The Knee 21 (2014) 1299

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The Knee

BASK—Editorial

BASK Presidency: The last 2 years

At the Brighton British Orthopaedic Association (BOA) meeting just past I handed over the Presidency to Richard Parkinson. Since we are in the times of reflective practice, and expected to write it down as evidence for our appraisal and revalidation folders, I have pondered on what has been achieved. On a superficial level we have a new logo which has changed the old black & white to colour. The patella now takes centre stage (no idea why) in the colour of the union flag. What a relief that Scotland decided against independence. There is also a new tie which will be available at the Telford Meeting next March. Within the Executive there have also been structural changes. It has become clear that there is a flow of initiatives from the Department of Health, through the BOA to the Specialist Societies to provide professional input and expertise for various government proposals. Of course no resources are included, but because these initiatives have a direct impact on our members' professional lives, we are obliged, and perversely, want to respond. It is not possible for the President to take on all this work individually. As a result the Executive has been expanded and Committees created to take it on. In addition to the President, Secretary, Treasurer, Webmaster, Editor of this journal, and the two early-year posts there is now an Education Committee chaired by Andrew Porteous that looks after such matters as fellowships and skills workshops and a Research Committee that is chaired by Andrew Price. BASK sponsors travelling fellowships and research fellowships which are processed through the two committees. We also have member-atlarge posts and a registry chair. The National Ligament Registry (NLR) whose link is Sean O'Leary sits on the Executive. This has been a major effort by the NLR focus group with sponsorship from BASK in the last two years bringing it to fruition. The new osteotomy registry United Kingdom Knee Osteotomy Register (UKKOR) has just begun in September. There is a BOA initiative to bring all the orthopaedic registries under one umbrella along with the National Joint Registry (NJR). This is all part of the government transparency agenda where orthopaedics is far advanced over all the other specialities. This has its advantages and disadvantages. However, at the moment we have great political capital, and through the BOA and President of the Royal College of Surgeons (RCS) of England, the ear of the government and Department of Health. Considering the transparency agenda and surgeon-level data in the public domain, there is no doubt that the government's aim has been to produce league tables. The new RCS President has made it clear to ministers and NHS England officials that it is essential that this process has the backing of all the surgical community. Since the data is of poor quality, due to poor compliance, then there is no validity. Stratifying surgeons in this circumstance and having some pilloried in the national press would be counter-productive. It also risks legal action against ministers and Department of Health officials if this results in loss of

http://dx.doi.org/10.1016/j.knee.2014.11.002 0968-0160/© 2014 Published by Elsevier B.V.

earnings. The current view is that unit level data are appropriate. Since the purpose of the transparency agenda is to help patients and increase safety, then unit level is appropriate as patients, in the main, cannot choose their surgeon, may be seen by one and operated by another, and the successful outcome depends on a team of people along the whole patient pathway, of which the operation is a small component. In the last year the NJR has begun a process to engage the Specialist Societies to help produce more useful outputs. The BASK President now sits on the NJR Medical Advisory Committee (MAC). This organisation is also involved in deciding on the NJR data placed in the public domain. They are also concerned with getting specialist societies involved in data analysis. The details of this process and subsequent data analysis will be handled by the Research Committee. Private practice and the direction of travel of the insurance companies involved me in various meetings in the first year of my presidency. After the unilateral reduction of reimbursement fees and the lack of any meaningful discussions about this the meetings stopped. The last interaction was a request to understand why only one revision ACL per year was being undertaken by most knee surgeons. The response was to ask how this information would benefit BASK members, rather than a fruitless discussion of the reasons for revisions and numbers in a surgeon's whole practice. Answers came there none. The Competition & Markets Authority (CMA) report has meant that the question of private practice has moved away from direct dealings between BASK and the insurance companies. The Federation of Independent Practitioner's Organisations (FIPO) has been acting on BASK's and others' behalf with regards to the CMA. We have helped fund FIPO's responses. I should add, returning to the NJR, that the transparency agenda will occur in private practice as well. The Private Health Information Network (PHIN) is an organisation bidding for this work. They are keen to get hold of NJR data and have had discussions with the BOA about this. They also stated at the NJR MAC that they had been in discussion with the BASK President as well as other specialist societies. I was able to inform the committee that they had not been in touch with me. It is yet to be seen how the transparency agenda in private practice will work. Over the last two years relations with the BOA have improved considerably. The BOA runs a Specialist Societies Committee to act as an exchange for information. Of note, also, has been Tim Briggs' Get It Right First Time (GIRFT) initiative. This will be rolled out over the next year or so. It is up to the new President to take on the reins. I wish him well. I shall stay on the Executive as the Immediate Past President to lend my support. Simon Donell Sept 2014

BASK presidency: the last 2 years.

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