RCoA and Association of Anaesthetists joint statement on winter pressures

Every winter, the NHS faces a crisis as its resources and staff are stretched beyond their capacity, with 2018/19 seeing 96% of trusts exceed their recommended bed occupancy levels^[1]. Staff at all levels of seniority may be asked to work in clinical areas other than their usual ones and, as in previous years, we are taking the precautionary step of issuing this guidance for anaesthetists who find themselves in that position.

The following principles apply to all anaesthetists of all grades who are asked to perform clinical duties outside of their normal clinical specialty or outside of their normal environment:

• Individual organisations’ winter pressure contingency plans should include clearly defined triggers and operational procedures for the short-term emergency deployment of staff to work outside their usual environment in exceptional circumstances.
• The decision to deploy staff to work outside their usual environment should only be made by the Medical Director or deputy, in consultation with the Clinical Director and, in the case of trainees, the Director of Medical Education and lead educational supervisor.
• No anaesthetist should be expected to practise beyond their clinical competence. Anyone working in an unfamiliar environment must receive an appropriate induction, be familiar with local governance arrangements. They should be given a clear line of senior medical supervision that is appropriate to their level of competence. This applies equally to consultants, SAS grades and trainees. Both the supervisee and the supervisor must be aware of their roles, their responsibilities to each other and have a reliable means of contact.

The following points apply to anaesthetists in training:

• Anaesthetists in training who are asked to support the service under pressure must be selected equitably from those who are most suitable to contribute to the area under pressure. Deployments should be kept as short as possible and the number of sessions for which any trainee is redeployed must be recorded by the Trust and closely monitored by HEE, local Schools of Anaesthesia and equivalent bodies in the devolved nations. They must ensure that these individuals are not disadvantaged at their Annual Review of Competency Progression. College Tutors, Regional Advisers Anaesthesia (RAAs) and Association Links are asked to provide or facilitate appropriate pastoral support to anaesthetists in training who are re-deployed. The hospital’s Guardian of Safe Working should be made aware of redeployments and any change to hours worked.
• If training opportunities are missed because of changed duties, arrangements must be made to access the training in a timely manner. We encourage anaesthetists in training to reflect with their supervisors on the experience of working in these circumstances, so that the issues encountered and any potential for learning can be better understood. 

Workload and workforce pressures impact the health of NHS staff and their ability to deliver quality care. Beyond this winter, and short-term actions to address the current pressures, we require sustainable long-term solutions for over-stretched front-line services. We urge any future government and all relevant bodies to work with us to develop a comprehensive long-term workforce strategy that provides for the necessary investment in capacity, medical training, ongoing pastoral support and facilities for staff working in NHS hospitals across the country.

Professor Ravi Mahajan, President, Royal College of Anaesthetists

Dr Kathleen Ferguson, President, Association of Anaesthetists

Reference

1. BMA: NHS Pressures – Winter 2018/19 A hidden crisis