All change

Tuesday 29 June 2021

Despite global concerns about emerging viral variants, universal vaccine access and the recognition of the long-reaching indirect impacts of the pandemic, many countries are beginning to relax the non-pharmaceutical interventions (NPI) that have characterised the past nearly 18 months. In some places, the relaxation appears driven by increasing fatigue among the general population to comply with the restrictions. On one hand, the shift from extreme anxiety about an unknown threat to a willing acceptance of living alongside it in such a short space of time is surprising to observe. On the other, adaptability is an essential part of human nature. Watching such an adjustment happen in real time is interesting, but perhaps unexpected given our previous tolerance, as a society, of the 6,000 flu deaths every year. Perhaps more worryingly, the message that double vaccination does not offer complete protection to viral transmission and the need for testing and NPI remains, has not fully landed among the population. Again folk often hear what they want to and the vaccine as the out is an oft repeated medical phrase. More challengingly the vaccine hesitancy currently being seen in Australia and New Zealand as a result of their excellent handling of the pandemic itself shows that humans assess and tolerate risk in very different ways, lodged in personal experience.

The GMC instructed all medical specialties in 2017 to rewrite their curricula to fulfil the criteria set out in Excellence by Design We are not the first specialties to have our curricula approved through the new process, but neither are we the last. Moving to fewer, higher-level outcomes can seem very different and challenging at first sight, but how much has really changed? We have always prided ourselves on producing a high-quality CCT holder who can innovate and change, flexibly adopting new knowledge and techniques while delivering the service needed for our patients on the ground. This remains unchanged with the new curricula, instead the emphasis is shifted toward the ability to implement the knowledge acquired, rather than the knowledge itself. For those of us in independent practice, application of knowledge is what we do day to day and what we seek when appointing new colleagues, so I think we are, perhaps unconsciously, doing this already.

The curriculum team, headed by Louise Leon-Andrews, has been 'visiting’ training programmes to offer advice and guidance on implementing the new curricula. This is especially pertinent in clinical oncology where the oncology common stem year will provoke changes in experience in ST3. All those whose CCT date falls before August 2022 will have to transfer to the new curricula, but we have worked hard to successfully secure a longer transition period for those training LTFT. The curriculum chairs have stayed on in both Faculties to see this huge project through to completion. We are seeking new chairs from the respective Specialty Training Boards (STBs), and while the work will not be as onerous, the GMC is keen to see the new curricula as living documents with built in flexibility. So, there will be some work to be done as we tweak the curricula to best meet the novel developments within our specialties.

One emerging area of expertise for all specialties is the potential impact of genomics. For radiology, genomics feeds into radiomics which has the potential to better stratify risk of illness and recurrence. For oncology, the personalisation of care and ability to perhaps even expose some patients to fewer treatments (and toxicities) without compromising outcomes is one aspect of the ’magic bullet’ holy grail. Undoubtedly we all need to expand our knowledge of genomics and the RCR is producing a range of high-quality resources to assist us all with this need.

Again in clinical oncology, this week saw the publication of the statement on improving care for sexual and gender minorities. This will be supported by resources to help clinicians address these issues, which our patients find important, in a sensitive and appropriate manner.

The APPG on minimally invasive cancer therapies will touch both Faculties, including radiotherapy and the multiple techniques used by interventional radiology to treat cancers. The group had a very productive discussion about the limitations of the current rigid levels of evidence required for commissioning and reimbursing new techniques. Rapid, responsive commissioning can only improve rapid patient access to cutting edge technologies. The work of the Radiotherapy Health Learning System (RHLS) in this space with clinical oncology may be transferable to our interventional colleagues, a positive outcome of cross-Faculty working. We also talked about uniform access to new radionuclide therapies due to the scarcity of ARSAC license holders.

The backlog of care across all specialties is beginning to be tackled, but, as a community, we remain concerned about the impact of the ongoing unmet need on patient outcomes, especially in cancer. Last week, we joined with other groups to sign the radiotherapy APPG letter to the Prime Minister calling for extra investment in cancer care.

I was invited by the UKIO Congress to take part in two events over the past two weeks, focusing on the shortfall in the radiology workforce. The first was a debate about community diagnostic hubs (CDHs) providing increased access and improved outcomes. The panel consisted of Professor Sir Mike Richards and Richard Evans from SCoR, as well as a number of radiologists who have set up or are about to embark on setting up CDHs. The second was a roundtable debate sponsored by AxREM on the challenges and barriers to transforming diagnostic service delivery.  Again Sir Mike, Richard and I were there, but this time joined by Andy Howlett (NHS England Director of Diagnostics), Sam Hare, National Specialty Advisor for Radiology and members of AxREM representing the equipment and software manufacturers, a vital component in the intricate jigsaw that is imaging service delivery. The events were well attended and gathered significant engagement from the audience as well as the speakers. It was great to see such a spectrum of groups agreed on the pivotal importance of imaging in the diagnostic pathway and an understanding of the need to properly fund diagnostics, including workforce expansion, to ensure better patient outcomes. A welcome change and great to see tangible results from the significant advocacy undertaken by the RCR over many years.

Dr Jeanette Dickson
RCR President


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