Mr Gavin Miller
Sheffield South Yorkshire, S105UB
I am a plastic and hand surgeon with a special interest in trauma, microsurgery and nerve reconstruction. I have extensive experience in personal injury and clinical negligence claims involving hand or plastic surgery cases since starting medicolegal work in 1997.
I have extensive experience in personal injury and clinical negligence claims involving hand or plastic surgery cases since starting medicolegal work in 1997. I currently prepare approximately 150 reports per year (approximately 90% are personal injury and approximately 10% clinical negligence). About 10% of my instructions are joint instructions; about 80% are on behalf of the claimant and about 10% on behalf of the defendant. I keep up to date by regularly attending report writing and courtroom skills courses. I have given expert evidence in Court in three cases (all in 2010).
EDUCATION AND QUALIFICATIONS:
I qualified from Newcastle University in 1984 (MBBS Newcastle) and I completed my basic surgical training in 1988 (FRCS Eng.). I underwent specialist training in reconstructive plastic surgery, microsurgery, and hand surgery from 1989 to 1996. I was placed on the UK Specialist Register (Plastic Surgery) in 1997 and received The Journal of Hand Surgery Prize for the highest mark awarded in the European Diploma in Hand Surgery examination in 1998. Since January 1997 I have worked as a NHS Consultant Reconstructive Plastic and Hand Surgeon employed by Sheffield Teaching Hospitals. In 2001 I was appointed Honorary Senior Clinical Lecturer to the Department of Surgery at Sheffield University. Between 2007-2011 I was Clinical Director for the Plastic Surgery Unit in Sheffield, spearheading the development of two multi-million pound projects, the new Sheffield Hand Centre and a new Regional Burns Unit (both opened 2011).
I have worked as a NHS Consultant Reconstructive Plastic and Hand Surgeon since January 1997 in one of the biggest plastic surgery units in the UK. Approximately 90% of my NHS practice involves the management of Hand & Upper Limb problems and 10% is Reconstructive Plastic Surgery.
Hand and Microsurgery Experience
This includes upper and lower limb trauma and post-traumatic reconstruction, peripheral nerve surgery, brachial plexus reconstruction, rheumatoid hand surgery and the treatment of patients with Raynaud’s syndrome. I have a major commitment to hand surgery and reconstructive microsurgery and have a national reputation in this field. As part of my work with the Council of the BSSH (1998-2002), the Interface Committee in Hand Surgery (2002-2005), and the Hand Diploma Subgroup (2006-2011) I have been instrumental in developing the national postgraduate Diploma in Hand Surgery. This examination will ensure that doctors practicing hand surgery in the UK have reached the highest possible standards before they become consultants. I also regularly teach and lecture on hand surgery topics in the UK and abroad. I believe that this training and experience entitles me to give an expert opinion in this area.
Plastic Surgery Experience
My current plastic and reconstructive practice is wide ranging and includes the management of skin tumours, post-traumatic soft tissue defects, scars, microsurgical reconstruction, and complex lower limb reconstruction. I am a member of the British Association of Plastic Reconstructive & Aesthetic Surgeons and regularly teach and lecture on plastic surgery topics the UK and abroad. I believe that this training and experience entitles me to give an expert opinion in this area.
I have previously conducted experimental research into the spread of melanoma tumours. This gives me insight into scientific methodology. My current research is clinically orientated and focuses on hand surgery. I have developed local anaesthetic day-case approaches to the management of common hand problems that are highly effective and minimally invasive. I have published more that 30 papers in peer-reviewed journals and have presented more than 40 papers on a variety of hand surgery and plastic surgery topics at scientific meetings. Details of my publications are included on my full CV, a copy of which can be provided if requested. I have also developed a PROMs iPad application to routinely measure patient outcomes. All this gives me good insight into scientific methodology.
- 1995- British Society for Surgery of the Hand (BSSH) - Council Member 1998-2002
- 1998- British Association of Plastic Surgeons (BAPS)
- 1999- The Society of Expert Witnesses
- 1999- The Academy of Experts
- 1999- The Expert Witness Institute
- Consultant Plastic and Hand Surgeon, Sheffield Teaching Hospitals
- The Churchill Livingstone Journal of Hand Surgery Prize -- Vienna 1998 (for the highest mark awarded in the European Diploma in Hand Surgery examination)
- Bronze Clinical Excellence Award -- 2010. This national award recognizes consultants «whose sustained and dedicated contributions to the NHS have been exceptional and above and beyond contractual expectations
ADDITIONAL POSTS CURRENTLY HELD:
- Honorary Senior Clinical Lecturer, University of Sheffield.
- I have worked as a NHS Consultant Reconstructive Plastic and Upper Limb Surgeon since January 1997 at one of the largest teaching hospitals in Europe, Sheffield Teaching Hospitals NHS Foundation Trust. The plastic surgery unit is a large regional unit with 13 consultants providing hand surgery, head and neck surgery, breast surgery, skin cancer, paediatric plastic surgery and burns surgery services to the people of Sheffield and South Yorkshire.
- For many years I was the clinical lead for hand surgery in the plastic surgery unit and in this role, in addition to being Clinical Director (2007- 2011), I led the development of an integrated multidisciplinary hand and upper limb surgery service within Sheffield Teaching Hospitals, The Sheffield Hand Centre, which opened in October 2010 (see below).
- Approximately 90% of my NHS practice involves the management of hand and upper limb problems and approximately 10% is reconstructive plastic surgery, mostly lower limb trauma and post-traumatic reconstruction. My upper limb practice is wide-ranging and includes upper limb trauma and post-traumatic reconstruction of the hand, free flap microsurgery, brachial plexus and major peripheral nerve reconstruction, rheumatoid hand surgery and the treatment of patients with Raynaud’s syndrome.
- I routinely monitor postoperative outcomes in my patients (see below) and undergo regular 360° assessment (utilising Res-360) as part of my appraisal and fitness to practice.
- In 1997 I initiated a multidisciplinary brachial plexus treatment programme in South Yorkshire which now treats 20-30 patients per year with this devastating condition. Brachial plexus injuries are comparable to spinal injuries in their wide-ranging effects on the patient. Before I instigated the service all brachial plexus cases were transferred outside the region for treatment. This service now provides access to specialised care which is closer to home, with obvious benefits for patients and their families.
- In 1997, I initiated a monthly joint hand/rheumatology clinic at the Royal Hallamshire Hospital and in 2005, I set up a bimonthly joint lower limb reconstruction clinic with my orthopaedic colleagues at the Northern General Hospital. In line with current accepted standards of best practice, these models of multidisciplinary care for patients with complex upper and lower limb problems is patient-centred and provides improved access to high quality care.
- Until 2009 I had a busy aesthetic surgical private practice and a laser practice in collaboration with Sk:n (formerly Lasercare).
Clinical Research and Innovation (see also references and presentations)
- My current research interests are clinically orientated and focus on hand surgery. I have developed approaches to the management of common hand problems that have high patient impact. I have published more that 30 papers in peer-reviewed journals and have presented more than 40 papers on a variety of hand surgery and plastic surgery topics. I am one of only a small number of hand surgeons in the UK who has significant clinical and research experience in the field of Performing Arts Medicine.
- Hand surgery is a notoriously difficult area for outcome assessment. I utilise PROMs (patient reported outcome measures) to assess my results I have tested and validated a new PROMs iPad application incorporating a site-specific domain, the Hand/Arm POS (Patient Outcomes of Surgery) and generic and patient experience domains, thus enabling much better assessment of patients before and after surgery.
- I believe that I personally deliver a high-quality hand surgery service incorporating many new advances including routine use of local anaesthesia with adrenaline for the majority of my cases. The adrenaline produces a bloodless operative field so a tourniquet is not necessary and no sedation is required (hence the term Wide-Awake Hand Surgery – WAHS). Patients generally find WAHS preferable to general or regional anaesthesia. WAHS is very cost-effective and is an efficient use of healthcare resources.
- I use minimally invasive techniques for Dupuytren's surgery. I also perform limited-incision decompressions for carpal tunnel and cubital tunnel syndrome, thereby reducing operating time and hospital stay, and allowing earlier recovery and return to work.
- I also have a clinical and research interest in lower limb trauma and reconstruction. With my orthopaedic colleagues I have devised a completely new approach of 'Flap and Frame' to the management of open tibial fractures. This technique has revolutionised the treatment of these challenging lower limb injuries which can often result in infection and nonhealing of the fractured bone.
Teaching and Education:
I have made a significant contribution to postgraduate teaching, training and evaluation of hand surgeons at a local, regional and national level.
In Sheffield, following on from my role as the SpR training supervisor for Plastic Surgery (1999-2002) I set up the Advanced Training Post in Hand Surgery (this is one of only 9 such posts in the UK).
I am responsible for the organization, teaching and supervision of this Regional post in addition to providing hand surgery training locally for all plastic surgery trainees in the unit and for medical students and non-medical staff.
In an external inspection of our unit by the Interface Committee in Hand Surgery (September 2005) we were 'highly commended for the excellence of Hand Surgery training provided’ and revalidated for 5 years.
- Research has shown that there is an unmet demand for hand surgery in the UK. Following on from my work within the Council of the British Society for Surgery of the Hand (1998-2002), I have served on the Interface Committee in Hand Surgery (2002-2005), and the BSSH Hand Diploma Subgroup (2006-2011).
- A principle aim of the British Society for Surgery of the Hand is to increase the numbers of highly qualified hand surgeons in the UK in order to increase the capacity of the NHS to deliver high quality hand surgery services to patients.
- I have participated in the inspection of UK hand surgery units as a member of the Interface Committee in Hand Surgery, thus monitoring the standard of hand surgery teaching and training.
- With my involvement in the hand diploma subgroup in setting up the Diploma in Hand Surgery, I have helped to set the minimum standards for a practicing hand surgeon in the NHS. The Diploma in Hand Surgery is a validated programme of study partnered between the BSSH and University of Manchester. The Diploma is aimed at younger consultants and senior trainees who wish to acquire and/or demonstrate their ability and expertise in Hand Surgery. There are 7 topic modules and a final 8th module containing a formal overarching examination (held twice a year in Manchester). Award of the Diploma is intended to be a signal of attainment and competence enjoying the confidence of both profession and public alike.
- The hand diploma subgroup is a small group of UK hand surgeons who meet regularly to organise the Diploma. With the rest of the group I help compile the examination by developing skill stations to test the candidate’s practical abilities and by writing multiple-choice questions. I also organise an annual one-day course in Sheffield to help prospective candidates prepare for the examination.
- With my involvement on the Hand Diploma Subgroup and acting as an examiner for the Diploma in Hand Surgery (2007-2012) I believe I improved the standards of hand surgery training and clinical practice in the UK.
- I regularly teach and lecture on hand and plastic surgery topics in the UK (see below).
- I was Clinical Director in Plastic Surgery at Sheffield Teaching Hospitals NHS Foundation Trust (STHFT) between January 2007 November 2011. As Clinical Director I was responsible for wholescale reconfiguration of the plastic surgery services in Sheffield and South Yorkshire. I have delivered a 5 million pound business case for two new projects; a new integrated orthopaedic and plastic hand unit (The Sheffield Hand Centre) and a remodelled and updated Plastics and Burns Unit, both of which opened in 2010.
- With the integration of the hand surgery services of the departments of plastic and reconstructive surgery and orthopedic surgery into the Sheffield Hand Centre, this regional centre, staffed by six consultant hand surgeons, will provide high quality care to patients with the whole range of hand, wrist and peripheral nerve disorders encountered in hand surgery.
- I have led increased subspecialisation in other areas within plastic surgery in Sheffield. Consolidation of clinical links with other specialties has helped to deliver higher-quality patient-focused care in the interface specialties of hand surgery (see above), lower limb reconstruction, breast reconstruction, head & neck surgery, and skin cancer. Subspecialisation within plastic surgery has also resulted in better training for junior doctors, and has concentrate resources were they are most needed.
- I am responsible for the extensive upgrading of the quality of trauma services provided by the plastic surgery unit in Sheffield. I have created consultant-led 2-session daytime trauma lists 6 days per week and this has resulted in a dramatic improvement in the standard of care provided to this group of patients. As Clinical Director I also improved depth and accuracy of coding of the procedures we performed in our unit and instituted more flexible and efficient working of my consultant colleagues who adopted ‘New Ways of Working’.