Principles for FRCS (Gen Surg)

The principle is that poor preoperative glycaemic control predicts surgical site infection, anastomotic and wound failure, longer stay and death, and that it is modifiable before elective surgery. UK guidance from the Centre for Perioperative Care and the Joint British Diabetes Societies advises that an HbA1c of 69 mmol/mol (8.5%) or more should prompt referral for optimisation and deferral of elective surgery where it is safe to wait. A value of 48 mmol/mol is the diagnostic threshold for diabetes and 58 mmol/mol a common treatment-intensification target, so both are too strict; 86 and 100 mmol/mol would allow operating with clearly poor control. Reference: Centre for Perioperative Care, Guideline for Perioperative Care for People with Diabetes Mellitus Undergoing Elective and Emergency Surgery (2021).

The principle is that the standards now measure what matters to the patient, a timely answer and timely treatment, not the first appointment. Since October 2023 NHS England has used three standards: the 28-day Faster Diagnosis Standard, by which a patient referred urgently or from screening should have cancer diagnosed or ruled out and be told; a 31-day standard from the decision to treat to the first treatment; and a 62-day standard from urgent referral, screening or consultant upgrade to the first treatment. The two-week-wait standard for first being seen was retired at the same time, although the term persists in clinical speech. Seven days is not a national standard. Scotland, Wales and Northern Ireland publish their own. Reference: NHS England, Changes to cancer waiting times standards from 1 October 2023.