President's News, February 2019

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This month I was fortunate enough to be able to announce to guests at our annual President’s Dinner the publication of a report, commissioned by the College: A teachable moment: delivering perioperative medicine in integrated care systems. This report showcases a number of innovative and award-winning programmes in hospitals across England that are improving patient care before, during and after surgery.

The report details how exercise and nutritional support before an operation can reduce the time patients spend recovering in hospital after surgery. The time preparing for, undergoing and then recovering from an operation is known as the perioperative period and we believe that tailored care throughout this time will improve long-term outcomes for patients after surgery.

As anaesthetists we help care for two in three of all hospital inpatients before, during and after surgery and this is the time when patients are most receptive to taking steps to improve their long-term health. There is a real opportunity for us to work across a range of healthcare specialties to help patients make informed decisions that improve their health – this is the teachable moment.

The report identifies examples of best practice that are already transforming people’s lives, and this is why I believe so strongly that common solutions can emerge from our independent endeavours. What works for a hospital in one part of the country, can provide a blueprint for another to help improve the care they provide.

Professor Stephen Powis, NHS England’s National Medical Director, who wrote the foreword for this report, summarised it best when he stated that ensuring a patient is in the best possible condition for their operation, receives high quality care during surgery and is supported through to a full recovery should not be seen as three separate aims.

Harnessing the national shift towards integrated care will ensure that we develop pathways of care that utilise everyone’s expertise at the most appropriate time.

The College’s report highlights how NHS England’s new integrated care systems (ICSs) can facilitate this wider adoption of perioperative pathways of care. The range of initiatives included in the report address a number of the priorities within the Long Term Plan for the NHS. Following its publication we are continuing to work alongside NHS England to ensure that the optimisation of perioperative medicine is positioned as a practical delivery mechanism for the priorities set out in the plan, including the development of national guidance to ICSs on initiatives that can be included in future revision of their plans.

In addition, to reinforce our commitment to championing the importance of perioperative pathways as a vehicle for improving patient health, in May, the College will launch a new Centre for Perioperative Care (CPOC) bringing together a range of healthcare professionals from a number of Medical Royal Colleges. CPOC will be a tool through which to develop and share best practice in perioperative care across the NHS and internationally that contributes to improvements in patient care and safety.

I am grateful to the Royal Colleges of Nursing, GPs, Surgeons of England and Physicians who have already offered their support, and I look forward to working with all of you on the growth of CPOC as a truly multi-disciplinary centre.

Centre for Perioperative Care clinical director and perioperative fellowship

CPOC is now inviting applications for a CPOC clinical director and a CPOC fellow.

Clinical Director

We are looking for a skilled and effective clinical leader with experience of leading change and delivering service improvement in perioperative care at a national level. This is an exciting opportunity for a senior clinical leader to shape the development of perioperative medicine in collaboration with cross-specialty stakeholders and partners across the health and social care landscape.

The post is supported by the cost of two periods of professional activity (two PAs) per week, back-filled to the post-holder’s employing trust. It is anticipated that the workload will fluctuate and the post-holder will need to be flexible enough to dedicate greater amounts of time to the Centre when this is required.

The clinical director will ideally commence their duties in June 2019 for a period of three years, subject to an annual review.

Closing date: Monday 8 April 2019.

Interview date: Interviews will be held on 10 May, please refer to the website for details.

CPOC Fellowship

CPOC is also offering a 12-month fellowship opportunity at 0.5 whole time equivalent to provide clinical support and knowledge to the development of standard setting, training curricular, professional education, quality improvement, research, and policy development in Perioperative Medicine. The fellowship will involve a combination of service delivery at the appointee’s employing trust and national working with the CPOC leadership at the Royal College of Anaesthetists.

Job description

For more information or to arrange an informal discussion please contact Sharon Drake, Director of Clinical Quality & Research at: sdrake@rcoa.ac.uk

Closing date: Friday 10 May 2019.

Interview date: Interviews will be held on 18 June, please refer to the website for details.

Date of launch of CPOC: 20 May 2019 at Anaesthesia 2019 in London

Successful applicants are invited to join the event on 20 May 2019 free of charge.

St John’s hospital, in Livingston is first in Scotland to be ACSA accredited

The anaesthetic department at St John’s Hospital, Livingston has become the first in Scotland to achieve ACSA accreditation and the 27th ACSA department in the UK to gain accredited status.

The ACSA scheme is recognised by national regulators, including Healthcare Improvement Scotland who state: ‘Healthcare Improvement Scotland recognises the value of professional accreditation. Our quality of care approach recognises ACSA standards and will take ACSA accreditation into consideration as part of the package of information about an organisation that informs review and inspection activity.’

Find more information about ACSA here.

Guidelines for Provision of Anaesthetic Services 2019

The Royal College of Anaesthetists is pleased to announce that the Guidelines for Provision of Anaesthetic Services 2019 (GPAS) have now been published. This is the first time that all chapters have been updated using our NICE accredited development process. NICE accreditation gives additional credibility to GPAS, providing independent assurance that the guidelines are robust and evidence based.

First published in 1994, GPAS is designed for anaesthetists with managerial responsibilities to set recommendations which inform how anaesthetic departments are run.  Not only does GPAS shape the standards used by the Anaesthesia Clinical Services Accreditation (ACSA) scheme, but national regulators also recognise them.

We are always looking for ways to improve GPAS. In line with the College strategy on perioperative medicine and the establishment of the Centre for Perioperative Care (CPOC), in partnership with the Royal Colleges of Surgeons, GPs, Physicians and Nursing - GPAS work has begun on a new chapter for  the perioperative care of elective and urgent care patients.

We are currently recruiting for authors to work on this chapter.

Clinical Trials Education Day

The UK Perioperative Medicine Clinical Trials Network will be holding a spring Education Day on Wednesday 1 May at The Studio in Birmingham. The day will encompass updates on Network-adopted perioperative trials currently running in the UK, as well as the opportunity for members to discuss new trial proposals under development. There will also be an extended session on consent, specifically tailored to issues around consenting patients for clinical trials.

The day delegate rate is £55 and there is a 25% discount for trainees, medical students and Allied Health Professionals.

Over 100 sites now participating in PQIP

We are delighted to report that the Perioperative Quality Improvement Programme (PQIP) now has 102 sites participating in the study, with over 16,000 patients recruited to date. This represents a huge amount of dedication and hard work from all of our local PQIP teams and we are hugely impressed and grateful. 

If you are participating in PQIP, remember to save the date for Monday 16 September 2019 for the big PQIP Collaborative Meeting, to be held at King’s Place in London.  More details will be released soon, make sure you’re following @PQIPNews for the latest updates.

If you are not participating in PQIP but would like to be, contact pqip@rcoa.ac.uk.

Recognise outstanding research contributions by NHS clinicians

Applications are still open for the joint RCoA/NIHR-CRN Research Awards.  The awards recognise NHS clinicians (consultants and anaesthetists in training – clinical academics are not eligible) who are making outstanding contributions to clinical research, particularly in relation to NIHR CRN portfolio research studies, and each award carries a £1,000 prize.

Click here for information and complete this short application form to apply. The deadline for applications is midnight on Tuesday 30 April 2019.

Annual College award nominations

The College is now inviting nominations for the College annual awards. Fellows and members are invited to put forward nominations for consideration on behalf of Council by the Nominations Committee. To find more details and to understand the criteria for the awards, please find the Criteria for Honours, Awards and Prizes here.

Past recipients are listed on the College website.

Nominations should be proposed using the nominations proposal form. Completed forms should be submitted via email to: awards@rcoa.ac.uk by 31 March 2019.

BMJ Awards 2019

On behalf of the College I would like to congratulate the anaesthetic teams within the below hospitals and Trusts, for being shortlisted for the Anaesthesia and Perioperative Medicine Team of the Year Award in the 2019 BMJ Awards:

  • The Queen Elizabeth Hospital, King’s Lynn – Arterial Line Safety
  • Queen Alexandra Hospital NHS Foundation Trust – Fascia Iliaca Block Project
  • Wirral University Teaching NHS Hospitals Trust – Perioperative Pharmacy Team
  • Sandwell and West Birmingham NHS Trust – Perioperative Trauma Care
  • Freeman Hospital – Post Amputation Pain Management
  • Sherwood Forest Hospitals – Reducing Cancellations.

I know the standard of entries this year was yet again extremely high. We look forward to celebrating the winning team on 24 April.

Started in 2008, the BMJ Awards are the UK’s leading medical awards programme, recognising and celebrating inspirational work undertaken by clinicians and the teams they work with. The Anaesthesia and Perioperative Medicine Team of the Year award recognises an innovative project in the field of anaesthesia which has measurably improved care for patients. More information can be found on the BMJ Awards website.

The College and the Association of Anaesthetists issue statement on Brexit supply pressures

The Department of Health and Social Care and more recently NHS England have written to health and social care providers on what they need to consider in the period leading up to March 2019 in case of a no deal Brexit.

In response, the College and the Association of Anaesthetists issued a joint statement on behalf of our specialty. A no deal scenario is something that may affect the levels of staff, medicine and equipment supplies required by anaesthetic departments to deliver a safe service.

In the event of a no deal Brexit, it is reasonable to expect at least some disruption to supplies of medicines and equipment in the run up to and the aftermath of 29 March 2019, although the scale is unknown. The statement aims to give guidance to anaesthetists, clinical and non-clinical managers when making decisions if resources are in limited supply or absent.

Read the full statement here.

College invites applications for the role of Bernard Johnson Advisor for Less than Full Time

The College invites applications for the role of Bernard Johnson Advisor for Less than Full Time.

The purpose of this role is to provide high-level representation of matters relating to less than full time training across the UK as well as facilitate two-way communication to enable dissemination of information and coordination of feedback. The successful candidate will also share best practice in less than full time working policy in postgraduate medical education and training.

The role requires a commitment of a minimum of three hours per week and is unpaid, however all reasonable expenses will be covered by the College.

Responsibilities:
  • to integrate and work alongside the College’s Training and Education departments
  • to represent the College on all matters relating to less than full time, including attendance at external meetings as required
  • to provide support and advice to College staff, Committees and Council in matters relating to less than full time training and working in anaesthesia, critical care, perioperative and pain medicine 
  • to provide information, advice and guidance regarding less than full time training and working, to both anaesthetists and those responsible for this group within anaesthetic departments or schools of anaesthesia
  • to contribute to the development, organisation and delivery of less than full time related meetings and events.

Closing date for applications is 1 April.

Curriculum review – Anaesthetic CCT Curriculum 2020

Following publication of the General Medical Council document Excellence by design: standards for postgraduate curricula in 2017, the curricula for all medical specialties must be revised by 2020. The existing Anaesthetic Certificate of Completion of Training Curriculum was launched in 2010 following approximately a two-year development process. Various changes and additions have been made to it since then, but a full, wholesale review of its clinical content has not been undertaken since it was first written.

The curricula for all medical specialties to be revised by 2020 must align to certain requirements including:

  • introducing generic professional capabilities
  • be structured round a limited number of ‘learning outcomes' - activities that describe the work of an independent clinician in each particular discipline

Further information and regular updates about the curriculum review on specially created webpages can be found here.

The 2020 Anaesthetic Curriculum must be fit for purpose so your input and support will be vital in helping ensure this is the case.

Global Partnerships

The College will hold its second Global Anaesthesia event on Friday 22 March 2019. The event will explore the greatest challenges in access to safe anaesthetic and surgical services across the world. Emphasis will be given to the importance of good quality research in the field, and how a systems based approach to the provision of health care can have a positive impact on service delivery. In addition, the importance of advocacy and cross specialty working towards shared goals will be explored.

Speakers include Professor Bruce Biccard who will present the findings of his recent African Surgical Outcomes Study (ASOS) and Professor Ramani Moonesinghe who will highlight the challenges and opportunities of undertaking research in a low resource setting. We will also hear from Dr Tom Bashford about having a systems based approach to healthcare, Dr Meena Cherian will talk about her work with the World Health Organisation on strengthening emergency and essential surgical and anaesthetic care, while Dr Caroline Kane who has recently returned from Sierra Leone, will discuss the challenges and opportunities of working as an anaesthetist in such a challenging setting.

The day will conclude with a panel discussion, with anaesthetic, surgical and obstetric discussions focused on the biggest challenges for the delivery of safe surgical services.

The day promises to be an informative and exciting one, and we would be delighted if you would be able to attend.

Indian College of Anaesthesiologists meeting

Recently the College hosted a delegation from the Indian College of Anaesthesiologists (ICA). The meeting was to see how both the College and the ICA could strengthen links and better work together in future. Fruitful discussions were had and a range collaborative projects were explored.

Of particular interest was curriculum development, assistance in the running of examinations and Training the Trainer courses.  The ICA’s ambition is to develop and provide an overarching standard of practice which sits above the Doctor of Medicine and Diplomate of National Board qualifications. 

I look forward to seeing how this progresses and updating you about these developments in due course.

SAS, NCHD and Trust Doctors fatigue survey

Following the results of the 2017 survey of fatigue within anaesthetists in training, and the 2018 survey into fatigue in consultants (findings to be published later this year), we are now keen to understand how fatigue is affecting Staff and Associate Specialist (SAS) doctors, Non Consultant Hospital Doctors and Trust Doctors. All of these groups should have received an email invitation to take part in the survey on fatigue. We strongly encourage all doctors to take part. If you have not received an email and believe that you should have done – the survey can also be accessed here.

RCoA responds to HSIB report on transfer of critically ill adults

In February The Healthcare Safety Investigation Branch (HSIB) published its Healthcare Safety Investigation Branch’s (HSIB) report on the transfer of critically ill adults.

The report, focused on the transfer of patients, the governance of networks supporting the transfers, the preparation of patients for transfer and the communication channels between clinicians in different environments and locations.

We welcomed the publication’s recommendations and look forward to being part of meaningful discussions about how to develop national guidance.

Read the full report here.

New Updates event coming to the South West in June

We have launched a new three day Updates in Anaesthesia Critical Care and Pain Management event on the 17–19 June 2019 in Bristol. Dr Claire Mallinson will be leading a team of local clinicians putting together an engaging and informative programme, exploring topics useful to your everyday practice as well as into the future. College Update events sell out fast so book your place now.

CPD Study Days – Don’t miss out.

Final places remaining for our CPD Study Days on the 20–21 March at the College. Topics include the Anaesthetists role in the management of Big Data, clinical challenges of managing the older patient as well as the management of acute pain along with much much more.

Can’t make it to the March CPD Study Days then join us on 21 June in Hull for a full day of engaging topics.

Safe Anaesthesia for Everybody – Today (SAFE-T) Summit 2019

The Safe Anaesthesia for Everybody – Today (SAFE-T) Summit to be held on 5 April at the Royal Society of Medicine, aims to advance the global patient safety agenda. By bringing together leaders from within and outside the perioperative setting it will highlight the importance of global equity and teamwork in anaesthesia and surgical care, with a focus on perioperative safety through equity, ethics, gender, diversity and social strategies.

In partnership with related industry, governments and NGOs, this one day Summit will contribute to safer anaesthesia, surgical and obstetric care around the world.

The objectives of the meeting are for participants to be able to understand and appreciate the impact of:

  • inequity in access to perioperative and anaesthesia care and safety
  • nursing’s role in perioperative safety
  • gender gaps/considerations in anaesthesia and perioperative safety
  • working together: teamwork and advocacy in addressing the safety gap.

I look forward to attending this summit and speaking on gender equity and the importance of a patient safety culture. Other speakers will include the Presidents of the World Federation of Societies of Anaesthesiologists, Association of Anaesthetists, the European Society of Anaesthesiology and the International Federation of Nurse Anaesthetists alongside other key influencers and practitioners.

Find out more and register here.

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