Bulletin 133, July 2022

From the Editor, Dr Helgi Johannsson

Welcome to the summer edition of the Bulletin.

I write this on a steaming hot June day, everyone is out and about and the COVID-19 difficulties of the last couple of years seem to have been forgotten. My own trust has recently removed the requirement for masks and social distancing unless in direct contact with patients, and things look like they’re truly going back to some version of normal, including a very successful Anaesthesia 2022 conference in Manchester.

So what is the version of normal that we’re going back/forward to? The last two years have led to an enormous change in the way we train and work, as shown by many of the articles in this issue. The mountain of elective work backlog, on top of poor NHS capacity pre-COVID has meant a greater use of the independent sector, and I’m very glad that includes training, not just picking off the straightforward cases to be done by consultants only, as it was traditionally done. We have a considerable vacancy rate nationwide in anaesthesia and we need to use all the training opportunities available to minimise it, and increase the number we train. 

The College identified last year a large capacity gap between how many doctors we train in anaesthesia each year and the number needed, and I’m glad NHS England has provided some additional training posts recently (along with Wales who increased their posts some time ago). This is not enough though, and many doctors are choosing to go down an equivalence route, as discussed in the article on CESR rotations by my colleagues at Imperial (page 24). I truly think this is a game changer, and will improve not only the number of trainees coming through, but give more doctors the flexibility they desire in their training.

Getting on the specialist register is not everything, and certainly doesn’t preclude a fulfilling and satisfying career in anaesthesia. The recent addition of the specialist post is another game changer, that allows career progression, and recognition of the important contribution of SAS doctors anaesthetic departments and patients nationwide. 

Please do read the new guidelines on prep, stop, block (page 48) – aimed at reducing the number of wrong sided nerve blocks, and share the discussion within your departments. 

COVID is not the only driver for change at the moment, and as I swelter here in June I’m very proud of the number of articles on sustainability and environmental issues. We have already come a long way in anaesthesia, reducing the use of desflurane, the most damaging agent, significantly, for instance. I’m proud of the efforts at the College to encourage more environmentally responsible medicine, but there is a lot more we can do, and the article by Drs Taylor-Smith and Lentzos (page 40) gives practical steps we can all take to reduce our carbon footprint. I would go further and suggest we need to incorporate environmental factors into all our guidelines. Did you know most of the carbon footprint from spinal anaesthesia is the sterile gown? Most of the rest of the world doesn’t scrub up for them and I would argue the gown is unnecessary (I stick my neck out here, I’ve stopped using one).

I hope you enjoy this edition and look forward to seeing many of you (face to face or online) very soon.