The Royal College of Anaesthetists and the Association of Anaesthetists joint statement on winter pressures

There is considerable pressure on NHS systems across the whole of the UK which is likely to significantly impact anaesthetic departments over the coming months. There are a number of factors including patients requiring treatment for COVID-19 and the seasonal pressures that perennially affect services over the winter period. In addition to this there is a drive to maintain activity in order to tackle waiting lists. Anaesthetists in all stages of their careers are suffering from the consequences of the huge challenges that the NHS has faced over the last two years. This has been particularly acutely felt by those trying to navigate the disruption to training, examinations and recruitment.

In common with previous years, the Royal College of Anaesthetists and the Association of Anaesthetists are offering the following guidance to support both individual anaesthetists in training and also our wider departments.

The following principles apply to 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. We have previously issued guidance on cross-skilling to prepare clinicians for this
• 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 anaesthetists in training, the Director of Medical Education and lead educational supervisor. This is particularly important with the likelihood of repeated surges of COVID-19 which may extend the need for redeployment beyond the normal winter pressures
• No anaesthetist should be expected to practise beyond their clinical competence
• Anyone working in an unfamiliar environment must receive an appropriate induction and 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 anaesthetists in training. Both the supervisee and the supervisor should be aware of their roles, their responsibilities to each other and have a reliable means of contact
• Any changes to working conditions must be in line with contractual obligations, employment law and national terms and conditions in order to ensure that efforts are sustainable, and anaesthetists are not working in a manner that compromises their health, safety, or wellbeing, nor that of their patients.

The following points apply to anaesthetists in training:

• Anaesthetists in training who are asked to support the service under pressure should be selected equitably from those who are most suitable to contribute to the area under pressure. The same trainees should not be redeployed successively as this will impact on their training
• Deployments should be kept as short as possible and such measures should be planned carefully, with input from local trainers and consideration of the impact on all doctors affected. The College Tutor should be involved in the decision-making and the Training Programme Director, Head of School and Postgraduate Dean must be informed of any movement in all cases. Any movement must be supported by a full hospital and departmental induction
• ACCS trainees working in Anaesthesia and Intensive Care Medicine in CT1 and CT2 should not be redeployed, if at all possible, in order to ensure that they meet the requirements of the training programmes during their six-month rotations.  Extensions are particularly difficult to organise and disruptive to training for this group
• As far as possible, it should be ensured that individuals are not disadvantaged at their Annual Review of Competency Progression. Outcome 10s should be used to show where training progression has been delayed by factors related to COVID-19. College Tutors, Regional Advisers Anaesthesia (RAAs) and Association Links are asked to provide or facilitate appropriate pastoral support to anaesthetists in training who are redeployed. 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 should 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. 

The College and the Association understand how workload and workforce pressures during these challenging times are impacting clinicians’ health and ability to deliver high-quality patient care. This has been highlighted during the entirety of the pandemic and reinforces our argument that beyond any short-term actions to address the current pressures, we require sustainable long-term solutions for over-stretched front-line services. We are urging government and relevant bodies to continue to work with us to develop a comprehensive long-term workforce strategy that provides for the necessary investment in capacity, medical training, ongoing wellbeing support and facilities for staff working in NHS hospitals across the country.

Dr Fiona Donald, President, Royal College of Anaesthetists

Dr Mike Nathanson, President, Association of Anaesthetists