Trends in the delivery of elective general paediatric surgery

Introduction There has been regular dialogue regarding the importance of developing clinical networks to compensate for the steady decline in general paediatric surgery performed by adult surgeons. Despite this dialogue, there are no contemporary published data to quantify the issue. This report documents patterns in delivery of general paediatric surgery in England and shows what is being performed where and by whom. Materials and methods Using the Surgical Workload Outcome Database, we compared hospital-level data between 2009 and 2017. Inclusion criteria were children under 18 years admitted to NHS hospitals in England for elective general paediatric surgery. Data were analysed with an online statistical package performing paired t-tests. Results There was no real change in the overall number of elective general paediatric surgical marker cases, but the type mix has changed. The number of marker cases performed by adult surgeons fell by 34% (4699 vs 3090 p < 0.05). The number of marker cases performed by specialist paediatric surgeons increased by 21% (8184 vs 9862 p < 0.05). This increase in workload occurred in both tertiary (21% increase) and peripheral (18% increase) centres. When analysing data by operation type it was apparent that 78% of the increased workload was attributable to an increase in orchidopexy rate. Conclusion Best practice is to treat children close to home by staff with the right skills. This study shows significant shifts in the general paediatric surgical workload. It is important to monitor these trends for successful succession planning as well as configuration of services.

Transition to Surgical Practice: The Early Years

The transition from years of surgical training to independent surgical practice is a time to enjoy the well-earned achievement of completion of training. The early years of clinical practice bring about many challenges to the young surgeon. These include transitioning to a more independent role in the operating room, running an office and understanding the business aspects of medicine, building clinical networks to sustain a clinical practice, and building a professional and academic reputation. This article will discuss aspects that are unique to the early career surgeon. Where possible, I will use the available literature to augment the discussion, whereas, in other areas, I will offer my thoughts from personal experience on the topic.

Alberta’s Strategic Clinical Networks: A roadmap for the future

Clinical networks are groups of clinicians, patients, operational leaders, and other stakeholders who work together to solve health challenges, translate evidence into practice, and improve health outcomes and clinical care. Networks enable health, community, and academic partners to align their efforts, address priority issues, and advance quality improvements, health innovation, and transformational change on a local and system-wide scale. Clinical networks have existed in some countries for nearly 20 years. Alberta first implemented clinical networks in 2012 in specific areas of health. There are now 16 Strategic Clinical Networks (SCNs) in Alberta, embedded within a province-wide health system. The SCNs have developed an action plan that builds on their experience and identifies common areas of focus. This article describes the SCNs, their impact to date, and the objectives, areas of focus, and processes Alberta’s SCNs will use to improve health outcomes and health system performance over the next 5 years.