What has been wonderful during the first few weeks has the been the way in which, leading up to the Annual General Meeting, and indeed following this, there has been such fantastic support from the previous President, Vice-Presidents and Honorary Officers. Few of you reading this may ever truly appreciate how much time, effort and dedication they have given to the profession, and what fantastic servants of the College, and of pathology, they have been. We are so much stronger, and so much more in the minds of politicians, senior decision makers and the public because of this commitment to pathology.

Lights and bushels ... #Expertsforlife

This is a good point to share my excitement at the inclusion of pathologists in the New Year’s Honours List. Our recent President, Suzy Lishman, was awarded a CBE for services to pathology. I am sure you will join me in congratulating Suzy for this richly deserved recognition of her tireless work for this College and our specialty more broadly. Also, we congratulate Angela Thomas, Paediatric Haematologist in Edinburgh, and a past President of the British Society for Haematology, on her OBE for services to regulation of public health. Professor Adrienne Flanagan, a histopathologist bone tumour expert, has also been awarded an OBE for services to pathology.

I have always had a deep and abiding passion for pathology and, since the election, having the opportunity to meet more members from different disciplines and across different nations, my respect for colleagues continues to grow daily. The talent, dedication and sheer brilliance of members is really impressive. What is done every day by members is truly epic, and often in very difficult circumstances. I am committed to making sure that this is known.

Helping leaders from all fields, and the public, appreciate the scope, scale and impact of what we all do and some of the brilliant advances being made by pathologists is one of my key goals.

Patients

So few patients understand the expertise that supports them in diagnosis, monitoring and treatment, and we do want to highlight this. We will work with patient groups and charities to get the role of our #Expertsforlife known, through patient journey articles, radio, TV and whatever channels we can. Personally, I will be happy when everyone having a blood test, biopsy or swab understands that their ‘test result’ is not just that, it is an opinion from professionals who have undergone many years of specialist training on top of their core professional training.

We also have a role to play in making sure we take a moment to think about the enormous contributions we all make, and to spread the news as well. I will let you know about some of the great examples of exceptional talent we have, and how it has been recognised. I hope that you will also take the opportunity with colleagues, especially trainees and potential trainees, to let them know how brilliant we are as a profession.

Special mention this time goes to Dr Lorna Williamson who has been awarded the James Blundell Award by the British Blood Transfusion Society in recognition of the outstanding contribution made over many years in the field of clinical blood transfusion. Professor John Pasi, one of our great haematologist colleagues, has achieved effective treatment of haemophilia A through gene therapy, published in the New England Journal of Medicine. Great research leaders, and a real example of research into practice. This is just a very, very limited snapshot so, if you or colleagues have more great examples, please let me know ... pathologists are a very modest bunch, and I do want to let everyone know all the great things that are going on.

May you live in interesting times ...

I mentioned the difficult circumstances in which many colleagues are working, and there are many at the moment. There is uncertainty and lots of overlapping programmes of work from NHSE and NHSI all affecting pathology services in England, with similar programmes in Scotland, Wales and Northern Ireland. These include network proposals from NHSI, with proposals for the formation of 29 hub and spoke arrangements, getting it right first time (GIRFT) initiatives, and the creation of a genomic medicine service in England, reducing the number of specialist genetic centres. The roll-out of the ISO15189 accreditation process has also created interesting and very busy times for many members.

On top of all this change and uncertainty there have been marked workforce shortages in many areas. This is also true in other specialties, and primary care, nursing, and radiology problems have figured in several press reports. Staff shortages in pathology are affecting patient care and the working lives of all of us and, with a rising workload, this has the potential to get worse. At the heart of the matter is the ‘leaky pipe and leaky bucket’ in staffing. At the time of writing, only 50% of doctors completing FY2 posts are continuing into higher specialist training. Of those who do go into specialist training, pathology is competing with other disciplines for trainees. We are not always successful in making sure we have a full complement of specialist trainees; our training post fill rates have dropped to, for example, 50% in infection and 72% in histopathology. Many of our trainees are taking the great opportunities to do out of programme activities, which helps enhance skills and support academic development, and we do need to encourage this, but we also need to make sure we have enough specialists in training to support future patient needs.

Our workforce over the age of 55 has higher than expected retirement rates. We have existing consultant vacancies across the country averaging about 12% but in some hospitals it is over 50%. This creates enormous pressure on members who are just trying to do their best for patients. It can be hard as a trainee or a consultant to be positive and ‘sell’ the job in such difficult circumstances, but we have to do exactly that.

As we have made our case for the pivotal role of pathology and our concerns about workforce pressures, pathology workforce problems are now beginning to come up as a key factor in planning and be recognised as a serious concern by other bodies, including Health Education England (HEE), Cancer Research UK  and other groups, and the publication of the first stage of the Cancer Workforce Plan by HEE has helped to highlight some of the problems and potential solutions and we welcome the focus on this.

So what are we doing to try to help?

One of the many issues in this field has been the lack of good workforce data. The NHS electronic staff record (ESR) is particularly poor for pathology, failing to consistently register specialties and the range of roles in the lab and, although independent providers of pathology services are often better at understanding the status of their own workforce, the national picture has been hard to define.

The Carter implementation team has recognised this also, and the data from NHS Digital that is being used to inform how potential networks might evolve has required enormous amounts of validation. We are working with bodies to try to help improve the situation, including talking with the central ESR team, to help produce a better structure and classification of roles going forward.

We do need your help though, as not everyone returns College census data on staffing, and data is key not only to validate what is going on in real time, but to help us argue our case. We will continue to press for more training posts, more support for backfill and training support, as well as infrastructure that will help us make the best of what we do have.

Getting pathology recognised by potential medical and clinical scientist students as a great career, encouraging them into our professions, and supporting our colleagues in training through their learning is all key. The Pathology Summer School run by the College is a great example of the way the message can be spread. Public talks – my first as President at a Cafe Scientifique in a community pub – also help educate people about the expertise that is on offer, as well as showing that we are not all weird and creepy (Cambridge medical students seem to think otherwise!).

We must ensure pathology forms part of the curriculum of all medical and biomedical courses, with exposure to those positive role models from our very wide range of talented colleagues. We also need to work to see that our own higher training curricula match future patient needs and include interesting and engaging modules, and that our continuing professional development offers are relevant and truly refreshing.

The College and the Institute of Biomedical
Sciences have developed a histopathology reporting curriculum for biomedical scientists; some scientists have embarked on this programme and our first graduates are emerging. Many thanks to all the colleagues who have supported them through their training. We are looking at other potential programmes akin to the advanced practitioner in cytology, and perhaps some of the specialist clinical chemistry disciplines.

Asking for more training places and the staffing to support them may seem odd given the fill rates, but we know that some centres recruit well, and we need to extend opportunities everywhere. We have to tackle the issues from many angles, at the same time ensuring that post-qualification members are given time to train.

We need to try to make life just a little bit easier for trainees, indeed  for all those in practice, including those for whom a traditional working pattern is difficult. Some colleagues who might not return to work following a break, or who might retire, might then consider continuing to work. We need to develop more ways of working flexibly, even working from home on some days. We will look at the possibilities and guidance to see how best we can support this. Initiatives such as digital imaging may also come to the fore here, and we are encouraging the cancer workforce group and NHSI to consider supporting roll-out where appropriate.

Some other things on the to-do list ...

Talking with colleagues from all regions highlights the recurring theme of the misuse or misunderstanding of pathology testing. One area which we will work on is the refreshing of non-pathology colleagues’ knowledge, in concert with other Royal Colleges and organisations. A CPD offer for those who probably haven’t done any pathology training for some while! The ophthalmologists have shown foresight in this, leading the way in a ‘Pathology for Ophthalmology’ seminar, and this will form the basis of a programme for others.

A personal issue that seems to be shared by many of you, is that not all boards of healthcare organisations  know a great deal about pathology, and their responsibilities in this respect. We will be working to develop a Good Governance Guide to Pathology that can be shared with Trust boards and the boards of other organisations, and we will also issue it in an e-learning form, to encourage uptake and demonstration of this awareness by boards.

Lots more on the ‘to do’ and ‘in progress’ list, with not enough space to cover the lot, and I will keep you updated as things move on. I do post regular ‘live’ updates via Twitter (@JoMartin_path) so you can track (at least some of) what I am up to on behalf of the College.

All the very best for 2018.