The joint themes for the 2024 Society’s ASM are ‘Complex teams’ and ‘Sustainability’. The ASM in Brighton will formally open with a joint Allied Vascular Society’s session on the management of the diabetic foot. ‘Doing more with less’ might be a more immediate theme cutting across all surgical specialities. NHS resources are increasingly stretched; NHS staff are reporting high levels of burnout; and some are seeking careers outside the NHS. These pressures are reflected in delays to treatment and the inevitable impact of this on disease severity and treatment complexity. So why focus on complex teams and sustainability?

The needs of people with vascular disease are too complex for care delivery by a single healthcare professional. Multidisciplinary teams (MDTs) are key to delivering safe and effective patient care. RCS England and Health Education England (HEE) describe the Extended Surgical Team that comprises consultants, trainees, nurses, allied healthcare professionals (AHPs) and medical associate professionals (MAPs).

The Vascular Society is working with the Surgical Royal Colleges and Federation of Surgical Specialists (FSSA) to develop curricula and scope of practice for Physician Associates (PAs). This work is urgent as the NHS Long Term Plan includes a significant expansion in PA numbers. We currently have a small number of PAs working in vascular surgery and interventional radiology. They are valued members of their local teams.

As a speciality, we have an opportunity to define the scope of PA roles within our services. This is initially likely to be ward and outpatient based, taking on roles traditionally done by doctors in training but which can be safely delegated – preparing for ward rounds, ward-based investigations (ie, cardiovascular risk factor assessment, taking blood, measuring ABPIs), organising preoperative workup (ie, booking appointments, completing waiting list bookings), booking follow-up and clinical governance activity (ie, preparing cases for presentation at M&M meetings). If planned well, freeing medical colleagues for training opportunities. Tasks that currently cannot be delegated to PAs are prescribing, requesting of ionising radiation and writing discharge summaries. This may change once PAs come into regulation by the General Medical Council (GMC) at the end of 2024. To help inform the Society’s position, a questionnaire on the scope of PA practice will go out soon to members.

The culture within a team is as important as its members. It was shocking to read examples of harassment and bullying within surgery, most distressingly the Survey of sexual harassment published in the British Journal of Surgery in 2023. PAs have been threatened by the response from doctors to government plans to expand their numbers. Some social media content has been inappropriate and offensive posts have been directed at individual PAs.

Only with adequately staffed and well organised multi-professional teams, with shared aims, and in which people feel comfortable and energised to work, will services deliver high quality patient care. Proper resource planning, recruitment and retention, positive team and organisational cultures and respect for each other’s roles are key to achieving these aims.

The most sustainable way to deliver healthcare is through self-care and prevention. These initiatives can also deliver greatest patient benefit. We know from the delivery of supervised exercise programmes (SEPs) how difficult this can be within current NHS models of funding. It is too early to say how devolving budgets to Integrated Care Systems (ICSs) will be a positive change, but hopefully Manchester provides an exemplar model for amputation prevention which others can follow (MARS Project).

Vascular and endovascular surgery are both heavily dependent on medical devices. These devices are often single use. Medical devices have a large carbon footprint from manufacture and transport costs. Few components are recycled. Patients need long-term surveillance and a high proportion have reinterventions. Both have an environmental impact, with the impact of travel made greater by networked models of care.

The challenge is how does vascular surgery, as a small surgical speciality, exert influence in this area? For any impact in this area, we will need to work with our partners including patients, patient groups, charities, provide organisations, commissioners and industry.
Surgery will never be carbon neutral but, with better prevention, pathway redesign, a focus on eliminating waste, evidence-based treatment and reducing unwarranted variation, we can reduce current resource usage. By doing this we protect both our services and our patients.

Other updates
Superficial venous interventions: The ideal team to perform endovenous procedures will be a focus of debate at the Venous Forum meeting in June ‘Developing a Venous Service for the Future’. The Vascular Society has convened a working group, chaired by Paddy Coughlin, with multi-professional involvement, to build a consensus on venous interventions.

Aortic dissection: The implementation of standard operating procedures (SOPs) for acute aortic dissection is on target in England. Regions will have an SOP with a single point of contact to ensure that people diagnosed with an acute aortic syndrome receive timely specialist management, including adult critical care transfer to a specialist aortic centre.

NHS England (NHSE) have recently confirmed funding for the NIHR EARNEST trial (Colin Bicknell, Imperial College, London) of early stenting to prevent later aneurysmal dilatation. The National Vascular Registry (NVR) has been approached to partner in the trial.
Data on aortic dissections in England from 2017 to 2023 are being made available on a National Consultant Information programme (NCIP) dashboard (see below to register).

MHRA revise advice on use of paclitaxel DCB/DES: In 2018, a mortality signal was reported by a systematic review and meta‐analysis of patients treated using paclitaxel for intermittent claudication and chronic limb-threatening ischaemia (Katsanos et al, 2018). In 2022, the MHRA issued advice restricting the use of these devices and advising patients be contacted to inform them of this risk.

Based on a review of new evidence in 2023 and following the FDA’s removal of restrictions to use, the MHRA has also removed all restrictions on the use of these devices (DSI/2024/001). Vascular services should now inform patients that the concerns have been dismissed and that paclitaxel devices have returned to routine use.

Outcomes and Registries Platform (ORP): This is the NHSE platform for recording of all NHS medical device implants introduced in response to the Cumberlege report. Since January 2023, NHSE – not the Health Quality Improvement Partnership (HQIP) – is the data controller for all NHS medical device data. The NVR held a separate contract with NHSE to continue aortic device capture in 2023. This contract has not been extended. Contract negotiations are ongoing and promising but, to date, whilst data collection continues through the NVR platform, this data is held by the ORP and is not available for processing by the NVR team. The Vascular Society, NVR Board and the ORP Steering Board, led by Jon Boyle, are keen to resolve this issue soon as processing this data is important to protect patient safety.

National Consultant Information Portal (NCIP): NCIP provides consultants and providers in England with 23 dashboards of vascular activity using HES data on the Model Health System. This data is extremely helpful for appraisal and revalidation. If you work in England and have not registered for an NCIP account, then you are encouraged to do so now (email your request to [email protected]).
Provision of Vascular Services (POVS) 2024: The Vascular Society recommendations from 2021 for the safe and effective provision of vascular care have not changed. However, not all the POVS 2021 recommendations have been implemented into UK clinical practice. POVS 2024 will therefore take a different approach, reinforcing the POVS 2021 recommendations and focusing on seven key areas which influence patient care: (1) people, teams and culture; (2) demand and capacity; (3) variation; (4) sustainability; (5) person-centered care; (6) outcome reporting; and (7) research and innovation. Our aim is that this approach will lead to transformational change, the adoption of best practice and new ways of working.

Charing Cross Vascular Symposium 2024: This was the first Charing Cross International Vascular Symposium without Professor Roger Greenhalgh. Andrew Garnham, Rachel Bell and I represented the Society at a memorial service for Professor Greenhalgh in Westminster Abbey on Monday 22 April.

Marcus Brooks
Honorary Secretary, Vascular Society
[email protected]