Gastrointestinal Surgery update

Why reconfigure GI services?

Historically UGI Surgery has been performed at Gloucestershire Royal Hospital (GRH) and CR Surgery has been performed across both Cheltenham General Hospital (CGH) and GRH. Procedures performed across both emergency and planned services include burst appendicitis, removal of gall bladders and surgical bowel cancer. Providing services across both sites has become increasingly challenging.

What problems are we trying to address?

• There are not enough trainee (‘junior’) doctors to cover rotas on both sites and there is negative feedback from trainees about their workload.
• There is pressure on senior doctor (consultant) time and pressure on rotas: The frequency and intensity of the consultant emergency rota differed between CGH and GRH.
• Shifts are were not covered and there were gaps in rotas.
• At times senior doctors (decision makers) are in theatre and unavailable to review patients if they were waiting for specialist assessment in the Emergency Department or Surgical Assessment Unit. This leads to delays.
• Although patients undergoing major operations for cancer seldom get cancelled, less complex planned operations requiring a short hospital stay or day case surgery can be cancelled when the hospitals are experiencing a higher number of emergency cases that put pressure on operating theatre space and beds. With a greater proportion of these cases being completed in CGH following this proposed reconfiguration, there will be a reduced risk of cancellation.

What services will change?

Under the reconfiguration of GI Surgery, the following work will be undertaken:

• The transfer of c1500 short stay and day case general surgery patients to Cheltenham General Hospital (CGH) from Gloucestershire Royal Hospital (GRH).
• The creation of specialised centres at CGH for Bariatric, Biliary, Pelvic Floor and Early Rectal Cancer.
• *Co-location of all resectional Upper Gastrointestinal Surgery at GRH.
• Co-location of all resectional Colorectal resectional surgery at GRH.

*The co-location of all resectional Upper Gastrointestinal Surgery to GRH has already been completed.

What does this mean for patients?

The benefits of developing services in this way means:

• Patients are more likely to see the right specialist, first time, 24/7 and have the best possible outcome and experience of care.
• There is more robust staff cover (and rotas) for the service (consultants and junior doctors) and better supervision of junior doctors 24/7.
• There are fewer cancelled or delayed operations.

In developing services in this way Cheltenham General Hospital will benefit from:

• The establishment of four specialised centres for Bariatric, Biliary, Pelvic Floor and Early Rectal Cancer and the transfer of approximately 1500 short stay and day case GI patients from GRH.
• Many of these patients being transferred will be cared for in Chedworth Surgical Unit, a modern, purpose-built facility costing £7.9m and dedicated to the needs of patients.

In developing services in this way Gloucestershire Royal Hospital will continue to benefit from:

• The co-location of resectional Upper Gastrointestinal Surgery will continue at GRH where it is aligned with Emergency GI and forms a longstanding Three Counties Oesophagogastric surgery centre.

These benefits align with our Centres of Excellence vision where there is more focus on planned care at CGH and greater focus on urgent and emergency care at GRH.

Patients who need to attend our hospitals for produces involving GI surgery should continue to access health services as normal. You will be directed to us by your healthcare professional whether that’s a GP, paramedic etc.

When will this transition happen?

Spring 2025.