Part 1 to be completed by the applicant Forename:

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: Panchal Employer(s) name(s) with number of sessions per employer (Lead NHS employer first) UHMBT = 13PA Part 1 to be completed by the applicant Forename: Professional Title: Sanjay Mr List of consultant appointments in date order Jan2011 -- to date -- ConsultantGeneral Surgeon with interest in Day case and Laparoscopic Surgery -- FGH Application type: Level applying for: New CEA Level 3 Accredited Specialties (main first) General Surgery Colorectal Year appointed to the consultant grade 2011 Primary Medical Qualification (Date and Institution) MBBS - Univ. of Bombay - May 1986 Current level CEA LEVEL 2 Year awarded 2014/15 Ethnic origin Indian Subsequent Qualifications (Date and Institution) MS. Gen Surg.-Univ.of Bombay- July 1990 ;FRCS. Exit Exam 2008; Dip. lap. Surg- Preferred address for correspondence GMC/GDC Reg No. 4332738 Work tel (Direct Line) Email sanjay.panchal@mbht.nhs.ukj 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). As xbay clinical lead for surgery - Over the last 2 years stabilised the department with proactive approach towards recruitment of 5 consulatnt vacancies xbay. - Improved delivery of emergency care by introducing ambulatory surgical care unit at fgh, now successfully running and similar work in progress at RLI - paediatric surgery services at Fgh currently provided adhoc bases and I am currently being mentored to take over this practice by early 2017. -- Developing new services within the department -- work in progress with relevant sub specialist colleagues. As ADME -- I have been involved in supporting 5 trainees in difficulty alongwith the education department of which 4 had a successful ARCP outcome. I am now leading a LIA project to develop effective suppport for trainees. Organised a deanery approved course to be held in house to train more educational and clinical supervisors to help reduce the burden of supervision from just a few supervisors and thus also help quality of supervision provided Within my department i have altered the working pattern of trainees which has increased the educ. opportunities for the junior doctors also approved by JDAT and with good feedback from trainees As a day case lead I have maintained my daycase delivery rate at 85% and in gensurgery we stand third compared to our peers. 1

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 work over and above my contracted PA allocation with @ 2 PA's worth of time unremunerated I have a 13 PA contract but work @ 15 PA's split into 7 direct clinical care + 2 PA for on call +1PA for admin +1.5 SPA + 0.5for educational supevision + 1PA for adme role + 2 PA's for Xbay lead role. My direct clinical care time is spent in outpatients clinics 2.5 a week spread arounf FGH,WGH,ULV, 2.5 thaetre sessions a week, 1 endoscopysession and 1 PA for ward rounds. On call commitments are 1 in 6 which is delivered as a hot week from Friday to Friday with no elective clinical activity that week. I chair various departmental meetings which include the governance meetings, xbay bussiness meetings, education committee meetings and I also take part in various other trust wide meetings ie, site lead meetings, clinical lead forum, consultant and GP meetings, these are all out of hours. I also regularly teach 2nd and fourth year students + junior doctors attached to the deparment as well as senior trainees. 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). I continue to provide a high clinical workload despite taking on xbay clinical lead role which has been demanding due to consultant vacancies from vascular reconfiguration, retirement and a colleague moving to a different trust. This gap has now been filled with succesful recruitment for all these vacancies by proactive approach alongwith colleagues. this will decrese the dependance on locums and associated problems and will ive stability to the department to deliver good quality service and also help new service development. My personal day case surgery rate is at 85% as per HED data with <5 % readmissions and no elective mortality.with various improvements via day case group meetings our trust stand 3 rd with in peers. Along with the division I have introduced and aligned the consent pathway in our department to improve the quality of patient experience. Alongwith my colleagues and the division we have worked on patient information leaflets to make them available for clinicians. The one stop minor operations clinic introduced 2 years back has had a fantastic response and take by the GP with increasing workload and we are looking at starting another additional clinic to cope with the demand. This service scored 5/5 for patient satisfaction on the surveys conducted.various other departments are looking at similar service. DOMAIN 2: DEVELOPING A HIGH QUALITY SERVICE (see Guide) (Box limited to 1350 characters) To address the problem of increased bed pressures one of the solutions put into place by me as surgical lead was to organise the set up of ambulatory surgical unit and putting into place appropriate support services in the form of on day u/s and CT scan availability, blood tests and early assessment. Prospective audit has shown 165 new patients seen in 6 months with 110patients discharged after assessment saving admission. The patient experience has also shown to be improved with this. Increased elderly population with increased referral of patients with faecal incontinence in my practice has prompted me to introduce service development and improvement for this condition. Towards this I have already passed and achieved a lower GI physology module from Newcastle Universityand also undertaken few masterclasses from sheffield and dundee to learn newer techniques towards management of this condition.i am in the processs of organising diagnostic service towards this with locally deliverable management plans to provide this service locally rather then patients having to travel to manchester. Local paediatric service at FGH is currently provided on adhoc basis by a visiting surgeon from a different trust.i am currently being mentored into providing this service locally and hopefully should be independent by early2017. 2

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. As Xbay lead for surgery I put into place an early plan on a page and consistently work towards it and have achieved considerable amount as described in my personal statement. I also chair xbay bussiness meetings, departmental governance meetings and work collabratively with the departmental and divisional teams. I have made some very valuable suggestions in the division including improvng the quality of consenting process, getting an International trainee for FGH and shred this with other departments in the division. I performed a readmissions audit recently to monitor the quality of gen surgery service which has shown the surgical department readmissions are well within the nationally acceptable rates. Recommendations from it will be reaudited. I have also been responsible for managing complaints, incidences,rca's within the surgical department and oragnise lesson learnt to be disseminated via our audit forum and through our departmental governance meetings. As ADME I have led the FGH site education team through a very successful deanery visit with extremely good feedback from the inspecting team. I have worked towards improving the quality of supervison provided to trainees by supporting the trainers get GMC accreditation as ES/CS. Also working with the prog directors towards delivering the curriculum requirements. 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. Undertaken clinical audit on HALO procedure for haemorrhids a new service which wa introduced by myself 18 months ago which has shown that the results are comparable to national and peer related standards. major advantage of same day discharge 100% and neraly 85% satisfaction. othe r audits regarding quality measure by looking at readmissions mentioned before and audit on newely introduced ambulatory surgical unit both showing meeting good standards 2 abstracts accepted at ASGBI 2016 submitted with another collaeague as co-authors. one of them was presented as oral presentation by my colleague as I could not attend, which also won a prize. One stop minor operations Clinic a QI project was presented as a poster at the prestigious BMJ Quality and Safety I nternational conference in London 2015 and was well received. 3

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) 2 Abstracts presented at ASGBI conference 2016 1) The use of serum Osteonectin as a sceening marker for pancreatic cancer. George Sgourakis, Aggeliki Papapanagiotou, Dimitris Raptis, Kyriakos Karkoulias, Sanjay Panchal Prize wining abstract, applied for publication -- rejected due to small numbers. 2)Is it an Acute pancreatitis or a Pancreatic Adenocarcinoma.( poster at ASGBI 2016) George Sgouraki, Sanjay Panchal, Aggeliki Papapanagiotou, Dimitris Raptis. Poster presentation at the BMJ international Conference on Quality and Safety at London 2015 One Stop Minor Operation Surgery ( OSMOS ) Clinic BJS Snapshot about a unusually rare case of appendix in a femoral hernia presented and accepted for publication by BJS 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. I am an education supervisor to FY2 and Clinical supervisor for FY1 and ST3 trainees in the departement. I have been instrumental in acquiring a RCS sponored International medical graduate for the surgical department at FGH -- organised a job plan with appropriate educational opprtunities and training structure, getting it sanctioned through the division and also through deanery. I have reorganised the working pattern of FY1 in the surgical department at FGH to maximise their educational opportunities which was approved by JDAT and with very good feedback from the trainees. I have also mentored and supported ahigh quality locum consultant colleague from EU who was subsequently successful in acquiring a substantive consultant position at our trust in open competition. I have mentored two nurse practitioners through their university courses and Iam currently a clinical tutor for an advanced nurse practioner in the department who is doing a university degree at the cumbria univ. I have aslo taken part in the medical school admissions ( MMI) interviews. I am still on the ALERT trainer panel and try and take part in atleast 2 training days in a year. I am currently leading a LIA project on Effective Support for Trainee doctors. we have already held the Big conversation. 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 : Mr Sanjay Panchal (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 4

1. 2. 3. 4. 5. Please give your reasons if you have marked any domain U, P or E (box limited to500 characters) 5

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 email 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. 6