RCoA and Association of Anaesthetists winter pressures statement

The NHS faces increasing emergency pathway demands, and it is likely once again, that during the winter, doctors in training may be asked to work outside their conventional training placements. We have re-issued the guidance below and will continue to raise concerns with health bodies at a national level. 

Patient safety must be the first priority of NHS staff at all times. To support the needs of patients, we believe the following principles are important, when re-deployment of anaesthetists in training is being considered. Some of the points made would be equally applicable to anaesthetists of all grades.

• All urgent and emergency care systems will have developed winter plans in conjunction with primary, secondary and social care partners. A key component of these plans should be the triggers to consider emergency short-term deployment of staff, to work outside their usual environment, in exceptional circumstances.
• The decision to trigger such a request should only be made by the Medical Director or deputy, in consultation with the Clinical Director, Director of Medical Education and lead educational supervisor, taking account of all service pressures and the clinical risk pertaining at the time.
• Anaesthetists in training should never 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. Both the anaesthetist in training and their trainer must be aware of their roles, their responsibilities to each other and have a reliable means of contact.
• 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 Linkmen are asked to provide 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. 
• 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 the government and all relevant bodies to work with us to develop a comprehensive long-term workforce strategy that provides for the necessary investment in 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