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June 2022 Issue 3 Sir Martin Landray The role of research in tackling COVID-19 Membership magazine of the Royal College of Physicians > PAs and research > Global Women Leaders > A new RCP treasurer > The Wales hospital landscapeJune 2022 Commentary 1 ANDREW GODDARD PRESIDENT A recent debate on social media around the new GMC consultation on ‘Good medical practice’ has centred on the new inclusion of an expectation for us to treat patients with kindness. This has led me to think about the place of kindness in modern medicine. The exact phrase used in the new GMC guidance under consultation (in Paragraph 22 if you are interested) is: ‘You must treat the patient with kindness, courtesy and respect’. I personally find this very hard to argue with. Kindness means different things to different people, but the dictionary definition is a good place to start: ‘the quality of being friendly, generous and considerate’. Kindness doesn’t mean that you must do everything that the patient asks or wants, avoid making difficult decisions or indeed recommending treatments that will have unpleasant side effects. Such actions, without the intent being known, would be seen as cruel. As doctors it is common for us ‘to be cruel to be kind’. As an aside, the origin of that phrase is from Shakespeare’s Hamlet (is there another?) where the Danish prince is trying to protect his mother, Gertrude, from the wiles of her new husband Claudius. It is a complicated plot twist and I wonder where revenge for his father’s death fits in, but I think most understand the idea behind the famous phrase. I think Nick Lowe put it more clearly, but then I am a music-loving child of the 70s. There is a significant difference in my mind between ‘being nice’ and ‘being kind’. The former is about pleasing an individual and how they have been made to feel, while the latter is more about an act of benevolence. Things can be nice (hats, jokes, dancefloor moves) but only people can be kind. I must also confess a bias, as I have long believed that kindness is one of the marks of a great physician. Indeed, I have said that in print (the BMJ in 2018) and say it at every MRCP(UK) ceremony. The advice I received as a medical registrar to ‘work hard and be kind to people’ has stuck with me. Furthermore, I find the notion that we would ever advise a colleague to ‘be unkind to patients’ ridiculous. So why has this caused such a furore (to the point that it has been raised as a discussion point at Council)? I think some people worry that the direction that we ‘must’ treat patients with kindness may be a standard that is not always achievable, given the critical pressures many of us continue to experience in the NHS – and thus we all risk the regulator’s wrath. There is no doubt that for time-poor physicians on a busy ward round, or in an over-booked clinic, it is impossible to spend as much time with our patients as we would like. However, it is our behaviours and attitudes in those situations where we can show kindness. I reiterate that this isn’t about being nice all the time and wanting to please patients; it is ensuring they get the best care (in its wider sense) that a situation allows. Osler put it best (another phrase I use at MRCP(UK) ceremonies): ‘The good physician treats the disease a patient has. The great physician treats the patient who has that disease.’ I also note that some interpret the instruction to ‘be kind’ as a way to marginalise those from different cultures, and see this as a big problem. I get that, but don’t think that is what the GMC is suggesting here. However, I also know that the regulator has had a more than chequered past with regards to diversity and inclusion, and many under their watchful gaze have not felt they have been treated kindly. In their defence, I think the GMC leadership have made great strides forward and that they are consulting in this way is a good thing. It is also a strong belief of mine that we should treat each other with kindness. I was struck as an SHO (before the phrase ‘central doctor’ entered the lexicon) by how I felt when I was treated unkindly by my seniors and resolved to not follow their leadership style. One job I had for a very famous surgeon consisted of him acknowledging my presence once and never using my name. I was a ‘grunt’ in both status and name. In conclusion, then, I support the notion that we should do our very best to treat patients with kindness and that they and we are better for it. I will continue to champion the principle of working hard and being kind to people. President’s perceptions: the meaning of kindnessContributors Featuring some of 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. Jon Barlow Jon is a photographer based in London, working all over the UK, producing editorial portraits for a variety of clients. By making people feel at ease within their environment, Jon uses his approachable and honest attitude to produce high- quality and meaningful work. Having worked for RCP for 3 years, he has found working with the members and listening to their stories an exciting and enjoyable experience. Dr Louella Vaughan Louella is an elected member of RCP Council and a consultant physician in acute medicine at Barts Health NHS Trust. As senior clinical research fellow at the Nuffield Trust, her research focuses on the organisation of acute and emergency care, smaller and rural hospitals, and patient safety. She is also a medical historian and the current Harveian librarian of the RCP, which also oversees Inspiring Physicians, the college’s collection of obituaries. 2 Commentary June 2022 CONTENTS JUNE 2022 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 Cover photo John Cairns 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 4 1 President’s message Amid the pressures faced by NHS staff, there is an ongoing debate in the health service about kindness, and its relevance to clinical practice. 4 News and comment The RCP’s new president and other elections; our new photography exhibition; the British government’s new energy strategy and much more. 9 The Spine: our 1-year anniversary We look back on our first year in The Spine, our home in Liverpool, and share what we’ve been up to in this state-of-the-art new building. 14June 2022 Commentary 3 Editor’s letter The working lives of physicians change continuously, reflecting the concerns of their patients and the needs of the wider communities they serve. What at one time may seem like ‘wokery’ (ugh) often ends up becoming part of the mainstream. Physicians, while not necessarily seeking to lead that change, are often at the vanguard of those forces of change. It’s a pleasure to have a feature by Dr Kieran Sandhu on the NHS’s ambition to becoming a net zero carbon emitter. With healthcare accounting for an estimated 5% of global emissions, this would represent a significant contribution to what is an international emergency. Elsewhere, Dr Justine Durno stresses the role of doctors in removing the barriers placed on Deaf colleagues and patients, including the lack of emphasis on signing, coupled with the ‘sympathetic but negative’ attitude towards deafness. The lack of availability of transparent face masks has compounded problems for lipreaders, as well as difficulties experienced by many attempting to conduct more phone consultations. There are small things we can do in practice that would have a great effect. Our interview is with Professor Sir Martin Landray and describes the narrative of the evolution of the RECOVERY trial and the hopefully lasting impact of the study beyond its outputs. Prof Landray’s reflections on how randomised clinical trials (RCTs) could be used to answer the common clinical questions for which we don’t have strong evidence will engage many – and challenge others who feel that RCTs are too blunt an instrument for this. Your feedback is valued, as ever. Research is the focus of an article by Silothabo Dliso, a physician associate in Liverpool. He describes the role of the PA as both a ‘generalist’ and a researcher – making clear that there is no dichotomy in these functions. The nature of how PAs work with patients and organisations provides a real opportunity to lean into research delivery. With more than 3,000 PAs in service, the opportunities for collaborative clinical research are wide. Anton Emmanuel Editor-in-chief 12 The RCP’s new treasurer Professor Simon Bowman, former deputy treasurer, took up the new role in April. 14 Interview: Sir Martin Landray Sir Martin, one of the architects of the RECOVERY trial, advocates for the importance of research. 18 Global women leaders An interview with RCP Global vice president Dr Mumtaz Patel about this new leadership programme. 22 Medicine 2022 We look back at the success of our recent annual conference, held in London, Liverpool and online. 24 Welsh trust visits Our vice president for Wales Dr Olwen Williams discusses the RCP’s visits to trusts in 2021. 26 PAs and research PAs form an important part of the workforce, and increasingly so in the field of research. 28 Practising as a Deaf doctor Dr Justine Durno explains the barriers to educational access for aspiring Deaf doctors. 29 Greener NHS Dr Kieran Sandhu explores how greener policies can translate into more effective care for patients. 12 Dr Mumtaz Patel Mumtaz is RCP Global vice president, a consultant nephrologist and postgraduate associate dean for Health Education England. Mumtaz has also worked as an RCP regional adviser for training and clinical lead for quality management for the JRCPTB. Mumtaz completed her medicine degree and foundation training in Manchester, did her renal specialist training in Yorkshire and gained her PhD from the University of Manchester in the genetics of lupus nephritis in 2006. She was appointed as a consultant nephrologist at Manchester University Foundation Trust in 2007. Mumtaz has been involved in various educational roles from department to divisional lead, renal training programme director and was then appointed as postgraduate associate dean in 2016. She obtained an MSc in medical education in 2014 and has a strong research background in assessment, professionalism, differential attainment and quality improvement. 18 244 Commentary June 2022 NEWS NEW PRESIDENT; PHOTOGRAPHY EXHIBITION A new exhibition from photographer Jessica van der Weert is now open at The Spine in Liverpool, telling the story of health and care workers’ experiences during the COVID-19 pandemic. While the public went into lockdown, health and care staff were working 16 hours a day, 7 days a week, putting themselves in direct path of the virus, often with very little protection. SELFLESS documents the NHS response to COVID-19, and the dedication, resilience and never- ending acts of kindness of those who have worked during the pandemic. The portraits were taken during the first UK lockdown in partnership with the RCP, Northumbria Healthcare NHS Foundation Trust and Brent GP teams. The exhibition opened with a private view on the evening of 18 May at RCP at The Spine, and is now open to the public until 19 June, when it will move to our Regent’s Park headquarters in London for the month of July. SELFLESS is generously supported by the Jerwood Foundation, and will be the inaugural exhibition in the space they have funded at The Spine. On the launch of SELFLESS, Jess said: ‘ At the start of the pandemic, it worried me that we were becoming numb to the numbers we saw on the news, which was far from the reality. These were people’s loved ones, their fathers, mothers, siblings and even children, reduced to numbers and graphs on television. Photography is the most remarkable medium for documenting history; it puts faces to numbers, gives names to graphs, and shows us what is really happening in an honest and unbiased way. Most importantly, it never let us forget. This was the goal of the project: to document the incredible human effort to fight this pandemic by our medical and care staff – to tell their stories.’ New photography exhibition launches Jessica in her studio, overseeing production of the show. RCP elects new president David Oliver (left) has been elected the 122nd president of the RCP. He will take over from current president, Andrew Goddard (right), on 13 September and serve a 4-year term. Seven candidates stood in the online ballot and a total of 3,125 votes were cast. Professor Oliver won with 1,302 votes: 79 more than the nearest candidate. Professor Oliver is a consultant physician in geriatrics and general medicine, was RCP clinical vice president and a trustee from 2016 to 2019, and was on the RCP Council from 2014 to 2019. On his election, he said: ‘I’m grateful that the fellows of the RCP have put their trust in me in what was a very close-run contest against some very able candidates. I hope I can repay their faith by serving the college and my fellow physicians over the next 4 years in what are some challenging times.’June 2022 Commentary 5 NEWS IN BRIEF NEWS The RCP is delighted to announce that thanks to a generous £175,000 gift from CAE Healthcare, we will be supplying the East, Central and Southern Africa College of Physicians (ECSACOP) with five patient simulators. The simulators will be used to deliver the advanced life support (ALS) training course across all six ECSACOP countries, and have clinical features and capabilities to help train emergency medical personnel in academic programmes, hospitals and emergency care services. Their arrival in the region will mark an exciting moment for ECSACOP’s vision of healthy communities with access to well-trained physicians and has been warmly welcomed by ECSACOP president Professor Innocent Gangaidzo: ‘This exceptionally generous donation of specialist training equipment from CAE Healthcare will enable us to build on the growth that ECSACOP has achieved in the number of participating member countries and in the overall number of trainees. Thanks to this gift, we will be able to implement the ALS course in countries across the region and to provide evidence-based resuscitation guidelines and skills to healthcare professionals. This is a real boost for ECSACOP’s work in ensuring a sustainable, independent and bright future for healthcare systems in the region and we would like to express our enormous gratitude to CAE Healthcare for supporting our mission in this important way.’ ECSACOP was established in 2015 to address the challenges faced by physicians and trainees in a region of 1.2 million square miles with a population of 207 million. Since then, and thanks to the support of donors including RCP members and fellows, ECSACOP has established a common curriculum, standardised training methodologies, and a new postgraduate medical qualification – the FCP (ECSA). It has enrolled over 400 physicians as fellows; accredited 14 active training sites; and completed formal training of over 160 physicians. ECSACOP has convened four annual scientific conferences for specialist physicians from across the globe to share best practice and research findings. It has recently collaborated with the WHO on a regional model for communication and digital learning in response to the COVID-19 pandemic. Heidi Wood, president of CAE Healthcare, commented: ‘We’re honored to support the efforts of both the RCP and ESCACOP to train medical personnel, advance quality healthcare and increase patient safety through simulation, education and practice. This noble mission drives CAE, and we appreciate the opportunity to demonstrate our commitment through initiatives such as this one that deliver real-world, risk-free training to those working in emergency medicine.’ If you are interested in supporting the work of ECSACOP, contact Tiffany Sutcliffe (tiffany.sutcliffe@ rcp.ac.uk, 0203 075 1472) for further information. Donation to ECSACOP The government has changed the ‘special rules’ so that more people nearing the end of their life will be eligible for financial support. Until April, they were called the ‘Special rules for terminal illness’ and applied to people who had 6 months or less to live. They are now called ‘Special rules for end of life’ and apply to people who have 12 months or less to live. The change follows an inquiry by the All-Party Parliamentary Group for Terminal Illness into the legal definition of ‘terminal illness’. The RCP provided written evidence, arguing that the definition should be brought in line with the healthcare definition of ‘end of life’: someone who is likely to die within the next 12 months. We are therefore pleased that these changes are being made. In the first instance, the rules will be changed for Universal Credit and Employment and Support Allowance. Eventually they will be extended to Personal Independence Payment, Disability Living Allowance and Attendance Allowance. More information and guidance on what you need to do if someone you are caring for has a progressive disease and you would not be surprised if they were to die within 12 months is at: https://bit.ly/3F8MAeh Financial support for end of life Fibromyalgia syndrome is common, with a worldwide prevalence of 2%. However, it can be challenging to diagnose as symptoms vary and may fluctuate. A common experience for patients is for diagnosis to take time and be a drawn-out process, sometimes taking many years. The RCP has recently published new guidelines to support patient-facing clinicians to consider a diagnosis of fibromyalgia. The idea for the guidelines came from wanting to improve the experience and outcomes for a group of patients who can often struggle to be heard. The guidance is available to download from the RCP website, along with a diagnostic worksheet and two information sheets: www.rcp.ac.uk/fibromyalgia-guidelines Support for diagnosing fibromyalgia6 Commentary June 2022 NEWS GOVERNANCE MATTERS; HEALTH AND CARE BILL The Health and Care Bill has now received royal assent, and will become law on 1 July. The new bill will place integrated care systems (ICSs) on a statutory footing, which will better enable integration at a local level, to improve health. RCP president Dr Andrew Goddard, said: ‘We welcome that government listened to sector organisations, including the RCP, and introduced key amendments to give ICSs new duties on health inequalities, clinical research and climate change. These changes will provide a good basis for action when the Act comes into force. ‘The RCP was one of over 100 health and care organisations calling for the bill to include a duty for regular assessments of how many staff are needed now and in future to meet demand. It is disappointing and frustrating that government did not accept this amendment and that no compromise was reached. This is a significant missed opportunity to begin to solve the workforce crisis which remains the limiting factor in the government’s plans for health and social care. ‘The RCP will be supporting its members to play their role locally. Integration will not happen without teams working differently, and we encourage physicians to be a part of this.’ The RCP-backed amendments that were passed with the Health and Care Bill represent important progress in working towards the RCP’s current policy priorities. You can read more about how the RCP influenced the bill in the next issue of Commentary . Future policy priorities Our current policy priorities – workforce, person-centred integrated care, health inequalities, and research and innovation – were set after an all-member survey in 2018. It is now time to identify new priorities to underpin how we deliver the RCP’s third strategic aim: influencing the way healthcare is designed and delivered. We need your help to make sure they are the right ones. Earlier this month, you will have received a survey from us about setting our priorities, which runs until 15 June. Please take this opportunity to help set the direction of the RCP’s work for the next 4 years. The RCP and the passage of the Health and Care Bill Comitia Notice is hereby given that the annual general meeting (AGM) of fellows 2022 will be held 5–7pm on Tuesday 13 September. Held as a hybrid meeting, with attendance either in person at RCP London or online, the AGM will be followed by the installation of the new president. Fellows attending in person will have the option to book for dinner after the AGM. College Day/presidential election 2022 Fellows and members can access Dr Goddard’s address and the announcement of the presidential election result: https://bit.ly/3P3AvM5 (behind the log in). CVP and Council elections 2022 Congratulations to the successful candidates for clinical vice president and Council, who will begin their tenures later in 2022. Further information can be found at: www.rcp.ac.uk/news/rcp-elects-new-clinical-vice- president-and-four-new-councillors Thanks are due to all candidates who stood for election, to fellows who voted and the current role holders. RCP roles – your chance to get involved Our officer, committee and other clinical volunteer roles are an ideal opportunity to support the RCP, guide our decision-making and ensure the voice of the membership is included across all activity. Visit www.rcp.ac.uk/education-practice/volunteering to see the latest opportunities. Current vacancies include: the improvement clinical director working with the Care Quality Improvement Directorate, two clinical adviser roles working with the Medical Workforce Unit and the key role of censor. One of our current censors, Dr Rasha Mukhtar, explains more about the role: RCP governance matters ‘ Being a censor has been a great learning experience. There are opportunities to influence decision-making, support educational initiatives and participate in RCP events. As a PACES examiner, it has been a pleasure to attend MRCP and FRCP ceremonies and celebrate the achievements of the new members. Last but not least, I have had the privilege of meeting and befriending so many wonderful people from all walks of life.’June 2022 Commentary 7 AWARD SCHEME; ACCREDITATION NEWS We have recently launched a reformed national reward and incentive scheme, and changed the name from ‘Clinical Excellence Awards’ to ‘Clinical Impact Awards’, reflecting our intent to reward the direct or indirect impact of consultants’ work in the NHS, moving away from a focus on activity alone. Our plans have been informed by a range of stakeholder events in 2020/1, experience and analysis of recent rounds, recommendations from the Doctors’ and Dentists’ Review Body, and by a formal government consultation process. The results of this were published recently here: https://bit.ly/3j6iBtb. We also commissioned an NIHR- funded research project focused on assessment and scoring processes, but also exploring the value of citations. Professor Campbell’s group from the University of Exeter will publish their full findings shortly, but valuable discussions with the research team have also informed our plans. There have been a number of changes for 2022. We have increased the number of available awards, restructured the award levels (now operating on a three-level system), and refreshed the assessment domains. The application process is now also simpler, as applicants no longer apply for an award at a specific level. We’re also pleased to announce that those working less than full time (LTFT) will no longer receive their post 2022 award payments pro rata, and all National Clinical Impact Awards are no longer pensionable or consolidated. We also plan to simplify the process for employers, who only need to indicate their support or their lack of support for an application and provide a citation for each applicant. Employer scoring and ranking are no longer required. Further information is now available: https://bit.ly/3j9hhpz What about citations? Third party citations are no longer allowed, as research has shown these to be of little or no value. We have also rationalised and reduced the number of national nominating organisations (NNOs – formerly NNBs and specialist societies). A full list is available at: https://bit.ly/3u9uxRq This is designed to increase the value to assessors of NNO citations, which we expect to focus specifically on the impact of a consultant’s work to the wider NHS, rather than to the individual organisation. This also means that royal colleges, including the RCP, will have an increasingly important role to play in the awards process. Will it be easier to get an award? The total award number is being doubled, with many more awards available at the top level than was previously the case. It is our hope and expectation that we will receive an increased number of strong applications from a more diverse range of applicants, particularly those who are working LTFT and making outstanding national contributions. Therefore, the bar is likely to remain high. In order for the 2022 scheme to be a success, we will need engagement from employers, assessors and nominating organisations. Most importantly though, we will need buy- in from consultant applicants. As of 2022, a ‘first-time’ applicant can put themselves in the frame for a top-level (platinum-equivalent) award, and the ‘non-stratified’ application system makes the national scheme accessible to everyone. As with getting a new job or an internal promotion, the surest way not to succeed is not to apply! The applicants’ quick guide: https://bit.ly/3x1rD2L All consultants eligible for top-level awards under new scheme An update from Professor Kevin Davies, medical director The RCP’s Accreditation Unit, All Wales Diabetes Implementation Group, East of England Diabetes Network and Diabetes UK are working together to deliver a pilot accreditation programme to support improvement in diabetes care in hospitals. The new Diabetes Care Accreditation Programme (DCAP) aims to improve inpatient care by setting quality standards and measuring how services perform against the standard, through an external peer assessment, thereby driving continuous improvement. The pilots will take place in Wales and the east of England between April and November 2022. Dr Daniel Flanagan, diabetes consultant based in Plymouth, will lead the programme: ‘I’m honoured to be appointed as clinical lead for the new diabetes accreditation programme. We’ve worked in collaboration with Diabetes UK and the RCP for a number of years to get the pilot off the ground and it’s been fantastic to see the enthusiasm from the community. I’m also very grateful to the East of England Diabetes Network and All Wales Diabetes Implementation Group for supporting the pilot and look forward to carrying out assessments later in the year and sharing the feedback from the pilot in due course.’ Dr John Dean, RCP improvement clinical director, said: ‘I’m delighted to launch the new programme, working in collaboration with a number of key stakeholders. We know this can drive improvements in care.’ To keep up to date with the pilot and plans for the future, register your interest here: www.dcap.org.uk/register-interest Pilot for diabetes accreditationNext >