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Oh, is it, is it um you're having a problem with your, with your mic? Ok. Um What you could do is what lo lo log out e exit this, this, the uh the call come back in and it should give you an option to change your mic. So, er, if you just click out this and then click the link again. Yeah, just. Ok. I think, II think, I think that's what you need to do. Yeah, let's see. Yeah, I'm afraid I'm not with him today to provide technical support. Not that I'm particularly well placed to do it, but all right, let's see. So he's, let me, he seems like he's logged on new line to stage again. Ok. All right. Yes. Yeah. There we go. How many people have you got Oliver? Uh So we have how many thousands? Well, we have 30 that have joined us just now and then we've got about 100 and 60 signed up. So he, hello everyone and welcome to the NHS England exer further faster for trainees um outpatient event. Um Thank you for joining us. Uh We've got some great speakers lined up for you. Um er, we're waiting for one more so we'll give it just a couple more minutes and then we'll get started if that's ok. All Stella's gonna be delayed, so, um All right. Ok. Yeah. Ok. Thanks. Thanks for letting me know. So, uh, so without further ado, then I'm gonna introduce Prof Briggs, who is our, the, the national director for elective career as well as a whole lot of other things and the chair of G the Getting It Right first time program. And he is going to talk to us about the importance of the further fast program. Uh And then we'll be followed by Graham Lama as the head of information at the Getting it right first time program. So I hand over to you. OK. So good evening everybody and welcome to this um webinar. Um And I'm gonna go talk to you about why it's absolutely critical. This program that we're gonna talk about and discuss this evening succeeds. We've all worked in the NHS and I've been a consultant now for over 32 years. And for me, the NHS is extremely poor, both for our patients and for our population and this country. And we've got to make sure that we provide timely effective care. Now, we know that before COVID, we were hitting 18 weeks treating patients once they were referred within that time. And our waiting list at that point was around 4 million as a result of COVID and the aftermath. Our waiting list has risen to its current state of 7.6 million and I've been working with Jim Mackey to really drive elective care. And we've had some real successes. If you look at the 7.6 million people on the waiting list, it's actually about 6.3 million patients. Cos there are a million, just over a million patients who are on multiple pathways. For instance, if a patient may be on a waiting list for a hip replacement or a knee replacement, they may be seeing the pain specialist and they may be seeing the rheumatologist. And so we know it's actually about 6.3 million. If you look at the 7.6 million, its totality, 80% of those patients require an outpatient appointment and only 20% require either an er, an admission to hospital for a day case procedure or indeed an inpatient procedure. And of that 7.6 million, we see 100 million patients a week in the NHS in, in our sector, GPS are seeing 1.5 million patients a day, but we see 100 million patients um a, a year which works out about 2 million patients a week. Now, when you put the numbers like that, then you see 7.6 million patients is about 3.5 weeks work. So when you look at the numbers and you think about it in that way, you can see how we can make a difference. Now of that 100 million patients that we see here, approximately 10% 10 million before we started our program were DNA ing. So one in 10 appointments, the patients were present for whatever reason. And of that 100 million patients, we see about 28 to 29 million patients who are new patients every year, which means that we're seeing over 60 million for a follow up. Now of that follow up patients at 60 million, the vast majority 40 million are seen with no procedure or no investigation. So just over um 2014, 40 a half million come in with a are seen for a follow up with a, with a with a procedure. The rest are seen for follow up with no procedure. And that means that we are seeing way too many patients in our follow up clinics and if we could convert that into new patients, then I think we could have a real opportunity to get our waiting list down because to get back to 18 weeks, we need to go from 7.6 million down to just over 4 million patients on the waiting list. Now, how are we gonna do that? So we're gonna hear today about a program called f faster across 16 specialties which allows us to look at things in a different way about discharging our patients appropriately following up when we need to virtual versus face to face appointments, follow up to new patient ratios, validation, super clinics, and importantly, standardization of templates where we can really make our outpatients much more efficient. Now, if you said to me as trainees, is that important for you? Absolutely right. Because if we can get our outpatients into the space, we want to where we're seeing the right patient at the right time. Then for you in terms of your training environment, very much better, better teach with your consultant and less reliance on long term follow ups, which actually just fill our clinics. If we then look at our patients that need to come into the hospital. Graham's gonna talk about day case rates, gonna talk about the need to be efficient and effective in theaters, which is critical. And the other thing that he's gonna talk about is our surgical hubs. We're gonna have 100 and 33 of those by May June next year with the expansion of 24 existing hubs, which are gonna give us a huge opportunity to increase our capacity in both outpatients and also in the operating theater. I was accrediting a hub in London last week. And what was very interesting was the trainees were there and I was able to ask some questions about how they were getting on. They all demonstrate and they all found the surgical happens to be a great place for learning, great place for surgery and a real opportunity to hone their surgical skills and fill their logbook. So in summary, what you're gonna hear tonight is a real methodology for driving change, doing things differently, but we need your help. We can't just keep following up our patients. We have to talk to our bosses about patients, we think we can discharge. So we maximize the outpatients that we see and then make sure that we use our lists hubs day case rates and put patients in procedure rooms where they um where they need to be. So we maximize our use of our theaters and our and our operating time. So I think we can achieve recovery of our waiting times. And I think the, what you're gonna hear from Graham today will demonstrate to you where we've come from where we are and where we're going. Thanks Oliver. Great. Thank you prof. So now I'm gonna hand over to, to Graham or Graham Lomax who is the director of implementation at the Getting it Right first time program. And he is the guy responsible for the fair fast program. Brilliant. Thanks Oliver. So I'll just um see your finger the slides up. Yeah. Yeah, we can see the screen. Good. Ok. Brilliant. Right. Well, that's always a good start. So, yeah, thank you very much for the introduction. So I I'm an operational manager by background. So I've been in the HS 20 years, the last seven working with Tim in G. And the reason for that is that obviously as an operational manager challenge to deal with productivity, efficiency and waiting times. And certainly the my view has always been that that should be through a lens of clinical improvement, getting the pathways right for patient and reducing variation. So it certainly was a huge surprise to me calling the NHS, the level of variation existed in clinical care. And therefore, it's, it's great to be part of a program that's looking to deal with that. So I'm going to take you through, obviously going to focus on some of the outpatient side of things, but just to give a bit of broader context, either side around the rest of the work that Tim has referenced. So in implementation, so with all our work streams, we have that kind of arrow there with a range of hands on operational support. So we're in the trust, working with operation clinical colleagues to help them implement changes that kind of middle bit really about sharing some of that learning, establishing clinical networks or working with existing clinical networks to share good practice and through to the kind of publication side. So through our gift academy and there's lots of stuff on our website, we publish pathways, toolkits and all sorts of guidance, case studies and all underpinned data. So again, as Tim said, clinically led data driven and we work at kind of national regional level system and that's the kind of integrated care boards down to individual trusts. So you can see some of the work streams that we've got the 50 odd clinical work streamss, but also some of that cross cutting work. So our this and program I'll touch on is a major part of, of the elective recovery. Clearly U EC and again, as we've kind of touched on all these things are interdependent. So we can't really have effective theater and elective care programs if we haven't got urgent care work streams under control the specialist network. So at both ends, we're looking at high volume strategies for high volume, low complexity, but also that more work and making sure the procedures are undertaken where they should be appropriately trained people and the focus support again, that's the kind of hands on support. So our trusts are particularly struggling for whatever reason we go and provide shoulder to shoulder support to our peers. And then so obviously, what we're here talking about today particularly is the outpatient transformation and, and we'll go through some of that, but it certainly includes that interface with primary care, reducing the unnecessary follow ups in order to create that clinical much needed clinical capacity and just improving pathways in terms of straight tests, one stop models, et cetera, et cetera. So, er as we said, what we what so Tim was challenged really with um or, or, or Tim set the challenge to our colleagues in trusts is how can we expedite elective recovery? Er and we were talking about 50 weight, of course, 50 weeks is far too long. And, you know, for those of us who have been on waiting list, it kind of hits home really when it's you or your family. Er, so absolutely, getting down to 40 weeks, er, should be our next target and from then, er, further and further closer to the 18 weeks. So we rapidly developed specialty handbooks we'll talk about in a second but very much a matrix approach. So we've got the individual specialty groups with detailed guidance, but also supporting organizations, the kind of executive and management teams to put things in place, to support the clinicians to make this happen. So. Ok. So has it been effective? So if you can see the light blue line there? That's the cohort one. So that's the 25 trust that we started in July and we mobilized this in about four weeks. The 25 trusts are a combination of er, large teaching trusts, small district generals, rural, urban, high performing, er, struggling trust. We purposely took a, a cross section and you can see that since we started in July, uh we had a significant and pretty rapid impact. This is the numbers of patients waiting over a year and that's continued. So the latest data is there were 58% of that baseline CO2 based on the success we were having there. So we on boarded CO2 and they were all the trusts that were in what's called the tier one and tier two. So essentially they were the trust that were the most challenged for waiting time and some of the factor as well. So clearly, that was difficult. And you can see they actually went up from 100% to about 100 and 810% from that initial start point. And through working us within, we've got them down to about 75% of that original total. Couple of three, essentially everyone else. But we're now in the process of on boarding about 30 of those trusts to work with more intensively again, sharing the learning. So you can see it absolutely has had a fairly quick and significant impact. Now, not all specialties having the same, all the bit of variation, but rheumatology, a good example there. So significant improvements there. Likewise in urology and also endocrinology again, challenges in different specialties. Of course, there's a a very much a Venn diagram of challenges but each has their own uniqueness. So what has it been successful? So I think firstly, having the, the SRO so the executive from the trust bought into this with a monthly meeting. So it's a drum beat meeting so we can check in on, check in on progress. We've got the, we've got the, we've got, I think 16 specialties meetings, most of those meet monthly. So we've got the learning and um i with the actions coming from those specialty meetings that we can then feed into the SRO groups to make sure things are happening. And of course, it's that shared learning, a bit of bit of friendly competition between organizations and and shared drive. So again, we're learning together and I mentioned the academy. So there's a link there with all the handbooks and also checklist which make it very easy for trusts, clinical and operational teams to quickly go through our section in a second of where you are as a trust in the national picture, but then also where you can get more information. So signposting to trust that are doing it well and some case studies and other information or if you need support from the gi team to get things off the ground. Um So that's just a quick example of again, the variation all trusts are, are delivering this as fast as others as you'd expect. But there's some really great examples and trust. We work with Leicester. We've been working very closely. The top left, the Devon Trust have been doing really well and clearly, this enables us to be a bit more targeted in terms of looking at trust that might need a bit more help and bringing in the clinical and teams to understand how we, how we can best support them. So, um again, this is just a, a flavor of er, the for faster handbooks. Er, so for each, so we've got on each specialty, there's the checklist there for each section of the pathway er with the data, the er key um success measures, the key actions that need to be taken. So again, very, very easy, you know, to, to, to kind of sit down understand where you are and therefore what are the material actions that are going to improve your services? Um So there's there's a bit of an example there in the middle of the. So that's the urology document and examples of urology investigation units quite detailed in terms of what the management, what the clinical staff would be and even examples of business cases, etcetera to help help individual trusts develop those themselves. Um So through the, this is just a, an example from the orthopedic group. So of course, what we're looking at is saying, well, if we can bottle the best, er, so there's all in every specialty in every trust meeting we have, there is something they're doing well, there is something that trust and that, that, that service is doing really well. And if we can just bring those together, er, to really learn from each other and harness the best, this is what it could look like. So we've got rates of at less than 3% of DNA, I'll show the variation in a minute. We've got patient initiative follow up in the high twenties, we've got rates of follow up. Um er first of all ratios below one. So what's what, what the opportunity is for us to standardize this. So if we look at DNA S, so I think Tim Tim mentioned this before and I think that you've got to look at the um the importance of DNA S is if patients aren't coming to the appointments, they're trying to tell us something. And that might be about the communication, the methods of communication, the timeless of communication. Um The meaningfulness we need to understand the reasons is the appointment needed. Was it a high value appointment? What are the other options in terms of virtual telephone? There's a lot of A I tools out there or, or or in some cases more simplistic tools to look at the um the main factors for patients DNA is to be able to identify those most likely to not attend the appointment and therefore put in place different interventions. So, you know, particularly phoning patients of particular groups and also there's just the kind of operational point of overbooking. If we know we're going to get a certain DNA rate, then you know, as airplanes would do you overbooked to, to cater for that. So you can see there over the course on the trend on the left. So obviously some kind of month on month variation, but you can see there has been an overall reduction but quite staggering variation really there. So Norfolk have done some incredible work really and and Devon to get to 2.6 and 3.3 er, respectively. Now, clearly there are demographic differences but that doesn't account for all this variation. So we've got bars there at 18%. Um, so from, from 3 to 18%. Yes, some is that is warranted, there is no way that all of that is warranted. So again, some opportunities, er, through the handbooks to learn from what those on the kind of top left are doing and see how we can, uh, see which of those interventions are most relevant to a particular population. So I mentioned patient initiated follow up a really simple and straightforward thing that patients like when we do it. Well, uh, so again, incredible, we've still got trustee orthopedic specifically, er, we've got trusts still 0% or, or less than 2% right up to those trusts that are in the high twenties important with all these metrics, look at them in the round. So if you just look at pu, we don't want to just increase pu and therefore not discharge patients clearly, it's about discharging, it's about pu in patients that you ordinarily would have invited for another appointment. And again, looking at through the specialty handbooks, the specifics of which pathways this is most relevant for. Um, so, um for example, following up patients following a, a high volume, low complexity operation, some I think Tim would probably tell us these days that we don't need to follow up patients for a hip and knee hernias and Stella might touch on that. So um there are various pathways that we to be specific and challenge ourselves about whether that's the most appropriate thing. And again, it goes back to communication with the patient, some great work in Harry Gate with patient specific videos. So essentially the surgeon very quickly records a one minute video on their ipad, which provides the reassurance and the instructions and the signposting for patients so they can be discharged confidently. Um I think the there's a few other kind of operational elements in there. Some of you might have the juries of a new electronic patient record or ordering system. And again, some opportunities there between sharing learning how some trusts have overcome some of those challenges more strongly or quicker than others. So what we need to learn from each other and I mentioned the follow up ratios quite a bit of variation there, again, quite difficult to be completely specific because of differences in case mix and various other things. Um But certainly in orthopedics, we think around about 1.3 is would be reasonable for the majority of patient of trust. And again, it's really this is a framework to understand internal variation as well. So looking at individual clinics and again, those individual pathways um that I've mentioned. Um so just go, I'm gonna tell talk a little bit about theaters in a second. But this again, just through the, the further faster lens, this is from a meeting we had on Friday. And again, you can see the variation there. We've got trust that are about 84% and we've got trust down at 74%. What can we learn from the left hand side of the graph? This is just an example of. So they were cohort two who came in in around October really struggling a number of ways and we were delighted to see the progress they've been to make just by putting in a essentially a structure where each of the specialties are regularly meeting with a medical director and senior ops team. So just kind of shortening that gap and just having that regular contact between the clinical executive and the specialty teams has enabled a 45% reduction, er, since they joined, they increased their advice and guidance from about 12 to about 22% increased pu and theater er utilization you can see on the bottom there has increased as well. So just a really good er illustration of bringing those teams together and getting, getting a good structure and a rhythm alongside these handbooks clearly um makes an impact. So there's just a summary there of where some of the documents exist. So if you go on to the, there's a future NHS workspace, it's slightly irritating because you do have to have a login. But once you've, once you've registered, it's then very easy to go in. So there are documents as I say for all the specialties for the different cohorts and including the more generic ones which has not got the trust specific information. Um There's also within there both in the futures workspace and on the GF website, lots of, lots of different toolkits and special guidance, whether it's about outpatients or about particular pathways. And again, there's that signposting of resources and we do have the clinical network. So as well as if there's anything of interest in those that you want to know a little bit more about, there are ways and means to find out more via our my implementation team and via our clinical leads. And again, our clinical leads and my implementation team, we're here to help. So we're always keen if trust to get in touch with us and whether that's to get a bit of advice to be linked up with others who have maybe been slightly further ahead on the journey or indeed to come and provide some of that hands on support. That's frankly why we're all here. So always keen to hear from colleagues. If we can help, just gonna say a little bit more about theaters, then uh because again, if as we um as we hopefully address our outpatient backlogs and as Tim's reference, the kind of conversion rate, clearly those patients will get onto a waiting list. And we're gonna have to make sure we use a make absolute best use of our assets to do that. So we established the National Theater program about three years ago now and there's a couple of stats there in the middle so it's a bit busy. But, so pre COVID, the theater utilization was about 76%. Uh, it wasn't that long ago. But, well, er, certainly within my career, the, the overall utilization about 68% the data, the liability was pretty poor but the fact we've got now a full data set of across all across the entire country of people measuring theaters, er utilization the same way. And we've got up to 79 as I say, from pre 76 I think shows this is this can be achieved. The day case surgery rates have increased from 78 to 81 and actually, it's slightly higher than that because um excuse me, as we've moved procedures out from day case into outpatients that slightly excuse the numbers. So we're going to have a new data set coming out in October, which will reflect that. And I think that will be an increase to about 83%. But you can see the trend anyway. So there was lots of progress being made on this. Um So at the bottom left there, so they're the main kind of pillars of the program. So Tim and the surgical hubs I will post in the chat when I can work out how a link to the health foundation report on this. That was just poisoned last week or, or, or yeah, last week, which breaks the benefits to this in terms of resilience and also efficiency and productivity. But also, again, as Tim said, some of the kind of softer elements of being a positive work place for staff and help with recruiting retention and indeed surgical training. Um I've mentioned the data so the data is infinitely better than it was a couple of years ago. It needs to get a lot better and it will continue to be something we drive. But again, as with all things we've learned with, with data and go over the years, you can, even if it's not perfect, we can work with it. And the more we work with it, the better it gets, the more valuable it gets the right procedure in the right place. I'll mention that again, we've got detailed guidance on our website about which procedures we should not be doing in theater and we should be doing in other settings to again make best use of our estate. Um And uh again, lots of, lots of good examples of innovation there, the outstanding theater teams. Again, that's lots of detail about uh new roles and ways of working and how we can really make best use of our um our our workforce. And again, they are clearly our most valuable resource and all things about theater productivity. I'm just gonna come on to ah the next slide. So again, we've produced guidance and it is very much about the whole pathway. So for things to be involved on the surgical side, this isn't about, well, a part of this is about what happened on the day, but really a theater list is you kind of win or lose really in the planning stages of this, in terms of the preassessment pathway, the scheduling, the communication, et cetera, et cetera. So we've got, we've got detailed guidance about all aspects of the pathway, including what happens on the day, but also what happens postoperatively. So I think there's six, I think we've published five, we've got one more to go. So again, all very practical. That's just an example. So when we go in to do theater reviews, again, working with the clinical teams, they're the sort of areas we go after and just an example of some of the impacts we've had where we've gone to get shoulder shoulder with the teams on the ground. All these are interdependent and you know, lots of complex reasons why theaters don't want as perfectly as we might want them to, but all of them are soluble. And actually, if we get the clinical operation teams working together, again, data driven, we can make an impact. Also just wanted to mention um er this metric. So er length of stay, again, our beds is a, is clearly a major currency in terms of additional capacity for um whether that's for the U EC pathways or indeed for elective. So, hip and knee are obviously one of our most common procedures. Um And you can just see the national reduction there at the top. So from where we started, so essentially, we've reduced it by about a day for both hips and for knees. And again, a good example of continuous improvement. So if you look at the pathway we've got now on our website, the ambulatory pathway, a lot of that's been developed actually by the Southwest, the orthopedic Center and there was the Nightingale in exeter. So when we started with G and with hubs, a number of years ago, there was a few common themes we looked at around extended physio support, communication with patients, all that kind of stuff. But now we've really got absolute detail on the anesthetic protocols. The what we say to patients, the trolleys used absolutely, every element of the pathway is detailed. So this is a tried and trusted approach. And again, as we go into trust like Leicester, you can see there then not only do they tend to adopt it, they also tend to find new ways of improving it further, which of course, then we can, we can share. So it wasn't that long ago, I was talking to trust about trying to get to about three days. And, and some of the colleagues in Devon said you're not being ambitious enough, which was not something we often got leveled off, but they were right. And they've got down to two days and a large proportion of those patients going home on the day with great results. So again, it just shows if we've got the pathway, we've got the clinical and operational support, we can make significant impact in this and part of that model. Then that we, we have again, go back to the continuous improvement aspect is we have clinical and operational teams who have been part of that journey. So potentially they were in a trust performing very badly maybe on this particular meric a year or so ago. But then having delivered this, they are perfectly placed to come and help others show the way and how we can uh and, and how we can actually deliver it and just quickly for those of you that might be interested in quality improvement and the kind of methodology side this just kind of sums up the technical approach really. So is established lean methodology with all aspects of G. So what we do is we define again, led by the clinicians to understand what it is, what's the point we're trying to solve what we're trying to address, measure using the metrics or what metrics have we got. And again, a gap analysis of what data might we need going forward to really understand. And that's critical, it's not really the data, it's about the insight that the data that leads us to. And again, understanding the interdependencies. Then improve. And when we do that very quickly, we're a program that quite quickly gets into the doing phase rather than kind of forever. It can be a danger. You can over analyze some of these things. So move quickly into the improvement phase. But then that's the control phase of looking at it, understanding what's worked, what could be better and then quickly adapting our approach. That's it. Sure. Great. Thank you so much Graham. And um I just wanna just add it, add to uh the end of your talk just to make trainees aware of. One of the benefits of the further faster guides is that this is a definite audit fodder. And if you're looking for ways to help improve your department, using the further faster guides as, as your national guidance in order to implement change is is an excellent way to kind of find an audit topic within your speciality and then an audit against the standards that we have. And, and I think that's one of the, the reasons why I felt having an event like this is important so that you guys are aware of that and are able to use that to your advantage. And I just wanted to kind of put it to both gran prof kind of how you feel trainees can fit into the picture of being able to implement the further fast step program. Go, do go. Yeah, I'll also take that question as well that I've seen in the chart if that's what I love as well. So I think um absolutely, as you say, so the checklists are designed for that to understand. OK, what, where are we and therefore go down a rabbit hole of? OK, what is, what is this, uh what else is out there? So there's a lot of side posts to go and look, understand what digital is out there, what process, what pathways and really just and some of this is also, it's about not even any particular metric. It's about the process of coming together with a clinical and operational team and looking critically if you like at your service. So just that bit about just taking a step back l getting yourself out there, we're all guilty of it. And, and you know, the more I look back at my operational career in the trust and you realize how insular you can become because your, you know, the day to day grind the challenges and as trainees actually, you've seen and you'll get to see a lot of different experiences how, how things are done elsewhere. And I think if you take that data approach, so if you, if you take your lived experience through working with those with those different organization, along with this kind of suite of resource, you are a really well placed um group to start challenging some of the status quo and also thinking slightly outside the box, particularly on some of the technical areas where, you know, frankly, the NHS hasn't typically been brilliant at kind of innovating and using some of those new tools and just what Tim might want to add to that. But I just quickly pick up on the point in the chat around some of the digital technology and supporting our elderly population. It's a couple of aspects that I suppose fundamentally, um if we can uh reduce the time, it takes our staff for all the coal patients, coal patients that can interact and use those digital tools, then it frees the time up for the staff to then actually provide more hands on support. So that was the case. I think about I swe I a good example, they had digital pre op. I can't quite remember the proportion of patients that use that, but essentially it meant that the staff, the nursing staff had time to go and look after those other cohorts of patients that weren't able to engage. So I think as long as we approach it in that in mind, understand that we have got different cohorts of patients and some of these things won't be appropriate for everyone. Then I think I think it can be a positive and to add to that, I still do a clinic every Thursday where I see sort of 1718 patients and I use the telephone now for quite a number of those patients which I know is right at the, the left hand side where digital. But actually if you speak to patients, they don't, if, especially if they're older, they don't want to come and see you unless they have to make that journey for a very good reason. And actually patients enjoy the conversation on the telephone. You can always do it on teams, but I found it really, really beneficial and you, as Graham says, you titrate your technology to the patient in front of you. And so we're seeing a huge upsurge in technology which is making a massive difference. So there's a one technology that I've seen called Dora and it is used for follow up patients when you speak to do. It's like speaking to a real person. It's absolutely phenomenal. So let's titrate the digital technology to the patients needs and what the patient understands and all of those will benefit everybody. So that's reversing. Second thing is what Graham and Oliver said about the further fast, it is an audit gold mine to be honest for you in your terms of your training. But I just want to highlight something else. We have eight fellows every year on the GF program and we have quite a large number applying. Why do they apply? Because they get to work right at the top of the shop, they get new experiences and new and learn new skills set. And importantly, they all come away with two or three papers, which absolutely helps them on their way the trouble is. But once you've been a fellow, it's very difficult to go back onto the coal, face into your ST job because you're there in the treacle. Whereas working with us, you're outside the treacle making real change. But just if you want to do something different for a year, think about it. We love having the young trainees. Oliver's been our fellow. You, they all thoroughly enjoy it and the numbers that are applying are rising because it's such a good experience and we look after you. Thanks. You're noting Oliver. Yeah, I completely agree with you. You've caught me out there. Oh, but, and I completely agree with what PA said. I think the girl Fellowship is an excellent opportunity to work at national level, looking at national data and being able to make a real difference within your speciality. So I would definitely look, look out for that as an opportunity if you are a trainee at any level. Um, so, I mean, there's, there's still a bit of time so please do ask your questions in the chat or if you wanna, er, unmute yourself. Er, I think you can, can we, if you, if you put your hand up, I can unmute, er, I can invite you to the stage. I ask you a question if you don't want to type in the chat. Um, the there was another question I was gonna actually put to the trainees within the group I did a poll and we found that 81% of the people in the call have not heard about the further faster program. And so I guess the first question is to Graham and prof that how can we increase training engagement with regards to the further faster program moving forward? And then, and then also a question to both of you in the audience of if you can suggest ways that we could also improve our engagement with you guys. So what I'd say to that is um like on calls like this Oliver and what we need is people to go out there. Now, look back at their trust, look out for the further faster handbooks, Graham and I are going back to meet all the I CBS which will be about productivity efficiency, getting our waiting down. We're going to mention that every single meeting we go to because the trainees are critical here in helping us get to where we need to. And so I think there's a real opportunity. So we'll be talking about it top down. We need everybody ground sort of opinion bottom out as regards how and where you can apply. That's a good question, Oliver. Do they apply to the G site? So, uh at the moment, um they're, they're, they're put on the NHS Jobs website. So um as, as the, as the individual fellowship, so if you look on the NHS Jobs site and search usually clinical fellows or fellowships G fellowship, you'll be able to find the available jobs. They do come out sporadic throughout the year as well. So there are opportunities as people advertise them. And then I think the main recruitment kind of happens February March time. And so keep an eye out for that. II, think profit might be worth maybe having a page on the GI F website for specifically for fellowship applications. I don't think we have one yet, but OK, radiology doesn't have a different approach. We've got radiology um further faster radiology teams. And just to let you know, G is now alive in Wales. It's taken a while. Graham hasn't it? But now it's, I think we've done eight specialties and um I think they're about to take a further faster program. So look out for it. France is because I think it's going to be important because of the waiting times in Wales. I think Oliver just going back to the point about how we can, I'd be really keen to get some feedback from the group either now or subsequently because clearly to a certain extent, we've been relying on a cascade approach of going through kind of kind of directs downwards. We know that's not as effective as we would like it to be. And that's the same with some of the consultant groups. So if this thing that we could do differently and whether that's as Tim says, whether it's a regular forum whether, you know, we could put some, you know, a particular page on the website you've just mentioned. Um But if, if, if colleagues think of all the ways that we could do that better, then we'd be really interested gra one of the things we could do with is a, is a junior do oc champion at each trust regarding further faster. So I am going to ask and challenge Oliver that to try and find us a champion. Oliver in each trust. There's 125 of them, there's try and find 125 champions. It doesn't matter if they're surgical, medical, pediatric rheumatologist and it doesn't matter what we want is people who understand it will give the training and then we can really cascade it down into the trust, right? Yeah, I think, I think that's a great idea and I think is a good idea too. Mohamed. I try and come up with good ideas. There's a question from Fatimae which I think is, is quite a good one actually. Um How can she access the data to check her department product? Yeah. So we've actually just got new clinical leads for pediatric rheumatology who I'm sure would be very happy to have a conversation with you. It is a the chronic specialties clearly have a different angle. So as as our rheumatology colleagues remind me, you know, you can't discharge some of the patients. You know, it's not like some of the surgical pathways. So clearly, there's a different lens. That's the point of us obviously having those specific documents. So I think have a read of the Rheumatology handbook. And as I say, I can link you in if you drop me an email with our our clinical leads, who can have a chat with you about uh where, where best to look and which trust are doing it particularly well. So you're happy to happy to do that. Oliver, can I just talk mention what Flora said? Can this be extended to new consultants? If you're a new consultant, it should be part of the induction program now and we'll make sure that um trust do that. But actually, you should be able to ask your colleagues in the trust, they should know all about it and also give you the support you need. But if you're not getting that, then you come back and speak to us and we'll certainly help you. Of course, you will. The other thing I would also add is that there is a lot of data available to every single NHS clinic, clinician via the model hospital platform. I'm going to stick the link in the chat, but it is a very useful platform which you can get data for your hospital measured against the girth metrics and again, can support your auditing of your department. So II would definitely take a look at that. You can use your NHS uh mail login, er, to, to, to sign up to that, uh, and you can get access to your department's data across a whole number of specialties. Um, and, er, and metrics. So I would definitely recommend that. Ok. So Oliver, we've got, um, already Mohammed Khazim, it says count me in Oliver. So we need another, 100 and 24 junior do champions. Who else is gonna sign up to it? We've got 91 in the chat. So if everyone, if everyone's at a different trust, I think we're almost sorted. But I think, I think moving forward, we can definitely put out a recruitment, do that message and I think we can create ourselves a further faster forum to get everyone and, and go from there. So Oliver, can I put you in charge of getting the junior docs? Yeah. Yeah. Thank you. Yeah. So, yeah, if anyone is interested in help in helping me do that as well, they're all count me in now, count me down, count me in. They're all welcome to get in contact. So feel free to get in contact with me. I'll, I'll leave my email in the, in the chat. Don't all bombard me at once, but then once we've got 100 and 25 let's have a meeting where 100 and 25 come and we can go through this again and really get them up to speed what we need to do. Yeah. Yeah. The, the model hospital Oliver, is it such a rich resource? Um There's a lot in there so it does take a little bit of time sometimes to, to get used to in terms of what you're looking at. But being able to look at, you know, as I say, there's some warranted variation here. So you can choose any peer group, you like, you can compare yourselves to, as I say, the teaching trust or, or look at regional level, you can look at the trends in there. You can look at what the benchmarks are. So there's, there's, there's loads of stuff in there to really get your teeth into. Wow. OK. To see the young because I have to say right to get back where we are, everybody who's got to step up to the plate, everybody has got to say, do you know what we could do this? And together we can so many thanks to everybody who wants to sign up to become part of this further faster movement if you like in Junior Dockland where we can really make a difference. Fabulous. And I think it helps that our agenda going forward as well. Tim because we need some new ideas. We, we need all the, all the new ideas we can get. So it would be great to have your input, right? Any further questions guys, but anyone else? So um I mean, if we haven't got any more any more questions, then I think we will leave that there. And um what I have done is I've just updated the feedback form to add a question at the end that if you're interested in becoming a further faster champion, please leave your email um in that question box and then I can get back to you about a further meeting where we can discuss the next steps. So that would be really useful. So please fill out the feedback form if they can tell their friends, that would be really great. So let's spread the word, let's spread the word. And then myself, Graham Oliver will have another meeting and let's really then start moving this style because you are as a workforce and your future. This is critical. Yeah. All right. Well, thank you. Thank you Graham for joining us today and thank you everyone for tuning in we've had at its highest 100 people, which is great and we'd like to see more. So please do fill out the feedback form at the end of the feedback form. There's a box to put your email if you're interested in becoming a champion and uh hopefully we can move things forward. Brilliant. All right. Well, have a good you great job. Cheers. Bye now. Bye everyone. Have a good evening. See you soon.