Council on the Health Industry and co-chaired the Harvard/ LSHTM Independent Panel on the Global Response to Ebola. 20 244 Commentary February 2022 NEWS DECEASED FELLOWS; ELECTIONS Munk’s Roll is the RCP’s collection of biographies of deceased fellows, published online as Inspiring Physicians: https://history.rcplondon. ac.uk/inspiring-physicians If you would like to write an obituary or notify the RCP of the death of a fellow, please: Email: munksroll@rcp.ac.uk Phone: +44 (0) 20 3075 1312 Here are the deaths reported since the previous Commentary, covering the period 16 November 2021 – 14 January 2022. Samuel John Machin Roy Malcolm Jones Ming Houng Chan Peter John Westlake Kersey Robert Stanley Edward Wilson Namita Pandita-Gunawardena Peter Beck Michael Bruce King Suresh Pratap Sahi Maxwell Winson Michael McBean Page David John Williams Nicholas Jonathan Dodd Nicholas John Nathan Ian Alasdair Burns Brooksby Peter William Fisher Ruth Jeanne Whitfield Albert Gyang Boohene Malcolm Edward Molyneux Geoffrey Frith Cohen Terence Edward Timothy West Ross St Clair Barnetson Rita Sood Ibrahim Nasr Owen St Clair Morgan Frederik Riach Ironside Middleton Ann Isabel Fawcett Man Chun Chiu Irvine Delamore Deceased fellows The nomination period for the roles of president, clinical vice president and councillors closed on 15 December 2021 and candidates are now preparing election material. As previously notified, the three elections will run concurrently with digital-only voting by fellows, although members will also have access to the election portal for information. For the election of the president, candidates will also complete a written Q&A based on suggested questions from the membership. A digital hustings event will also be recorded and made available to the membership. These two components are designed to increase engagement, and for fellows to get to know the candidates for president. The written answers and hustings will be made available on the RCP website with the agreed election material (statement, CV, photograph and DOI) hosted on the election portal by Civica Election Services (CES), the RCP election partner. Timetable 2022 > 26 January – Council receives a list of candidates in all elections > 31 January – List of candidates to made available on RCP website > 9 March – Voting opens. Fellows emailed by CES with directions on how to access the election portal and vote > 9 March – Written Q&A and recorded hustings for candidates for president made available on RCP website > 11 April (midday) – Voting closes > 11 April – College Day including the presidential election, Fitzpatrick and Samuel Gee lectures (hybrid meeting). Papers will be sent electronically at least 2 weeks before the meeting. The result of election of president will be announced at the end of College Day. Details will be updated at www.rcp.ac.uk/news/special-general-meeting- fellows-election-president-college-day-2022 > 18 April (week beginning) – Results of the clinical vice president and councillor elections will be announced > 13 September – Annual general meeting of fellows (hybrid meeting), including installation of the new president Voting and engagement Fellows are encouraged to use their vote for these pivotal roles. To receive the voting invitation and related governance meeting papers fellows can check, update or add an email address (or career stage) by logging on to ‘MyRCP’ on the RCP website www. rcplondon.ac.uk/user and clicking the link ‘Manage contact details’. Alternatively, fellows should email membershipqueries@rcp.ac.uk quoting their RCP code. Pre-registered fellows physically attending the presidential election, as part of College Day, will have an option to vote in person at the election of the president. The use of social media by candidates regarding the election is permissible, once the list of candidates is made public, but is limited to specified factual information. Please see the nomination webpages (now closed for nomination) where the Election material 2022 and the RCP social media principles and code of conduct downloads provide further details. Role descriptors are also available to provide context to each role. www.rcp.ac.uk/news/presidential-election-2022 www.rcp.ac.uk/news/clinical-vice-president-and-councillor-elections-2022 As ever, the RCP would like to extend its thanks to all fellows who have nominated others or agreed to stand for election. For more information, contact Simon Land, head of professional governance: simon.land@rcp.ac.uk Elections 2022February 2022 Commentary 5 Creating a diverse, representative RCP In 2019 the RCP commissioned Ben Summerskill to review our performance on diversity and inclusion, and we promised to deliver against the recommendations he made, including those regarding necessary improvements in monitoring and reporting. The intention was to look at how the RCP can become a best practice organisation in the health sector. A year on from Ben’s landmark report, we have published an update on our progress to date (www.rcp.ac.uk/progress-report-edi). We know that to achieve the report’s recommendations and become fully representative, we must first determine the diversity of our members, fellows and other stakeholders who work with the RCP, so we know the representation we are aiming for. We cannot be what we cannot see. We are beginning an overarching diversity data collection initiative and invite you to complete your personal data collection form at www.rcp.ac.uk/myrcp. This form is the same for everyone and we kindly ask that you fill it in, even if you ‘prefer not to say’ – this is an option on every question, and a valid choice. To use the data in a meaningful way, we need to have a high completion rate so your submission is strongly encouraged. You can be reassured that we will only report on aggregated data, never individual. We are grateful for your engagement with this data collection initiative as a vital part of the RCP’s drive to achieve representation at all levels. Dr Sarah Logan, consultant in infectious diseases and general medicine has been appointed as director of the RCP’s Medical Workforce Unit (MWU). Dr Logan, a consultant at the Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, studied at Cambridge University and finished her medical degree at Imperial College. She trained in London working both full time and less than full time as a medical registrar. Dr Logan was appointed to her consultant position on a less-than-full-time contract and continues to work flexibly at 0.75 whole time equivalent. Alongside her role as director of the MWU, Dr Logan is clinical lead for the Hospital of Tropical Diseases and lead for the outpatient parenteral antibiotic service at her trust. In response to her appointment, Dr Logan said: ‘The medical workforce and supporting those within it has been a long- held passion of mine. I have been involved with the work of the MWU at the RCP over the past 12 years and could not be prouder to be leading the unit and its work.’ RCP appoints new director of Medical Workforce Unit The Faculty of physician associates (FPA) hosted their first virtual physician associate (PA) conference in November 2021. As an annual event, the physical conference is a key date in the diary for the PA community, and the first virtual event welcomed over 800 delegates. Throughout the 2-day conference, more than 30 speakers, including PAs, delivered compelling presentations on a vast range of topics – some, such as lesbian, gay, bisexual and transgender medicine and interventional radiology, were covered for the first time at an FPA conference. Coupled with exclusive live Q&A opportunities and interactive sessions with FPA Board members, the event provided delegates with the opportunity to consolidate their learning, gain new knowledge, and interact virtually with fellow PAs. Speaking about the virtual conference’s success, FPA president, Kate Straughton (right) said: ‘While we had hoped to offer an in-person experience, we were delighted to welcome over 800 delegates into our virtual community. Everyone remained fully engaged over the 2 days and we were pleased to offer something for everyone – whether they had been a PA for a number of years, were newly qualified or just starting out on their journey to qualify as a PA.’ With such a vast range of sessions available, the FPA are pleased to provide all registered delegates access to watch on demand until 24 February 2022. For anyone still wanting to register, you have until 25 January to sign up – and until 24 February to watch sessions too. The FPA team is busy behind the scenes planning their 2022 conference, which is promised to be bigger and better. Faculty of Physician Associates virtual conference success 6 Commentary February 2022 NEWS HONOURS Order of the Companions of Honour (CH) – Members of the Order of the Companions of Honour Sir Paul Maxime Nurse HonFRCP For services to science and medicine in the UK and abroad. Order of the Bath – Knights Commander of the Order of the Bath (KCB) Sir Patrick John Thompson Vallance FRCP Government chief scientific adviser, Government Office for Science. For services to science in government. Professor Christopher John MacRae Whitty CB FRCP Chief medical officer for England. For services to public health. Order of the British Empire – Dames Commander of the Order of the British Empire (DBE) Dr June Munro Raine CBE FRCP Chief executive, Medicines and Healthcare products Regulatory Agency. For services to healthcare and the COVID-19 response. Knights Commander of the Order of the British Empire (KBE) The Rt Hon Professor Ajay Kumar Lord Kakkar HonFRCP For services to healthcare and public service. Knights Bachelor (Kt) Professor Shakeel Ahmed Qureshi FRCP Professor of paediatric cardiology, Guy’s and St Thomas’ Hospitals Foundation Trust. For services to paediatric cardiology and charity. Professor Jonathan Stafford Nguyen-Van-Tam MBE Deputy chief medical officer. For services to public health. Order of the British Empire – Commanders of the Order of the British Empire (CBE) Professor Kamlesh Khunti FRCP Professor of primary care diabetes and vascular medicine, University of Leicester and general practitioner, Hockley Farm Medical Practice, Leicester. For services to health. Professor Peter Openshaw FRCP Professor of experimental medicine and proconsul, Imperial College London. For services to medicine and immunology. Professor Iqbal Singh OBE FRCP Chair, Centre of Excellence in Safety for Older People. For services to equality and inclusion in healthcare. Professor Russell Mardon Viner FRCP Professor in adolescent health, University College London. For services to child and adolescent health, particularly during COVID-19. Order of the British Empire – Officers of the Order of the British Empire (OBE) Professor Anthony John Avery HonFRCP Professor of primary healthcare, University of Nottingham. For services to general practice. Professor Ali Sadiq Mohammad Jawad FRCP Professor of rheumatology, Barts and the London School of Medicine and consultant rheumatologist, Barts Health NHS Trust. For services to healthcare. Professor Hugh Edward Montgomery FRCP Professor of intensive care medicine, University College London. For services to intensive care medicine and climate change. Order of the British Empire – Members of the Order of the British Empire (MBE) Professor Richard John Haynes FRCP Professor of renal medicine and clinical trials, University of Oxford. For services to global health. Dr Bnar Talabani MRCP Kidney and transplant medical specialist, University of Wales and immunology scientist. For services to the NHS and to the ethnic minority communities in Wales, particularly during COVID-19. Professor Anthony Barrington Ward FRCP Lately professor, rehabilitation medicine, Midlands Partnership NHS Foundation Trust. For services to rehabilitation medicine and people with disabilities. Order of the British Empire – Medal of the Order of the British Empire (BEM) The Very Reverend Doctor Susan Douglas Salt FRCP For services to the community in the Diocese of Blackburn, Lancashire, particularly during COVID-19. New Year Honours List 2022 – RCP members and fellowsFebruary 2022 Commentary 7 NEW FELLOWSHIP PROCESS NEWS New fellowship election process We’re delighted to announce that, following a review guided by RCP Council, our new fellowship election process is launching later this month. Fellowship of the RCP (FRCP) remains a hallmark of achievement for physicians, but the way that we award fellowship has changed. Our election processes are being updated to keep pace with the values and diversity of modern medicine, increase inclusivity and become more transparent. What is changing? > Both proposal and self-proposal will now be easier and the same for UK consultants, SAS doctors and international physicians, made via a 500-word maximum application over two domains. For proposals, candidates are advised of their nomination at the start of the process and encouraged to add supporting information. > Proposals will be made via a dedicated IT platform and simple webforms, with clear guidance and explanation of the process. > Once submitted, proposals are endorsed by an impartial local source and graded anonymously using a scoring matrix to judge against: > scope of professional practice and > one chosen area of special interest/expertise from: service improvement innovation and leadership; training and education; research. > Following final review led by the registrar and RCP Council, unsuccessful proposals will receive feedback and advice where possible on when and how to re-apply in future. > Successful candidates will be published, as is tradition, on the Green List. More information can be found at www.rcp.ac.uk/fellowship, where you will also find a link to the application portal. Process initiated by either candidate or sponsoring fellow Endorsement and grading Sent to candidate to complete Senior colleague endorsement Shared proposal webform Anonymised scoring panels Meeting of panel chairs Council Sponsoring fellow to complete College tutor endorsement ApplicationQA and approvalNext >