Impact of the New Deal on vascular surgical training.

The rapid development and technological advances in vascular surgery have provided the impetus for the establishment of dedicated pure vascular surgical services. It remains unclear whether all vascular surgery will be provided by such units in the future or whether several district general hospitals will combine resources and provide dedicated vascular on-call rotas between surgeons on separate sites. Training in vascular surgery is also changing rapidly. A modular training scheme encompassing three levels of training has been recommended (1). Some of the training will only be performed in large training units, but there remains a requirement for general surgeons to be exposed to some vascular surgery during their training. The "New Deal' for junior doctors has imposed limits on the amount of hours worked during a week. Junior doctors should not on average be contracted for more than 72 hours a week or work more than 56 (2). The maximum on-call rota which fulfils these criteria is a 1 in 4 on-call with no early starts, late finishes and no prospective cover. Allowing for holidays, study leave, early starts and late finishes a 1 in 5 or 1 in 6 rota system is required. Implementation of the Calman report in higher specialist training would reduce the time spent in training at high specialist level to perhaps five years. In a modular training programme in vascular surgery there may be as little as one year Level II training spent in vascular surgery or perhaps two years if the candidate opted to have vascular surgery as their only sub-specialty. In an attempt to assess the impact of the New Deal and the Calman report on vascular surgical training we have assessed the exposure to vascular surgical procedure of hypothetical trainees on a 1 in 6 rota.