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RAD1962 Dec 2012 Journal Number 38, THE FUTURE OF ASGBI: December 2012 A PERSONAL VIEW My term as President comes to an end this month. It has been a their trainees should not be obliged to do as much “general surgery” in privilege to serve the ASGBI and, usually, a pleasure. The single issue their training on the basis that they will not use it on consultant that has caused most discussion has been the future of general surgery. appointment. Whilst I have sympathy with this view, it has to be Like many of you, I have strong views on this topic. I do not adhere to recognised that a consequence of evolving different training programmes the Luddite school of surgery, which argues that nothing must change. within the umbrella of the general surgical CCT would be inappropriate. Neither do I agree with the view that General Surgery is dead, and that It would be wrong for someone to be awarded a general surgical CCT the time has come for it to be supplanted by a loose grouping of who was not competent in the management of the EGS take. smaller craft specialities. I share the aspirations of breast surgeons and others who argue that My opinions are not, I assure you, based upon any preconceived they should be recognised as distinct specialities in their own right. But notions or prejudice. They have evolved after careful consideration of a this cannot happen without GMC approval. ASGBI, therefore, has a number of factors, which will inevitably influence the provision of all responsibility to collaborate with its constituent parts. There must be surgical services in forthcoming years. These include manpower issues no “competition” with the craft sub-specialities, as these have their (the number of trainees is falling, consultant expansion has stopped own clearly defined roles. This concept of the ASGBI as ‘federation’ is and, in many specialities, there is a surfeit of CCT holders without how I see the future of this Association. My vision for the ASGBI is jobs); EWTR (apprentice style training has gone, we now have shifts based on this, and can be summarised into three salient points. and CCT holders will not be as experienced in the future as they were 1. The Annual International Surgical Congress will continue to expand and in the past); life style issues (not just the feminisation of the workforce, be comprised of a number of parallel, co-located, meetings. I favour the but a recognition that no-one - male or female - wants to work development of a “surgical week”. We have to recognise that study ridiculous hours, and why should you not have a life outside surgery); leave allowance, both in terms of time off and expenses, is becoming an increasing acceptance that much surgery does not require super- increasingly difficult for both consultants and trainees. We, as a surgical specialist skills; and lastly, but arguably most importantly, an increasing profession, would make everyone’s lives much easier if we reduced the realisation that outcomes for emergency surgery are inconsistent ludicrous number of surgical meetings in the UK each year. around the country, and are often poor. All these issues are discussed in detail in a document entitled Training Surgeons for Future Service 2. ASGBI is a not-for-profit membership company. It is not constrained Requirements. This paper is available to all who want a copy from our by Charity Law as are most surgical associations and Colleges. As website. It has been discussed at all four Surgical Royal Colleges, the such, we can unashamedly act in our members interests (charities FSSA and the Surgical Forum. It has generated heated debate, but must act exclusively in the public interest). The ASGBI is the only there is now a growing consensus that the primary principle espoused Surgical Association that can legitimately comment on terms and in this paper is correct; this is that we, as a profession, have a conditions of service, facilitate member benefits which may be responsibility to train surgeons for the needs of society. Therefore, material (like the new ASGBI Surgical Indemnity Scheme) and training requirements and the need - or otherwise - for specialists must represent surgeons from any part of the UK and Ireland. In time, be determined not by what surgeons want, but by what society needs. the ASGBI should evolve into the surgical equivalent of the BMA. Society needs emergency surgeons. The single most frequent reason Professions are only permitted a single representative Trade Union. for admission to either a UK or Irish hospital is emergency general In my view, the BMA does not represent the views and aspirations surgery (closely followed by trauma). of the surgical fraternity. I think this is the future of the ASGBI. The issue is not, as many would have it, a question of jobbing general 3. ASGBI has demonstrated, to all who care to look, that it is surgeons dabbling in the management of breast, oesophageal, hepatic extremely effective in looking after other, sister, associations. For or rectal cancer. These comments merely serve to obfuscate matters. example ASGBI organises subscription collection and membership There is no debate over the fact that uncommon complex conditions databases for around a dozen other societies, administers offices require specialist provision. But, we need to recognise that the skills and facilities and, as already mentioned above, has a proven track required to look after such complex conditions will not be attained by record as a professional conference organiser.I think that ASGBI CCT, will almost certainly need post CCT training, and will not be should expand these activities on behalf of other surgical disciplines. needed in every hospital up and down the land. We have already been approached by some of the smaller SAC- defined specialities, and I feel we should encourage these potential So, in my view, General Surgery is not dead. It is alive and well and partnerships. As such, ASGBI will increasingly represent a federation represented by the needs of the emergency general surgical take. Some of surgical specialities in which none lose their separate identities, might argue that this is, in fact, an emergency abdominal or visceral but all function together for the benefit of British and Irish Surgery. surgeon, and I have no problem with this except to point out that this is This might necessitate, as suggested by some, finding a new home. not what is, at present, defined in the curriculum for the award of a general surgical CCT. The curriculum for the CCT in General Surgery has Let me conclude by welcoming John Primrose as your next President. I recently been re-written to take account of changes now that vascular am delighted to be leaving the ASGBI is such capable hands. I have no surgery is a recognised independent speciality. This revised curriculum has doubt that he will continue to take the Association forward for the been submitted to the GMC, who, whether we like it or not, are the benefit of all members irrespective of College or speciality affiliation. arbiters of recognition of speciality status. The whole issue of speciality Merry Christmas and a Happy New Year! status and future surgical training is now the subject of the Greenaway review, which will not report for at least another year.I know that many John MacFie breast surgeons, and some in other craft specialities, feel strongly that President, 2011 to 2012 Association of Surgeons of Great Britain and Ireland, 35-43 Lincoln’s Inn Fields, London, WC2A 3PE • Tel: 020 7973 0300 www.asgbi.org.uk JOURNAL OF THE ASSOCIATION OF SURGEONS OF GREAT BRITAIN AND IRELAND: CONTRIBUTOR GUIDANCE (As at November 2012) The Association welcomes and encourages contributions from Fellows, and asks that potential contributors take the following guidelines into consideration. Aims to improve the presentation or content of the The Journal of the Association of Surgeons of article to meet the standards and style of JASGBI. Great Britain and Ireland (JASGBI) is a Article length quarterly publication which has evolved from the Please submit articles in point size 12, Calibri previously named Newsletter. It aims to publish font. Each page of JASGBI can accomodate material of topical or general interest to members around 750 words with a small picture. While we of the Association, which will promote and are flexible as to content, articles should usually advance the reputation and functions of the be of 2,000 words or less, with up to four original Association to a wider professional audience. images and/or figures. In general terms, JASGBI is not a peer reviewed, academic publication PowerPoint graphics detract from the quality of and is not intended as a vehicle for conventional presentation and should be avoided. academic papers. We nevertheless welcome a wide Images and Copyright range of subject matter which may include: We support full colour pictures. Please only • Articles of national and strategic relevance in submit pictures for which you own the copyright, relation to surgical training, teaching, career or have the written permission to reproduce development, and issues in national politics, as from the person who holds the copyright. If the they bear upon surgical and professional practice. source requires attributing, please include this in • Articles of topical debate. the article. Number the images and state the • News from the Regions, and from affiliated appropriate figure title in the correct location in Speciality Associations and Societies. the text. Please send images separately and as • Articles on international surgical practice, as single files. Ensure images are high resolution observed by members of the Association on (minimum resolution 640 X 480 pixels) and their travels, attachments and secondments.
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