Preparing for the START Assessment- Parts 1 and 2
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President’s Update October 4th, 2020
Dear Members
I hope that since my last bulletin, on 28th July, you have remained safe and well and have had time to rest.
Covid -19 has been the focus of bulletins this year, the pandemic having dominated all aspects of life – home, work, school, and healthcare.
We couldn’t foresee that in March, COVID would continue to be with us for so much longer than we thought.
Life has been busy with many challenges, but also with opportunities to reset the way we work.
I trust that you have all been getting to grips with restoring delivery of your services as best as your local resources will allow and that teams continue to be resilient in dealing with patients’ needs and concerns. I hope that trainees are supported to get back on track to achieve their ARCP targets.
One of the spin offs from the pandemic is the way we deliver education. The BSPGHAN Education series is live and also available on demand. The series of twice weekly live webinars offers CPD for trainees, associates and all members and usually a chance to join a friendly chat with colleagues.
Please do get in touch with myself or a council member if you need a discussion about your service or any items below-
1. ‘Shielding’ advice for children and young people
While up to up to 76 000 children were initially shielded at the start of the pandemic, the target was reduced to about 10 000. BSPGHAN this week will be contributing towards updating the national advice with the RCPCH and other key stakeholders. See information on which paediatric patient groups should be advised to ‘shield’ during the COVID-19 outbreak. We have an opportunity to discuss the definition of children who might be seen as clinically extremely vulnerable. As increasingly reassuring data becomes available, the definition includes far fewer children, but it would be good to have feedback from members, as to which children and young people in our speciality remain clinically extremely vulnerable. It seems likely to be restricted to those children and young people who are peri transplant or have specific immune deficiencies, but please do feedback.
2. Recovery and Restoration of PGHAN services
We saw widespread disruption to normal diagnostic activity with very low activity for almost 6 months – see some data https://www.rcpch.ac.uk/resources/covid-19-guidance-paediatric-services .
Changes in clinical practice emerged:- opportunities to redesign some outpatient services using remote consultations and clinical triage may already be altering endoscopy practice to lower volume- higher yield. While endoscopy was restored in children by July to 40% of pre Covid levels, there is a backlog of patients waiting, with concern about variation in activity and unintended harm due to long waits. Endoscopy activity in children is being highlighted to regional commissioning teams in order to support the reduction in the backlog of priority procedures.
3. RCPCH Conference 2020 online – FREE to register NOW. BSPGHAN speciality session is October 22nd 09.00-12.00
British Association for Paediatric Nephrology and British Society of Paediatric Gastroenterology, Hepatology and Nutrition is on https://www.rcpch.ac.uk/news-events/events/conference-webinar-british-association-paediatric-nephrology-british-society
4. BSPGHAN Annual meeting January 26-28th 2021
Please remember to book your study leave to join the virtual BSPGHAN Annual Meeting and AGM.
The meeting will provide a unique opportunity to show case the activity of BSPGHAN’s Working Groups, sessions for the Trainees, PEGHAN and Associate members and a virtual platform for posters.
The importance of the meeting in allowing colleagues to socialise and link up is important we hope that the sessions can be arranged to allow this aspect to continue.
We have delayed the BSPGHAN Annual Meeting in Birmingham to January 2022
5. RCPCH/BSPGHAN Clinical Standards Audit
The audit is up and running again. We have a registered PGHAN Audit lead in around 60% of potential Health Boards and Trusts and so please support the request to bring up the percentage up as high as we can before we start the data capture phase soon.
6. Recent Resource
A national consensus management pathway for paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS): results of a national Delphi process. https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30304-7/fulltext
Best wishes
Sue Protheroe
BSPGHAN President
President update 28th July 2020 Shielding advice – What will change from 1 August
The current BSPGHAN advice on shielding will change on August 1st in line with Government advice.
From 1 August, the government will pause shielding unless the transmission of COVID-19 in the community starts to rise significantly.
This guidance will be updated on 1 August.
See specific advice for our patients’ families
https://www.cicra.org/news/coronavirus/
http://s3-eu-west-1.amazonaws.com/files.crohnsandcolitis.org.uk/Shielding_UK_nations.pdf
https://childliverdisease.org/coming-out-of-lockdown-how-do-we-integrate-back-into-a-new-world/
**Clinically extremely vulnerable children and young people (0 to 18)
Specialists in paediatric medicine have reviewed the evidence on the level of risk posed to children and young people from COVID-19. The latest evidence indicates that the risk of serious illness for most children and young people is low.
All children and young people currently identified as Clinically Extremely Vulnerable, and advised to shield, should continue to do so until 31 July, when the government will pause shielding for everyone.
All decisions on whether children and young people should be removed from the shielded patient list (and therefore will not be advised to shield again in future if transmission starts to increase significantly) should be based on a consultation with a paediatric specialist or GP who will be best placed to determine the most appropriate care. Gov.uk advises that a paediatric specialist or GP will be in touch over the summer to have these discussions.
Returning to school
- children who are clinically extremely vulnerable can go back to school (when the rest of their class goes back)
See guidance on supporting children and young people’s mental health and wellbeing.
This advice is of a general nature and should be treated as a guide.
This does not replace any local public health measures put in place to protect the local population. If there is an outbreak of COVID-19 within your area, please follow any guidance set out locally or any specific law which applies to the area you live in .If local restrictions are in place in your area, please visit local lockdowns guidance
Best wishes
Sue
BSPGHAN President July 28th
Presidents Update June 28th 2020: 1. Pause of BSPGHAN/RCPCH Quality Standards Audit; 2; Shielding Update 3. Innovations. 4. ACCEA update
Dear Members
- Pause of the National Audit of Quality Standards for Paediatric Gastroenterology, Hepatology and Nutrition (‘the PGHAN Audit’).
The RCPCH/BSPGHAN PGHAN Audit Project Team have put the audit on hold during the COVID-19 pandemic and will reinvigorate the audit in August. The pause has given us an opportunity to discuss consider potential changes to the dataset that might be required due to the effects of COVID-19 on the healthcare system and PGHAN services in particular.
I am grateful for all of your input and support with the PGHAN Audit to date. The dataset had been agreed and built into a data platform which was ready to pilot in May/June. The PGHAN Audit clinical lead had registered in around 45% of Health Boards and Trusts across the UK by the end of April.
Please can I ask you to contact your Medical Director if you haven’t recruited a PGHAN Audit clinical lead.
The pause in the audit has offered us chance to reflect on its purpose in the context of BSPGHAN’s strategic intentions-
- To continue to examine PGHAN professional networks and see how BSPGHAN can support research, education and training,
- To allow us to consider the impact and value on PGHAN health care provision that the BSPGHAN Clinical Standards provide,
- To reflect critically on BSPGHAN’s function, to promote national best practice and outcomes of our patients especially moving forward from paused activity,
- To harness opportunities to support service resetting and recovery post COVID-19, and how this may be done at a national level,
- To harness opportunities to sustain any positive changes in the way we work, capturing innovations that have been rapidly developed during the pandemic (Please still feedback to me on innovations. See below **).
Additionally, it is timely to reflect on further intentions-
- To accelerate BSPGHAN’s national education strategy to develop virtual learning opportunities for trainees and members,
- To use our new website to share education / clinical updates; to measure the impact of the content of our new site;
- To build on the closer links that have arisen during the pandemic when writing joint rapid updates for example; for BSPGHAN to work more closely with key stakeholders such as the BSG, Royal College and charitable partners
- To support the productivity of BSPGHAN “task and finish” projects– using virtual get togethers. I hope that remote meetings will encourage participation from more members from devolved nations and foster rapid outputs from council and working groups.
2. Shielding Update
I know most will have seen the latest shielding letter from the Chief Medical Officer & NHS Medical Director AVAILABLE HERE which provides New clinical evidence on children
Recent experience and knowledge of the impact COVID-19 infection has on children and young people with comorbidities suggests not all those on the Shielded Patient List need to be shielding. RCPCH recently published updated guidance which paediatric patient groups they think should be advised to shield. They have identified three groups:
- children and young people who are cared for just in primary care are very unlikely to need to continue to shield;
- a small group of children who are clinically extremely vulnerable due to their pre-existing condition will need to continue to shield; and
- a further larger group of children exists who due to their underlying condition may need to shield and the decision to continue to shield would normally result from a discussion between the clinician, the child and their family.
RCPCH expect that all patients who need to continue to shield will be seen in a specialist centre before September 2020 (but not all those with specialist appointments will need to shield). Decisions on shielding will generally be led by a specialist, balancing the clinical and social impact of shielding. Patients should only be removed from the Shielded Patient List by their GP or specialist following consultation with the child and their family, and other clinicians where appropriate.
Further guidance on having conversations with children and families can be found on the RCPCH website The Government works closely with the RCPCH and welcomes their valuable scientific input. We recommend that clinicians follow up with children (and their parents) on the Shielded Patient List to discuss what RCPCH guidance means for them.
Risk stratification (adults) A team academics have been working with clinicians to develop a predictive risk model that reflects a wider range of factors such as demographics alongside long-term health conditions, to better understand cumulative risk of serious illness for individuals if they catch COVID-19. The COVID19 risk stratification model will be set out in the BMJ soon . It will only be for people aged 18 years as fortunately there’s a paucity of data for modelling in children and young people — see the publication of the research protocol
3. Feedback from members on Service Innovations **
I mentioned a few weeks back, I am keen to capture service changes relevant to our patients.
This is a polite nudge to ask those of you who haven’t got back to me, for your thoughts, so that I can make sure they’re captured.
See survey via this link or see the questions below
The survey asks the following four questions:
- What beneficial innovations/changes have occurred in your specialty and within patient pathways?
- Please describe the impact of these innovations/ changes (e.g. population health outcome, patient outcome, safety, wider system, efficiency, productivity). How did you measure the benefit?
- What is needed to sustain the change?
- What, if anything, hasn’t worked so well.
Thank you for getting back to me by 4pm on 30th June. If you can’t make this deadline, please still feedback as your input will be useful to harness and share improvements in patient pathways.
4. ACCEA secretariat update
Ministers agreed the suspension of the 2020 national Clinical Excellence Awards round https://www.gov.uk/government/news/extension-to-clinical-excellence-awards-due-to-expire-in-april-2021
Subject to Ministerial agreement, there will be an extended National awards 2021 competition, with a lengthened timetable from November 2020 until the end of January 2021.
Please stay well and as always, I welcome your involvement and your feedback.
Best wishes
Sue
Sue Protheroe
BSPGHAN President
28th June 2020
Email: President@bspghan.org.uk