Part 1 to be completed by the applicant Forename:

Transcription

1 ACCEA FORM A (Application Form) Employer-Based Award CLINICAL EXCELLENCE AWARDS SCHEME APPLICATION FORM 2012 Round It is the consultant s responsibility to ensure that this form is fully completed all boxes to be completed Surname: Kakkar Employer(s) name(s) with number of sessions per employer (Lead NHS employer first) University Hospitals of Morecambe Bay Foundation NHS Trust Part 1 to be completed by the applicant Forename: Professional Title: Rahul Mr List of consultant appointments in date order Consultant Orthopaedic & Hand surgeon since 6 th January 2014 Application type: Level applying for: New CEA Level 3 Accredited Specialties (main first) Trauma & Orthopaedics Hand &Wrist Surgery Upper limb surgery Year appointed to the consultant grade 2014 Primary Medical Qualification (Date and Institution) MBBS- University of Delhi, 1997 Subsequent Qualifications (Date and Institution) Current level NO AWARD Year awarded FRCS(T&O)-2012 Diploma Hand Surgery, France MS(Orth)-2002 Ethnic origin Indian GMC/GDC Reg No Work tel (Direct Line) rahul.kakkar@mbht.nhs.uk Preferred address for correspondence Department of Trauma & Orthopaedics Westmorland General Hospital You cannot fill this form out without using the Guide to the Scheme, to which you must adhere strictly PERSONAL STATEMENT Give up to four examples that summarise your achievements. These should be since your last award. (Box limited to 1350 characters). Since my appointment as a consultant at UHMBFT, I have set up a comprehensive, high quality hand & wrist surgery service. This has benefitted the local patient population immensely as they don't have to travel afar to tertiary centres anymore.this has been reflected in positive patient feedback & press coverage on multiple occassions. I have introduced new techniques like arthroscopic surgery for wrist conditions & introduced innovative treatments for conditions like scaphoid fractures, which allow them to be treated as day cases, allowing a better patient experience and cost saving.although not part of my job remit, I have taken on the provision of Shoulder trauma at FGH to help patients receive care locally & support my colleagues. I believe in quality education & am involved in the same at both local and national levels. Apart from partaking in the usual educational activities (Educational & clinical supervisor, OSCE examiner etc),i have taken on the Foundation Program Director role at FGH & instituted regular ES/CS meetings, GP surgery visits. At a national level, I tutor on the MCh(Orth) program hosted by the RCSEd and am faculty on the FRCS courses at Wrightington. I continually strive to improve my practice by partaking in national (Hip fracture database)& local audits(daily trauma lists at FGH) & publish regularly. 1

2 JOB PLAN List agreed programmed or other activities relevant to the NHS. The Plan should itemise the number of remunerated direct clinical care PAs, the number of remunerated supporting PAs (SPAs), the number of other remunerated sessions / PAs for activities described in this application with a description of what these are, and also list unremunerated activities. (Box limited to1350 characters). I have a 12 Programmed Activity (PA) contract which is split in to 10.5 Direct Clinical Care PAs and 1.25 Supporting Professional Activities with a further 0.25 SPA achieved by exchanging DCC (audit sessions). I get 1 PA for my role as the Foundation Program Director for Foundation trainees at FGH and 0.5 SPA for their supervision. Broadly, my direct clinical care time is spent leading Hand & Wrist clinics, Shoulder & Elbow clinics, theatre lists and ward rounds for the elective work. For the trauma component I provide an on call on a 1:7 weekly trauma week rotation during which I am responsible for all the acute admissions to the Orthopaedic ward. As a consultant I also take teaching and training sessions and help develop training and have delivered Upper limb lectures to GPs and Physio/Occupational therapists. My job plan reasonably closely relates to my actual work although I frequently stay later than planned if operations or meetings take longer than expected. Unremunerated activities- Drug and Therapeutics Committee- I am the Surgical representative. OSCE/LOCAS examiner for Lancaster University. Domains If you are applying for levels 1-9 you can include additional information for Domain 3 OR Domain 4 OR Domain 5. Please provide additional information for one domain only. DOMAIN 1: DELIVERING A HIGH QUALITY SERVICE (see Guide) (Box limited to 1350 characters). I deliver cross bay high quality hand&wrist surgery. Since 2014,local patients don't need to travel to tertiary centres anymore, as they are treated locally. This has received positive press coverage. I take on complex hand/trauma referals from colleagues & provide a tertiary referral service. This requires dedication & flexibility & I often see patients at short notice to optimise the outcomes achieved. In order to support my colleagues & to prevent patients being referred elsewhere, I took on the additional responsibility of delivering Shoulder trauma surgery at FGH. I also established advanced shoulder arthroscopic procedures like cuff repairs & stabilisations at FGH allowing state of the art care locally & I am the sole surgeon at FGH offering Platelet Rich Plasma injections for Elbow conditions. HED data shows an extremely favourable comparison for my commonly performed operations- 28 Day Readmission(%) Day case(%) Carpal tunnel 0 (1.3 national) 97(95 national) Trapeziectomy 0(1.2) 88(82) Cuff repair 0(1.5) 84(56) Stabilisation 0(0.8) 100(62) Arthrosc SAD 0(1.2) 74(68) Ulnar Nv release 0(1.7) 100(86) Patient feedback has been extremely positive and very encouraging. 2

3 DOMAIN 2: DEVELOPING A HIGH QUALITY SERVICE (see Guide) (Box limited to 1350 characters) As part of the Hand &wrist service development, I have been instrumental in introducing innovative procedures like wrist arthroscopy which has allowed better mangement of patients specially with ulnar sided wrist pain. I have instituted the "hybrid technique" for management of scaphoid fractures. This techniques allows harvest of bone graft from the distal radius rather than the iliac crest(traditional method necessitating overnight stay), thus allowing the patient to be treated as a day case, resulting in cost savings for the Trust and better patient experience. In collaboration with the nursing and therapy colleagues, a "one stop hand clinic" has been instituted as a Listening into Action pilot project which has immensly improved the patient experience as it has reduced the number of patient follow up appointments. I am in the process of introducing Xiapex (collagenase) injections for the mangement of Dupuytrens contracture, which will allow these patients to be treated in outpatient clinics and save valuable theatre time, again resulting in cost savings. I have also raised awareness amongst colleagues about these procedures so that the patients are referred appropriately, and have liaised with the Coding department so that an appropriate tariff can be allocated for these new procedures. DOMAIN 3: MANAGING AND LEADING A HIGH QUALITY SERVICE (see Guide) (Box limited to 1350 characters) If a candidate at any national level completes form F to illustrate their leadership and management achievement it is not necessary to fill in domain 3; simply enter see form F. I lead a patient centred, evidence based, cost effective & high quality hand & trauma service which is reflected by the high proportion of named referrals.this,i believe is due to my personal investment in patient care & accessibilty to GPs. I have led the development of the Hand service and am in the advanced stages of recruiting a Hand Therapist who would form an integral part of the delivery of hand surgery and hand trauma care cross bay. As the only Hand surgeon for the Trust, I receive many referrals from colleagues & I manage them all in a timely fashion to optimise patient outcomes, very often operating at short notice. I have concieved of & led on the audit on the provision of daily trauma lists at FGH and this had reaffirmed the necessity for the trauma sessions to take priority on a daily basis. Since hand surgery was new to the trust, I have also led on the training of the staff by holding teaching and training sessions and developed protocols so that patients receive the appropriate postoperative care. I have also been instrumental in the recruitment of Orthopaedic colleagues and was involved in the appointment of two consultant colleagues and Middle grade doctors. In addition, I manage the Foundation Year 2 traineees at FGH and organise the teaching program in keeping with the curriculum. 3

4 DOMAIN 4: CONTRIBUTING TO THE NHS THROUGH RESEARCH AND INNOVATION (see Guide) (Box limited to 1350 characters) If a candidate at any national level completes form D to illustrate their research achievement it is not necessary to fill in domain 4; simply enter see form D. I have been a keen researcher and produced multiple publications. I have also co-authored a chapter in Postgraduate FRCS viva book in My main focus of research was about the transfer of nerve fascicles from the Ulnar nerve to the biceps musles. This technique has become one of the mainstay treatments for Brachial plexus palsy patients, allowing them to get useful flexion back at the elbow, thus transforming their limbs from being of limited use to providing them independence. I have also published on the management of Acetabular fractures, Femoral shaft fractures, Distal radial Fracture indices and Ankle Replacement design and stresses. I contribute to the national audits via the National Hip Fracture Database and use it to continually improve my practice. I am a reviewer for the Indian journal of Orthopaedics and McMaster Online review of Evidence. Within the last 5 years, indicate how many publications you have had, how many of these were in peer reviewed journals and list the 3 most important ones. No other text is allowed. (Text limit 1350 characters) I have had 8 journal publications and 1 book chapter published in the last 5 years. Kakkar R, Banaszkiewicz P (2012). Hip structured oral questions. In P Banaszkiewicz & DF Kader (Eds.), Postgraduate Orthopaedics: viva guide for the FRCS (Tr+Orth) examination, pp Cambridge: Cambridge University Press. Kakkar R, Cochrane J, Banaszkiewicz P: Acetabular fractures and their management. Foundation Year Journal 2012 Mar; Vol 6(3) Kakkar R, Siddique MS: Stresses in the ankle joint and Total ankle replacement design. Foot and Ankle Surgery 2011 Jun;17(2):58 Devalia KL, Asaad SS, Kakkar R: Risk of redisplacement after first successful reduction in paediatric distal radius fractures: sensitivity assessment of casting indices. J Pediatr Orthop B Nov; 20(6):376 Siddiqui B, Senevirathna S, Hayes A, Rajeev A, Kakkar R, Harrison J: The use of the three-point index in the management of extraarticular distal radius fractures. Acta Orthop Belg Feb;79(1):42-7 EWAS wrist arthroscopy tour 2014, Z Jotanovic, T Halsey, MZ Saeed, R Kakkar, R Swaminathan, P Nowicki Journal of wrist surgery 3 (03), 216 Pain and fracture after anterior cruciate ligament reconstruction caused by giant cell tumour of the distal femur.dowen D, Kakkar R, Dildey P, Gerrand C. BMJ Case Rep Sep 26;2013. DOMAIN 5: CONTRIBUTING TO THE NHS THROUGH TEACHING AND TRAINING (see Guide) (Box limited to 1350 characters) If a candidate at any national level completes form E to illustrate their teaching and training achievement it is not necessary to fill in domain 5; simply enter see form E. I have a keen interest in improving the teaching and training of junior doctors and other health professionals and thus contributing to the quality improvement in NHS. I am the Foundation Program Director for FY2 doctors at FGH. Within the last year, I have instituted regular ES/CS meetings to improve the interaction amongst trainers and also for identification of problems in training at an early stage. I have also organised regular GP surgery visits for quality assurance of training and improving feedback. I also conduct regular one to one meetings with the trainees. Local level activities: 1. OSCE examiner for medical students from Lancaster university. 2. Panel member for medical student interview at Lancaster university-2016 intake 3. Clinical and educational supervisor at UHMBFT for Foundation doctors. 4. FRCS viva sessions for exam going candidates. 4

5 5. Given educational presentations to GP's, Physiotherapists and Foundation doctors from Cumbria and Lancaster on upper limb pathologies. 6. ARCP panels Chair for Foundation doctors. 7. Panel member for PreEmployment Checks for foundation doctors. National level 1. Faculty member for the FRCS(Trauma & orth) upper limb course at Wrightington hospital (twice yearly). 2. MCh (Orth)- Royal College of Surgeons Edinburgh- Tutor on the shoulder modules since Verification of Completion I declare that to the best of my belief this information is accurate and I am not aware of any disciplinary or professional conduct and performance issues against me Full Name Signature : Rahul Kakkar (The applicant needs to print a hard copy, which needs to be signed and retained.) Assessment by domain For each of the domains please indicate your assessment of the candidate in terms of contribution to work for the primary employer and the wider environment of health care locally, eg in the SHA or Deanery. You are not asked to judge national or international contributions, for which ACCEA will receive advice separately. X No contribution in this domain U Has not delivered contractual obligations at a level expected C Delivers contractual expectations at a level expected P Some aspects of delivery have been clearly over and above expectations E Outstanding delivery of service Domains Please give your reasons if you have marked any domain U, P or E (box limited to500 characters) 5

6 GIVE YOUR ASSESSMENT OF THE CANDIDATE OVERALL FOR THIS LEVEL OF AWARD (Please give your reasons for your assessment of the candidate box limited to 500 characters) a) Is the consultant to the best of your knowledge working to the standards of professional and personal conduct required by the GMC and/or the GDC? Has the consultant during the last 12 months b) had a formal appraisal c) agreed his/her job plan d) fulfilled his/her contractual obligations e) complied with the private practice code of conduct? f) Are you aware of any actual or potential disciplinary or professional proceedings inside or outside the Trust? If the answer to (a-e) is No or the answer to (f) is Yes, further details must be supplied. (Box limited to about 500 characters) Name of person completing this form: Position Held: I, as Chief Executive, certify that the contents of Part 2 are accurate. The comments represent the considered opinion of the employer. Chief Executive Name: Direct Line tel: Direct address: Date: Chief Executive of: Signed by Chief Executive Note to Chief Executive: Please sign personally and date the copy which the candidate will retain. 6