1. Paediatric surgery in a general hospital The view of the general surgeon

2. Elective operations 19812007 HerniasHernias OrchidopexyOrchidopexy CircumcisionsCircumcision Cutaneous lesionsCutaneous Insertion of V-P shunts

3. Emergency operations 19812007 Spina bifida AppendixAppendix HerniaHernia Intussussception Scrotal operationsScrotal operations Pyloric stenosisPyloric stenosis

7. Consultant staff Raigmore Belford Caithness Anaes1433 Surgeon843

8. Hernia/Groin operations YearRaigmore Belford Caithness 1991463 1993553 1995463 2003/556(28)5(3)4(2) Number <=5 44(22)/1(1)/4(2)

9. Circumcision YearRaigmore Belford Caithness 1991315 1993408 1995254 2003/540(20)05 Number <=5 13/0/3

10. Orchidopexy YearRaigmore BelfordCaithness 19913810 1993401 1995264 2003/586(43)4(2)5(3) Number <=5 49

11. Appendicitis Raigmore BelfordCaithness 2003/5 109(55)8(4)16(8) Number <=5 1 at Raigmore

12. Pyloric Stenosis YearRaigmoreBelford 199180 199350 199560 200320 200410 200500 200610

13. Two recent cases 4 week old (gestational age 43 weeks) Weight 3.0Kgs Pyloric stenosis 9 week old (gestational age 43 weeks) Weight 3.6 kgs Incarcarated inguinal hernia

14. Total number of operations 2003/5 All ages<=5 Raigmore414(207)219(105) Belford63(32)10(5) Caithness50(25)12(6) Excludes ENT/Opth/ortho/dentists

15. Classical problem(1) Low number of admissions Low number of operations Increasing numbers of surgeons and anaesthetists Increasing public expectations re outcome

16. Classical problems(2) Will travel for elective procedures Expect emergency care locally Guidelines re “children friendly areas” increasing Political pressure

17. Requirements for paediatric surgical care (1) Designated ward (beds) Designated lists Paediatrician active involvement Theatre reception child friendly OP clinic child friendly A&E child friendly area

18. Requirements for paediatric surgical care (2) Paediatric trained nurses Paediatric trained surgeons Paediatric trained anaesthetists

19. Types of Hospital Teaching hospitals DGH Remote & Rural hospitals

20. Teaching hospitals Aberdeen, Edinburgh and Glasgow They have all the above Can therefore provide a comprehensive paediatric surgical service

21. Requirements for paediatric surgical care (1) Designated ward (beds) Designated lists Paediatrician active involvement Theatre reception child friendly OP clinic child friendly A&E child friendly area

22. Requirements for paediatric surgical care (2) Paediatric trained nurses Paediatric trained surgeons Paediatric trained anaesthetists

23. Dundee Visiting service from Edinburgh 2 days per week. Clinics and op lists Joint appointment 2 local surgeons do 1 in 4 o/c for 3 &<3 Edinburgh cover the other nights. GS look after 4 and >4 Active involvement of paediatricians.

24. District General Hospital Can and should provide all of the above requirements. No neonates Elective service by nominated GS/Anaesthetists Emergency service - ?all GS/Anaesthetists ? separate rota Visiting service ?clinics ?op lists

25. Requirements for paediatric surgical care (1) Designated ward (beds) Designated lists Paediatrician active involvement Theatre reception child friendly OP clinic child friendly A&E child friendly area

26. Requirements for paediatric surgical care (2) Paediatric trained nurses Paediatric trained surgeons Paediatric trained anaesthetists

27. Raigmore hospital 8 GS 2 do elective work 8 do emergency work 1 fully trained paediatric surgeon Elective theatre/clinic work in Inverness 1 week O/C in Aberdeen

28. Remote and rural hospitals They have very few of the above Could provide a visiting service for elective cases What about the emergencies? Should they transfer all emergency paediatric cases? Island versus mainline hospitals

29. Requirements for paediatric surgical care (1) Designated ward (beds) Designated lists Paediatrician active involvement Theatre reception child friendly OP clinic child friendly A&E child friendly area

30. Requirements for paediatric surgical care (2) Paediatric trained nurses Paediatric trained surgeons Paediatric trained anaesthetists

31. The future More visiting services to DGH and R&R Elective work by those who undergo training as trainees Emergency work by these surgeons when O/C. When not O/C ?transfer ?”babysit”?phone around. GS o/c treat 5 and >5 ? Dual appointments by 2 hospitals close to each other. Active paediatrician involvement.

32. Surgical training N&N/E scheme do 6/12 in first year or two This will continue with MMC ? Where else will training be available Needed to provide future DGH surgeons Proleptic appointment or top up training