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: Garg 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: Shashi Kant Cons. Ortho Surgeon List of consultant appointments in date order From 02/10/2000 to now Application type: Level applying for: New CEA Level 8 Accredited Specialties (main first) Trauma & Orthopaedics Foot & Ankle Surgery Year appointed to the consultant grade 2000 Primary Medical Qualification (Date and Institution) MBBS, 1975, University of Allahabad, India Current level CEA LEVEL 7 Year awarded 2014 Subsequent Qualifications (Date and Institution) MS Orth,1980, University of Allahabad FRCS (Glasgow), 1987 FRCS Orth, 2000 Ethnic origin Indian GMC/GDC Reg No Work tel (Direct Line) shash.garg@mbht.nhs.uk Preferred address for correspondence Royal Lancaster Infirmary Department of Orthopaedics Ashton Road Lancaster LA1 4RP 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). Introduced cutting edge technology last 2y to one of the best Foot & Ankle unit for Surgery and Training in North West 1.Image guided Total Ankle Replacement (TAR) - first in NW to introduce this cutting edge technology - 10 patients already benefited and excellent tool for training of fellowship candidates. (presented BOFAS Nov.'15, Guildford). 2.Intrduced Tight rope technique for Hallux Varus (first hospital in UK) - avoids fusion and maintains normal function of Big Toe with ability to run and play sports. 4 patients benefited - presented in Combined NOFAS and LAFF meeting, 2015 and adopted by others. 3.Silastic joint replacement in Lesser toes for Arthritis and chronic dislocation (unsolved problem) - first hospital to pioneer & present good results in BOFAS '15 meeting. 4. We won II best presentation award BOFAS'14 for Big Toe Fusion 98% success rate (national ave. 90%), technique perfected in our unit. I gave plenary lectures on TAR, Adult flatfoot and calaceal fracture in Isareli Ortho Conf, Dec 16 and in Indian F&A congress, Aug, 16 and contributed as faculty for trauma workshop. President of Israeli Foot & Ankle Asso. invited me to Tel Aviv to teach, demonstrate ansd assist 5 TAR operations in March excellent for our trust profile as institution providing high quality of care, teaching and training. 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 split into 10 Direct Clinical Care PAs and 2 Supporting Professional Actitivities. Broadly clinical care includes: 3.5 operating sessions; 3.5 clinics; pre and post-op ward rounds; on-call weekends; and attending audit, multidisciplinary team, local and regional teaching, and business meetings. I also stay 1.5 hrs extra 3 d/week to respond to letters and s from patients, WLO, POA, AHP and GPs to ensure a safe efficient service for patients and to reduce follow-up appointments. I am a lead consultant for Total Ankle Replacement (TAR) and complex hind-foot and ankle surgery with tertiary referrals from ortho colleagues and others, e.g. diebetalogists and rheumatologists. I am a faculty member for TAR training - 30 surgeons (national and international) annually. I participate in the Lancashire Foot and Ankle Forum(LAFF), NOFSA, MAFIA(North & Manchester) focusing on teaching and training of SpRs in the North-West Deanery. This has resulted in Foot & Ankle fellowship training at UHMB (2 candidates trained), since Aug 2012, enhancing not only the training and research profile of the Trust but has also led to improved patient care. Due to my efforts UHMB -WGH is a Centre for Excellence for Zenith TAR and visiting centre to see live surgery for surgeons from UK and abroad. 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). 1. As a centre of Clinical excellence for TAR: We prospectively collect data our long term outcome with 96% survival of TAR over 7 years in 70 patients, compares well with inventor series (national 90-92%), patient satisfaction 94% ( 96% will have surgery again). No other hospital asked patient satisfaction question. Presented BOFAS '15, Guildford. We have introduced cutting edge technology in image guided TAR, already 10 patients benefited (excellent tool for training) at no extra cost. 2. We have refined and developed award winning technique (II Best presentation BOFAS '14) for Big toe fusion - 98% success rate, (151 ops). This has been disseminated in our trust and nationally. Cost effective day case surgery. No plaster needed, patients able to walk full weight bearing immediately post op. 3 First hospital to provide Tight rope technique in UK for Hallux varus - avoids fusion of big toe and maitain mobile joint with ability to run and play sports. Presented Combined meeting NOFAS+LAFF. Accepted and adopted by colleagues. 4. We are the first to present the results of Slastic joint replacement for Lesser toes - unsolved problem with unsatisfactory results with other tecnniques. Five year results were presented in BOFAS, Guildford '15 on 20 patients (25 toes). 87% satisfaction rate cf 60% with other techniques. 2

3 DOMAIN 2: DEVELOPING A HIGH QUALITY SERVICE (see Guide) (Box limited to 1350 characters) I introduced Tib Post Tendon Transfer for patients with foot drop due to truma, or complication of hip/knee replacement and spinal surgery. We have successfully treated 6 patients to enable the patient to walk without the use of calliper - a truly life changing surgery. Audited and presented in our meetings (with video). This operation is offered trustwide. In fact this is the most satisfying operation of my carrier - seeing a patient giving up calliper after 15 years, brings tears of joy to my eyes! TAR: Centre for excellence Introduced the cutting edge technology of image guided TAR allowing us perfect implantation and alignment of TAR and thus reducing the rates of complications. No extra cost. Excellent training tool. UHMB -WGH is now one of the only two centres of clinical excellence in the UK for live Zenith TAR surgery training for visiting surgeons from UK and abroad. We have developed safe surgery techniques. Due to one post-op complication of wound breakdown in calcaneal fracture fixation using traditional approach, we introduced (with Mr Millar) a minimally invasive technique. Eight patients have been treated with no wound problems. Now this is preferred. In Acquired adult flat foot - use of Bioarch and for Achilles tendinopathy - use of G - Force screw fixation has improved results - audited (20 pts.) 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. Mentoring and supporting a new colleague by offering second opinion, advice, discussions and combined lists for complex cases - Prospective data collection - regular audits and implementation of quality improvement across the whole practice.(see domain 1) Member of the advisory committee of British Association of Physicians of Indian Origin (Lancaster branch): Involved in organising a patient safety seminar (2 May 2014). Regular meetings with medical and human resource director to develop better culture. Support UHMB - Inclusion and diversity conf. Happy staff - happy Patients. 360 Feedback - multi-disciplinary colleagues, patients and regular clinic audits (by nursing staff) is available. Patients are parteners in their tratment and fully informed. All SpRs/ trainees as part of the team are briefed on quality of service expected and trained to provide such with very positive feedback. No readmission after TAR and very low after complex hindfoot surgery. All complications are analysed with measures taken on board for prevention. Very low complaints and high compliments rate with tertiary referrals from outside our trust reflects the popularity of the unit. But we are not complacent and constantly looking to improvements using cutting edge technology and CPD within financial constraints and cost effective treatment. 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. Research As a foot and ankle specialist, I have focused on the total ankle replacememnt research for the last ten years. I am an expert faculty member for Zenith TAR (since 2009) and an expert for Mobility TARs ( ). Due to this and my collaboration with Zenith TAR inventor, Mr Winson, at the Avon Orth Centre, WGH is now a part of the prospective multi-centre trial for Zenith TAR operated by non-inventors ; and I'm a co-investigator. We hope to establish whether the non-inventor and inventor results are comparable. My research on soft tissue repair peroneal tendon instability ( publication n=4 (see next section) but now n=10) has a 100% success rate compare to the more complex bony procedures with lower success (70%) and higher complication rates. Now it is a recommended procedure in a classic text book, 'Mann's Foot and Ankle Surgery' (2013, 9th edn), Elsevier. Early results of my on going research on synthetic bone support materials (since 2013), patient numbers 12, have benefited patients in several ways: no donor site morbidity (autograft) and no transmission of diseases (allograft and xenograft) (see next section). Intrduced: G Force fixation of Achelles tendon repair - minimal invasive technique - copied in NW. Cons. Manag. of Achilles rupture - no admiss, no surgery but good results. 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) 1) Number of peer review Journal publ.: 3 Millar, T. & Garg, S. (2013) The Zenith total ankle replacement: Early results of the first 50 cases in non-inventor series. Bone & Joint Jn, 95-B: 11 Choudry, Q. & Garg, S. (2010) Mobility total ankle replacement - early results. Jn of Bone and Joint Surg Br, 92-B: Millar, T. & Garg, S. K (2009) The Singapore operation for chronic recurrent peroneal Tendon subluxation - short-term follow-up in four patients. Foot & Ankle Surgery, 15(3): )Invited faculty Israel: Plenary lect. TAR, Dec.16 Israel: Foot & Ank.Soc.Training and assist in 5 TAR Mar.15 India: Foot & Ankle congress Aug.16 Copanhagen: Bone Support expert panel, Feb.'14 Guest Lect., Golden Jubilee Congress of Asia Pacific Ortho. Asso., Oct.'12 3) Presentations ( ): IOA '16 TAR, Adult flatfoot, Calcan. Fracture (Israel & India) BOA '15- Mobility TAR 10y results BOFAS '15-Zenith TAR 5-7y results BOFAS'15-Silatic joint lesser toes 5y results BOFAS '14-1MTPJ fusion 9y results HalluxVarus '14) NOFAS & LAFF Mini invasive Calcaneal Fract. Fixa.'13 LAFF BOFAS '12 Zenith TAR - First Fifty 4) To GPs Foot and Ankle problems '15 Inj. technique for joints and soft tissues (Nov '12) 4) Patient info: Garg, S & Winson, I. Your ankle: A guide for patients. 4

5 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. Local: SpR Foot & Ankle tutorials - 6-8pm weekly, my own time after work. Foot and Ankle Talks and demonstrated injection techniques to local GPs, AHP in organised events (23 Nov 2012) & in GPs '15. Medical students attending clinics and OT. NW Deanery: Trainer for foot & ankle (since 2007), SpRs and Fellows. Excellent feedback (evidence available) because I provide comprehensive training. I also organise a training session in Lancaster on foot & ankle modules for the North-West Deanery SpRs. The feedback has been very positive (evidence available). Regional Teaching: 3 monthly LAFF, MAFIA(manchester), annually NOFAS. Teaching of SpRs, updating and learning from colleagues. Annual NW Forefoot Course - faculty - own time weekend. National: Since 2009, faculty annual training course Zenith TAR surg. - simple and complex TAR (lecutres and cadaveric), tips for safe surg., national and international surgeons. Over100 surgeons have been trained in the last 7 y - the feedback has been 'very positive' (data avilable). Offer an online advice. International: Israel: Plenary lect.tar Dec 16 Foot & Ank. Soc. demons. & assist 5 TAR Mar India: Foot & Ankle congrress - facult trauma workshop Copanhagen: Faculty, Bone supp. - expert panel '14 Guest lect.:tar (Golden Jubilee Cong. Asia Pacific Orth Asso.,Oct '12); 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 : Shashi Kant Garg (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

6 Please give your reasons if you have marked any domain U, P or E (box limited to500 characters) 6

7 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. 7