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General surgery of childhood in the UK: a general surgeon's perspective
Andrew C Gordon1, Mark Davenport2
1Royal Berkshire Hospital, London Road, Reading RG1 5AN, UK.
Insights
The practice of pediatric surgery in general hospitals is declining due to specialization and risk concerns. Collaboration and adherence to best practices are crucial for maintaining safe pediatric surgical services.
Area of Science:
- Pediatric Surgery
- Surgical Training
- Healthcare Management
Background:
- The provision of pediatric general surgery in District General Hospitals (DGHs) and Rural General Hospitals (RGHs) by adult surgeons is facing an uncertain future.
- Factors contributing to this uncertainty include increasing specialization, clinical risk concerns, regulatory ambiguity, and reduced surgical training opportunities.
Purpose of the Study:
- To analyze the challenges facing pediatric general surgery in non-specialized hospitals.
- To evaluate the impact of these challenges on Regional Pediatric Surgical Units (RPSUs).
- To propose strategies for improving the delivery of pediatric surgical care.
Main Methods:
- The study is based on a review of current practices and expert opinion (Level V evidence).
- It examines the reasons for the decline in pediatric surgical services in DGHs and RGHs.
- It assesses the implications for RPSUs and suggests potential solutions.
Main Results:
- The transfer of certain pediatric surgical conditions from DGHs/RGHs to RPSUs is justifiable, while others are not.
- Effective communication, formal networks, and managerial cooperation are essential.
- The "Getting It Right First Time" (GIRFT) initiative and adherence to evidence-based practices are vital.
Conclusions:
- Urgent changes in management and National Health Service (NHS) ethos are required to address the decline in pediatric surgical services.
- Enhanced collaboration between regional specialists and local generalists is necessary.
- Targeted strategies and encouragement can help reverse the negative trend in pediatric surgical care.
Abstract:
The future of general surgery of children as practiced in District General (DGHs) and Rural General Hospitals (RGHs) by adult general surgeons and urologists is uncertain. It is likely that this is because of a combination of the overall trend towards specialization, concerns about clinical risk; uncertainty within the profession about the behavior of the regulator and criminal justice system when considering cases of alleged incompetence; reduced and more targeted training time, curriculum changes, and perhaps a concern by other specialties regarding the ability of DGH and RGH surgeons to provide a safe service. The impact of this on regional pediatric surgical units (RPSUs) is however considerable. While transfer of some conditions such as infantile hypertrophic pyloric stenosis and intussusception is justifiable, transfer of others such as undescended testis and suspected torsion is not. Close communication between regional specialists and local generalists, preferably in the setting of a formal network, together with a change in the priorities of local medical and nonmedical managers and cooperation between competing Trusts is required. Strategies for dealing with the problem are available but require a change in management and National Health Service (NHS) ethos to enact effectively. Adherence to evidence-based best practice with the help of the "Getting It Right First Time (GIRFT)" initiative is vital and, together with targeted publicity and encouragement, the trend may not be irreversible. LEVEL OF EVIDENCE: Level V.
