newsRCPCHSPRING 2008

Royal College of Paediatrics and Child Health

Finlay Scott of the GMC on ChildProtection 6

Finlay Scott of the GMC on ChildProtection 6

4Medicines for Children Research Network

8-9Recertification – what does it mean for you?

10Mastercourse update

Leading the way in children’s health

Collegeresponse 77

Page 2

As our Registrar Hilary Cass moves topastures new and different challenges, we allwish her well in her future endeavours andthank her for her vision and commitment tothe College. Not only will her presence, witand humour be missed, but more importantlywe had to find someone who was going towrite the Registrar’s Column in this Newsletter!On my graduation from Medical School thequotation in the Year Book was: “Sue has 3ambitions. 1) To get married 2) To be aPaediatrician and 3) To write a gossip columnin the BMJ!” Is this now my big chance?!

Writing the column is a hard act tofollow. I asked the Publications team whatthey wished me to write about. “Finance andthe new building” was the reply. OurPresident, in her column in the WinterNewsletter, has spoken of our vision for thenew building and hopes and aspirations forthe future. There will continue to be a lot inthe Newsletter, President’s email bulletin andon the College website about our impendingmove. I was a “new girl” as RegionalRepresentative on Council when we movedfrom St Andrew’s Place to Hallam Street. Iwas in awe of the then Honorary TreasurerJohn Osborne that he had undertaken such amammoth task, never thinking that in years tocome it would be my turn. That move at thetime seemed a huge leap in our “growingup”. This second move, as the college entersadolescence, is another amazing step in thedirection of our future. With growth comesthe challenge of being a business in everysense of the word: dynamic, innovative,responsive, professional are just a fewadjectives that come to mind. It is theopportunity for our staff and members to puttheir considerable talents together to producea College that is second to none in itsproductivity and delivery of service. Theopen-plan offices will foster the cohesionbetween departments and there is plenty oflight modern space for members and fellowsto meet, debate, and discuss issues incomfortable surroundings.

Finance has been a major and veryimportant aspect of this purchase. There hasbeen a lot of hard work reviewing facts andfigures going on behind the scenes frommany of the College staff and Officers. Thehours committed to the project to ensure thiswas a viable and affordable propositioncannot be underestimated. We are lucky tohave a hard working dedicated Finance Team

led by Mike Poole, Director of InternalServices; and yes, our belts will have to betightened but with good financialmanagement and prioritisation of work,business will proceed as usual.

So what else does a College Treasurer doapart from buy new buildings? A “Day in thelife of ...” or “All you ever wanted to knowbut were afraid to ask” comes to mind. I chairmany internal committees such as Finance,Membership and IT Strategy. As a member ofother committees - SASGs, Publications,Council and EC - I contribute from theperspective of being a District GeneralHospital Paediatrician. I work closely with theFinance and Membership departments on aday-by-day basis supporting the delivery ofgood financial governance. I chair severalexternal committees such as BNFCPublications Board and ADC ManagementCommittee, and meet regularly with otherRoyal College and Faculty Treasurers. I attendRCN meetings and use my “day jobexperience” to input into discussions with ournursing colleagues and continue to use myworkforce experience in meetings regardingconfigurations of services.

As Senior Officers, I and my colleaguessupport our President in delivering theCollege’s Strategy. The work is divided so weattend different internal and external meetingssuch as with Ministers, DoH, Colleges andEducation to name a few and completeallotted tasks. It is a team effort and on yourbehalf we represent your views and concernsto produce policy and solutions.

Yes, it is busy as I also have my day job,but very rewarding. In these financially-challenged times in the NHS, Trusts are notrecognising the invaluable work you all dofor the College and hence the greater good ofthe NHS. It is important this does not stand inthe way of College work and with a newbuilding and work ethos this input will beeven more necessary.

So with all the hard work, let’s raise acheer for the new building, and drink a toast(Bucks Fizz from the local supermarket!) tothe College and a great future.

Dr Sue HobbinsRCPCH HONORARY

TREASURER

Editorials

From the Treasurer4The Medicines for ChildrenResearch Network

Media update

6GMC on Child Protection

7Commentary on the GMC article

Do you and your team enjoyteaching medical stidents

8 & 9Recertification

10Mastercourse tomembership

The effect of cancertreatment on reproductivefunctions

12SASG news

Cairo event

13Tackling childhood obesitywith HENRY and the Glugs

14Trainees column

15Meetings

Advocacy guide

Going carbon neutral

In the newsSpring 2008

Page 3

Regular readers of this column mayremember Sven the gardener, a Nordic godwho periodically descends from Valhalla (orat least the Battersea branch thereof) toprune the trees and generally tame mygarden. I recently realised that the housewas becoming as unkempt as the gardenand called for the builders and decorators.To my great delight the painter’s name isRaphael. Whilst my Victorian terraced housedoes not really run to the space for it, Inevertheless have fantasies of returninghome to find a Madonna or a Transfigurationpainted on the ceiling. (Yes, I do know it’sMichelangelo who does ceilings, but he’sbusy in Lambeth).

Raphael comes from Poland. We areseeing an influx of eastern European doctors(and patients) and at the same time areduction in the numbers of non-EUinternational medical graduates (IMGs). Wehave agonised over the latter – many ofwhom have played such an important part indelivering paediatric services in many parts ofthe UK – but who, overall, were contributingto an imbalance in the numbers of availableposts and the number of applicants. We feltinevitably there must be change but also thatwe must be fair to those who have workedso hard. The outlook for IMGs is stillundecided but the dilemma has made thetraining department here at the College startwork on senior fellowships that could giveseveral years’ training at a senior level forthose IMGs who plan to go back to theirown countries after a fixed training period.

There is a serious problem for paediatricshere too. Whilst over-subscribed specialtiessuch as surgery were unable to provideenough posts for aspiring UK graduatesurgeons, we in paediatrics are struggling tofill unexpected vacancies in posts above ST1.We are hearing from regional advisers andfrom clinical directors that we seem to haveexhausted the pool of doctors looking to fillthese posts. The “Hutton” numbers and otherextra unplanned allocations have seen tothat, and along with the departure of manyIMGs – and a fall in PLAB registrants - thereare few prospects of suitable applicants.There have been, of course, many applicantsfrom the EU but there are concerns aboutcommunication skills and difficulties inassessing competence. There are lots ofopportunities in Europe to try to setstandards for training and assessment that

will help new accession (and indeed older)countries to have confidence that they canapply and be judged fairly for jobs acrossEurope. The old CESP (Confederation ofEuropean Specialists in Paediatrics) is still thepaediatric branch of UEMS (Union ofEuropean Medical Specialties) but is aimingto expand into a European Academy ofPaediatrics - a bit like the AmericanAcademy. It already has a syllabus defined asthe “Common Trunk” but it is not really acurriculum or competence framework as yet.It also is only equivalent to our first 5 years,i.e. up to the end of core higher specialisttraining – 2 years after the exam. There is anopportunity here for us to offer theMastercourse leaning package and parts ofour exam – especially the part 2 written – asa model for Europe. There is interest in this,but the wheels in Brussels grind very slowand new sprouts are rarer than you mightthink. We persevere.

Do look at the article on the Mastercoursein this newsletter (page 10) – even better,buy a copy or persuade your trainees to doso. You get not only an imaginative textbookbut also a brilliant DVD and a fantasticinteractive website which gives inexhaustibleinformation and assessment tools which youcan complete and put in your portfolio.

The Darzi children’s clinical pathwaygroups are beginning to report as I write this.London is on a different timescale but all thegroups are identifying similar themes.Inequality, difficult access, need for joined upcommissioning and regulation. There are alsoother Darzi work streams and I am alsoinvolved in the one on Leadership.

This came about because I chair thesteering group of a project called EnhancingEngagement in Medical Leadership. This isrun under the joint banners of the Academyof Medical Royal Colleges and the NationalInstitute for Innovation and Improvement.The aim is to promote the concept thatelements of management and leadership arecore to delivery of services and as essentialto good patient care as are pharmacologyand physiology. As a doctor you cannotdeliver best service to your patient withoutthese essential skills. We are producing acoherent curriculum for undergraduates,postgraduates and the newly qualifiedconsultant (or SASG doctor) up to the first 5years post specialist registration. We want toget away from the idea that management and

clinical leadership are only for those whowant to “go over to the dark side”, but ratherthat they are essential for all. Like any aspectof medicine some may wish to specialiselater, and we hope that many will and thatthere will be a larger and better trained poolof people who want to do this. The team hasdone a lot of work with reference groupsand interviews with undergraduate andpostgraduate deans and chief executives totry to get understanding and acceptance ofthis curriculum. We know that the overallcurriculum is already overcrowded and wehave tried to keep it simple and clinicallyrelevant – so that it is taught alongsideclinical cases or problem based learning.Assessment is of course the next step andmultisource feedback is an obvious tool thatcould be used. This is really all part ofprofessionalism and we hope that starting itearly will help to deflect the cynicism of therecently qualified but overburdenedconsultant. We hope it will grow the leadersof the future – and encourage women intothese roles. You will see from our HonoraryTreasurer’s column opposite that this is a realchallenge for the College. More informationabout the Medical Leadership CompetencyFramework and the project may be found atwww.institute.nhs.uk/medicalleadership.

Finally child death review teams arecausing concern amongst paediatricians whoare uncertain as to how we can possiblyimplement the duties set out in WorkingTogether. We have taken up these issueswith the Departments of Health (DH) andChildren, Schools and Families (DCSF). Wehave said that whilst we support the generalconcept we are unable to participate in therapid response teams without proper trainingand a clear understanding of what isexpected of us at each stage of the process.This will require resources as teams arealready stretched to breaking point. Webelieve our concerns have been heard and Ihope that by the time you read this we willhave news about those resources and alsowe shall have published our guidance forpaediatricians.

Dr Patricia HamiltonRCPCH PRESIDENT

RCPCH newsEditorials

From the President

Following on from the commentaries that appeared in this newsletter last year, this article sets out to describe one of the primary functions ofthe Medicines for Children Research Network (MCRN), the provision of effective infrastructure support for clinical studies. Six Local ResearchNetworks (LRN) were appointed following an open, competitive process,in January 2006, and are the primary vehicle for providing this support.The LRNs cover 60% of England and have access to approximately 6 million children. The MCRN liaises closely with the equivalent groupswithin the devolved nations (Scottish Medicines for Children Network,Northern Ireland Clinical Research Network – Children, and the WelshChildren’s Research Network) to ensure that the medicines for childrenresearch agenda is addressed and delivered across the entire UK.

Locations of MCRN Local Research Networks

Cheshire, Merseyside & North Wales LRN (cmnw@mcrn.org.uk)

Greater Manchester, Lancashire and South Cumbria LRN (gmlc@mcrn.org.uk)

London - South East, North, Central and East (SENCE) LRN (sence@mcrn.org.uk)

South West LRN (swest@mcrn.org.uk)

Trent LRN (trent@mcrn.org.uk)

West Midlands LRN (wmids@mcrn.org.uk)

Each LRN is led by one or more Directors, supported by a full timemanager and a team of research and administrative staff. LRN staff areavailable to support studies in the MCRN Portfolio in a number of keyways; reducing the administrative burden by assisting with local approvals;publicising studies and disseminating results; facilitating recruitment ofchildren to studies; and reducing study set up time. This support willensure that studies complete within time and to budget, thereby reducingthe need for extension grant applications to funding bodies.

The LRNs are working on a growingportfolio, which currently includes 58studies covering a wide range of topicsfrom large, multinational neonatal trials, tosmaller qualitative studies. The MCRNStudy Adoption Committee (SAC) meetevery other month and view betweeneight to ten studies per meeting, so thesize of the portfolio is rapidly expanding.Studies eligible for adoption must be fullyresourced and funded following opencompetition with peer review. BothIndustry-sponsored and non-commercial

studies can be supported and the role of the SAC is to assess thefeasibility of running each study through the network, and to ensure thatthe appropriate level of support is available. The diverse nature of theMCRN portfolio is providing the LRNs with an exciting, if somewhatchallenging, selection of studies on which to focus their support.

We are holding a MCRN Symposium at the RCPCH Spring Meetingon 17 April 2008, and our 2nd Annual Conference will take place thefollowing day, also in York. Registration for the MCRN Conference isfree, see the MCRN website www.mcrn.org.uk for more information.All are welcome to attend both events to learn more about the MCRN.

Dr Vanessa PoustieASSISTANT DIRECTOR, MCRN

The Medicines for Children ResearchNetwork – the infrastructure supportfor clinical studies in England

Back in November, a study published in Archives of Disease in Childhoodled to medical experts suggesting children should be vaccinated againstchickenpox at the same time as receiving the MMR vaccine, whichreceived wide coverage in the media. The Food Standards Agency andthe Department of Health also set out stricter controls for the advertising,promotion and labelling of infant and follow-on formulas. The Collegewelcomed these changes, and released a statement to the media whichwhilst encouraging breastfeeding, recognised the need for parents tobe better informed about the healthiest ways to feed their babies.

On 4 December, a prominent paediatrician was struck-off themedical register having been found guilty of serious professionalmisconduct by the GMC. In a statement to the press, PatriciaHamilton said the College was “saddened and disappointed to learn ofthis judgement” and recognised his contribution to child health duringhis career. The Guardian, Times, Independent, Mirror and BBC Newswebsite used her quote. The President also appeared on Channel 4News to express her concern about the impact of the ruling on thefuture of child protection work. Rosalyn Proops, Child ProtectionOfficer, talked to the Times about College initiatives in child protection.

Also in December, the National Audit Office published a report onneonatal services in England. Reporting looked at the current level ofneonatal care within the NHS. The report revealed that many neonatalunits were not meeting British Association of Perinatal Medicine’s(BAPM) guideline ratio of one nurse to every four babies and wastherefore compromising the overall outcome for vulnerable babies.

At the beginning 2008, Patricia Hamilton contributed to the BMJreview of 2007, in which she hoped for improvement in the selectionand training of junior doctors. The BMA and Royal College ofPathologists raised concern over the illegal transport of children’s bodiesdue to a shortage of paediatric pathologists too. The College shares these concerns as the recommendations made by a working group fromthe RCPCH and Royal College of Pathologists in 2004 called for anypathologist examining the body of child to be trained in child deaths.

Towards the end of January, Terence Stephenson, Vice-President forScience and Research spoke to Children and Young People Now aboutprescribing medication for children. And finally, the College raisedconcerns – which were quoted not only in the UK but even on a USradio show in connection with Channel 4’s ‘Bringing up baby’ programme.

To keep up-to-date with news articles that mention or quote theRCPCH, or to stay informed about what is going on within paediatricsand child health, visit the website for a regular summary of articles –www.rcpch.ac.uk

Claire BrunertHEAD OF MEDIA

Media Update

News RCPCH news

Page 4

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GlaxoSmithKline encourages healthcare professionalsto report adverse events, pregnancy, overdose andunexpected benefits to the company on 0808 1009997. Information about adverse event reporting canalso be found at www.yellowcard.gov.uk

References 1. Rotarix Summary of Product Characteristics2. Vesikari T, Karvonen A, Prymula R et al. Human rotavirusvaccine RotarixTM (RIX4414) is highly efficacious in Europe.24th European Society for Paediatric Infectious Diseases(ESPID), Basel, May 2006© GlaxoSmithKline group of companiesROT/FPA/08/35005/1 - Feb 2008

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In the light of recent discussion about the GMC’s role in dealing with the issues around Child Protection, Finlay

Scott, the GMC’s Chief Executive, has contributed the article below. On the facing page can be found a commentary

on the article by the College’s Child Protection Officer, Dr Rosalyn Proops. Letters responding to both are welcome

at newsletter@rcpch.ac.uk .

It is being suggested in some quarters that the GMC’s fitness to practise procedures are unfair to

paediatricians engaged in child protection work. It is most important that the facts are understood.

Paediatricians attract complaints like other doctors. But it is untrue that large or disproportionate numbers

of paediatricians are represented in our fitness to practise procedures. Between April 2006 and December

2007, we received 8,400 enquiries or complaints about doctors of all specialities. Of those, eight were about

paediatricians connected with child protection work. In the course of investigation, one of the eight doctors

entered into voluntary undertakings related to their health, without the need for referral to a fitness to practise panel. The other

seven cases were also concluded without referral to a fitness to practise panel and with no effect on the doctor’s registration.

It is extremely rare for a paediatrician to appear before a panel in connection with child protection work. Since 2004,

panels have considered more than 600 cases. Only two could reasonably be said to have been about paediatricians involved

in child protection. In a third case, Sir Roy Meadow was an expert witness in a criminal court.

It has been suggested that the GMC does not understand the special nature of the work of paediatricians. This reflects a

misunderstanding. When we are investigating a complaint, we can – and do – take advice from specialists where appropriate.

The material available, including expert opinion where appropriate, is considered by two case examiners – one medical and

one lay – who will decide whether to refer the case on for adjudication.

It has also been suggested that fitness to practise panels are not qualified to judge cases involving paediatricians because

they don’t include specialists in child protection work. As it happens, this line of argument about the composition of panels

was considered and rejected by the High Court in 2006 ([2006] EWHC 2468 (Admin)). But, more importantly, it would be

potentially unfair to the doctor if expert opinion was given in private by a specialist panel member. The key point is that

expert opinion should be given in open session so that it can be tested by both sides. This is what happens in the courts.

We are committed to processes and procedures that are fair, objective, transparent and free from discrimination. And the

facts suggest that, in general, we live up to that challenge.

But this is not to claim that everything works perfectly. We recognise that the investigation of some complaints can take

too long before a decision is taken. Even where the doctor is not referred to a fitness to practise panel, a protracted

investigation, and the associated uncertainty, undoubtedly cause stress and strain We have worked hard to reduce delays but

we face particular problems in securing transcripts from the Family Courts. We will continue to press for improvement.

Meanwhile, it is far from helpful when pressure groups – claiming to speak for doctors or patients – paint an inaccurate

picture of our work. Doctors can be confident that we view each complaint or enquiry on its merits, without fear or favour.

The motives of the complainant do not influence the decisions taken; and our guideline and rules are in the public domain.

The figures demonstrate that our processes and procedures are capable of distinguishing where there is a real problem.

Of course we understand that it cannot be in anyone’s interest if paediatricians are deterred from undertaking vitally

important child protection work. Equally, it cannot be in the public, or the profession’s, interest, if the GMC does not act

when doctors practise incompetently or inappropriately.

Our critics are trying to create the impression that the GMC is intent on unfairly persecuting paediatricians involved in

child protection work. Nothing could be further from the truth; and, by painting a misleading picture our critics risk creating,

or adding to, the very problem they say they wish to resolve.Finlay ScottChief Executive, GMC

News

Page 6

The GMC on Child Protection

News RCPCH news

Page 7

Child protection is still everyone’s businessIt has always been a difficult area to work in – and so it should be. The morbidity andmortality for the children is high and the price paid by parents can be the most profound loss tofamily life as their child is removed from them by the state. Finding the right path betweenreturning the abused child home and removing a child from an innocent family must be one ofthe most difficult decisions we contribute to as part of the Safeguarding team. We should not besurprised if this generates so much upset, distress and attention.

What is it that most of us are worried about? Making the wrong decision? Being quizzed in court? Receiving a complaint? Being reported to theGMC? Seeing our name in the local or national media? The effects on our families? Probably all ofthese at some time, and now even more than ever the anxiety looms very large and feels very real.

Parts of the media paint a distorted picture We can do something about this by taking the initiative and take any opportunities that arise tooffer balanced evidenced based stories. But there will always be some parts of the media whichwe cannot influence. Bad news stories make better copy and we find it hard to persuade thepress to publish articles that support doctors.

What are the risks of being reported to the GMC? Please read the article from the GMC, and let’s carefully consider this and our own complaintssurvey from 2004. The GMC letter tells us that of 8,400 complaints about doctors in allspecialties only 8 related to paediatricians and child protection work. All 8 of these were closedwithout referral to a fitness to practise panel with 1 agreeing to voluntary undertakings withoutreferral to a panel. The RCPCH survey asked paediatricians (3879) if they had ever (over theirwhole careers) been the subject of a complaint related to child protection. 533 doctors reported786 complaints. 79% were dealt with locally, of which 9% received publicity and 3% wereupheld. 71 doctors (86 complaints) were referred to the GMC. At the time of the report 59%were found unproven, 20% were ongoing and none were upheld.

So, what does this mean in reality? The risk of receiving a complaint that is reported to the GMC is low and the risk of any furtherinvestigation or sanction on the part of the GMC is extremely small. The distress and anxietyhowever is very significant. The process for those very few caught up in it, takes far too longand the style of communication from the GMC is quite daunting.

We have been meeting with the GMC for some time and we welcome this article and the factswhich they lay out for us. We are asking for more information and will pass this on to you assoon as it is available.

We have successfully addressed some of our other concerns. The GMC have accepted ournominations of 10 paediatricians to act as advisors and experts at any part of the proceedings.

Rosalyn Proops and Terence Stephenson met with the 12 GMC case examiners in January2008 to talk about the specific problems associated with child protection. Case examiners are thepeople who review the complaints in detail, obtain further expert advice, and decide if thecomplaint requires further action. This was a useful meeting from which both sides gained. Whilstthere are no paediatricians in the case examiner group, five of them have direct experience ofchild protection, three as general practitioners, one as a barrister and one as a social worker.

We need to move on and focus on good and competent practice in the clinical environmentas well as in the courtroom. Our College training courses, guidelines and evidence-basedpublications will help us to practise in a way which not only keeps children and families safe –but keeps us safe too.

Dr Rosalyn ProopsOFFICER FOR CHILD PROTECTION

Commentary on GMC article

If so we are looking for two-week residency placements in local district generalhospitals for Imperial College students. We currently have 20 hospitals all over thecountry and our students enjoy theseattachments immensely as they are in smallgroups of two or three and can receive very personalised tuition and experience.The aim for these residences is for thestudents to consolidate their knowledge and experience learnt back at the teachinghospital bases, and for them to feel part of the local team. They will be required to be resident and therefore can help current staff with appropriate duties on call out of hours. We are currently recruitingfor the next academic year starting Autumn2008 . The current reimbursement forstudents is approximately £500 per studentper attachment to include appropriatehospital accommodation. Please discuss with your team and housing departmentsand contact me by telephone or e-mail to obtain further details before the end of April.

Dr Mitch Blair PAEDIATRICS COURSE DIRECTOR

IMPERIAL COLLEGE LONDON

Tel: 0208 8693330 Email: m.blair@imperial.ac.uk

Do you andyour teamenjoy teachingmedicalstudents?

Annual GeneralMeeting 2008In accordance with Bye Law 8 (ii) theCollege wishes to serve notice to themembership that the next Annual GeneralMeeting of the College will be held on Wednesday 16 April 2008 at 6.15pm at the University of York, during theCollege’s Spring Meeting.

Revalidation will comprise renewal of adoctor’s licence to practise (relicensing) andrenewal of a specialist’s accreditation(recertification). It arouses mixed responses.Patient pressure groups believe it is longoverdue and will weed out medical “rottenapples”. Health professionals are wary of un-piloted and unproven systems which mightconsume time better spent seeing patients.Many patients believe that doctors are testedregularly in some way. Doctors tend to regardrecertification as a bogeyman that is wheeledout at intervals to frighten and worry them, butthey suspect it does not exist. However, just incase it does, senior doctors are keeping an eyeon their retirement date and youngerconsultants keep looking over their shoulders.

To what extent are these perceptions andexpectations fulfilled?

BackgroundThe system of revalidation was first proposedin 2006 by the Chief Medical Officer (1). Thissystem was refined by the publication ofTrust, Assurance, Safety in February 2007 (2).It is a proposal for a regulation of all thehealthcare professions, not just doctors.

What is Recertification?Recertification will require a doctor todemonstrate that they meet specialty-specificstandards – i.e. being a paediatrician andhaving specialist expertise. It will also relateto specific skills on the register – such asendoscopy or being lead consultant fordiabetes. The process will be undertaken at5-year intervals, coinciding with relicensing inorder to reduce the burden for individualsand organisations.

The GMC recognises that the evidenceprovided will vary between specialties andsubspecialties and will be drawn from a numberof sources. The publication Your GMC (3) suggeststhat the evidence required might include appraisal,audit of clinical outcomes, patient feedback,CPD, observation of practice, simulator testsand knowledge tests. The last three are likelyto be particularly challenging to the professionand may not be applicable to all branches ofpaediatrics - for example, simulator tests wouldbe difficult to apply to community child health.

Implications for the RCPCHRecertification will be a statutory duty for theCollege to undertake. It will be a major challenge.It must be a fair and transparent process forall paediatric specialists and sub-specialists,and career-level, specialist-recognised SASGdoctors, whether members of RCPCH or not.There are 3000-3500 such paediatricians andthe number is expanding. It will be temptingto invent a process that is complex andunwieldy, but recertification must be botheffective and feasible.

The major implication for the RCPCH isthat the College may have to recommendwhether specialist paediatricians – i.e. thosewith CCT - are fit to practise as specialists forthe next 5 years through the process ofrecertification. This may be done locally but inany case will be assessed against standards andevidence set by the RCPCH. There was initiallyambiguity about SASG doctors, who may notbe on the specialist register, but it was recentlyemphasised that the recertification system will beapplicable to all doctors who have completedtraining, whether they have CCT or not, Thecriteria applied to those who do not have CCTcannot be the same as the criteria applied to thosewho do. Each College or Faculty needs todesign and implement a recertification systemthat will command the confidence of the public,the GMC and the doctors who participate. Thereis unfortunately little evidence about what thecomponents of a scheme might be, which wouldboth identify doctors who are fit-to-practise atspecialist level in the UK and select out thosewho are not. A combination of validatedassessment tools and other evidence is likely toprove the most informative.

Development of SchemesThe Academy of Medical Royal Colleges(AoMRC) and GMC are leading on developmentof recertification. Work is focusing on CPD, e-learning and multi-source feedback (MSF), for each Specialty Group. There will be layrepresentation on all groups.

There may be other work-streams. Therewill need to be work on the issues raised bydoctors who are not Members or Fellows of aCollege and also work on other componentsof recertification.

There are of course many other interestedparties - for example BMA, NCAS, BAMM, etc- whose views will be taken into account, butthe GMC will be the final arbiter.

Shape of Recertification for PaediatriciansThere is as yet no generally accepted orimplemented model for recertification. Therecommendations are under debate, but it isanticipated that recertification will require at a minimum:1. 50 appropriate credits per annum of CPD;2. Multi-Source Feedback (MSF) on specialist

practise (to complement that on genericpractice that will be required for re-licensing);

3. Outcome data (possible in paediatrics only if a paediatrician is in a sub-specialtywhere outcomes are easily measurable, e.g. neonatology);

4. Evidence of clinical audit activity by thespecialist;

5. Other evidence as determined by thespecialty or sub-specialty.

How this evidence is gathered and who willassess it are not clear. What criteria are to beused to reach decisions and who will beresponsible for the recommendation on whetherto recertify or not will need careful consideration.An appeals mechanism will be needed.

Principles for Development ofRecertification The recertification scheme for paediatricspecialists:a) Must conform to the guidance set out in

the documents cited above.b) Should change minimally after

introduction, in order for continuity andconsistency: otherwise confidence could belost by all stakeholders.

c) Should maintain continuity with the currentCPD Scheme. Not only because the CPDScheme has proved so far ‘fit-for purpose’(notwithstanding some complianceproblems – see below - which are to dowith implementation) but also becausepaediatricians have been documenting andusing CPD points for appraisal over the lastquinquennium (i.e. the period to becovered by revalidation).

Revalidation

Page 8

RecertificationDr Alistair Thomson, RCPCH CPD OFFICER, Dr Hilary Cass, RCPCH REGISTRAR

Revalidation RCPCH news

Page 9

d) Should maintain continuity with theTraining and Assessment Department’sguidance on trainee assessment.

e) Should outline what other evidence ofperformance will be acceptable.

f) Must resemble the recertification systems ofother Colleges.

Components for Recertification forPaediatriciansContinuing Professional Development willremain the basis of revalidation – in fact it hasbeen recognised that CPD is important both forrelicensing and recertification. The RCPCH CPDscheme has stood the test of time as a frameworkwithin which paediatricians can collect CPDcredits. These can now be notified to the Collegeonline. Evidence of CPD is supposed to bepresented and inspected at appraisal. But in thelatest complete audit (2004), <80% of the 5%sample of paediatricians surveyed could produceevidence of > 25 external CPD points; and < 40%could produce evidence of > 25 internal CPDpoints. The criteria used for the acceptance ofevidence for the CPD audit are not stringentenough to satisfy recertification standards andneed review. This will reduce still further thepercentage of returns that are acceptable andincrease the risk of an individual failingrecertification (which could lead to the GMC’sFitness to Practise procedures). There is an AoMRCresearch project underway on the ‘Effectivenessof CPD’. This is funded via the GMC, led bythe College of Emergency Medicine and isbeing conducted over the next 2 years.

A recent comparison of all College CPDschemes by the Directors of CPD (DoCPD)showed that they are broadly similar, probablybecause they adhere to the 10 principles of CPD(4). Classification into clinical, academic andprofessional categories and internal, external andpersonal was reaffirmed (RCPCH does not use‘personal’, but reflective notes are similar).

Another part of the problem is thatstringent attention may not be paid to CPD atappraisal. Some paediatricians still do not haveregular appraisal. Rigour at appraisal will assistrevalidation and appraisal is being reviewed.

MSF will be a major component ofrecertification, a good test of performance inpractice. The generic MSF tool for re-licensingis ready: around 100 members and fellows ofthe RCPCH have participated in the AoMRC360 Appraisal/MSF study. This MSF is genericand a specialist MSF will be needed. TheRCPCH could use SPRAT for recertification,but it would need validation in this context.

There are other components ofrecertification which are shown in the draftroadmap (see figure).

Current RCPCH Work Towards RevalidationThere are many strands of work which havebeen set off to cover the ground. These arenot funded by membership, but are subject ofa bid to the Academy of Medical Royal Colleges,which has funding from the Department ofHealth. The initiatives include consultation withmembership by telephone interviews withtargeted groups, (generalists and subspecialists),and focus groups of invited members. These willbe aimed at development of CPD recordingand recognition systems, the generation of aself-assessment/self-mapping tool and guidanceto assist paediatricians in planning thecomponents of their recertification submission.

Work also needs to be undertaken ondevelopment of MSF and development of clinicalassessment processes for recertification.Fortunately the RCPCH already has tools availablewhich have been used for assessment inpostgraduate medical education, which couldbe adapted. These include SHEFFPAT(Sheffield Patient Assessment Tool) and PCAT(Peer Consultation Assessment Tool). Studies of

the validity and reliability of these tools in thecontext of recertification are being considered. ThePilot ST7 Assessment which is being exploredmight be extended into recertification.

It will not be just individual doctors who areaffected; departments of paediatrics may needhelp with revalidation of their members. Certainly,a department will not be able to function unlessall the members are currently revalidated andcollecting information that will allow them torevalidate again in the future. Development ofdepartmental quality assurance processes (toensure a fit environment for revalidation) andcompilation of a list of standards for use bypaediatric departments will become necessary.This early work will need to be followed by apilot study of a sample. Other components ofthe quality assurance system will be needed,for example, recruitment and training of local(hospital) revalidation coordinators. There willneed to be an evaluation of the Collegerevalidation process as it proceeds. The Collegewill also require new full-time staff toadminister revalidation.

Assessment of competence

Version 2

StructuredAssessment?

StructuralPaediatricAssessment

Assessment of performanceCons 5

Cons 4

Cons 3

Cons 2

Cons 1

ST8

ST7

ST6

MSF x2 (annually?)CBD (external validation)PCATSHEFFPAT(Others: SAIL, etc)

MSF (annuallyCBD (external validation)SAILSHEFFPAT

CPD Portfolio (inc. Reflective Notes)

Annual Appraisals

Clinical Audit

Outcome data

Clinical Governance info.

Portfolio and trainers reports

DOPS as required

RCPCH Recertification Road Map - Draft

Figure: The possible shape of revalidation. There is continuity with Postgraduate Medical Education and with current CPD and Appraisal.

Summary

Recertification is a five-yearly process which will have to be undertaken by consultants andSASG doctors, who will have to prove their performance is satisfactory and justifies their licenceto practise as a specialist continuing for a further five years. There will be a strengthenedappraisal process. Documentation for recertification will be in the form of evidence from CPDrecords, audit, multisource feedback and other components of assessment which are still underdevelopment. Paediatricians should collect and retain as much information as possible andhaving this stringently reviewed at appraisal in order to lay the groundwork for recertification.

Ultimately, the system of recertification should assist in identifying doctors who may needsupport and help to practise, should identify those very few doctors whose practice is potentiallydangerous and should support the majority who practise safely by interfering with their work aslittle as possible. We must not lose sight of the aim of revalidation - the benefit of our patients.

AcknowledgementsThere are many people who have contributed to this paper through background work, discussion and comments. I ammost grateful for their input, direct and indirect, over the last months and years; in particular, Pat Hamilton, Hilary Cass,Colin Campbell, Chris Verity and the members of the RCPCH CPD Sub-Committee. However, any errors are ours alone.

References1. Good doctors, safer patients. Chief Medical Officer’s report, London 20062. Trust, Assurance and Safety – The Regulation of Health Professionals in the 21st Century. White Paper, London 2007.3. Your GMC. GMC, London.4. The Ten Principles of CPD. Academy of Medical Royal Colleges, revised 2007.

During his Presidency of the College, Sir DavidHall decided to commission a learningpackage for the MRCPCH examination. He wasconcerned that no books existed at that timethat were written specifically for membershipcandidates. He was also worried that thescientific basis of paediatric practice was notunderstood by many membership candidates.That was in 2002, and by June 2007 theresulting package, MasterCourse, was

published. It has sold over 1,000 copies in itsfirst six months, probably suggesting that it isseen by candidates as giving them anadvantage in passing the examination and inimproving their practice.

MasterCourse is a multi-media learningpackage comprising two books, a DVD andaccess to an interactive website for 3 years.Volume 1 is a tool-kit for paediatricians intraining which covers child development(physical and emotional), nutrition,pharmacology, research methods, ethics, publichealth and community paediatrics. It isdesigned to help those intending to take onlyMRCPCH Part 1A as well as careerpaediatricians. Volume 2 deals with hospital-based paediatrics. Both volumes are written ina problem-orientated manner underpinned bybasic science. The DVDs contain over 80 videoclips demonstrating clinical signs, examinationskills and developmental landmarks. Bothbooks are extensively linked to externalwebsites so that candidates can extend theirknowledge beyond the published material byassessing relevant links.

The website development makes thisproject unique and offers another dimension inpublishing as the site is updated every monthwith new material, case presentations, reviews

and a website of the month feature. Users canthereby follow the field of paediatrics andchild health between editions in a limitlessmanner. The website also contains a veryclever self-assessment area which allows thecandidates to calibrate their learning againstthe list of College competencies. A traffic lightsystem allows the candidate to see theirgradual progression from red (failure toachieve that competency) through amber togreen (competency achieved).

MasterCourse is a project between theCollege, which holds the copyright, and thepublishers (Elsevier) as well as a large numberof individual paediatricians who havecontributed to its development over the last 5years. Preliminary feedback from purchasershas been very encouraging and we hope thatMasterCourse will grow organically through thewebsite until the need for a second edition.

Professor MalcolmLeveneEDITOR-IN-CHIEF,MASTERCOURSE

Mastercourse to membership

New guidance produced by the RoyalCollege of Physicians, The Royal College of Radiologists and the Royal College ofObstetricians and Gynaecologists.

Remarkable advances have taken place in themanagement of cancer in recent years, with amarked increase in cure rates. This rapidprogress, though, has not been matched by aproper evaluation of the gonadal toxicity of themany new drugs now in routine use.

This new guidance, written by amultidisciplinary expert group, sets out the

effects of a range of cancer treatments onreproductive functions, and provides clearstandards for management. Approximately11,000 adults in the 15–40 age group arediagnosed with cancer each year, and formany of these younger cancer patientsfertility is or will become extremelyimportant. The report makes the case forcomprehensive provision and funding offertility services nationwide.

The working party stresses the need forfull discussion with patients before theirtreatment about its possible effects on fertility,

and provides clear patient information for menand women.

This guidance is essential reading for allclinicians, health professionals and clinicalservices managers involved in cancer care,fertility specialists, service commissioners, andresearch funders. It will be useful to generalpractices, primary care trusts, government healthadvisors and cancer charities. The language usedhas made technical information as accessible as possible to cancer patients and their families.For more information and to purchase a copy,please call 020 8935 1174 ext 358 or visitwww.rcplondon.ac.uk/pubs/brochure.aspx?e=238

Jason PlysiROYAL COLLEGE OF PHYSICIANS, LONDON

The effects of cancer treatment onreproductive functions

News

Page 10

RCPCH news

Managing editor: Graham Sleight

Editor: Joanne Ball

Email: newsletter@rcpch.ac.uk

Editorial services: Chamberlain Dunn Associates

Advertisements: British Medical Journal

Published by the Royal College of Paediatrics andChild Health, 5-11 Theobalds Road, London WC1X 8SH. Tel: 020 7092 6000, Fax: 020 7092 6001 Website: www.rcpch.ac.uk Email: enquiries@rcpch.ac.ukThe College is a registered charity: no. 1057744

© 2008 Royal College of Paediatrics and Child Health. The views expressed inthis newsletter do not necessarily reflect the official positions of the RCPCH.

RCPCH newsCopy deadline for next issue:

1 May 2008

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Page 12

As a SASG committee we are looking at waysto ensure the work we do is informed by theviews of all the SASG paediatricians. We areplanning several strands of work to captureyour views. We want to meet with you face toface so there are a couple of dates you maywant to put in your diary. The first isWednesday 16th April 2008 our SASG businesslunch at the RCPCH meeting in York. Wehope to use this meeting to hear about theissues that are currently important to you inorder to influence the agenda of work for theSASG committee for the next 12 months. Theother is our SASG information day on Friday14th November 2008 in London. This is wherewe try and arrange a variety of speakers torespond to the topics you have raised in April.We are aware that not everyone is able to usetheir study leave to attend these events so weare trying to organise a census to capture yourviews. Next we want to try and make ourSASG regional representative network moreeffective. So we are starting a piece of workthat aims to ensure that each region has aSASG regional rep, that all the SASG

paediatricians in that region know who it isand how to contact them. Once this is inplace we intend to support the regional repsby meeting with them annually, having a rotafor them to attend SASG committee meetings,email contact and sending them copies of theSASG committee minutes. The next piece ofthe jigsaw is to ensure we involve SeniorOfficers of the College in supporting the SASGagenda. We are very fortunate that some ofthe Senior Officers regularly attend SASGmeetings. We also have a voice at Council bySASG doctors occupying the Associate seats atthe Council of the RCPCH.

Those of you who are Associate Membersof our College should have received a letter fromme encouraging nominations for one of theAssociate seats on Council. It is disappointingthat this seat has now been vacant for over 18months. Council is the governing body of theCollege. An Associate Member on Council cancontribute to all the discussions in Councilmeetings reflecting how the issues affectAssociate Members. They have full voting rights.I hope by the time you are reading this therewill have been a good response to my letter andthis seat will soon be occupied.

However we recognise that many SASG

paediatricians have full College membershipand are therefore ineligible to apply. We hopeto resolve this by converting one of the twoseats on Council restricted to Associate Membersto become one for all Staff Grade and AssociateSpecialist Grade doctors (with the remainingseat representing Associate Members). This willbe discussed at our AGM in York in April.

Finally we recognise that all the Collegessupport their SASG doctors in different ways, sowe are organising an Intercollegiate SASGmeeting, which will allow us to learn from thegood practice of the other Colleges (and so theycan learn from our good practice). I hope youwill see that we are working at a lot of differentlevels to capture and respond to your view.

At the point of writing, the one issuemost SASG doctors are talking about is theproposal for our new contract – the reason Ihaven’t dwelled on this issue is that by thetime you are reading this the ballot may havealready been completed. I will be veryinterested to hear what is decided and I hopeit is something we all feel happy about.

Dr Nataile LythCHAIR OF THE RCPCH SASG COMMITTEE

The last week of January saw an event of triplesignificance take place in Cairo. The first everRCPCH course for candidates preparing for theMRCPCH Clinical examination was held. Runningalongside this was training for potential localexaminers to familiarise themselves with theexamination for when it is launched later thisyear. The week concluded with the inauguralmeeting of the Egyptian Members Associationof the RCPCH (EMA-RCPCH).

Overseas candidate in the MRCPCH tendsto perform less well in those section of theexamination that focus on candidate approachto, and interaction with, patients and parents.

In order to improve the skills of trainees in theseareas we have developed short, examiner-ledcourses to help. The emphasis with these coursesis not “This is how you pass the MRCPCH...” itis about giving trainees an understanding ofhow they can improve their skills to make thembetter in their day to day work.

Our colleagues in Egypt have turned to theMRCPCH in order to be able to assess thecompetence of their own trainees. Egyptians workacross the Middle East and Persian Gulf regionand, as our examinations there are oversubscribed,it makes sense to incorporate Egypt as a centre.

A lot of preparatory work has to be undertakento ensure an equivalence of standards between anyMRCPCH centre, whether the centre is in Cairoor London, the standards are the same. In order toget the locals conversant with these standards theyobserved the UK-based team putting on the course.

The venue for the course was the Children’sCancer Hospital, often referred to as 57357. Thisrefers to the account number given to the hospitalwhich has been financed entirely from charitabledonations from across the globe. It has a trulyremarkable history given that approval to establishthe hospital was given only six years ago, nowthe monies have been raised, the hospital is built,and is nearly full functional. It is, I am told,one of the largest oncology centres in the world.

EMA-RCPCH has been established to become

the umbrella organisation for paediatrics in Egypt.It aims to act as a focal point for the developmentof paediatric and child health practice and forleading education and training development. Itsfirst president is Dr Abla El Alfy from BenhaChildren’s Hospital. Abla has been a drivingforce behind establishing links between theCollege and Egypt.

All involved agreed that the week’s workhad been hugely successful. Course participantsgave us glowing feedback on what they hadlearned, our potential local examiners felt itwas a very important piece of professionaldevelopment for them, and the launch of EMA-RCPCH was attended by many, manypaediatricians from across many centres in Egypt.

The team from the UK consisted of Dr JanetAnderson, Dr Roy Harris, Dr Majeed Jawad andmyself. I cannot thank them enough for theirhard work in advance of the trip and for theirefforts whilst in Egypt.

My final thanks goes to all those in Egypt whodid so much to ensure the event’s success, thereare too many to mention. We hope that this weeksignals the start of a very useful collaborationbetween the College and colleagues in Egypt.

Graeme MuirHEAD OF ASSESSMENT

SASG news

Exams in Egypt

News RCPCH news

In 2004 a multidisciplinary group was drawntogether by the College to explore its role insupporting research into childhood obesity. Asno funding was attached, there was a gooddeal of scepticism about what could be achieved.As it turns out, a process was set in motion thathas resulted in the creation of HENRY with£370,000 granted to the College to date, and afurther £350,000 to Warwick and LeedsUniversities to trial EMPOWER, its academic arm.

The impetus for HENRY was a systematicreview published in the BMJ showing thatinfant weight gain was predictive of obesitylater in life - rapid weight gain even in thefirst weeks was associated with increased risk1.As efforts are almost universally focused onschool-age children, the review was a wake-up call that “stable doors were being shutafter horses had bolted”. This informationpointed to urgent need for action in the veryearly years, especially given the evidence thatobesity is already a problem by school entry,that many toddlers’ lifestyles are unhealthyand that children as young as five yearsalready have early signs of atherogenesis.

We started with an exploration of what wasneeded to help young families tackle obesity.Interviews with mothers of obese preschoolersand focus groups of health visitors2 indicatedthat there was a clear need for training. Healthvisitors felt they did not have skills or time, andadmitted their discomfort about raising the issueof obesity at all. Mothers mirrored their concernsand felt that their needs had not been met.

The Group decided to tackle the problemthrough developing HENRY as an interventionfor practitioners working in Sure Start Children’sCentres and beyond. Its approach focuses onenhancing emotional literacy when workingwith parents around the sensitive issue ofobesity and is underpinned by the FamilyPartnership Approach3. Key componentsinvolve improving eating patterns, nutrition,activity and parenting skills.

The training is enlivened by the Glugs4, a

group of animals who live on an isolated islandand get up to all sorts of escapades as theydevelop and grow. Among the Glugs areEartha, the wise earthworm, and Snappy, acrocodile-cum-dragon who cooks for the crewby flambéing food with his fiery breath. BabyHenry is cared for by the whole family and isintroduced to healthy living in a fun way.Together with the Glugs team, and with a grantfrom the Child Growth Foundation, the HENRYteam has developed an imaginative toolkit ofresources for professionals and parents.

In 2007 the Department of Health launchedHENRY with a generous grant to the College,closely followed by a further grant from theDepartment of Children, Schools and Families.Our challenge is to work with staff of Children’sCentres and other early years practitioners tostrengthen their work through HENRY training.This is already well under way in Oxfordshireand is moving to Harrow and Leeds later this year.To make the training more widely available anonline training programme is also being developedand is due to be piloted with 200 Children’sCentres from April.

Alongside HENRY, the EMPOWER

feasibility trial of an intensive health visitorintervention for at risk babies is under way inLeeds and Birmingham. We have hopes thatfurther funding for a second year for HENRYwill be made available by the DH. The HENRYFoundation, HENRY’s charitable arm, is beingset up to encourage other funding sources.

HENRY is ambitious. It aims to address thepyramid of obesity risk at all levels (see diagram).Its strength lies in the strong evidence base thatunderpins the development of the intervention,along with the academic rigour of the group(already under way in evaluating EMPOWER).Our intention is to seek research funding indue course to evaluate the effectiveness ofHENRY as a complex intervention. ProfessorMala Rao, Director of Workforce Planning at theDepartment of Health, expressed her confidencethat “HENRY is the answer to turning aroundthe epidemic of obesity”. Let’s hope we canmatch her expectations!

Professor Mary RudolfCandida HuntEmail: HENRY@rcpch.ac.uk

Tackling childhood obesity with

HENRY and the Glugs

Page 13

Professor Mary Rudolf Paediatrics, Leeds Dr Penny Gibson RCPCH Advisor on obesityCandida Hunt HENRY Programme Director Prof Sarah Cowley Health visiting, KCLProf Jane Barlow EMPOWER lead, Warwick Prof Tim Cole Biomedical statistician, ICHDr Mitch Blair Paediatrics, Northwick Park Professor Hilton Davis Psychologist, KCLDr Kati Hajibagheiri SpR paediatrics, Imperial Coll. Dr Pinki Sahota Dietetics, Leeds MetProf Carolyn Summerbell Nutrition, Teeside University Prof Sarah Stewart-Brown Warwick University

1 Baird J, Fisher D et al. Being big or growing fast: systematic review of size and growth in infancy and later obesity BMJ 2005; 331: 929-312 Edmunds L, Mulley B, Rudolf MCJ. How should we tackle obesity in the really young Archives of Disease in Childhood 2007; 92 (suppl 1) A753 Davis, H., Day, C. & Bidmead, C. Working in Partnership with Parents: the Parent Adviser Model 2002. Harcourt Assessment4 www.theglugs.com © Haberman LLP

The RCPCH Obesity Research Group

Veryhigh risk babies &

preschoolers

Children’s Centres inmost disadvantaged areas

Population attendingChildren’s Centres

The whole preschool population

EMPOWER

HENRY

Glugs

HENRY Professional AccreditationShort courses addressing:l Advanced practitioner skillsl PCT managerial responsibilityl Competence to monitor obesity and targetsl Quality monitoring of Henryl Supervision of team

HENRY Licence Level 2l Intensive staff trainingl Long term support for centrel Parent education programme

HENRY Licence Level 1l Provision of toolkitl On line training

THE PYRAMID OF OBESITY RISK AND HENRY’S PLANS TO TACKLE IT

Trainees

Spring Meeting 2008This is one of the most important events in the College Calendar. It runs from 14th-17th April. The Spring Meeting is theCollege's main forum for the presentation ofbasic and clinical science, together withupdates in clinical practice in both generaland subspecialty paediatrics. As well asbeing an educational forum, York providesan excellent background and friendlyatmosphere for trainees from around thecountry to meet. As usual we will beholding the Trainee’s meeting on Wednesday16th April at lunchtime. This is the idealopportunity for trainees to voice their opinionabout any issues that they have in training.Last year the transition into MMC was nothingshort of volatile. Many issues have beensuccessfully addressed. Several remain. It isvital that trainees provide us with their viewsso that we can effectively deal with the currentproblems and identify new areas that need tobe worked on. Senior members of the Collegehave always been present at this meeting toanswer your questions. Please keep an eyeout for exact times in the registration pack.Lunch will be available on request.

Trainee Social Event:Spring meeting 2008 This year we are organising a Trainee SocialEvent on the Wednesday evening on theYork Campus. After a busy day at the Yorkmeeting, this is the ideal opportunity tomeet with friends and colleagues. There willbe food available for a small price and wehave invited one of the Senior members ofthe College to give a presentation.

MMC Recruitment into Specialties is underway.Recruitment into Paediatrics as with the majorityof specialties will operate locally, based uponnational principles. Trainees are encouragedto regularly check the MMC website forupdates. Trainees are expected to accept ordecline offers with 48 hours of receipt.

There are ongoing discussions regardingthe introduction of new methods ofrecruitment into ST1 for 2009 and pilotschemes are being formulated to identifysuitable specialty specific methods ofrecruitment. In addition, work is underwayto formulate a new system for nationalrecruitment in England and Wales.

Academia Interviews have now taken place for AcademicClinical Fellow (ACF) posts and appointmentsare being made. Following the first round ofappointments, the remaining posts will beadvertised locally. I would encourage traineeswho are interested in Academic Paediatricsto seriously consider one of these posts. TheACF’s provide a solid base to gaining experiencein both clinical medicine and research.During these posts, trainees will prepare forestablishing a significant research project toobtain the degree of MD or PhD.

PMETB Over the Christmas period, The PostgraduateMedical Education and Training Board issued aconsultation regarding the fees for CCT andCESR (Article 14). PMETB have stated that theyintend to increase the CESR fees by approximately50% to £1250, with other fees rising with therate of inflation. This has been on the background

of discussions with the Royal Colleges basedupon the limited funding that the Colleges havepreviously received for processing CESRapplications. The Trainees Committee throughthe Academy of the Medical Royal CollegesTrainees Group has strongly opposed thismove following discussions with regionaltrainees. Whilst we understand the pressingneed for the RCPCH to receive extra fundingfor processing CESR applications, we feel thatthe burden of this considerable levy shouldnot rest solely with trainees.

The Trainees Survey issued by PMETB hasnow closed. The results of the survey should beavailable by the middle of this year. In addition,the Trainers survey has now commenced.

PMETB have released a booklet forTrainees describing their role,responsibilities and remit. PMETB have also included a trainee’s directory sectionwhich can point readers in the rightdirection for further information aroundtheir training. Trainee stakeholders have hada significant input into the development ofthis guide. I would encourage trainees whoare interested in education and training to download this from the PMETB website.

Trainee Section on the RCPCH Website This is now well established. Profiles ofyour regional representatives and theirdeputies should be available shortly withtheir details. I would encourage to traineesto contact their regional representativesregarding issues they have with training.

Trainees’ column

Dr Paul Dimitri pauldimitri@hotmail.com

Page 14

The Royal College of Paediatrics

and Child Health is moving!

After Easter 2008, our address will be:

5-11 Theobalds Road, London WC1X 8SH

Our new telephone numbers are:

Tel: 020 7092 6000

Fax: 020 7092 6001

There will also be individual direct dial numbers,

which we shall let you have as soon as we can.

Meetings RCPCH news

UK meetings and courses

2008

14-18 April Developmental Paediatrics and Special NeedsVenue: Warwick Medical School, CoventryContact: Annette FinnTel: 024 7652 2035Email: cpdenquiries@warwick.ac.uk

22 April Childhood illnesses-where paediatrics meetschild mental healthVenue: Liberty Stadium, SwanseaContact: Andrea TorokTel: 020 7290 2986 Email: paediatrics@rsm.ac.ukWebsite: www.rsm.ac.uk/academ/pde105.php

29 April Autism and Aspergers Syndrome (RSM)Venue: BirminghamContact: Chloe WaiteTel: 020 7290 3844Email: chloe.waite@rsm.ac.ukWebsite: www.rsm.ac.uk/academ/autismbham.php

30 April 2008 - 1 May Accredited Course in Child Protection TrainingVenue: City Hospital, BirminghamTel: 0121 333 8710Email: d.reay@bham.ac.uk

30 April Why Children DieVenue: British Library, LondonContact: Nicola CogdellTel: 020 7467 3219Email: nicola.cogdell@cemach.org.ukWebsite: www.cemach.org.uk

13-14 May Court Skills in Child Protection (Englandand Wales)Venue: RCPCH, LondonContact: Aaron BarhamTel: 020 7307 5633Email: aaron.barham@rcpch.ac.ukWebsite: www.rcpch.ac.uk/Education/Education-Courses-and-Programmes/ Court-Skills-in-Child-Protection

12-16 May Diploma in Paediatric Nutrition5-day College Diploma CourseVenue: Chilworth Manor Hotel, SouthamptonContact: Education Projects AdministratorTel: 020 7307 5644Website: www.rcpch.ac.uk/Education/Education-Courses-and-Programmes/Diploma-in-Paediatric-Nutrition

15 May Developmental origins of health and diseaseVenue: The Royal Society of Medicine, LondonContact: Nicole LeidaTel: 0207 290 3946Email: nicole.leida@rsm.ac.ukWebsite: www.rsm.ac.uk/academ/dohdisease.php

3 June 7th Dermatology for Paediatricians CourseVenue: Birmingham Heartlands HospitalContact: Dr Helen GoodyearEmail:helen.goodyear@heartofengland.nhs.uk

RCPCH meetings

Page 15

AdvocacyAdvocacy guidePlease look in the publications section of the College website under A forAdvocacy. There you will find an updated version of ‘Advocating forChildren’, the guide for paediatricians on how to be an effective advocate.Bursting full of information on methods and techniques, using the media,writing to decision makers and the all-important ‘levers for change’, this isessential reading for all paediatricians – and particularly trainees – at atime when services are under threat, and children remain the mostvulnerable members of the community. Concerned about child protection,school based services, bullied children or the problems of asylum seekerfamilies? This guide will help you to lobby and to speak out effectively forchildren and their families. Make sure this guide is on your hard drive andavailable to you at all times as for sure, children need your support.

Going carbon neutralWith this newsletter you will find a flyer advertising a conference to beheld in the new College building, on Monday 30th June 2008. Be surethat someone from your Trust comes to this meeting as you will learnhow to reduce your hospital’s carbon footprint and follow the RCPCHdown the route to becoming carbon neutral. Sometimes it seems theNHS is the last one to recognise the threat to our environment fromglobal warming, but there are good examples about and they will bepresented on the 30th June.

The meeting is jointly organised with the BMJ and Faculty ofPublic Health and will include ideas on carbon free conferencing,the myths and reality of offsetting, and how to save a trustthousands of pounds in waste, which could go towards expansion of children’s services. Using the experience gained in tackling itsown carbon footprint, the RCPCH is in the lead in tackling thenumber one public health threat in the new millennium. Make sureyou are there.

14-17 April RCPCH 12th Spring MeetingUniversity of York

Registration is now open at:

www.rcpch.ac.uk/Education/Events/RCPCH-Annual-Spring-Meeting

You will need your membershipnumber (this appears in theHandbook) and an email address. On completion of your registration,you will receive confirmation byemail. To keep costs down, paymentis by debit (preferred) or credit card (excluding American Express) in advance.

Registration help is available from:

Website: www.rcpch.ac.uk

Email: Saheeda.rahman@rcpch.ac.uk or Aaron.barham@rcpch.ac.uk

Telephone: 020 7307 5632 or 020 7307 5633

Dr Tony WaterstonCHAIR OF ADVOCACY COMMITTEE

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