A stringent process is in place to ensure that the MSG recruits and retains consultants and administrative staff of the highest possible calibre. Consultant applicants must hold higher qualifications as defined by the appropriate Royal College and must be on the Specialist Register of the General Medical Council.
After a post has been approved, the appointment process will begin. Applicants for consultant posts are interviewed by a panel of MSG consultants, senior HSC personnel and a representative from the relevant Royal College.
Once appointed, the new consultant will be required to register with HSC to practice in Guernsey and ongoing assessments will take place throughout their time with the MSG.
All MSG consultants undergo annual appraisals by senior MSG or Southampton personnel and also a ‘360 appraisal’ (assessment by staff and patients) every five years. Their performance is periodically reviewed by a duly-appointed Responsible Officer (currently HSC’s Medical Director), while they must also maintain a programme of Continuous Professional Development – keeping themselves up-to-date with new and developing methods of delivering healthcare within their particular specialty.
The MSG employs locum doctors to cover absence of permanent consultants (training, leave, illness, sabbatical) and similar high standards are required.
Nurses and other clinical staff must hold the relevant qualifications and undergo annual appraisals and maintain a programme of CPD.
Administrative staff are required to hold the relevant qualifications and skills criteria for the post applied. Various recruitment analytics are utilised to ensure we recruit the right people for the right roles.
The MSG allocates a specific training budget to develop its staff, employees are encouraged to attend courses and achieve qualifications to enhance their skills and knowledge.
SECONDARY HEALTHCARE CONTRACT
Services provided by MSG under the secondary healthcare contract commenced on 1st January 2018. The contract is a perpetual contract. Should notice be served, there is a five year notice period on the part of the States and a three year notice period on the part of the MSG.
Under the new contract, there are formal mechanisms to deal with contractual matters (through the Contract Management Group), clinical matters (through the Clinical Reference Group) and governance matters (through the Single Clinical Governance Group). Regular meetings between these three groups ensure a close working relationship between MSG and HSC and, where appropriate (for clinical and governance matters in particular) other healthcare providers on the island are included and involved.
The secondary healthcare contract is about working in partnership with our colleagues at HSC and all other service providers on the island for the benefit of service users – our patients and their families. While 2019 has brought challenges in meeting demand for our services, we have worked closely with HSC to address these challenges in a spirit of partnership and cooperation.
MSG consultants have had 76,518 patient interactions across outpatients, inpatients and theatre operations in 2019.
53,404 outpatient episodes were undertaken, 32.3% were new appointments and 67.7% were follow ups. 82.3% of appointments were contract patients and 17.7% were private.
Orthopaedics saw the highest number of outpatients at 10,188; of which 4,095 were in fracture clinic and 6,093 at MSG. In 2018, when an additional outpatient waiting list initiative was run in orthopaedics, we saw 6,458 at MSG, but the historic levels have averaged around 5,200; so the last two years have shown a sustained 20.5% increase in workload from previous years (5,131-5,274 p.a. for 2014-2017).
Outpatient clinics are held mainly at the MSG’s premises at Alexandra House and Mill House. Some clinics are undertaken on the PEH premises (oncology, cardiology and at the Breast Unit) with a few paediatric clinics being undertaken in the community or on other States premises. Some clinics are also undertaken in Alderney.
14,852 inpatient episodes were cared for by MSG consultants at the Princess Elizabeth Hospital. 79.3% (11,777) were elective episodes and 20.7% (3,075) were emergencies. This total figure is similar to but slightly up on the previous year (14,231). 82.2% of the episodes were contract and 17.8% were private.
The highest number of inpatients were in the general medicine department (2,423 including geriatrics, rehabilitation, diabetes, respiratory, stroke and nephrology) followed by oncology (2,249). Orthopaedics had 1,689 inpatients, which is their all-time record number.
8,262 theatre operations were performed during the year. 92.5% (7,646) were elective and 7.5% (616) were emergencies. The number of operations shows a significant increase of 13.2% from 2018 (7,298). During 2019 there has been an improvement in the number of ward beds available which has helped support the increase in Theatre and inpatient activity.
81.1% of episodes were contract, 18.5% were private and 0.4% non-contract. General surgery accounted for the highest number of theatre operations (1,431), followed by orthopaedics (1,412) and then gastroenterology (1,227).
Healthcare services in the Bailiwick of Guernsey are continuing to see increased demand across the board and our consultants, nurses and staff continue to work hard to deal with the pressures on the hospital infrastructure.
The Orthopaedic Department in Guernsey, as has been seen nationally, have been the most affected by rise in demand, with the 20% increase in patients seen and record inpatient levels. This rapid growth in a short time frame has stressed the capacity to manage patients in need of orthopaedic surgery, which resulted in procedures being extended beyond the eight week Secondary Healthcare Contract target.
A review of the service identified several factors which attribute to this, including the ageing population, cancellations of procedures due to emergency cases and a lack of ward and theatre capacity.
The MSG and HSC recognise the pressures the Orthopaedic service has had to endure over the recent years and the impact this places on patients and their families. We have been actively working together to find solutions to help reduce the time patients have to spend waiting for their orthopaedic surgery and in 2019 an Orthopaedic Waiting List Initiative for theatre patients was implemented in order to help manage demands and increase the current capacity.
This initiative saw patients being sent off island to selected hospitals in the UK for their surgery. To date, 104 patients have had surgery off island at either the Orthopaedic and Spine Specialist Hospital in Peterborough, Jersey General Hospital, Spire, Southampton or New Hall, Ramsay. 17 patients also had elective operations in Guernsey on Saturdays.
The arrival of Dr Michelle Le Cheminant, Consultant Anaesthetist in May 2019, meant that extra theatre lists could be allocated to the Orthopaedic Consultants.
These various initiatives have gone some way to improving the waiting times, with 522 contract patients on the inpatient list at the end of 2018 compared to 390 patients at the end of 2019.
Orthopaedic lists have been prioritised and any unused theatre lists are allocated to the Orthopaedic Surgeons where possible. We are hopeful that these initiatives will continue to help with waiting times and the Orthopaedic department and the MSG will continue to work hard to find other solutions.
In 2018, progress had been made to the Chronic Pain service with the recruitment of an additional Chronic Pain Consultant, which saw the waiting list for outpatient appointments reduce to within the requisite contract time.
However, like Orthopaedics, this service also saw a significant rise in demand in 2019 with an increase in referrals of patients in need of the service which has resulted in waiting times extending beyond the eight week target.
In 2017, an initiative was developed jointly between the MSG, HSC and GTG (Guernsey Therapy Group) which was designed to provide increased capacity to the pain service to accelerate access for patients and ensure management was provided by a multi-professional team. This included a Specialist Pain Nurse, Extended Scope Practitioner and a clinical Psychologist. Recruitment issues led to these posts being filled later than intended.
The MSG, HSC and GTG continue to work closely together to expedite the recruitment and training of staff to provide the increased capacity and quality of service that is required.
The Oncology department has also seen a rise in demand as patients are living longer, with an improved quality of life due to enhanced treatments that are now available. In 2017, the general medicine review recommended a third Oncologist to maintain the service. We have successfully recruited for the post and saw the arrival of the third Oncologist, Dr Mohammad Butt in January 2020.
An anaesthetic review by the Royal College of Anaesthetists took place in April/May 2018 which identified areas which were affected by capacity constraints. The review recommended the recruitment of additional Anaesthetic Consultant posts, with subsequent review of impact. Two posts have recently been recruited; one is in place and the second will join in spring 2020.