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    • Paul
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      Thanks Jo for your review of the report which as Jim says is being implemented by the networks. Some of it appears quite aspirational and also strangely detailed. Clearly, much came from a BCS report.

      I undertook doing mutual aid during COVID at the nearest district hospital, an hour’s drive (with no traffic) and I really can’t see how I would cover both with a digital passport. We have 14 CCU beds, an ITU, see all new cardiology admission on the cardiac ward and the acute assessment unit and provide TPW and echo cover at weekends. We have upto 35 cardiology beds (depending on need). RCP guidelines suggest 15 mins per patient (if they are NP) or 10 if not. So, this report suggests that all patients need to be seen = 49 cardiology + ITU + acute admissions = minimum 8 hours work just for cardiology inpatients (with no break).

      The report does not bear in mind holidays, procedural cross cover, sick leave, existing vacancies and people exhausted after a pandemic. Its fine shipping people out for TPW / PPM / Sunday CRTD but not when it snows and the motorway is shut (that happens most years). Ok, close our primary service down but then its 2 hours in an ambulance for some patients to another centre.

      Simon kindly replied to my points “I understand your concerns but can I think offer you reassurance. There should be no question of already fully committed clinical staff being required to do additional work as the result of the report. The networks we describe will be clinically led and we have been clear from the outset that our recommendations provide a broad framework which needs to be interpreted and enacted in a local context. Both Sarah and I will be involved in the process of development of the networks as will Nick Linker as NCD and each will have local clinical leads.

      We are aware that there are hospitals where some or all cardiologists on otherwise equivalent contracts (and other than for personal reasons) do no on call either for GIM or cardiology and that is something that needs to be addressed both in terms of service provision but also in terms of equity or workload. There are localities where passporting to allow cross cover will resolve long term issues of lack of on call cover, my own patch in Greater Manchester being a prime example, with 40 plus cardiologists at MFT and 3 in Macclesfield 14 miles away and no current network on call arrangement. But is not going to be the answer everywhere. The key is that each network needs to resolve on call cover problems locally as they need to resolve the provision of PPCI and other services. My take on this is that, if there is a need for a PPCI service that need is there continuously and the network should be charged with finding a local answer that fits within the principles of the GIRFT report.

      We recognise that not all of our recommendations are going to be easy to enact but remain convinced that what we are describing will improve services to patients and the traditional model of competing institutions will not work in future. Undoubtedly there will need to be an increase in staffing and we are lobbying both for an increase in cardiology NTNs and their redistribution away from London. We are also working with HEE to expand the pipeline of cardiac physiologists and to develop the ACP role to allow more work traditionally performed by cardiologists to be performed by other groups.”

      I do worry that outside major urban connurbations, this report will be difficult to implement without causing knock on problems. We are already struggling with personnel for the wards without enough junior doctors, and nursing staff out of hours is becoming an issue with an aging workforce.

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