Training in private units


by Miss Fiona Myint.

Miss Fiona Myint

Trainee surgeons must be given an opportunity to operate in the independent sector as well as the NHS.

As consultant surgeons, we can all look back and recognise that some of the best training we had was in the operating theatre. 

That is not to decry all the other significant and educationally rich learning events, but as surgeons we are happiest in the operating theatre. A happy trainee is both eager and receptive. 

Over recent years, and most acutely during the recent Covid-19 pandemic, operating theatre exposure has decreased for surgical trainees. 

During the pandemic, many elective procedures were paused entirely and large numbers of surgical trainees were even taken out of the acute operative setting to be redeployed to much-needed support for the Covid effort. 

A recent GMC report1 showed that more than half of all UK surgical trainees have not been able to compensate for their lost operative training. Furthermore, 25% have been unable to gain the necessary operative competencies to progress to their next stage of the curriculum.  

This is borne out by a Joint Committee on Surgical Training (JCST) finding2 that in excess of one million elective training opportunities were lost as a result of the Covid-19 pandemic. 

Workforce shortages

Of note, trainee logbook case numbers in cardiothoracic surgery dropped by 60% and those in ENT by 30%. This will result in longer training periods and ultimately in consultant workforce shortages as trainees will require extra time to meet their competencies. 

It is, therefore, imperative that every operating opportunity is available to trainees, with appropriate supervision. 

As NHS elective cases are still recovering and many are being diverted to the independent sector, trainees should be given training opportunities in the independent sector. 

In particular, when an NHS patient has an operation in the private sector and a trainee is sent along to ‘assist’, there is no reason why that trainee cannot be the primary surgeon under consultant supervision just as would have occurred if the operation were performed in an NHS hospital. 

Indeed, in September 2020, during the pandemic, the Indep­en­dent Healthcare Providers Net­work (IHPN), Health Education England (HEE), NHS England and the Confederation of Postgraduate Schools of Surgery (CoPSS) came to an agreement to support the independent healthcare sector in training the next generation of medical professionals. 

More than 4,000 trainees have had the benefit of some training under this arrangement. Long may it continue. 

Patchy implementation

However, implementation of this agreement has been patchy. Some independent-sector hospitals clearly see the bigger picture and have accommodated surgical training on their operating lists, providing similar support to that which is found in NHS hospitals. 

Morale is low in the NHS at present, not least among the many trainees who have lost training opportunities. 

There is burnout in doctors and the ‘Completing the Picture’ survey, looking at why doctors are leaving the NHS, showed that 27% of those who had left the profession had done so due to burnout and stress.

Boosting morale

As trainers, we can do our best to create a positive training environment. We can be innovative with simulation and new methods of teaching, but from our own experiences we know that hands-on practical operating taught us well and boosted our own morale. 

If we cannot make the most of every training opportunity, we run the risk of letting morale drop further, increasing anxiety over gaining competencies and having trainees reach the end of their training with their operative confidence in the balance. 

A recent survey undertaken by the British Orthopaedic Trainee Association (BOTA) and Royal College of Surgeons of England showed that 30% of BOTA members did not feel confident to take on a consultant post because they lacked operative experience. 

They may seek fellowships after gaining their Certificate of Completion of Training, thus further impacting on the consultant workforce in the next few years. Increased mentorship of new consultants will become the norm. 

There is often a fine line in balancing the pressures of service and training, but the equation can incorporate both NHS and independent-sector operations; it may be easier to balance with such a broader view. 

HEE has facilitated the process, having published a clear pathway for trainees holding a valid National Training Number to attend NHS operating in independent hospitals. Indemnity is covered by NHS indemnity. It is much the same process but in a different building.

It is important that we look hard at the present to prepare for the future. There are shortages in the workforce which will impact on safe and efficient patient care. 

To reach our ultimate aim of good patient care, we will need well trained and happy surgeons. Thus, in the present, we must ensure that every training opportunity is utilised both in the NHS and the independent sector.  

Miss Fiona Myint is a consultant vascular surgeon and vice-president of the Royal College of Surgeons of England

1. GMC, ‘The state of medical education and practice in the UK’, December 2021
2. Joint Committee of Surgical Training, Association of Surgeons in Training, British Orthopaedics Trainees’ Association, Confederation of Postgraduate Schools of Surgery. ‘Maximising training: making the most of every training opportunity. 2021’.