Report on the Global Leadership Forum

6th June 2012

 

The latest meeting of the Global leadership Forum of plastic surgical society/association Presidents was held in Munich last week (24th May), just preceding the EURAPS meeting. This initiative, now gaining a head of steam, was generated by the American Society of Plastic Surgeons (ASPS) following the signing of several Memorandums of Understanding with national organisations that have a commonality of purpose and would benefit from shared understanding and activity.

BAPRAS has had a place in this group following Eric Freedlander's welcoming of the then ASPS President Michael McGuire to Sheffield in 2010. The BAPRAS-ASPS MoU was signed by myself in Denver last year. The burgeoning relationships of trust and work have since been reinforced by attendance at subsequent meetings in San Francisco this April, teleconferencing, and the exciting development of an additional ASPS/BAPRAS joint meeting day this December at our Winter Scientific Meeting, under Rick Milner's guidance. 

The Munich summit brought together the current ASPS President, President-elect, past-President, ASPS CEO and other staff, PSF & PSEN Chairs, President of AAPS, and Presidents from Australia, New Zealand, Holland, Belgium, Switzerland, France, Ireland and ISAPS with an agenda that spanned a convivial working dinner and an early start breakfast meeting that lasted six hours.

The topics discussed were:
-the possibility of generating International Breast Reconstruction Guidelines 
-NAPBC (US National Accreditation Program for Breast Centers (... their spelling not ours...) which is likely to be offered for wider international use
-PIP implant developments: updates and discussion from around world, led by Claude LeLouarn, President of French Vigilance Committee
-Breast Device Registries - proposal for an internationally agreed minimum data set from Rod Cooter (Australia)
-Impact of changing regulations on medical education (hours and other legislation)
-New initiatives from the US and other nations to promote specialty and patient advocac

Breast Reconstruction Guidelines
The fluid situation with development of breast reconstruction services throughout the world has generated patchy access to the best quality advice and procedures for patients, as well as some conflict between specialties. Following previous discussions on the value of agreed international protocols for individual member states, Philipe Blondeel has been Chairing an ASPS group to see what scope was available for harmonising best practice ideas. The process is underway but slow, and it is likely that a significant Dutch exercise to generate their own guidelines will produce an additional document by the end of 2012. Our own NICE guidelines, the NMBR Audit, Lipofilling guidelines, and other papers have been shared with the group, and are widely acknowledged as having been exemplary in their methodology and value. 
Alongside the guideline process, some discussion took place around the need for far better cross unit (ideally international) evaluation of robustly measured outcomes of both psychosocial variables and more objective physical outcomes. A major NIH funded study of several US units is already underway, and we will be exploring the potential for this to be widened internationally if further funding can be obtained.

US National Accreditation Program for Breast Centers
Michael McGuire brought this new program to the meeting, with encouraging news that the ASPS has secured important access to the table for plastic surgery. It is likely that American health funders will insist upon such accreditation in due course, and the possibility of other health purchasing agencies following suit outside the US was discussed since the NAPBC are already selling the idea abroad. Such 'credentialing' of provider units is attractive to insurers and private hospitals, and is a process which we will do well to be aware of and ahead of the game.

PIP Implants
The French experience was well described by the ex President of the French Society, and the following 'lessons' described:
-Implant ruptures are 'an awaited risk' ... (his description ...)
-EU controls on CE marking are inadequate and the French have instituted their own society 'vigilance committee' who will be running the website pages for reporting of adverse implant experience in the future - liaising closely with the authorities on findings
-liabilities and insurance system must be reviewed, since the French offers of removal of implants did not cover replacement as has been widely believed

The French presentation concluded with a statement of three objectives: to minimise fees for PIP related surgery, to champion the principle that plastic surgeons were devoted to the patient's cause primarily, and finally that our sole aim was to assist those caught in this predicament.

Breast device registry development
Rod Cooter presented further thoughts on the highly developed Australian breast device registry, with the objective of agreeing at least a minimum dataset which would be useable by all authorities in due course for more rapid identification of problems. This would be monitored on a quarterly basis (compared with the annual review of orthopaedic joint replacement registry in Australia), and has been developed in conjunction with Prof John McNeil of Monash university who runs a 'registry of registries'.

The presentation was well received, and members will be discussing the dataset with their home organisations. Rod is also in contact with the MHRA which is engaged in its own review (under Sir Bruce Keogh) of registry development.

Changing regulation/work rules on medical education
Michael McGuire led a wide ranging discussion on the impact of work hour regulation. This sharing of perspectives from disparate governance arrangements was helpful, and the possibility of improving pathways for trainees from different authorities to undertake fellowships to enhance training was suggested. Knowledge of the obstacles encountered by trainees seeking such exposure abroad by the senior members of societies was felt to be important.

New initiatives in Plastic Surgical Promotion
Malcolm Roth, the current ASPS President presented the current media initiatives that had had considerable success in reaching the US public with a strong message supporting the understanding of Board certification in Plastic Surgery when compared with other practitioners. The 'Do Your Homework' campaign … strapline ' Anyone can wear a white coat … not everyone is Board Certified in Plastic Surgery' was a short 15 second advert that cost $35K to develop and had generated an estimated $1.3M value in revenue, reaching 24 of the top 25 markets in the US. They have offered it for adaptation by other international societies. 
A new campaign, centred around the statement 'Truth in medical education … truth in advertising' is being developed.

BRA day … an international 'Breast Reconstruction Awareness' day being promoted this coming October  (17.10.12) was brought to our attention, and the link to the Canadian website www.bra-day.com mentioned. 

Taxation of cosmetic surgery
An additional item discussed the imposition of tax on cosmetic procedures - a well understood threat in the UK market. The experience of New Jersey in the US, where a tax had been imposed, only now to be repealed following the finding that it cost between 3-4 times as much to impose as it did generate revenue, was valuable information. The widely understood argument that such taxation predominantly affects the female population, and many on low incomes, has been a powerful factor in restraining poorly thought-through legislation in several countries. 

It is hoped that the International group will meet again in London, and our members will have more of an opportunity to meet senior colleagues during the Winter Scientific Meeting. It is anticipated that demand for the Winter BAPRAS will be high, and early booking is recommended!

Tim Goodacre
Chair, BAPRAS Professional Standards Committee

 

 

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