President's News, August 2019

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The past few months has seen workforce placed at the front and centre of the NHS agenda both in the wider NHS and at the College. This month we saw the government agreeing to implement the Migration Advisory Committee’s proposal that all medical practitioners be added to the shortage occupation list. The College supports the development of a self-sufficient workforce by 2025 with increased funding for training. However, in the meantime, if we are to keep workforce levels up and remain committed to reducing shortages already seen in anaesthesia, it is essential we are able to recruit from abroad. I hope the agreed regulations will go some way to easing concerns over workforce pressure for many healthcare staff.

There was also welcome workforce news from the General Medical Council which was named as the regulator for Anaesthesia Associates (AA). Anaesthesia Associates perform important complex, time-critical tasks, and their practice in healthcare requires regulation. Properly regulated AAs, under appropriate supervision, will become important members of perioperative care teams across the NHS.

Here at the College we have begun to consult on a new workforce strategy. We are currently speaking to our internal stakeholders including the Clinical Directors’ Executive Committee, the Workforce Strategy Committee and the Training, Curriculum and Assessment Committee. I want to make sure that our fellows and members are put at the heart of our workforce development and we look forward to engaging and consulting with our wider membership across the UK over the coming weeks and months as we work to develop the strategy.    

Alongside consulting on our workforce strategy, we will also be feeding into the development on the final NHS People Plan. It has been encouraging to see a focus on cultural change within the interim People Plan and NHS Long-Term Plan for England, and a commitment to engage with doctors and other front-line healthcare workers to help deliver a more compassionate workplace. Ultimately, we know that in order for the NHS workforce to deliver the best healthcare we need to work towards an integrated, multidisciplinary model and we look forward to contributing to the workforce conversation. If you would like to read our submission to the interim People Plan, you can find this here.

If you would like to find out more about the work of the College on workforce including information from our 2015 workforce census and our 2018 workforce data plan - you can find it here. Looking to the future, the College will keep workforce as a key priority. We will continue to be a strong voice in supporting our fellows and members in their positions to not only help deliver the best healthcare system possible but to look at how we can make the NHS a better place to work.

Prevention Green Paper ‘Advancing our health: prevention in the 2020s’

We were pleased to see the government publish its Green Paper ‘Advancing our health: prevention in the 2020s’. In recent years the NHS moved away from prevention to instead focus its efforts on immediate, acute demand – this Green Paper is a chance to rebalance this and return the NHS from an ‘illness’ to a ‘wellness’ service.

The commitments outlined, combined with those in NHS England’s Long-Term Plan, recognise the vital role the NHS has to play in reducing health inequalities and tackling obesity, smoking and alcohol intake. We look forward to supporting the government in its efforts to deliver greater emphasis on the role of secondary care providers in population health and prevention.

One way it can do this is through the development of perioperative care. By empowering the millions of patients having a surgical procedure every year to adopt healthier lifestyles and change behaviour ahead of their operation, the NHS can improve patient care and the health of populations, while reducing healthcare costs.

We welcome the government’s ambitious targets to end smoking and halve childhood obesity by 2030. If government is to reach its aim of boosting life expectancy and decreasing health inequality, it needs to go further than individual policies, but work to embed prevention in system-wide measures. This will facilitate greater collaboration between care settings.

Finally, we hope the government will reflect its prevention ambitions in the forthcoming Spending Review. We look forward to contributing to the consultation and to seeing the truly cohesive, preventative and people-focused system outlined in NHS England’s Long Term Plan.

Response to the government agreeing to place anaesthesia on the shortage occupation list

The government agreeing to implement the Migration Advisory Committee’s proposal that all medical practitioners be added to the shortage occupation list was a welcome step forward.

Overall, 75% of departments across the UK have at least one unfilled consultant anaesthetist post. This represents a combined total of 411 unfilled consultant posts or a 6.9% gap across the UK; a 57% increase since 2015.

We know that 30% of our members received their Primary Medical Qualification from outside the UK, therefore the College is very happy to see the removal of recruitment barriers including the resident labour market test and minimum income threshold.

The College has previously called for significant investment into training so the UK can become self-sufficient in doctors by 2025. However, growing a domestic workforce will require time to develop. In the interim, it is therefore essential that the NHS be able to recruit talent from abroad to fill rota gaps and maintain adequate staffing levels.

Election to RCoA Council: Nominations are open

Nominations for election to College Council are now open.

Council vacancies are as follows:

  • 3 consultant vacancies: Those eligible for nomination are those who are on the specialist register and are Fellows by Examination or Fellows ad eundem
  • 0 anaesthetist in training vacancies: There are no trainee vacancies this year
  • 0 SAS vacancies: There are no SAS vacancies this year

Nominations close at 12 noon on 30 September 2019. Further information, including a detailed timetable, can be found here.

Statutory regulation of Anaesthesia Associates

This month saw the General Medical Council  named as the regulator for Anaesthesia Associates. Anaesthesia Associates are highly valued and contribute greatly to patient care and we look forward to working with the government, the GMC and wider stakeholders to ensure a statutory register is implemented as soon as possible.

We have called for the statutory regulation of Anaesthesia Associates for many years. We believe this announcement is a very important step towards ensuring Anaesthesia Associates continue to provide high quality, safe care as part of a multi-professional team.

Don’t forget to download your e-Portfolio

The final anaesthetists in training will be moved over to the Lifelong Learning platform this August. So the Lifelong Learning team advises all anaesthetists in training to download their e-Portfolio onto a few different devices, as the Training e-Portfolio will be decommissioned at the end of August 2019.

If you have previously used the e-Portfolio as an anaesthetist in training, please also ensure you download an offline version of your e-Portfolio record from the ‘View Portfolio’ section. The College will not hold a copy of the e-Portfolio after the August 2019 date and will be unable to retrieve entries after this, so please do ensure that you download the necessary materials.

You can find a step by step guide on how to download your portfolio via this link.

Curriculum Review Survey – Anaesthetics CCT Curriculum 2020

The College has opened a survey for College Fellows and Members to provide comments and feedback on the proposed High-level Learning Outcomes (HLOs) for the new 2020 Anaesthetics curriculum. The survey is due to close on 2 September 2019.

The College is running a large project to re-write the anaesthetic curriculum in line with new GMC standards that were published in May 2017. We are especially interested in how the changes may affect groups of people who share protected characteristics. All of this information is 100% anonymous & helps us provide anaesthetics training that is modern and inclusive.

Further information is available on the College website. Comments from the survey will be considered as we further iterate the HLOs prior to submission to the GMC for approval.

We are still developing our implementation and transition plan which will be communicated in due course, and published widely with the final version of the curriculum following GMC approval. We anticipate this will be in late spring 2020, with implementation of the new curriculum scheduled for August 2021.

The 2020 Anaesthetics Curriculum must be fit for purpose and your input and support will help ensure that the new anaesthetic curriculum produces anaesthetists capable of managing the acute general workload of a hospital and the wider anaesthetic services for the NHS.

Research and Quality Improvement

Choosing Wisely Fellowship
Guys & St Thomas’s has announced a Leadership and Innovation Fellowship opportunity for a senior or post-CCT anaesthetist to lead a national ‘Choosing Wisely’ pilot programme within their Directorate of Theatres, Anaesthesia and Perioperative Medicine. The successful applicant would ideally have previous leadership and research skills. At least one publication would be expected during the 12-month fellowship. The post comes with a one day per week clinical requirement based on perioperative medicine opportunities at GSTT, with no on-calls.

I am delighted to see this new opportunity for anaesthetists to lead on a national pilot of an international initiative, and would encourage all with an interest to apply.

Book now for Anaesthesia Research 2019
Bookings are now open for Anaesthesia Research 2019, a brand new two-day event to be held at The Principal Hotel in York on 2-3 December 2019. The meeting will incorporate all NIAA-affiliated activities across the research spectrum, ‘from bench to bedside’, including experimental medicine, the Health Services Research Centre (HSRC), UK Perioperative Medicine Clinical Trials Network (POMCTN), and the BJA Anaesthesia Research Forum (ARS).

The single day rate is £87.50, or £175 for both days, with reduced rates for trainees, AHPs and QuARCs. 10 CPD credits are anticipated.

PQIP Collaborative Event 2019
The Perioperative Quality Improvement Programme (PQIP) will be holding its 2019 Collaborative Event on Monday 16 September at King’s Place in London. Are you participating in PQIP in your hospital? If so, this day is for you. Attendance is free to PQIP participating sites, with up to three places available (as long as one of the people you bring is a surgeon!) The day will also feature the launch of PQIP’s second Annual Report.

Events update

Advanced Airway – 24 September 2019
Enhance and refine your existing airway skills at our hands-on advanced airway workshop. You will have the chance to get your hands on and practice on a variety of equipment across scenarios including flexible bronchoscopy (including through SAD), front-of-neck access, awake tracheal intubation and paediatric airways and many more. Face to face teaching from an experienced faculty and industry experts will allow you to hone your technique as well as discuss patient scenarios with your peers.

The workshop also covers the latest airway guidelines and how they influence your everyday practice. Throughout the day the faculty will also help you improve your non-technical skills to ensure the patient is at the heart of your airway procedures.

The workshop is most appropriate for airway leads, anaesthetic consultants and senior trainees. Places are limited to ensure you have the maximum amount of time possible using the equipment so register your place today

CPD Study Day, Newcastle 17 – 18 October 2019
Join us for a CPD Study Day in the North East for a day of world-class anaesthetic learning to aid your revalidation and improve your patient outcomes. This event will cover a broad range of engaging topics, bringing you up to speed on the latest thinking and new techniques.

Highlights of the day include:

  • Getting It Right First Time (GIRFT) in perioperative medicine and ICU
  • end of life care in ICU
  • pre-hospital medicine
  • National Emergency Laparotomy Audit (NELA) from a surgeon’s and geriatrician’s perspective.

Explore these topics and more, and join your peers as we question the experts.

Delegate feedback from previous CPD Study days

“Well thought out, mix of general and sub-speciality oriented aspects of anaesthesia were covered”

“A good way to keep updated on interesting topics run by people who care about the specialty”

“Excellent broad based update in Anaesthesia”

A Career in Anaesthesia 9 October 2019
Do you know a medical student or foundation year doctor considering a career in anaesthesia? We are holding the Career in Anaesthesia event - a half-day information session for those who want to find out more about the specialty. The day will provide an insight into life as a trainee and consultant anaesthetist covering topics such as intensive care medicine, pre-hospital medicine, ACCS anaesthetics, the recruitment and application processes and the future of anaesthesia and the skills required

Anyone interested in a future career in the specialty should book their place now.

Feedback from a previous event

“Informative event with the opportunity to talk to anaesthetic trainees from different backgrounds about what it is like to apply for and to work as an anaesthetic/ACCS trainee.”

“An incredibly informative experience, which has given me the confidence to apply for anaesthetics as my future career.”

“Great opportunity to hear about current trainees’ experiences and to de-mystify the application process.”

Volunteer as a Clinical Content Lead
Would you like to get involved in planning an upcoming event?

Do you have ideas for topical, relevant and diverse topics and speakers for a programme?

We are currently looking for volunteers to get involved as Clinical Content Leads for educational events throughout 2020. As a Clinical Content Lead you will work with the College to develop event content and themes to meet the needs of our members. This will involve suggesting topical, relevant and diverse speakers and chairs for the programme as well as supporting the event during the build-up, attending on the day and de-briefing to ensure event evolution.

Email the events team today for more information.

FRCA Examinations update

I would like to congratulate all those who passed the Final FRCA SOE examinations which took place in June. A total of 278 out of 413 candidates were successful, achieving a 67% pass rate, which is in the normal range.

Preparation for the 2019–2020 exams schedule is already well underway. The application window for the Primary and Final written exams in September 2019 has closed and we are expecting a high number of candidates. FRCA examiners and the examinations directorate at the College continue to refine its quality assurance processes and engage in ongoing development work.

Constructed Response Questions (CRQs) will replace Short Answer Questions (SAQs). The September 2019 paper will be a hybrid CRQ/SAQ, comprising 6 CRQs and 6 SAQs. From March 2020 onwards this component will consist entirely of CRQs.

The examination paper will continue to be answered across six individual, coloured question booklets, A – F. At the September sitting each booklet, will contain one CRQ and one SAQ. The first question in each of the booklets will always be a CRQ and the second will be a SAQ. CRQs and SAQs will continue to be marked out of 20. The number of marks available for the CRQ/SAQ examination is 240. Unlike SAQs, CRQs have specific spaces in which candidates must place their answer for each subsection. Where a CRQ subsection asks for a specific number of responses e.g. “List 6 factors”, then you must limit yourself to this number.

I wish candidates all the very best with their exams.

NHS Patient Safety Strategy

The NHS Patient Safety Strategy was launched on 2 July 2019 by NHS England and NHS Improvement’s National Director of Patient Safety, Dr Aidan Fowler.

The strategy sets three strategic aims for the NHS:

  • to improve understanding of safety by drawing intelligence from multiple sources of patient safety information (Insight)
  • to equip patients, staff and partners with the skills and opportunities to improve patient safety throughout the whole system (Involvement)
  • to design and support programmes that deliver effective and sustainable change in the most important areas (Improvement).

Under each of these aims the document commits to a series of actions, or recommits to existing work, that will support the NHS to save more lives and the costs associated with patient safety incidents. These include:

  • using new digital technologies to support learning from what does and does not go well
  • establishing principles and expectations for the involvement of patients, families, carers and other lay people in providing safer care
  • creating the first system-wide and consistent patient safety curriculum, training and education framework for the NHS
  • delivering the National Patient Safety Improvement Programme and wider work to support safety improvement in key areas such as maternity and neonatal safety, mental healthcare safety and medicines safety.

The strategy and its supporting information, is available online at www.improvement.nhs.uk/resources/patient-safety-strategy

SALG-BIDMC Scholars

The Safe Anaesthesia Liaison Group has announced the second round of its programme of fellowships for anaesthetists interested in patient safety.

In collaboration with the College and the Association of Anaesthetists, the Safe Anaesthesia Liaison Group (SALG) is offering a unique programme of formal training through Harvard Medical School that aims to develop international expertise in perioperative quality and safety.

The two successful candidates will be known as the SALG-BIDMC Safety Scholars, and will be provided with:

  • a fully funded place in a Master of Healthcare Quality and Safety (MHQS) course from Harvard University, while also engaged in clinical practice at a suitable level at the Beth Israel Deaconess Medical Center (BIDMC), a major Harvard Medical School teaching hospital with a long tradition of clinical, academic and research excellence in Boston’s highly competitive healthcare environment
  • Co-mentorship from the Vice Chair of Quality and Safety at BIDMC (Professor SK Ramachandran), and the SALG co-chairs: Professor JJ Pandit and Dr CR Bailey
  • scholars will identify project(s) in the UK that they will develop and lead on, after their return to the UK.

Please note at least Steps 1 and 2 of USMLE are essential. The closing date for applications will be Friday 10 Jan 2020, with interviews at the end of January 2020.

This program is endorsed by the American Board of Anesthesiologists (ABA). Successful candidates will receive official letters from the ABA in support of their visa application, where necessary.

Further details of the programme are available here.

SALG Patient Safety Conference

The SALG Patient Safety Conference 2019 will be held on the 31 October at the Royal College of Anaesthetists, Churchill House, 35 Red Lion Square, London WC1R 4SG. The programme will be themed around paediatrics.

For further information, and the opportunity for you to book your place can be found here.

Latest hospitals to be ACSA accredited

Anaesthetic departments at Royal Manchester Children’s Hospital, Dudley Group NHS Foundation Trust and Airedale NHS Foundation Trust have been awarded ACSA accreditation. All three departments have been recognised for providing the highest quality care to patients. Plaque presentation ceremonies at each hospital will take place in the coming weeks.

Why become accredited?

Organisations that engage with ACSA will benefit from:

  • a structured and supportive process for improving services
  • an expert advisory on-site review, followed by a report that provides targeted advice
  • benchmarking against standards and anonymised local, regional and national performance
  • the engagement of staff in service improvement.

Accredited departments will:

  • be entitled to use a quality mark to denote their commitment to quality and patient care
  • be awarded a plaque to display in the department
  • be more attractive to potential employees and trainees.

The accreditations at Royal Manchester Children’s Hospital, Dudley Group NHS Foundation Trust and Airedale NHS Foundation Trust takes the number of NHS anaesthetic departments in the UK that have achieved accreditation status to 33. Encouragingly, over 60 per cent of NHS trusts and boards with anaesthetic departments across the UK are now actively engaged with the ACSA programme which is a great foundation on which to continue to build on quality improvement.

Fitter Better Sooner shortlisted for BMA Patient Information Award

I was delighted to see the Fitter Better Sooner patient information toolkit on preparing for surgery, has been shortlisted for the 2019 BMA Patient Information Awards.

Endorsed by the Royal College of Surgeons and the Royal College of General Practitioners, the Fitter Better Sooner resources were developed to advise patients on how to prepare for going into hospital and encouraging them to improve their health before surgery. The toolkit consists of one main leaflet, six specific leaflets on some of the most common surgical procedures and an animation designed to be shown in clinic and surgery waiting areas.

The awards aim to reinforce the BMA’s commitment to support good educational practice and acknowledge new approaches and technologies intended for the public audience.

Winners will be announced at a ceremony and reception on the afternoon of Tuesday 10 September 2019 at BMA House.

Your chance to join the BJA Education editorial board

The British Journal of Anaesthesia is looking to recruit two anaesthetists in training members to the editorial board of BJA Education. The role will include overseeing the production of podcasts and contributing to the social media activities of the journal. Applicants should be in possession of the FRCA or equivalent and the appointment will be for a three-year term to commence in January 2020. Please note that these are non-commissioning editorial roles.

Applications, in the form of a covering letter and a brief CV (maximum two sides of A4) should be sent to bjaeducation@rcoa.ac.uk by 31 August 2019.

The selection process for shortlisted candidates will involve a short presentation and interview to be held at the College on Tuesday 17 September 2019.

New to the NHS meeting

The College will be running its first ‘New to the NHS’ meeting outside of London in Manchester on 16 September. This is a free event and is open to all anaesthetists who are new to the UK. The programme will include the GMC’s Welcome to UK practice, which includes practical guidance about ethical scenarios that doctors may encounter when working in the NHS. The afternoon sessions provide guidance specific to anaesthetists, with one stream focusing on MTI doctors, and the second providing guidance for non-MTI doctors, including sessions on crossing cultural barriers, FRCA exam techniques, the CESR process and the Lifelong Learning Platform.

Places are limited, so please book as soon as possible to avoid disappointment.

Anaesthesia in ECT Special Interest day

The Electroconvulsive Therapy Accreditation Service is organising a free Special Interest day on Anaesthesia in ECT. Taking place on 4 October at the Royal College of Psychiatrists, the day is targeted at consultant or trainee anaesthetists and operating department practitioners (ODPs) that have an interest in ECT and may be relatively new to delivering anaesthesia in ECT, about to start a new role in ECT or looking to get into the ECT field.

Learning objectives:

  • Understand what ECT is, who it’s for, and its effectiveness
  • Learn about the specifics (and variants) of anaesthetic practice in relation to ECT
  • Learn about considerations for anaesthesia in non-theatre settings
  • Understand the role of the ODP in anaesthesia for ECT
  • Explore case studies of patients with complex or unusual presentations
  • Understand the role of the ECT accreditation service and how you can get involved.

Delegate fee: £0

CPD: Up to 4 CPD hours subject to peer group approval

If you would like to attend this event please download the registration from the events page and return to ECTAS@rcpsych.ac.uk

If you have any comments on the issues highlighted in this e-newsletter or would like to express your views on any other matter, I would like to hear from you. Please contact me via presidentnews@rcoa.ac.uk

Professor Ravi Mahajan
President