YCOHNS matters or does it matter_ As the second largest ENT organisation in the UK with over 190 members - clearly it does! Thirteen years ago it was considered necessary to have a body that would promulgate the opinions and htmlirations of young consultants within the auspices of the BAO-HNS. Of course, the term young is a relative concept and the constitution permits membership up to 12 years after taking up an NHS consultant appointment. This has the benefit of adding experience and maturity to any debating forum and many members have experience as clinical leads or clinical directors within their hospitals. YCOHNS has representation at all levels of the BAO-HNS (BAO-HNS Council, SAC, CPAG and ETC). Of course, we are non-voting members and undoubtedly some would like to see us removed from influence altogether – the precise reason why we need to be there!

One area for concern is the lack of representation from Scotland, Wales and the North of England – come on folks! This is not a Southern England Clique; we need your support, membership and vital input. On 31st March YCOHNS will go on-line at YCOHNS.org. The site will permit on-line membership, updating of e-mail addresses, downloading of important documents, such as the consultant handbook, which contains excellent practical information for those starting private practice. Also there will be bulletin boards and other practical information pertaining to future meetings. All business is now conducted on-line, partly to allay costs but mainly to improve communication so that YCOHNS acts as a dynamic, proactive and, if necessary, reactive body! Two meeting are held annually, the spring meeting is always held jointly with the AOT at the May RSM (2/5/03). Our main meeting is in November (14/11/03) with the format having been changed from a family orientated weekend at half term, to a business and educational meeting on the Friday, followed by an evening black tie dinner for members only. This has been driven by the exponential increase in work for council members by a very active and extant political arena! The list of the council members is provided below. If you are interested in joining I can be contacted by e-mail or you can join on-line after 31st March at YCOHNS.org. Existing members, please update your e-mail addresses on line at this date if necessary. Specialist Registrars are also eligible for membership once they have achieved CCST. Finally, there has been nothing, at least to date, that has generated so much angst and discussion among the membership as the proposed BAO-HNS manpower document. I responded on behalf of the membership and have included a shortened response in this article. YCOHNS is important – so do take the time to join us!
A regular YCOHNS newsletter slot has now been kindly offered to YCOHNS matters so you can judge if your council are doing a good job on your behalf! Provision of UK Otolaryngological Services This is a summary of the official YCOHNS response presented at the BAO-HNS Council Meeting at the RSM on 6th December 2002. The document had much to commend and we fully support the ethos of being proactive in the planning of ENT services. We agree on the need for consultant expansion and that the driving forces of the EWTD and junior doctor training issues will make a hub and spoke arrangement both desirable and inevitable where practical. However there are some fundamental concerns with the degree of expansion recommended. Figures of 1600 and over 1600 have been stated without support on how this has been calculated. As a format for a business plan, this has to be backed up by hard figures and financial considerations. The new consultant contract was also clear on what is considered on call work, this does not include being available by phone! YCOHNS is eager to preserve the interests of colleagues working in smaller and peripheral units where such “drivers” might be used to undermine their interests.
Finally, this document sets out to define a service configuration to provide a quality ENT service without defining what this means. The public may have different opinions on what constitutes a quality service, so a lay input is vital if such a document is to have credibility and validity. Almost certainly the public will recognise a quality service as one that is delivered by the right person, at the right time and place; they will not necessarily regard greater travel to a hub as an enhancement of service quality! The YCOHNS membership would also like to make the following comments:
1.Surely the Hub/Spoke Model will decrease the number of IP units thereby decreasing the projected need for consultant expansion forced upon us by the EWTD and changes in junior doctor training!
2.The overall ENT workload for ENT has been steady since the inception of the health service in 1947 (John Yates, 2002 personal communication). Productivity, however, has fallen steadily and the audit commission has further shown no correlation between demand and capacity indicators (John Yates, 2002, Audit Commission Report, 2002). The reasons behind a fall in productivity are clear, but variability in demand and capacity indicators have not gone unnoticed. Expansion has to be allied to resource provision and the wide variations in Day Care practice also has to be addressed. Also the effect of On-Call experience and cover is much overstated.
3.If financial considerations are analysed, a consultant costs in the order of £450,000/annum (Nick Bosanquet, Professor NHS Planning and Strategy 2002, personal communication). An expansion to 1600 will therefore cost an additional 466 million/annum! In England the Audit Commission revealed that we are not doing too badly, with 75% of surgery being done within 6 months and 92% of patients being seen at outpatients in less than 6 months! Finally, there appears to be significant variation in GP referral rates and, with some medical schools now eliminating ENT from their curriculum altogether, doesn’t this need to be addressed by the association_
4.The report completely ignores the findings and recommendations of the Modernisation Agency and it’s action on projects. The views on NCCG’s and GPwSI of some council members are well known. Nonetheless, it has been proven that working within an ENT network useful work can be undertaken safely and efficiently, leading to significant and positive changes in waiting times. Whatever, your opinion they are here to stay and we should work proactively and constructively with them. If not, YCOHNS fears that the specialty might become alienated from political influence.
5.The Consultant Contract. What will happen on 1st April_ Furthermore, the implementation of the “sub consultant” grade is imminent. These factors will clearly have a major impact on the expansion required to achieve the parameters outlined within this document.
6.Finally, Europe, North America and the rest of the World have an entirely different medical system to the UK. In Europe and elsewhere the average ENT surgeon is little more than a primary care physician. In Belgium, (1:40,000), Surgeons have significantly lower salaries and simply have not received a comparable training to that seen in the UK. Furthermore, this cascades down to their trainees! So why support an expansion that will reduce salary, status and the level of professional satisfaction_ Some members have also stated, not unreasonably, “it is outrageous for Surgeons close to retirement to try and inflict a system that they wouldn’t have tolerated when they were junior consultants”. “Why wasn’t something done about NCCG’s 25 years ago”_ YCOHNS considers that in its present form this document will not be taken seriously and at worse may stop the modest consultant expansion that is required. It is our recommendation that this document should be withheld until it becomes clearer what the next political move is going to be. We consider that the document needs considerable revision before submission and needs to be presented in a more business plan format with supporting appendices.

The BAOHNS leaflets entitled 'How to become an ENT surgeon' (career guidance) and 'What does an ENT surgeon do_' (information for the public) are available free to members from the office. Sample leaflets are being sent out with the January mailing. We used them at the recent Open Day, which was held at the RCS of England. Furthermore the first ten patient information leaflets will be available very soon, hopefully with the NHS logo if endorsed by the DoH. The new consent process strongly suggests that patient information leaflets should be given to the patient at the time an operation is discussed. The first ten leaflets include topics such as Septal Surgery, Adenoid Surgery, Tonsil Surgery, Grommets, and Sinusitis. There is room on each leaflet for each Department to add 'local details'. I expect the final leaflets to be available at the end of February. Several more are being produced and if any of you have exceptionally good 'local' leaflets please send them to Matthew Yung, (Chairman CPAG), if you would like to help.
The Open Day at the RCS was a great success and the BAOHNS stand was organised by Michelle Wyatt with valiant contributions from Archie Vats of DP Medical, Barbara Komoniewska and myself. We were adjacent to the Association of Coloproctologists, so we looked good! Chris Milford, Rachel Powell and others have been working hard on developing the Website, although no changes have happened yet. Alan Johnson together with Andrew Faulcounbridge did a lot of work in developing the website and the plan is to improve it further and to bring it into the office so that Rachel Powell can update it directly. Exciting news is that we are soon to appoint another full time member of the BAOHNS staff whose main responsibility will be Public Relations. Ian Mackay has been at the heart of the Public Relations effort and he has always wanted a full time member of staff to take on the responsibility of presenting our exciting speciality to the public and media. Hopefully the appointment will happen while Ian is still President. By Grant Bates

Revalidation (linked to appraisal) is fast approaching being a reality. Almost all of you will by now have gone through some sort of NHS appraisal process. There was a lot of bad press recently about how well these appraisals would support revalidation, with the interpretation by some in the media that a lot more was going to be required over and above the information gained with appraisal to allow revalidation to be granted. Having attended various meetings recently, I don't believe this is necessarily the case. The pilot revalidation groups simply had problems being sure that revalidation was possible from the final appraisal statements, and felt that if they had been provided with the information that had been produced for the original appraisal there would have been no problem. Thus, they were not asking for any more information than would have been gathered already; it had simply not been presented to the revalidation group.
For those of you who are still uncertain what appraisal and revalidation really involves, there is a good website that shows a tool kit that might be used in General Practice at: I hope the consultant and hospital doctor equivalent will be available shortly. The planned release date for the full revalidation documentation is March 2003. I have now been a Conduct and Performance screener for 12 months, so I thought it might be useful to let you know where I see doctors most frequently putting themselves 'at risk' as far as the GMC is concerned. A large number of complaints from the public relate to alleged poor treatment in patients who have died, where relatives feel that they have not had a satisfactory explanation of why death has occurred and often want to blame somebody.
My own impression of these problems is that very often the relative has not been aware of how seriously ill the patient was. The GMC referral might have been prevented if more had been done to make sure that relatives had a realistic expectation of a poor outcome. Although these cases rarely raise a question of Serious Professional Misconduct and do not go beyond the screening stage, the existence of a complaint is extremely disturbing for the doctor concerned (and his/her family). On a more general note, it is clear to me that if any doctor has a well founded complaint made about him or her, which arrives at the GMC, there is far less like hood of progression beyond the screening stage if any mistakes are readily admitted and insight into the problems are demonstrated. Even if the complaint does proceed to a public hearing, I have seen at least two cases where this approach has probably made the difference between a doctor being 'acquitted' and being convicted of Serious Professional Misconduct. We all make clinical errors, and the GMC appreciates that, but only when doctors can see the error of their ways.
In the early autumn, the GMC circulated all of you with its latest pamphlet on 'Withdrawing and withholding life-prolonging treatments: good practice in decision-making.' . I would urge all those of you who are involved in these situations (that is probably most of us!) to read this very valuable and well thought through advice as to how to manage what can often be a very difficult situation. In my last 'bulletin', I mentioned that there are GMC elections due in the New Year. These will be based around 8 constituencies in the UK and Northern Ireland. I will be standing for re-election in the South and West Constituency. If I fail to be re-elected, I hope there will have been others standing in other constituencies who are successful; as I feel that having had an ENT surgeon on the Council has been very useful to our specialty in general and specifically to a few individuals, to whom I have been able to offer advice on GMC related matters.
By Robert Slack

A PPC teleconference was held on December the 11th. Our strategy with regard to BUPA and the other insurance companies was discussed and the PPC is meeting Dr Natalie MacDonald of BUPA on the 6th of February. Invitations have also been extended to PPP and WPA for separate meetings on the same day. The PPC hopes that BUPA will be in a position to issue an uplift on the next 'ten' procedures. The fate of the relative reviews document and the BUPA partnership will also be discussed. If members have items that they would like discussed please email me . Concerns were expressed about provisional documents relating to hospital practice privileges being produced by the Independent Health Care Association (a group mainly representing the insurers and providers). The committee is pursuing this. FIPO has yet to publish its' code of practice, so the PPC is producing its own for BAOHNS members. Professional Practice issues will be discussed at BACO, with a talk on the 'top ten tips' for Private Practice at the Thursday breakfast meeting - don't miss it! . There are plans to hold a Professional Practice Day in 2004, following the success of the meeting in 2001. Suggestions will be gratefully received and I will supply further information on this and all the other issues after the meetings on February the 6th.
By Grant Bates

The GMC will be holding elections for their new Council in early 2003. Voting will take place in either March or April. The number of elected places will be cut from 54 to 19. At present there are two ENT surgeons serving as elected members, Rob Slack and Arnold Maran. Rob Slack is standing for re-election in the large South and West constituency. He has been a great asset to the specialty both for being able to inform us generally of issues at the GMC, and I know he has been able to offer advice confidentially to some ENT surgeons who have been in need. It would be a great shame if we were not to continue to have this sort of help, and, as a speciality, I believe it is important that we try to ensure an ENT voice within the GMC continues after these elections. Therefore I would urge you all to take the trouble to vote and to give serious consideration to putting any ENT surgeons first or very high on you preference list. In the context of the reduced numbers being elected, it will be important that we vote in large numbers if we are to keep an ENT surgeon on the Council. The BAOHNS will be circulating those of you who have e-mail addresses registered with the office nearer the time giving details of which ENT surgeons are standing in the various constituencies. USE YOUR VOTE! IT COUNTS!
By David Bowdler

Notices for Members

COST OF ADVERTISING – NOTICES AND LABELS: You are asked to note that from 1 October 2002 the costs of advertising in the Newsletter and of buying labels – unchanged for a number of years – will increase as follows: Newsletter notices: £50 per insertion Purchase of self-adhesive labels: £60 for BAO-HNS Members £80 for charities/ organisations £300 for commercial orgs Inserts with BAO-HNS mailings: £60 for Members/charities £300 for commercial orgs Please also note that payment is required with your order and that all cheques should be made payable to BAORL-HNS.

E-MAIL – AN REMINDER: It is hoped to use e-mail to send important information quickly to Members. Members should notify the secretariat of their correct e-mail address as soon as possible

CHANGES OF ADDRESS: You are reminded that it is essential to notify the secretariat quickly of changes of address to ensure that both Association mail and Clinical Otolaryngology is sent out correctly. It is also essential to notify the secretariat if your Region changes.

ANNUAL SUBSCRIPTIONS TO BAO-HNS: Members: £195 p.a. and Trainee Members: £85 p.a.. Subscriptions at the new rate will be collected by Direct Debit in October 2001. Please note that the subscription to Clinical Otolaryngology is included in the annual membership subscription fee. A change to subscriptions is being tabled at the AGM in February and the result of this deabte will be published in the next issue of the Newsletter

THE ROYAL COLLEGE OF SURGEONS OF ENGLAND:
A number of lectures are delivered at the College throughout the year. Details of these may be obtained from the Secretary, RCS, 35-43 Lincoln's Inn Fields, London WC2A 3PN (tel: 020-7405-3474). The College also disburses a number of Fellowships and Scholarships which may be of interest to Members and details of these are available from the Secretary's Office at The Royal College of Surgeons.

NCEPOD 2000/2001:
On November 11th 2002 NCEPOD published its 14th report entitled ‘Functioning as a team_’ A sample of deaths within three days of a surgical procedure (performed by a surgeon, anaesthetist or gynaecologist) has been reviewed. The sample was determined by looking at the first death for each consultant surgeon or gynaecologist that occurred on the day of or within three days of the procedure during the data collection year 2000/01. The report follows the patient journey from preoperative care to the autopsy. Further information can be obtained from NCEPOD,

DATA PROTECTION:
Names and Addresses. All Members are reminded that from time to time the Association is asked to provide the names and addresses of Members to other medical organisations or to commercial companies to enable them to send our either information about courses etc or about books or medical products. If you do not wish you name and address to be made available for these purposes please ensure that you notify the secretariat without delay.

CHANGES OF ADDRESS:
You are reminded that it is essential to notify the secretariat quickly of changes of address to ensure that both Association mail and Clinical Otolaryngology is sent out correctly. It is also essential to notify the secretariat if your Region changes.

ANNUAL SUBSCRIPTIONS TO BAO-HNS:
In line with the requirements of the Direct Debit Guarantee, Members are formally notified that an increase in the annual subscription was approved at the Annual General Meeting held on 1 December 2000. The increases will come into force on 1 October 2001 and will be as follows: Members: £195 p.a. and Trainee Members: £85 p.a.. Subscriptions at the new rate will be collected by Direct Debit in October 2001. Please note that the subscription to Clinical Otolaryngology has also increased to £38 for both paper and electronic versions of the journal, the cost of which is included in the annual membership subscription fee.

SUBSCRIPTIONS MADE BY STANDING ORDER:
Members (most of whom are paying by Direct Debit) are reminded that some banks still persisting in making outdated Standing Order subscription payments to the Association. As in previous years these payments, unless they are for the correct amount, will be treated as outright donations to the Association, which is grateful to those Members who contribute to its funds in this way. Members are again urged to check their bank statements carefully to make sure that they are making one payment – by Direct Debit – only. If an old Standing Order is still being honoured, Members are asked to cancel this immediately though they should make sure that Direct Debit mandates remain in force.

FIRST INTERNATIONAL CONGRESS ON SALIVARY GLAND DISEASES, 27–30 JANUARY 2001, SWITZERLAND
Further information: Pavel Dulguerov and Francis Marchal, Clinic of Oto- Rhino-Laryngology - Head and Neck Surgery, Geneva .

SURGICAL ANATOMY OF THE NOSE, 26 FEBRUARY – 1 MARCH 2001, LONDON
Further information: ENT Course Assistant, Raven Department of Education, The Royal College of Surgeons, 35 – 43 Lincoln’s Inn Fields, Lon don WC2A 3PE. .

TEMPORAL BONE DISSECTION COURSE, 20-21 MARCH 2002, BRADFORD
Further information: Norma Thresh, Cochlear Implant Service, Bradford Royal Infirmary, Duckworth Lane, Bradford BD9 6RJ

SEVENTEENTH FUNCTIONAL ENDOSCOPIC SINUS SURGERY COURSE AND KTP/532 WORKSHOP, 3-6 APRIL 2002, OMAGH, NORTHERN IRELAND
Further information:Mrs. Martina Corrigan, Tyrone County Hospital, OMAGH, Co Tyrone, N. Ireland BT79 0AP.

ENDOSCOPIC SINUS ANATOMY WORKSHOP, 22 APRIL 2002, LONDON
Further information: ENT Course Assistant, Raven Department of Education, The Royal College of Surgeons, 35 – 43 Lincoln’s Inn Fields, Lon don WC2A 3PE .

CORE SKILLS IN E.N.T. SURGERY, 29 – 30 APRIL 2002, LONDON
Further information: ENT Course Assistant, Raven Department of Education, The Royal College of Surgeons, 35 – 43 Lincoln’s Inn Fields, Lon don WC2A 3PE .

GREAT ORMOND STREET INTERNATIONAL PAEDIATRIC OTOLARYNGOLOGY ENDOSCOPY DAYS, 9 – 10 SPTEMBER 2002, LONDON
Further Information:- Courses and Conferences Office, Institute of Child Health

8th INTERNATIONAL CONGRESS OF PAEDIATRIC OTORHINOLARYNGOLOGY, 11-14 SEPTEMBER 2002, OXFORD.
Furhter information:- E-mail: