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November 2021 Issue 6 A new generation Celebrating fellowship, raising standards and improving care Membership magazine of the Royal College of Physicians2 1 3 ROYAL COLLEGE of PHYSICIANS of EDINBURGH Complete the 2021 consultant and SAS physician census Have your say … The census is now live and available for you to complete. It provides the three Royal Colleges of Physicians with essential data that we share with politicians and policymakers to help make the case to lobby for changes, such as additional consultant and SAS posts and medical school places, improved facilities, and a greater focus on regions in need. If you want to know more about how we use the data, you can refer to The medical workforce BC (Before COVID-19): the 2019 UK consultant census. You can also download a tool that allows you to interrogate the data yourself. If you haven’t received your census email invitation, please contact mwucensus@rcp.ac.ukNovember 2021 Commentary 1 ANDREW GODDARD PRESIDENT According to the latest figures from NHS England, October 2021 was the busiest month on record. It is going to be a very hard winter and this month’s Commentary adds fuel to the debates about the long-term solutions for healthcare. I often write about workforce in this column, and make no apologies for majoring on the topic again. At every hospital I have visited over the past 3 years, either in person or virtually, workforce has been the key concern. This is reported by trainees, consultants and exec members – and the two trusts I visited in the week I wrote this column were no different. Politicians and some NHS leaders have repeatedly said that the service is not overwhelmed, but the description of feeling ‘more than whelmed’ by consultants at one trust says it all. To those practising medicine at the moment, it feels very different from the narrative given to the public. The latest census report is contained within these pages and makes for grim reading, especially when it comes to the success of appointing to consultant posts. Our latest membership surveys add to the picture the census paints, revealing that 26% of consultants intend to retire in the next 3 years. If trusts are to retain skilled and high-value consultants, they need to look at ways they can support physicians to work flexibly. This is also true for trainees, of which 56% would prefer to work flexibly. Sarah Logan’s article on the work of the RCP Flexible Working Group and views from the Trainees Committee make this clear. The system will have to think differently if it is to survive. There are positives, though. While I and the RCP will continue to push hard for a doubling of medical school places, this will not solve the problems we face here and now. The fastest expanding cohort of the healthcare workforce is physician associates (PAs). Again, if I reflect on my recent visits to hospitals, PAs have been a great success at sites where they are funded, trained, supported and integrated into medical services. I was very disappointed by the recent announcement of a further delay in regulation for PAs (now slated for summer 2023). That should not stop us continuing to develop that part of the workforce though, and it is obvious that more hands and feet on the wards and admission units make everyone’s lives easier, as well as improving patient care. Last month we celebrated PA week and I hope those celebrations will get bigger each year. If things are bleak in the NHS, we should not forget that they are bleaker elsewhere, and an article on healthcare in Myanmar brings this reality home. We must stand together with our physician colleagues across the globe, and while our political challenges are substantial, they are nothing in comparison to those faced by doctors in Myanmar. We send our thoughts and strong support to them. The situation in that beautiful country reminds me that we should be grateful the future of healthcare lies in the hands of a democratically elected leadership in many countries. Talking of democracy, I need to bring fellows’ attention to the upcoming elections for RCP officers. This includes councillors, the clinical vice president and the (mildly challenging) role of president. Fellows will have received details recently about how to nominate for these roles; if you haven’t, please check your inboxes, spam folders and junk files. The closing date for nominations will be 15 December and I am really looking forwards to seeing the nominations. For the first time ever, we are planning hustings for the presidential election, intended to put RCP candidates through their paces (no pun intended). To give some idea of the highs and lows that come with these roles, the interview with our treasurer, Chuka Nwokolo, should be required reading for all prospective candidates. The past few years have been remarkable in the history of the college, and the treasurer has been in the front row of the rollercoaster (I’ll leave the image of Professor Nwokolo with his arms raised high with you). I have no doubt that the next 5 years will be as remarkable and challenging, and the RCP will need strong collaborative leaders if it is to prosper and influence the delivery of health and healthcare. Knowing the fellowship, there are many strong leaders out there who will be up to the challenges we face. President’s perceptions: a workforce under pressureContributors 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. Dr Rifca Le Dieu Rifca is a lymphoma consultant at St Bartholomew’s Hospital, as well as a clinical reader at Queen Mary University of London, where she has an undergraduate teaching role. Rfica is the champion of flexible training and supported return to training lead at Barts Health NHS Trust, where she works at 70% FTE. She is joint deputy director of the RCP Medical Workforce Unit alongside Sarah Logan. Dr Sarah Logan Sarah is clinical lead for infectious diseases at the Hospital for Tropical Diseases, which is part of University of College London NHS Trust. She works flexibly at 80%FTE. In addition to her NHS roles, she shares the deputy director of the RCP Medical Workforce Unit role with Rifca Le Dieu. 2 Commentary November 2021 CONTENTS NOVEMBER 2021 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 photograph Saul Perryman 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 12 1 President’s message Andrew Goddard discusses the findings of the latest consultant census and his recent visits to hospitals around the country, and looks to what the future holds for the RCP, as we plan for elections in 2022. 4 News and comment Our new international advisers and associate global directors; progress on our equality and diversity goals; Black History Month; our recent new fellows ceremony and the memorial for Donal O’Donoghue. 9 COP26 The RCP academic vice president reflects on his experiences attending the COP26 conference in Glasgow, and how to highlight physicians’ voices in conversations about climate change. 12 New consultant reflections One doctor working in the field of dermatology reflects on becoming a consultant during the pandemic, and the subsequent effect this has had on training and patient-facing interactions. Physician associate (PA) awareness week ran 4–8 October. PA week aims to raise awareness of the profession, and also provides a platform to celebrate and showcase PAs, and the important work they do as part of the multidisciplinary team. Pictured above: the PA trauma and orthopaedic team from St George’s NHS Foundation Trust in London. To find out more about PAs, read our feature on page 18, and visit the Faculty of Physician Associates (FPA) website: www.fparcp.co.uk Dr Harriet Gordon Harriet is a consultant gastroenterologist in Winchester. She was previously director of the RCP Medical Workforce Unit and has continued addressing workforce issues at the RCP as chair of the RCP Flexibility and Wellbeing Unit. She is also an RCP censor, and associate medical director (workforce) for her trust, and the chair of the Academy of Medical Royal Colleges Flexible Careers Committee. 18November 2021 Commentary 3 Editor’s letter The impact of the pandemic on the workforce is reflected in a number of pieces in this edition of Commentary. When it was established in 2019, the RCP’s Flexible Working and Wellbeing Group can have had no idea how pivotal its work would become by virtue of the COVID-19 pandemic. The massive impact of the pandemic on the working patterns of physicians has been tracked through a series of surveys. The results of the June survey, undertaken to evaluate this impact, are presented by Drs Logan, Le Dieu and Gordon. The findings may surprise some: the majority of doctors reported improved work–life balance from the greater degree of home-working, and a majority of trainees would opt for continuing less than full time. The implications for job planning and organisational culture is discussed in the summary article. A personal example of the challenges and opportunities is described by Dr Manisha Panchal, who was appointed as a new consultant at the start of the first lockdown in 2020. Her story complements the data presented in the summary of the consultant census. While always interesting, the trends that emerge in the context of the experience from the pandemic – especially with regard to general internal medicine – are notable. Another RCP collaborative that has been in especially active is the Diversity and Inclusion Delivery Group. A representative of that group, Dr Syed Mukhtar, contributes a personal and operational view of the initiatives undertaken in his trust on the Isle of Wight, with regard to the equality and inclusion agenda – and specifically focused on international medical graduates. These individuals are regarded as a key component of the workforce as the NHS aims to recover urgent and elective recovery. Serial data have shown that, very regrettably, such colleagues experience the worst of conditions in the service. The article highlights the practical actions that can be deployed to reverse aspects of this differential experience, emphasising the importance of organisations having a strategy to address this ‘wicked’ and deep-seated inequity. Anton Emmanuel Editor-in-chief 14 Regional advisers and policy We interview an RCP regional adviser who has been working with our Policy team to inform and advise MPs about the Health and Care Bill that is currently working its way through parliament. 20 COVID-19 in Myanmar Healthcare in Myanmar has been disrupted by political unrest. The RCP Global team spoke with physicians working there to find out how this has impacted the treatment of COVID-19. 24 Improving induction for IMGs Along with colleagues, Dr Syed Mukhtar (right) has been working to improve the induction process for international medical graduates at his trust on the Isle of Wight, and to help the trust better understand the social and cultural needs of its new recruits. 28 Interview: Chuka Nwokolo Professor Chuka Nwokolo, the treasurer of the RCP, discusses the decisions he has taken in the role, and how the pandemic has affected the college. 32 Consultant census The findings of the 2020 consultant census, undertaken by the RCP Medical Workforce Unit. 36 Flexible working The RCP’s Flexibility and Wellbeing Committee and the Trainees Committee have surveyed our membership to better understand the impact of the pandemic, and how it has affected working habits. Dr Sanjeev Gupta Sanjeev completed his medical training in India in 1987, and came to the UK to complete his MRCP in the UK. He became a substantive consultant in Cornwall in 2003. He was an SAS tutor for his trust for 4 years, then training programme director in acute medicine in the Peninsula region for another 3 years. He has been been host PACES examiner in Truro for the past few years. 28 24 Professor Chuka Nwokolo Chuka took up the post of RCP treasurer in November 2016. As treasurer, he has oversight of finance and resource issues. Chuka is a consultant gastroenterologist at University Hospitals Coventry and Warwickshire NHS Trust and an honorary professor of gastroenterology at Warwick Medical School. He is the UK’s representative on the European Board of Gastroenterology. He has been a member of various RCP committees including Council, the Finance and Resources Board, and those covering the organisation of gastroenterology services and training. He has also been an active member of the British Society of Gastroenterology, both as a Council member and as treasurer of the BSG. 204 Commentary November 2021 NEWS GLOBAL NEWS 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 3 September – 15 November: John Samuel Staffurth Rena Lewis William Alexander Charles Douglas Julian Andre Bradley Alan William Matthews Maria Gilleece Alfredo Jadresic David Alfred Owen Sutton Richard Collingwood Brown Robert Newton Smith Angus Leith Macmillan Jeremy Peter Heath Kenneth Theodore Evans Malcolm Irvine Manoah Pines Avindkumar Ratilal Shah Stuart John Saunders Drummond Bowden Malcolm Gallaway Kerr-Muir Eva Maria Kohner Jean Donald Wilson Alan Frederick Hofmann Alastair Cushnie Young John Alun Morgan-Hughes Michael Llewellyn Rutter Peter Oswald Derrick Pharoah Deceased fellows New associate global directors and international advisers RCP Global works with RCP members and fellows to improve healthcare standards worldwide. In January, the new 2021–24 Global Strategy was launched, following a wide consultation process, and based on RCP’s vision, mission, and principles. Led by Global vice president Dr Mumtaz Patel, international work is supported through associate global directors (AGDs) and an extensive network of international advisers (IAs). AGDs are appointed by Mumtaz on an honorary basis for a 4-year term. They guide RCP Global activity in their regions, build relationships and links with local physicians and institutions, participate in clinical training projects and act as RCP ambassadors. The Global team has recently welcomed four new AGDs to their team: > Omar Mustafa – Middle East and North Africa > Phil Gothard – Sub-Saharan Africa > Mo Aye – Asia Pacific > Haroon Hafeez – South Asia To find out more about the new AGDs and the RCP’s other international officers, visit: www.rcp.ac.uk/about-rcp/whos- who/international-officers IAs are RCP fellows who live and work outside of the UK. They act as local representatives from their country, engaging with local members and identifying opportunities for RCP activity. IAs provide advice and guidance on a range of professional, postgraduate education and training issues, and are the Global team’s link to members and fellows in their respective regions. Thirteen new IAs have been welcomed into the RCP Global community in 2021: > Mahmud Hasan – Bangladesh > Daniel Yuk – Hong Kong > Ian Chan – Hong Kong Geetha Philips – India (Kerala) > Amit Saraf – India (Mumbai) > Edmund Ong – Malaysia > Thin Thin Nwe – Myanmar > Ifeoma I Ulasi – Nigeria > Yeo Siaw Ing – Singapore > Ntobeko Ntusi – South Africa > Chandimani Undugodage Sri Lanka > Richard Maude – Thailand > Stella Oloo – Uganda Visit www.rcp.ac.uk/international- advisers to find out more. Top left: Mumtaz Patel Top right: Omar Mustafa Middle left: Phil Gothard Middle right: Mo Aye Bottom left: Haroon HafeezNEWS FROM THE RCP NEWS One year on from the 2020 publication of Ben Summerskill’s report on diversity and inclusion at the RCP, the organisation has made significant progress in implementing its recommendations. The RCP is starting to collect diversity information across almost all its activities, and is working towards ensuring a wide diversity of representation on its committees and boards. A formal dashboard for monitoring and reporting on diversity and inclusion in future is being developed. The RCP is promoting diversity and inclusion through its conferences and educational products and has published a new policy for how it presents equality, diversity and inclusion in its communications and events. Some of the Summerskill report’s 29 recommendations relate to particular functions and have been integrated into business planning for individual departments. For those recommendations requiring cross-RCP collaboration, three task and finish groups have been established to draw on expertise around the RCP. These groups focus on showcasing diversity (digital presence and physical spaces); data, recruitment and onboarding; and volunteer roles. A Diversity and Inclusion Delivery Group (DIDG) has been established to oversee the achievement of the recommendations. It includes staff leading various parts of the organisation, representatives from the RCP’s membership, a staff representative and Patient and Carer Network (PCN) representative and is co-chaired by the RCP’s president and its human resources lead for learning and organisational development. The RCP will continue to work over the coming years to achieve the recommendations in the Summerskill report to increase inclusion and reflect the rich diversity in society, the RCP’s membership and the wider medical workforce. A further update on progress is planned for late 2022. You can read more about the work that has been going on by visiting: www.rcp.ac.uk/progress-report-edi Progress report: improving equality, diversity and inclusion at the RCP November 2021 Commentary5 Black History Month (BHM) took place in October. The month provided an opportunity to celebrate Black history, and for people of African and Caribbean descent to share life stories, success, and talk about what diversity means to them. To mark the occasion, the Faculty of Physician Associates (FPA) worked with three of its members to gain insights into their histories, what diversity means to them as Black women and their future ambitions. > Debbie Jegede – Emergency Department PA, Guy’s and St Thomas’ NHS Foundation Trust and PA representative in the RCP Diversity and Equality Group > Marcia Hylton – PA, women’s transformational facilitator/educator and one of the first African-Caribbean women to train as a PA in the UK > Taneil Lee – first-year PA student, Newcastle University Speaking about the BHM celebrations, FPA manager Pia Sykes said: ‘The PA profession is a diverse one and that deserves to be celebrated. As a Black woman of Jamaican heritage, it made me proud to see our FPA members using Black History Month to share their success.’ Black History Month – physician associates reflect and celebrate Debbie JegedeMarcia HyltonTaneil Lee6 Commentary November 2021 NEWS FELLOWSHIP CEREMONY Welcoming new fellows: the return of in-person fellowship ceremonies The RCP held its first in-person fellowship ceremony in more than 2 years on Wednesday 29 September, run with social distancing and with reduced numbers. RCP registrar Dr Cathryn Edwards opened with a speech that outlined the fellowship process, welcomed new fellows and looked forward to ‘a career-long engagement (of new fellows) with your peers, with medicine and with the RCP’. After this, 37 new fellows stood together, in the Dorchester Library at the RCP’s Regent’s Park building, to collectively take their oath of fellowship, before accepting a diploma from RCP president Dr Andrew Goddard. The ceremony was then followed by a celebratory reception. Deputy chief medical officer for England Professor Jonathan Van-Tam was also admitted as an honorary fellow of the RCP. Professor Van-Tam gave the Harveian Oration earlier in the month, as detailed on page 8. For more information about routes into RCP fellowship, please visit www.rcp.ac.uk/fellowship Photos: Saul Perryman > Joshua Agbetile > Lankanatha Alwis > Samuel Blows > Patrick Byrne > Susannah Collins > Janet Magdaline Costa > Hari Hara Chakradhari Dukka > Sabeen Farhan > Francesca Forzano > Ioulia Grapsa > Rhys Anthony Hewett > Gareth Jones > Georgios Karagiannis > Foteini Kavvoura > Camelia Kirollos > Nickolaos Koulouris > Andreas Koutsoumpas > Anna Kydd > Christine Hui Min Leong > Nina Ruth Lewis > Ibrahim Malik > Praveen Molanguri > Elizabeth Muir > Susan Elizabeth Piper > Carla Maria Plymen > Jeyanthy Rajkanna > Saad Rana > Aamir Anver Ali Saleem > Ahmed Shaheen > Madhukar Sudhakar Shetty > Rajini Sudhir > Kyaw Minn Thu > Sarah Ann Waters > Susannah Woodrow > Golam Yahia > Helen Caroline Yandell > Qazi Zaman We look forward to welcoming more new fellows at our next fellowship ceremony, and extend our congratulations to the 1,843 new fellows who we have also admitted since we were last able to hold a face-to-face event. New fellows admitted at the ceremony DONAL O’DONOGHUE NEWS Remembering Donal O’Donoghue: memorial for the former RCP registrar Friends, family and colleagues of the former RCP registrar Donal O’Donoghue came together for a memorial held at RCP The Spine on Wednesday 6 October. Donal was loved and respected by so many people during his life, and while only 90 or so could be accommodated safely in person, many more joined online on a fittingly beautiful sunny day in Liverpool. The event was appropriate to the memory of Donal, echoing his talent for bringing people together. The live broadcast from RCP at The Spine was available as a full session at the UK Kidney Week conference, enabling colleagues around the world to watch this tribute to someone who had touched so many lives. Professor Phil Kalra opened the proceedings with a thorough appreciation of Donal’s career in the north west. Professor Kalra, professor of nephrology at Salford Royal Hospital, was a close friend and colleague of Donal’s, and gave a very personal perspective with illuminating anecdotes. He then introduced the first ever O’Donoghue Memorial Lecture, given by the chief medical officer for England, Professor Chris Whitty. The lecture, entitled ‘The role of the medical profession in tackling UK health disparities’, covered another major concern of Donal’s – fairness and equality in healthcare and in life generally. Professor Whitty showed the current patterns of disease across England, including fascinating slides on the variations in the age of the population in coastal towns. He concluded with a series of messages on how physicians themselves can contribute to reducing health disparities. Donal’s widow Mrs Marie O’Donoghue then provided a warm, witty and touching perspective on her late husband, accompanied by a string of lovely photographs of Donal with Marie and their children, grandchildren and other family members. She spoke of his generosity and thoughtfulness, often whisking her away for surprise weekends abroad, and leaving her well-chosen gifts, not necessarily on a special occasion – but just because. Dr Graham Lipkin and Dr Andrew Goddard then followed with their perspectives from the world of renal medicine and the RCP respectively, outlining the ways in which Donal had driven better care for patients with kidney disease and in his RCP role, pushing for closer relationships with the specialty societies and improving the college’s relationships with junior doctors. Dr Goddard described how Donal was happiest out and about on regional visits to hospitals, meeting old colleagues and friends and making new ones, which never took him very long. Perhaps the most fitting and poignant tributes were from people with kidney disease, in recorded videos of their memories of being treated by Donal. His humanity shone out from these contributions as they recalled he treated them as whole individuals. He was interested in their lives, their backgrounds and how he could help them manage their kidney disease to live their best life, rather than treating them simply as ‘kidney patients’. Following the formal presentations, close friends and family were invited to the ground floor, where Marie revealed the new portrait of Donal by artist Lisa Timmerman, who was also there to share the occasion. The portrait will sit under the O’Donoghue Wall, a permanent memorial to Donal and a new fundraising initiative in which donors will have a named oak block in the same shape as the Voronoi-pattern on the outside of The Spine. Above : Dr Andrew Goddard remembers his friend and colleague Below: Mrs Marie O’Donoghue unveils the portrait of Donal November 2021 Commentary 7Next >