Aims of the Study: There has been regular dialogue regarding the importance of developing clinical networks to compensate for the steady decline in GPS performed by adult surgeons. Despite this there is no real published data to quantify it.
This report documents patterns in delivery of GPS in England and shows what is being performed where and by whom.
Methods: Using SWORD we compared hospital-level data between 09/10 and 16/17. Inclusion criteria were children younger than 18 years admitted to NHS-England hospitals for elective inguinal herniotomy, hydrocele, umbilical herniotomy, circumcision, orchidopexy or orchidectomy. Data was analysed with an on-line statistical package performing paired t-tests.
Main Results: 09/10 vs. 16/17.
There was no real change in the overall number of elective GPS cases (12883 vs. 12952) but the type mix has changed. The number of cases performed by adult surgeons fell by 34% (4699 vs. 3090 p<0.05). The number of cases performed by Specialist Paediatric Surgeons (SPS) increased by 21% (8184 vs. 9862 p<0.05). This increase in workload occurred in both tertiary (21% increase) and peripheral centres (18% increase).
When analysing data by operation type it was apparent that 78% of the increased workload was attributable to an increase in orchidopexy rate with a 90% increase in rate of orchidopexy performed in the under one age group. >95% of these surgeries were performed by a SPS. This would correspond with a change in practice following the 2011 consensus statement issued by BAPU.
Conclusion: Best practice is to treat children close to home by staff with the right skills. This study shows the hub and spoke framework is no longer embryonic however a significant proportion of the increased workload was provided in tertiary centres. It is important to monitor these shifts for successful succession planning as well as configuration of services.