General Surgery of Childhood in the UK: A General Surgeon's Perspective
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Read the article on jpedsurg.org ↗Article · Nov 2019 · 1 min read
In brief
In brief
This perspective examines the declining provision of pediatric general surgery by adult surgeons in UK district and rural hospitals, driven by specialization trends, training changes, and risk concerns. The shift creates strain on regional pediatric units through inappropriate transfers of routine cases like undescended testis, requiring network-based collaboration and evidence-based practice reforms to maintain safe local care.
Written by the GCMD Library team from the article.
The future of general surgery of children as practiced in District General (DGHs) and Rural General Hospitals (RGHs) by adult general surgeons and urologists is uncertain. It is likely that this is because of a combination of the overall trend towards specialization, concerns about clinical risk; uncertainty within the profession about the behavior of the regulator and criminal justice system when considering cases of alleged incompetence; reduced and more targeted training time, curriculum changes, and perhaps a concern by other specialties regarding the ability of DGH and RGH surgeons to provide a safe service.
The impact of this on regional pediatric surgical units (RPSUs) is however considerable. While transfer of some conditions such as infantile hypertrophic pyloric stenosis and intussusception is justifiable, transfer of others such as undescended testis and suspected torsion is not.
Close communication between regional specialists and local generalists, preferably in the setting of a formal network, together with a change in the priorities of local medical and nonmedical managers and cooperation between competing Trusts is required. Strategies for dealing with the problem are available but require a change in management and National Health Service (NHS) ethos to enact effectively.
Adherence to evidence-based best practice with the help of the "Getting It Right First Time (GIRFT)" initiative is vital and, together with targeted publicity and encouragement, the trend may not be irreversible.
Level of evidence
Level V.