The President’s Message

June 2017

Focusing on the future of AUGIS

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A fair amount has happened since my last missive. Most of the important things relate to politics, policy and service provision – important stuff that affects us all and, more importantly, our patients.

AUGIS Council met recently and considered the future of AUGIS; should it contract to become an association for upper GI cancer and metabolic surgeons, or continue trying to represent the entirety of upper GI surgery. The conclusion was overwhelmingly in favour of the later and I believe this is the right decision.

If you are a surgeon with in an upper GI interest in a hospital which does not resect UGI cancers or perform obesity surgery, what is your affiliation to AUGIS? My answer to this question is that our focus needs to be on our patients and the clinical problems they present with.

Numerically, the number of patients with gall bladder pathology far outnumber those with cancer. A poorly executed laparoscopic cholecystectomy can result in as much misery as a badly done gastrectomy. Gastro-oesophageal reflux disease (GORD) is a very common problem but not every patient gets symptom relief from medication; the surgical treatment of GORD is complicated and the outcomes highly dependent upon patient selection and the technical skills of the surgeon.

Only an organisation that has these common clinical conditions in its sights can influence the provision of services and the quality of care for patients. AUGIS produces guidance for its members, patients and provider organisations on the full range of UGI conditions and is frequently invited to give expert advice to policy makers.

This leads me nicely on to the recent discussions AUGIS has been involved in looking afresh at the General Surgical training curriculum. It currently pushes trainee surgeons into declaring a sub-specialty interest relatively early on (OG, HPB, Metabolic, Colorectal etc) and does little to encourage General GI surgery as a specialty. The reality is that the health service needs many more general GI surgeons each year than it does super-specialists.

Many trainees are consequently finding that the consultant jobs available do not match their aspirations. The majority of new Consultant posts currently being advertised are in Emergency General Surgery +/- a special interest. The drive to improve outcomes for cancer patients has been very successful and AUGIS is rightly proud of the part it has played in this.

We now need to focus on the huge number of patients with non-cancer UGI pathology who are struggling to get timely, safe treatment. Some argue that what is left of “general surgery” should separate even more and that each hospital should have a different upper GI and colorectal team on call. I will admit that I used to think this was the way forward but have changed my mind. This model may work in large teaching hospitals serving populations of 1-2 million but is not possible in most UK hospitals serving smaller populations and the unintended consequences can be negative (ie on call frequency).

In addition, there is a strong argument that GI surgeons dealing with undifferentiated abdominal GI emergencies should be able to confidently deal with all the common pathologies they might encounter. The balance between being a specialist and a generalist is difficult. As a patient, I would not wish to have a “laparotomy and proceed” done by a specialist who can only safely deal with half the pathology they might encounter. Likewise, I would not want an under-trained generalist to “have a go” at something they have little or no experience of, in the day or night. Somehow, we have to ensure that the training to be a general GI surgeon is broad enough and has the depth to produce the next generation of confident, experienced and safe consultants.

Trainee surveys repeatedly report that many newly qualified surgeons do not feel ready for independent practice so something is not right. AUGIS and The Association of Coloproctologists (ACPGBI) represent the majority of general surgeons working in the UK. Our joint document on the provision of Emergency General Surgery services published in 2015 has been widely read and referenced and is a good example of the influence we can have.

The Association of Surgeons (ASGBI) under its new President, Rowan Parks, has recognised the importance of good collaborative working between AUGIS and ACPGBI and is working with all parties to facilitate this. As AUGIS President, I have entered these discussions with an open mind and hope we can find enough common ground for the re-establishment of specialist general GI surgery as a well regarded, rewarding and viable career for a new generation of trainees. Ironically, AUGIS proposed this more than 10 yrs ago.

Enough politics! There have been some excellent AUGIS meetings since the last newsletter which many members attended. The IFSO meeting in London in late summer promises to be well attended and has a fantastic programme. AUGIS meets in Cork  in September and I know that many of you will wish to attend and enjoy warm Irish hospitality. Planning ahead to Edinburgh in 2018, we are looking to move the meeting to Wednesday and Thursday with two full days so we can put more into the programme. There will then be a training day on the Friday. This is all in the planning stage but do watch out for announcements.

AUGIS has now moved to its new offices in the Nuffield building along with most of the other specialty associations so that the RCS re-development can start. All contact details for the team will currently remain the same and you will be notified of any changes.

I wish you a warm summer and hope you are able to enjoy a holiday.

Richard Hardwick
President