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 = 12PA Part 1 to be completed by the applicant Forename: Professional Title: Sanjay Mr List of consultant appointments in date order Jan 2011 - to date -- Consultant General Surgeon with interset in Day Case and Laparoscopic Surgery at FGH Application type: Level applying for: New CEA Level 1 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 NO AWARD Subsequent Qualifications (Date and Institution) MS.GenSurg.- Univ of Bombay July 1990 FRCS - Intercoll. Exit Exam. - 2008 Year awarded Ethnic origin Indian Preferred address for correspondence GMC/GDC Reg No. 4332738 Work tel (Direct Line) Email sanjay.panchal@mbht.nhs.uk 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 Gen. Surgery lead for daycase I have worked alongside different groups and have managed to increase the general surgerydaycase rate at FGH. My contribution also includes increasing the variety of casemix offered as dasycases to involve more minimal invasive procedures ie. Lap. cholecystectomy, Lap. hernia and Incisional hernia repairs, HALO procedure, and other coloproctology which were not previously offered at FGH as day cases. Alongwith this I have also improved the quality of support service given to patients by leading the organisation of Post Op.Tel Fu service for Lap cholecystectomy patients, inturn helping increase daycase rates, gain best practice tariff for trust and also reduce readmission rates and increase patient satisfaction I have also set up a one stop minor operations service to be provided in outpatients dept. thereby relieving the pressure on main theatre list for GA cases, helping decrease waiting times for GA and minorops, increasing patient satisfaction for minor procedures. I am also surgical lead for Theatre Utilisation and Productivity workstream group and together we have improved theatre utilisation to 95% by successfully decreasing start and turnover times. I hve also introduced regular departmental governance meetings helping improve quality and efficiency of care we provide.. 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 have a 12 Programmed Activity contract split into 9 Direct Clinical Care ( incl 1 PA for on call) + 1.5 for admin. and 1.5 SPA time. My Direct clinical care time is spent leading outpatinet clinics at 3 sites (FGH, WGH, ULV), operating theatre lists at 2 sites ( FGH, WGH), performoing endoscopy, ward rounds. My on call committments are 1in 6 which involes a whole week on call dedicated entirely to emergencies. I aso take part in various departmental, governance and relevant MDT meetings. I also lead various other group meetings eg. daycase outcomes and theatre utilization. and productivity workstream, to improve quality and efficiency of care. Frequently I have to stay later than planned if operations, lists or meetings take longer than expected. My objectives include taking a lead to improve daycasse surgery cross bay and make theatres more productive and efficient. As a consultant I also teach 2 nd year medical students regularly in clinics, and the FY1's on ward rounds. I also regularly train our trainee registrars and middle grades in surgical techniques in operating theatres. 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). CHKS reports for last 2 yesrs have consistently shown high vol of cases seen in outpatients and operated on with finished consultant episodes for each @ 1250 and 1500 respectively. My personal successful daycase rate has beeen 84% which is well over 75% aimed for by the NHS plan, with only 5% readmission rates and 0 % mortality and outpatients new to follow up ratio 1: 0.5 compared to 1 : 1.2 of peers. As day case lead at FGH I put in to place various improvements along the daycase pathway which has helped increase the whole General Surgery Unit's daycase performance figures to go up to @ 65% compared to before I started. I am now working with the cross bay group to improve daycase rates across sites. My day case Laparoscopic cholecystectomy rate is 50% compared to 16% national average and BADS target of 60%. The units peformance at FGH has also improved with successful day case Lap Chole rate at 35% which was 0% before I started. This has helped increase patient satisfaction and the trust benefiting in acquiring the best practice tarriff. Alongwith this I offer an increased variety of casemix than before within daycase at FGH eg. Lap hernias, open hernias under Local anaesthetic, HALO procedure for haemorrhoids and various proctology procedures. DOMAIN 2: DEVELOPING A HIGH QUALITY SERVICE (see Guide) (Box limited to 1350 characters) Day case surgery audit under my supervision at FGH in 2012 highlighted that majority of day case surgery performed in main theatres befor 2011 were minor procedures under local anaesthetic. I therefore developed an one stop minor ops service and a full patient pathway from GP referal to one stop minor operation ( Lumps and Bumps) within outpatients department at FGH. This is now fully functional and preliminary audit has shown 100% patient satisfaction with only single attendance for assessment and procedure. This has completely removed minor ops. from main theatres freeing up more space for GA cases in main theatres, and reducing waiting times for both Minor ops and GA cases. This audit had also shown daycase Laparoscopic colecystectomy rate to be 0 % at FGH. I therefore organised scheduling of op list by waiting list with consultants, standardised surgery and anaesthesia, implemented nurse led discharge, introduced and set up a post -op telephone FU for daycase Lap cholecystectomy patients by surgical care practioners and developed the questionaire and pathway for this. This has helped increase support and confidence among nursing staff and patients helping increase Lap. chole. daycase rates to overall 35% for the dept.this was also presented in the international conference for quality and safety organised by BMJ. 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 surgical lead within the theatre utilisation and productivity workstream at FGH, I have led multiple meetings and helped device various strategies and increase awareness amongst staff and colleagues regarding theatre start times, turnover time, theatre runover times. I have also implemented scheduling for lists in General Surgery department. Overall these changes have shown improvement from 95% delayed starts to only 5% delayed start by oct 2013, KPI's for utilisation have improved to avg. more than 90% making considerable savings to the trust already. Further improvement process continues to increase productivity. As Daycase lead I have been actively involved in multiple multi disciplinary meetings with differnt staff groups bringing about cultural change in the thinking regarding daycase operations and therfore being able to instill confidence in staff and patients, reflected by improving our daycase surghery rates compared o peers. I have also been instrumental in starting the the departmental governance meeting in 2012 which I have chaired on multiple occassions and we have implemented cahnge in working pattern for FY1 with increase prescence on weekends, increasing support on weekends by availibility of radiographer for ultrasound over w/e., effective risk managementand root cause analysis of incidents. 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. High quality audit of Laparoscopic cholecystectomy in 2012 presented to the department has lead to development of service towards operating on hot gall bladders helping patients admitted as emergency get the operation during the same admission in majority of cases. The lap chole data is aslo being entered in a National Cholecystectomy Audit. I am also taking part in entering data for the National Emergency Laparotomy Audit. 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) Poster presentation -- Post discharge telephone follow up for lap cholecystectmy- improves daycase rates for lap. cholecystectomy. - presentaed at BMJ Quality and Safety international conference in Paris 2014. this was very well recieved by an international audience with further contact from an Australian hospital in Victoria for information to set up similar service. Comparision of outcomes following laparoscopic posterior rectopexy vs laparoscopic ventral rectopexy -- paper submitted to Colorectal Disease 2010 -- rejected. Being attended to for esubmission pending further data collectoion as recommended. Bowel obstruction in the postpartum period as a result of caecal volvulus around a large Uterine Leiomyoma. Pollard JS, Taylor SE, Wallis G, Panchal SN, Egun AA. J Obstetrics & Gynaecology 2009 Oct;29(7):673. 3

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. Unedrgraduate teaching for yr 2 - in one stop minor ops clinic -- giving the advantage of students being able to assess and present the case ( lumps and bumps) and then watch the procedure being performed making it extremely interesting and interactive. -- excellent feed back received form sudennts.- now being introdiuced in the year 2 logbook. ALERT trainer on panel since 2013 I under take @ 3 courses a year with lecture and scenario based teaching to all different staff groups from junior doctors and nurses to pharmacist etc. I am also a Locas examiner since 2013 and have taken part in Locas examinations. As part of the FY1 ARCP panel member I have helped in assessing and feedback of annual progress of FY1 doctors. I am currently involved in developing a simulator based Laparoscopic skills training for junior doctors as well as postgraduate trainees. 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 1. 2. 3. 4. 5. Please give your reasons if you have marked any domain U, P or E (box limited to500 characters) 4

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. 5