Message from the Chair: Mr Andy Williams
Having been elected as your new Chair I plan to continue building on established links with the entire multidisciplinary team, being “inclusive” rather than “exclusive”. This needs to be done in close association with the ACPGBI to further strengthen the relationship with the PFS.
More specifically my key areas of development will be;
- Defining a process to start accreditation of pelvic floor units around the country. Having a framework for what constitutes a unit will be vital, but much of this work has been done in writing the ACP “Resources for Coloproctology” document. The aspiration is to provide a national structure to support units and seamless patient care across the community and institutions so that inequalities between centres and regions is minimised.
- Having started to formalise anal ultrasound training we need to take the bold step of instigating a national training scheme, and accreditation for all those wishing to perform anal ultrasound. This should include doctors, nurses, physiotherapists, scientists and midwives alike. This will help support many practitioners who feel vulnerable in delivering a service without professional credentials. This is not a small undertaking and will have to be done in conjunction with BMUS, RCR, CASE, ACPGBI.
- It is clear that pelvic floor services are coming to the forefront in modern medical practice. Many institutions are requesting that new consultant appointments have knowledge of pelvic floor surgery and are aiming to set up new pelvic floor units. The PFS has an opportunity to drive this and support the sensible development. This should include the establishment of national training fellowships for trainees.
It is clear that these plans are very ambitious! There is no doubt that to achieve this will take a great deal of hard work and support from the entire society. I do however believe that they are possible and that we should build on the excellent leadership and drive that we have had thus far from Tony.
The QA & Governance Subcommittee (Chaired by Bandipalyam Praveen & Steve Brown) will have an important role in helping colleagues with governance whilst also helping with patient information (led by Karen Telford Hon. Chair of membership) etc. Their greatest challenge will be to:
• Define and then work towards peer review and the accreditation of units for ‘service’ as offering best practice implementing agreed national guidelines as well as Clinical Standards that will adress the whole patient pathway and non-subspecialty units who provide good quality care
• Work towards securing standardized nomenclature and multi-disciplinary assessment as well as treatment e.g. anorectal physiology assessment and biofeedback, relevant radiology as well as training, accreditation etc with physiologists, physiotherapists, continence advisors and others. Prof Knowles' capaCITY trial provides a timely impetus to the need for standardisation.
The Training Subcommittee (chaired by Jon Randall) will work towards ensuring high quality training in “Pelvic Floor” and lead in the provision of CME for members of the PF MDT by:
• Contribute to the development of programmes in training, a curriculum; define the index operations for training and their assessment cf the LAPCO model.
• Create, support and disseminate programmes in CPD accross the MDT.
• Enhance the use of IT for educational purposes.
We are fortunate to have within our membership a number of Physiotherapists, Physiologists and Allied Healthcare Workers and in recognition of this we have within our constitution a sub-committe dedicated to this group. The chair Jane Dixon being a full member of the Executive.
Another major achievement will be the Pelvic Floor LVMR Audit Database originally proposed by Karen Nugent when Hon. Secretary of ACP. The work, undertaken by Tony Dixon & Formedia has been outstanding and they deserve our thanks and gratitude for providing us with a wonderful opportunity to collect data for all LVMR surgery and more importantly provide a formal mesh/implant registry. In addition the system has the potential to become a National Database/Registry. The database has been a high priority and significant funding has been provided from our industry partners inparticular Cook medical to ensure that it is available to all members free of charge. Please use it! In addition there has been collaboration with various groups including the UK national trials portfolio and RCOG pelvic floor clinical studies group. These will play a leading role in defining priorities for research. It is hoped that this committee will help members participate in clinical and basic research.
The Scientific committee (chaired by Oliver Jones) is responsible for our annual meetings in January (free papers and a platform for scientific presentation and discussion/networking) and July @ ACPGBI where on-going or new research can be presented for advice and constructive feedback! The next meeting is 18-20 April in a combined meeting with UKCS to be held in telford.
If these goals are met we will be in a position to enhance the emergence of the next generation of leaders in this discipline as well as liaising with government, civil servants, members of parliament and other opinion formers about the importance of practice and research in pelvic floor problems as well as influence the international community. The future for TPFS is I believe bright. I welcome you to join in with this exciting project.
Training Sub Committee – The Pelvic Floor Society (TPFS): Chair Mr Jonathan Randall
QA & Clinical Governance Committee TPFS: Chair Prof Steve Brown & Mr Bandipalyam Praveen
Physiotherapy Sub Committee: Chair Jane Dixon
Hon Treasurer: Mr Shahab Siddiqi
WEBMASTER & Dukes' Club Represenative: Miss Jennie Grainger
Scotish & SPFN Representative: Miss Dorin Ziyaie
UKCS Representative: Mr Phiil Tooze Hobson
In addition to his secretarial duties and liaising with his conterparts at UKCS (Stephanie Knight) BSUG (Tim Hillard) and ACPGBI (Steve Brown), Mark represents TPFS within the Complex Colorectal CRG.
Aims: Organise the spring/ACPGBI & autumn meetings of TPFS
Duties of the Subcommittee Chair:
- Ensure that the committee aims are met.
- Organise at least 4 subcommittee meetings per year
- Attend at least one Executive committee meeting per year. [In the event of being unable to attend an Executive committee, the Chair will ensure that an up to date report is available to each meeting in his/her absence].
- Ensure appropriate minutes are kept
Term of the Chair will be for 3 years. The Chair may stand for a further 3 years if requested. This will need to be agreed by the rest of the committee and approved at TPFS AGM. The Chair should indicate whether he/she wishes to stand for a second term at the end of the second year of office. This will allow the appropriate and timely appointment of a shadow chair elect. The Chairman must have previously been a member of the Scientific subcommittee for at least one year.
The Scientific Subcommittee will have no more than 4 members (3 members + 1 trainee) plus the executive TPFS. Membership (as per chair) is for 3 or 6 years. Prior to a member leaving the committee, The Hon Secretary of TPFS will indicate potential committee vacancy to all PFS members by email to request applications from any interested party. A member may leave the committee at any time, although 3 months notice would be useful to fill that position with a replacement.
• Promote local and national audit with respect to pelvic floor interventions through use of a web based database
• Maintain and update the database in conjunction with the system administrator
• Produce an annual anonymous national audit report and present this back to TPFS members
• Liaise with the ACP/BSUG/UKCS etc to produce joint guidelines.
• Create independent guidelines.
• Choose authors for the guidelines (not necessarily members of the committee)
• Prepare responses to national guidelines for the executive committee
• To develop parallel information on the guidelines
• Produce information leaflets on commonly performed procedures
• Promote high quality “Pelvic Floor” research in the UK.
• Foster a “research” culture among TPFS membership
• Be a member of the RCOG PFCStudies group (Kath Gill and Steve Brown)
• Provide expert opinion on research matters to other organisations when requested or indicated.
• Provide a point of contact between individual researchers or organisations wishing to work with TPFS in specific projects
• Be a member of the scientific committee of the AGM
• Organise the educational component of the AGM to provide CPD in matters relating to research design, conduct and governance
• In conjunction with the Webmaster develop and maintain TPFS web site
Duties of this post:
• Ensure that the committee aims are met
• Organise at least one separate audit & research sub committee per year as well attending at least one executive committee meeting per year. In the event of being unable to attend an executive committee, the Chair will ensure that an up to date report is available to each meeting in his/her absence.
• To ensure appropriate minutes are kept and file a copy of these with the Hon. Secretary
Term of Chair will be for 3 years. The Chair may stand for a further 3 years if requested. This will need to be agreed by the rest of the committee and approved at TPFS AGM. The Chair should indicate whether he/she wishes to stand for a second term at the end of the second year of office. This will allow the appropriate and timely appointment of a Shadow chair. Experience of research work is an essential requirement for all members of this committee. A Shadow Chair elect will be appointed at the AGM by the membership during the 3rd/6th year of the current Chair to shadow the responsibilities and ‘learn’ the roles of the position. This person should have served on the Audit Committee.
The R&D Committee will have no more than 8 members. Membership (as per chair) is for 3 or 6 years. Prior to a member leaving the committee, TPFS Hon. Secretary will indicate potential committee vacancy to all PFS members by email to request applications from any interested party. ONE member will be a subspeciality member.
Members will be removed if they do not attend subcommittee meetings or contribute to the work of the committee. A member may leave the committee at any time, although 3 months notice would be useful to fill that position with a replacement.
Our mission is to improve standards of the training and assessment of patients with peri-anal conditions and “functional” disorders that will begrouped together as “The Pelvic Floor”. We aim to achieve our goals by liaising with the relevant committees of TPFS & ACPGBI on matters pertaining to the "Pelvic Floor”. We welcome members contacting us with suggestions and comments on training.
The main focus of the committee’s activity will be to establish figures for PF training in the UK and to have a list of preceptors, clinical supervisors and trainees. In order that we can establish a register we will:
- Working in conjunction with the SAC in General Surgery, to maintain appropriate curricula for surgeons in training and, where appropriate, facilitating skills courses within the Section’s disease area/area of interest.
- Liaise with the RCS, SAC & ACPGBI on curriculum development for Pelvic Floor
- Develop workplace-based assessments to demonstrate competency in the skills required for signing off completion of training
- Define, identification and approval of subspecialty training centers
- Identify trainees & register them as having an interest in TPF
- Liaise with deanery training directors
- Develop theoretical courses and content
- Develop and support a programme of educational activities (including teaching courses) to enable colorectal surgeons, urologists, urogynaecologists (post CCT) and allied workers to meet their needs in relation to continuing professional development and revalidation / recertification.
- The new curriculum will take a broader view of the subspecialty, combining the current benign colorectal surgery modules of the ACPGBI with newer modules. The new curriculum will be made available on the ACPGBI and TPFS website.
Trainees should seek career advice from their educational supervisor, deanery training director/committee and regional pelvic floor preceptor. They should plan their options during year 4 which should be documented on conclusion of their year 4 RITA. During year 5 they should make arrangements for specialist training and confirm their rotation commencing at the end of year 5 and this should comprise at least 2 sessions/week in PF. SSTs should progressively develop skills that will enable them to manage recurrent and complex cases of pelvic floor dysfunction.
Future developments: We aim to develop e-learning packages in PF and review workplace-based clinical assessment. Trainees will be able to download generic mini-Clinical Evaluation Exercise and OSATs for PTNS, SNS, Sphincter repair, LVMR, sacrocolpopexy, STARR, THD/HALO, PPH, Excision Haemorrhoidectomy, Pudendal nerve release, EUS, proctography, anorectal physiology as well as basic urodynamics. Trainees will be expected to attend a theoretical course, in addition to practical experience acquired through regular attendance at anorectal physiology clinics.
The committee will be a multi-professional, multi-specialty group set up to provide professional advice on setting up and maintaining thecertification/accreditation process and register in colorectal pelvic floor surgery. The committee will also provide support and advice on certification issues on behalf of TPFS when collaborations are forged or input required.
Accountability: The Certification/accreditation committee will be accountable to TPFs Executive Committee
Membership: The suggested membership includes at least 2 representatives from Coloproctology, and representatives from the following: Radiology, GI Physiology, Physiotherapy, BSG/BSUG/UKCS. Other professional groups e.g., chronic pain may be represented as felt appropriate. Discussions within the group would remain confidential until agreed and circulated for wider public consultation.
Term of membership: Nominations will be received from the TPFS membership at the Annual General Meeting. Proposed membership should be for a period of 3 years, renewable for a further 3-year term. Each member will be required to show continued active involvement in the committee on an annual basis. A Chairperson and Vice-chair will be elected from within the membership for a term of office of 2 years. The Chair would represent the committee in an executive role on TPFS.
Terms of reference - The purpose of the Certification/accreditation committee is to:
- Develop professional standards that define the satisfactory and safe practice of PF treatments within the societie’s disease area / area of interest.
- Develop effective working relationships with allied groups and organizations
- Set criteria for automatic certification of the PFMDT as well as established colorectal & radiological practitioners at appropriate levels
- Set up a central register of certified colorectal & radiological practitioners and preceptors.
- Design methods for registration of colorectal practitioners and preceptors based on recommendations from the Training & Education committee.
- Define the mechanisms needed to manage this process including the need for special staffing, accommodation, funding, and methods of communication.
- Recommend mechanisms for re-certification - accreditation of the MDT and its members.
- Suggest processes to deal with grievances
- Liaise professionally with the Post-graduate Medical Education and Training Board, Royal College of Surgeons, Royal College of Obstetricians & Gynaecologists, Royal College of Nursing, Chartered Society of Physiotherapists and other relevant professional organisations whose membership undertake colorectal pelvic floor surgery.
- Liaise with the Education committee as appropriate
- Liase with the Governance committee of the ACPGBI & BSUG
Frequency of meetings: Most of the communication would be through e-mail and teleconference. It is proposed that the group will meet twice in a year, once at ACPGBI and once at a mutually convenient time and place. 50% of the membership would constitute a quorum provided at least two main disciplines are represented.
This committee represents and supports all physiotherapy, specialist nurses and allied health care members as well as encouragingand maintaining the multidisciplinary strength of TPFS. The chair is a member of the executive of TPFS and acts as a liaison between the Chair, Executive and the members as well as POGP and other professional groups regarding matters of mutual concern. It is responsible to TPFS chair and Executive. This committee has 3 functions: communication, research/development and education.
a) Membership and communication
• In conjunction with the Webmaster, create and manage the PTSNAHW pages of TPFS Website
• Seek out and encourage members to run for each of TPFS committees
• Maintain and archive of committee activity on the web site
b) Research & Development
• Encourage research
• Provide a member to the R&D committee TPFS
• Keep members informed of new research opportunities, developments and outcome
• Foster member involvement in workshops and courses
c) Education and Professional development
• Foster physiotherapy, specialist nurse and AHW education under the auspices of T&E and Scientific committees TPS that is of the highest quality, including but not limited to courses and workshops at AGM.
• Create a competence profile for pelvic floor therapies
• Produce educational material
Chair: Elected by the members TPFS. A member must sign his/her agreement to stand. This nomination is co signed by nominator and seconder, all being members of TPFS. Term of office: 3 years. The chairperson reports to: The Chair and TPFS Executive and prepares an annual report outlining achievements, future objectives and strategies. The sub committee chair should also:
i. Coordinate the activities of the committee
ii. Be present at the AGM should the membership have any questions about committee activities.
iii. Lead all committee members in active participation in committee activities
iv. Review committee member performance annually to determine contribution based on attendance at meetings, responsiveness to projects etc. Non-active members will then be asked to resign.
All members of this Committee must be active members of TPFS & are required to attend at least 2 out of three Annual Meetings. Members are also required to join teleconferences.
• Face to face eg., during the summer and January scientific meetings.
• Teleconferences as required, with other communications carried out by email.
• One third of committee membership plus one shall be quorum.
MINUTES: Executive Committee meetings and sub committee meetings must be recorded, and kept and published on TPFS website in the member’s only section. Draft minutes of the meetings shall be sent to all those who attended for correction and subsequently made available to all members TPFS via the website within six weeks of the date of that meeting. Only a member attending the meeting in question may comment on the accuracy of the draft minutes. Any member of TPFS can comment on the subject discussed or the issues raised.
The membership committe is responsible for the processing of applications for membership of TPFS and comprises the Chairman plus four other members, each representing the different specialities within the society. Membership is by election at the appropriate AGM and will normally be for three years, but is renewable. The chair shall liase with the secreatary of ACPGBI on membership issues relating to prospective and current colorectal surgical members of TPFS. The chair and committee are accountable to the executive of TPFS.
At the relevant Annual General Meeting, the Chairman of the Membership Committee will report the views of the committee on each applicant. He/she will also either pre-circulate or table a summary sheet of all the applicants. Should a vote be necessary, at least two thirds of those members present (including senior members) must be in favor before membership is granted. The proposer is responsible for informing the candidate of the result and the Membership Secretary will write to those who are elected.
The membership chair shall hold a list of the membership, their professional status, contact details and publications relevant to the pelvic floor. The latter shall be indexed and be made available to the membership via the web site. The membership chair also represents TPFS on the External Affairs Committee of ACPGBI.
The treasurer is responsible for maintaining the treasury and the day to day finances of the society to include its meetings. This role requires aclose working relationship with Mr Baljit Singh, Hon Treasurer of ACPGBI, its administrator Anne O'Mara and our industry partners.
The Dukes Club Representative shall be a senior trainee wishing to persue a special interest in Pelvic Floor Surgery and will be a full member of the executive, the training and education committee and scientific/programme committee. The post is for a fixed term of 1 year. Please view trainees section
Scotland as a region has lacked the well defined Pelvic Floor groups that have evolved in the South and PF has not found a specific place on the activity list of the ACPGBI chapter. There are pockets of good practice with interested individuals and teams but no forum for exchange of views or for the multidisciplinary components to interact and plan together. This is especially important now that devolution of healthcare appears to be creating an increasing divergence in the organisation and mechanism of funding of health services between England and Scotland. Scotland is also unique in having the RCS(Ed) and the RCPSG. These colleges have significant international memberships and are the dominant forces in the East and West coasts of Scotland rather than RCS(Eng). Although there are some areas of intercollegiate working between the UK colleges and examinations are equivalent they remain distinctly independent otherwise. This has to be borne in mind by any UK national organisation.
The existence of the Scottish Pelvic Floor Network (SPFN) means a multi disciplinary group already exists. This has been an excellent vehicle for urogynaecology and has a strong academic and research interest in that area. There is a very well organized and attended annual meeting and a number of training events. There has been some increase in content of a colorectal nature but this does remain peripheral at present. A key issue has been how to integrate the increasing colorectal involvement with the pelvic floor and the needs of those surgeons, with the aims and remit of the SPFN. A key question to address is whether the SPFN is currently the approporiate mechanism to advance and support colorectal surgeons with a PF interest in Scotland.
A Pelvic Floor Course was organised in Dundee in 2014 with the aim of bringing together colorectal surgeons with a PF interest and the multidisciplinary teams they work with in Scotland. Although informal there was representation from most regions of Scotland thus approximating the first national gathering of this group. A valuable opportunity for teaching and training was created but also a chance to discuss the future of PF surgery in Scotland and the role of TPFS and the SPFN. Although not an official body there was a clear feeling that colorectal surgeons with a pelvic floor practice required a supporting organisation. It was further felt that the SPFN in its current format would not be able to provide the appropriate framework and that a UK national body allied to the ACPGBI would be the best choice.
There was thus very clear support from colorectal surgeons for moving PF surgery forward in Scotland under the umbrella of TPFS. There was also support from the gynaecologists present. It was acknowledged that it would be important to avoid any feeling of conflict or competition with the SPFN and this element must be carefully handled to ensure the multidisciplinary basis required.
Within Wales, the development of Pelvic Floor services has been gradual. Recognition of the patient syptoms by health professionals is often rudimentary and the crossover with other symptoms of bowel disease often leads to non-specialist referral before problems are recognised.
This is not a unique problem to Wales. The high number of smaller hospitals however, and the limited arrangements for the transfer of carebetween Health Boards makes access to specialist services difficult. In addition, the uncertainties regarding the outcome of the South Wales Plan and the anticipated movement of services to other units/centralisation have been at the top of the agenda at the cost of expanding newer services such as Pelvic Floor.
With affiliation to The Pelvic Floor Society through a representative for Wales, the argument for investment can be made more strongly. These patients may have several contacts with secondary care, with different departments and often over several years. The abuse of a tariff-based treatment model places more emphasis on reducing hospital contact with consultants and reducing the number of visits/treatments required.
Thankfully these aims are well served by developing a multi-disciplinary service in line with the recommendations of The Pelvic Floor Society. It provides a framework within which to develop services locally and some guidelines on more specialist procedures and when referral for these is indicated. Moreover, it provides a research and audit benchmark so that outcomes and practice parameters can be measured and improved. These have been lacking except in units with an academic department or clinicians who have a sole practice in pelvic floor disorders.