President's News, January 2019

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This month I was pleased to share with the College’s Perioperative Medicine Local Leads my thoughts about the future of anaesthesia and the College’s role within our specialty. With the recent launch of the Long Term Plan, which included direction on integrated care systems, and with the Department of Health and Social Care’s 2018 decision to proceed with regulation of Physicians’ Assistants (Anaesthesia), the landscape of healthcare policy and delivery is changing.

Our original vision for perioperative care was launched in 2014, with the appointment of Perioperative Medicine Local Leads. Much has been achieved since then, with challenges identified, addressed and many overcome. Understanding the vision and evidence gathering have and continue to be central to generating support for our approach.

We welcome input and insight to our vision from a range of healthcare providers and stakeholders. True collaboration is the only way our current healthcare system will thrive. There is still much to do and mind sets to shift, but when we continue to work with surgeons, nurses, GPs and other healthcare providers, much can be achieved together for the benefit of patient health, which is central to all our aims.

There is now a wealth of evidence that demonstrates how prehabilitation is truly of benefit to the patient – our message is resonating. I am keen that we build on this strong and compelling foundation and continue to turn the original vision for perioperative care into a tangible, beneficial and long-lasting reality.

As we know, the NHS faces challenges that are multi-factorial – resourcing and workforce are issues, as is multi-morbidity. These are major areas within which there is an opportunity to ensure that the perioperative pathway can have a significant impact and help to alleviate pressure points.

In meetings with senior Department of Health officials, I am always keen to share the positive messages around perioperative healthcare and I am committed to informing and educating mindsets at this level, so that the way is paved to make positive material differences at a grassroots level. The idea that patients should be encouraged to prepare for surgery while waiting for their operation, is something which resonates well with the Department of Health and Social Care ministers. They see that not only is this an opportunity to save money in the long term, but prehabilitation enhances the recovery of the patient, ensuring that they are more quickly able to resume contributing to their families, communities and society.

This premise is central to the College’s decision to establish the Centre for Perioperative Care (CPOC), in partnership with the Royal Colleges of Surgeons, GPs, Physicians and Nursing. The Centre, to be based at the College, will facilitate closer and more effective cross-College working on perioperative care. Much more detail will be shared with you over the coming months and the College is working in step with our Perioperative Medicine Local Leads and others to ensure that we stay true to the vision. Since the inception of this perioperative journey, it has been the development, dissemination and the delivery of perioperative medicine for the overall interest of patients that drives us forward. I look forward to working with many of you to make real this ambition.

RCoA responds to the NHS Long Term Plan 

In response to the publication of the Long Term Plan for the NHS this month – I am keen to share with you the College’s response to it.

The Long Term Plan sets an ambitious course for the NHS over the next decade. Its success will be dependent on a number of factors including the forthcoming strategy for the NHS workforce, long-awaited plans for social care reform and the allocations in the Spending Review.

Improving prevention through lifestyle support and care that anticipates future health issues before they emerge is core to this plan and the future sustainability of the NHS.

As a College, we have championed this approach in the area of surgical care, through the development of perioperative medicine and shared decision making that supports patients to discuss, prepare for and recover from surgery when it is required.

The plan aims to improve quality and uptake of pulmonary and cardiac rehabilitation that should, for example, be coupled with targeted ‘prehabilitation’ incorporating exercise, nutrition and psychological support that can help to prepare patients for a procedure that treats their long-term condition.

This type of perioperative care has been shown to improve treatment outcomes, reduce the amount of time spent in hospital and help avoid the need for repeated hospital care in the future. All of which makes for a more efficient and cost effective healthcare system.

We also agree with the assessment that more emphasis should be placed on preventing people from requiring hospital treatment, by enabling healthier lifestyles and addressing major public health challenges of smoking, obesity and harmful drinking. This can be realised as part of a fully integrated system of care that reduces the need for people to attend hospital through investment in public health services and targeted marketing that engages with people that would benefit most. 

We recognise the need for a clinical workforce that marries a high-degree of specialist skills with the generic skills needed to care for an ageing population. As a College we are in the process of evolving our curriculum to ensure that it provides high-quality training that enables the provision of the best standards of care.

Ultimately, the plan for the future of the NHS is dependent on proper integration of care and a sustained investment in those delivering care.

The establishment of a national workforce group is a welcome step to addressing the challenges facing NHS staff, including welfare and morale. We are pleased that Royal Colleges will be included in this group and look forward to working with partners by offering the insight and experiences of our membership.

The Academy of Medical Royal Colleges – resources for doctors 

The Academy of Medical Royal Colleges (AOMRC) of which the College is a member, has published resources aimed at supporting doctor’s wellbeing. AoMRC recognises that working in the NHS can be very challenging and that doctors and NHS professionals deserve support to make choices that promote healthy lives and wellbeing, in order for them to provide care for patients who desperately need their expertise.

This initiative directly aligns to our own position. As a College, we continue to include the morale and welfare of our members within discussions with national decision makers and the media. Whether it be the need for adequate rest facilities for all or the mental and emotional wellbeing of our members, we know that there is a moral and financial imperative to safeguard the welfare of the anaesthetic workforce.

When we surveyed anaesthetists in training, we found that two thirds of young hospital doctors felt under serious stress and six out of seven of them felt at risk of burning out. Long hours, concerns over patient safety, the disruption of working night shifts and long commutes were identified as key reasons for growing fatigue and disillusionment.

Whilst the survey did not reveal any regrets for doctors specialising in anaesthesia, it remains clear that as a College we must remain steadfast in our ambition to improve the lives of doctors so they are able to continue to deliver the best care for patients possible.

If you or a colleague are looking for support, there are a range of organisations, services and websites which can offer help. The College has a range of resources on its website to support you.

Will a seven day NHS be possible after Brexit? 

Chief Executive Officer, Tom Grinyer, has written a blog entitled: Will a seven day NHS be possible after Brexit? which was published on the website The UK in a Changing Europe.

In his blog Tom stresses that maintaining a seven day NHS after Brexit will only be possible if the workforce is there to deliver it. While there is a clear need to develop a home grown health and social care workforce, immigration from Europe should still be part of the solution to maintain adequate staffing levels and ensure the delivery of safe and effective patient care. Read more of Tom’s thoughts here.

NAP7 Clinical Lead appointed

Dr Jasmeet Soar has been appointed as the clinical lead for the Seventh National Audit Project. NAP7 will examine perioperative cardiac arrest. Jas is a consultant in anaesthesia and intensive care medicine at Southmead Hospital Bristol, and has a major interest in cardiac arrest and cardiopulmonary resuscitation.

Jas is the current chair of the International Liaison Committee on Resuscitation (ILCOR) ALS Task Force, Chair of the European Resuscitation Council ALS Science Committee and is an editor for the journal Resuscitation. He is a past Chair of the Resuscitation Council (UK), and chairs the ALS course subcommittee. His anaesthesia interests include anaesthesia for major urological and adrenal surgery.

Jas is looking forward to taking on the NAP7 role and working with anaesthetic and other colleagues to improve knowledge of perioperative cardiac arrest. Visit the National Audit Project website for updates on NAP7.

Benenden Hospital Trust – recognised as the first ACSA accredited independent sector organisation and Worcestershire anaesthetists are rewarded for high quality patient care 

The College is pleased to announce that the anaesthetic department at Benenden Hospital Trust has become the first independent sector organisation to receive ACSA accreditation. While independent sector organisations are assessed against the same standards as NHS organisations, Benenden hospital acted as a pilot site to test how the ACSA standards would be applicable in a non-NHS, non-acute setting.

Following the successful pilot and the opening of the ACSA scheme to independent organisations, Benenden has been recognised for the excellent care provided to patients. For more information about how ACSA is applied to independent sector organisations, please see the ACSA website.

In addition, Anaesthetists at Worcestershire Acute Hospitals NHS Trust have been recognised for providing the highest quality care to their patients. The prestigious ACSA  plaque was presented at a ceremony on 9 January.

I would like to offer my personal congratulations to the entire anaesthetic department on achieving ACSA accreditation. It is richly deserved and demonstrates the team’s commitment to providing the best possible care for patients.

The review team were particularly impressed with how the anaesthetic department worked to unify policies and practice across three diverse hospital sites whilst retaining excellent flexibility to match the needs of patients.

As well as meeting the standards, the department demonstrated many areas of excellent innovative practice that have now been highlighted for sharing through the ACSA network.

ACSA is the College’s peer-reviewed scheme that promotes quality improvement and the highest standards of anaesthetic service. To receive accreditation, departments are expected to demonstrate high standards in areas such as patient experience, patient safety and clinical leadership. The College’s website has all the information required for you to understand how ACSA could benefit your anaesthetic department.

Applications open for RCoA/NIHR Research Awards

The Royal College of Anaesthetists is pleased to announce that submissions are now open for three awards in conjunction with the National Institute for Health Research (NIHR) Clinical Research Network (CRN). The awards recognise NHS clinicians (consultants and anaesthetists in training) who are making outstanding contributions to clinical research, particularly in relation to NIHR CRN portfolio research studies.

Applicants must be NHS clinicians (clinical academics are not eligible) and a fellow or member of the College. Clinicians can enter under one of three categories: consultant (including SAS doctors), anaesthetists in training (individual) and the anaesthetists in training network category. Each award carries a £1,000 prize.

Applicants are required to outline their contribution to the leadership of several NIHR Clinical Research Network portfolio studies with particular focus in the following areas:

  • how they demonstrate clinical leadership, enabling their organisation to increase its participation in clinical studies
  • how they engaged with patients to inform them of new opportunities to participate in clinical research
  • their contribution to the successful delivery of clinical research studies.

Complete this short application form to apply and for more information on criteria please visit the website. The deadline for applications is midnight on Tuesday 30 April 2019.

Perioperative Medicine MOOC reopens

The next run of the UCL/RCoA Massive Open Online Course (MOOC) on Perioperative Medicine in Action goes live on Monday 4 February 2019. This is a fantastic opportunity for clinicians of all grades to back up their clinical perioperative medicine with an overview of the principles and future of the discipline. The course is free and open for six weeks; however, there is an option to upgrade for ongoing access beyond this. Find more details here.

Medicolegal and ethical hot topics

Medicolegal and ethical dilemmas in clinical practice are increasingly common and many doctors feel ill-equipped to manage them. The College is holding a day of case based learning on 13 March that will address some of the key principles of medical ethics and law, and also give you the opportunity to apply these principles to a range of common scenarios. Small group work will allow time for you to ask questions and debate issues with other delegates and faculty. Topics covered include whistleblowing, the legal implications of clinical guidelines, regulation and ethical justification for funding surgery. This popular course has been running at the College as a one-day event for five years. It forms part of a three-year programme that rotates annually in response to feedback in order to address a greater range of topics.

Feedback from the event is always great:

  • ‘excellent, informative and challenging’
  • ‘really interesting and informative day’
  • ‘I have been recommending this course all morning to my colleagues!’

To find out more and to book your place, go to the Ethics and Law for Anaesthetists page on the College website.

CPD Study Day – 20 and 21 March 2019

Join us to hear about best anaesthetic practice, maintain your competence and earn CPD points to aid revalidation at our CPD Study Days event on the 20–21 March at the College.

From the clinical challenges of managing the older patient, to the Anaesthetists role in the management of Big Data, this event will cover a variety of topics across the two days. UK leaders from across the specialty will come together to share their knowledge with you to help improve outcomes for your patients.

Other highlights include:

  • management of acute pain in patients with chronic pain syndromes
  • reducing critical incidences in obstetric anaesthesia
  • prehabilitation: evidence of its usefulness.

Places at the event are limited so book your place now to avoid missing out.

College invites applications for Physicians’ Assistant (Anaesthesia) Clinical Lead

The College is inviting applications for a Physicians’ Assistant (Anaesthesia) (PA(A))s Clinical Lead role. The role is unpaid, however all reasonable expenses will be covered by the College.

The purpose of the job is to provide information, advice and guidance to:

  • PA(A)s on issues of training, and support
  • those responsible for PA(A)s in their hospitals about the role, further training and support
  • anaesthetic departments and hospitals considering appointing and training PA(A)s
  • other stakeholders and/or stakeholder organisations in relation to the PA(A) profession
  • College internal committees, trustees, staff and Council.

Key tasks and responsibilities for the role include:

  • acting as a point of reference for clinicians contemplating training PA(A)s
  • providing advice to individuals wishing to become PA(A)s
  • feedback the views and concerns of clinical leads supervising those involved in training PA(A)s
  • attend meetings of the Anaesthesia Related Professions Committee.

Applicants should provide a 500 word statement describing what they would bring to the role, alongside a copy of their CV which should be sent to Chris Scorer at: cscorer@rcoa.ac.uk

The deadline for applications is 18 February.

Case studies required

The College, the Association of Anaesthetists and the Faculty of Intensive Care Medicine (FICM) have been working together to address the impact of fatigue and shift working on doctors and the consequences for wellbeing and patient safety.

In continuing this work we are looking for case studies from membership that demonstrate what provisions are available in hospitals and trusts to help doctors combat fatigue. We are looking to collect stories of great practice that we can share with membership and media.

If you are interested in being involved – email your interest to comms@rcoa.ac.uk.

SAS 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 this year), we are now keen to understand how fatigue is affecting staff and associate specialist (SAS) doctors. SAS doctors will, on 31 January 2019, receive an email invitation to take part in the survey on fatigue. We strongly encourage all SAS doctors to take part. If you do no not receive an email on the 31 January and you are an SAS doctor please email Elizabeth Eyarhono at eeyarhono@rcoa.ac.uk who is happy to assist.

New #FightFatigue resources available

With the start of new rotations, we would like to remind our membership of the useful educational resources available on the Association of Anaesthetists website to help educate on fighting fatigue within hospitals. These include new factsheets (napping and rest facilities) and a useful slide deck, to be used at forthcoming anaesthetist in training inductions. To download these helpful resources please visit the #FightFatigue campaign pages here.

Lifelong Learning – offline Logbook 

Following the successful launch of the e-Portfolio and Logbook aspects of the Lifelong Learning platform, the Technology Strategy Programme and Training team are now developing new features to the system. 

The first is the offline working of the Logbook which will allow users to work on their log cases when their device is offline. This newly developed feature will enable users to update their work experience in real time, in patchy internet coverage areas or where there is no internet access at all. This new offline working will facilitate ease of use and allow anaesthetists in training to quickly and accurately record the work that they are doing. This feature is due to go live in early 2019.

Another feature in development is enabling users of the Continuing Professional Development diary to also work when their device is offline. Consultants will easily be able to record and reflect upon their activities in a way that does not currently exist. We will update members in the coming months.

In addition, development of a single sign-on to the College website has also begun. This feature will allow users to log into one portal and have access across all platforms on the website without having to log in and out each time.

Lastly, the College would like to remind all e-portfolio users to download their portfolio before the 1 August to ensure that all records are retained. A handy video detailing how to do this can be found here.

There are a number of developments in the pipeline and we look forward to sharing them with you.

Gas in eye alert wristbands available

Intraocular gas is commonly used in retinal detachment surgery and, more recently, also corneal transplant surgery. Use of nitrous oxide may subsequently be contraindicated for a period of up to 8 weeks, with a potential risk of loss of vision. Ophthalmic surgeons should warn patients to avoid gas analgesia (eg Entonox), general anaesthesia using nitrous oxide and high altitude or airline travel. These patients are also advised to inform healthcare professionals responsible for their care about these limitations.

“Gas in Eye Alert” wristbands are available from the medical gas suppliers, and patients are advised to wear these for the duration of the at-risk period. Some trusts also issue “Gas in Eye” warning cards which patients are also advised to carry at all times, and present when seeking medical help.

It is worth noting these wristbands and warning cards come in different designs (colour, wording and symbols) and it may not be immediately obvious, especially in an unconscious patient, that they may have intraocular gas.

Work is currently being carried out by the British Ophthalmic Anaesthesia Society (BOAS) and the Royal College of Ophthalmologists, along with the British and Eire Association of Vitreoretinal Surgeons (BEAVRS) to standardise the appearance and use of these wristbands and warning cards in consultation with gas manufacturers.

The full alert has been published on the Royal College of Ophthalmologists website

2019 Annual General Meeting

The 2019 Annual General Meeting of the Royal College of Anaesthetists will be held as follows:

Tuesday 21 May 2019 at 12.40
etc venues
St Pauls
200 Aldersgate
London EC1A 4HD

The procedure for the submission of motions to the agenda is set by College regulations. Any motions for the meeting should be submitted to the Chief Executive by midday on 2 April 2019 at: ceo@rcoa.ac.uk for consideration at the April Council meeting.

A full AGM agenda will be available online the month before the meeting.

This AGM takes place as part of Anaesthesia 2019: The International Meeting of the RCoA. If you are not attending Anaesthesia 2019 and wish to attend the AGM only please email: ceo@rcoa.ac.uk

The year has already started at pace with January being a very busy month for the College. If you have any comments on the issues highlighted in this e-newsletter or would like to express your views on any other matters, I would like to hear from you. Please contact me via presidentnews@rcoa.ac.uk

Professor Ravi Mahajan
President