President's News, January 2020

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I hope everyone had a peaceful festive season and good start to the new decade. The College went into the New Year with a vital project. At the start of January, the 2020 Medical Workforce Census was sent to all National Clinical Directors across the UK to complete, with a request for them to provide up-to-date data by 6 February. Complete data is essential for monitoring evolving gaps, enabling the College to make official bodies aware of the anaesthetic workforce crisis and ensuring our workforce position is based on robust information. The data helps identify key issues, and will also form the basis of the College’s workforce strategy later in 2020.

In 2015, the date of the last workforce census, the College received an incredible 100 per cent response rate, testifying the willingness and professionalism of the anaesthetic community and the recognition of the importance of the census. The College plays an important role in shaping healthcare policy and practice by campaigning for change and working collaboratively with key partners and national government. Reliable and up-to-date data ensures what we say is evidence-led, authoritative and independent. Without it we have no credible voice to form and argue our workforce position during a period of increasing challenges in the NHS.

I strongly encourage all College fellows and members to get involved and engage with their clinical directors and College tutors to complete the census and raise awareness of this important task. The census closes in early February and we urge every single anaesthetic department to contribute.

Welcoming our new CEO

This month we welcome our new Chief Executive Officer, Jonathan Brüün.

Jonathan (or ‘Jono’) joined us from the British Pharmacological Society, where he was CEO since 2012. Jono brings a depth of knowledge in developing and delivering organisational vision, mission and strategy in a healthcare setting. I know that College staff, Council and Senior Management, are all looking forward to working with Jono and marking the shift into a new decade with a fresh look on strategic leadership.

You can find out more about our new CEO in his welcoming blog.

I would also like to pay tribute to Sharon Drake, who did a fantastic job leading the College as Interim CEO after the previous CEO, Tom Grinyer, moved to the BMA in mid-July last year. Sharon and the Senior Management team worked hard to keep the College moving forward and delivering our goals at a time of considerable change.

Anaesthetic CCT curriculum 2020 update

The College is pleased to share the latest Anaesthetic CCT curriculum 2020 update.

The proposed 2020 Anaesthetic CCT curriculum is currently under review by the General Medical Council (GMC). Once GMC approval has been obtained, it is planned that the new curriculum be implemented from August 2021 with a two-year transition period.

Transition will take place at the following times for anaesthetists in training entering each level of training as below in August 2021:

  • new CT1: 2020 curriculum from start of training
  • CT2: transition to 2020 curriculum from entry to CT2
  • CT3: trainees completing CT2 from August 2021 onwards will continue in an additional third year to complete Core Training on the 2020 curriculum
  • ST4: will complete intermediate training then transition to 2020 curriculum at ST5
  • ST5: transition to 2020 curriculum on entry to ST5
  • ST6/7: remain on 2010 curriculum to CCT (up to two years).

Less than full time trainees and those on out of programme training, maternity or paternity leave will need an individualised plan to ensure they transition to the 2020 curriculum by the deadline of August 2023.

Trainees rotating in February will transition in the same way, but six months later.

The College has requested that trainees who have completed CT2 and are not in a training post at the time of the transition will be able to access 12 month posts to complete Stage 1 of the 2020 curriculum.

For further details read the full update including a list of FAQs.

Response to the GMC survey of Specialty and Associate Specialist, and Locally Employed Doctors

The College welcomes the publication of the GMC’s first ever survey of Specialty and Associate Specialist (SAS) and locally employed (LE) doctors.

The survey showed that many doctors see SAS and LE roles as positive choices that provide fulfilling careers. Despite this the results found that 30 per cent of SAS doctors and 23 per cent of their LE counterparts had been bullied, undermined or harassed at work in the last year, either by colleagues or by patients and their families, and almost half of LE doctors and 41 per cent of SAS doctors had difficulties accessing continuing professional development opportunities.

The College council has two of its members represented by SAS doctors; these doctors are fully integrated in every aspect of the College business.

MBRRACE-UK The 2019 report on maternal mortality in the UK: highlights and messages for anaesthetists

We welcome the release of the latest report of the longest running medical audit in the world: that of maternal mortality in the UK.

Several of the top level recommendations have direct relevance for anaesthetists, such as using focussed point of care ultrasound examinations, eg FAST, ECHO, in the management of maternal collapse.

The report identified a number of improvements, between 2015–2017 there were marginally fewer deaths (209) compared with 2014–2016. There were also fewer women who died from haemorrhage and amniotic fluid embolism. This is encouraging for our profession who are almost always involved in managing these cases.

Non-direct causes continue to outnumber direct ones with cardiac disease remaining the leading cause and the report emphasises the importance of prompt perimortem caesarean section in the case of cardiac arrest. Sick women should be cared for by midwives and nurses trained to deliver enhanced and level two care as required.  The pathway of escalation to critical care needs to be clearly defined and critical care outreach services should be available to women.

Although 44 per cent of women were judged to have had good care, in 29 per cent assessors concluded that women might have survived with different care. A sobering reminder that safety in childbirth needs to be at the top of the maternity care agenda.

Many common themes among the cases remain unchanged from previous reports: the need for earlier recognition of serious conditions, (despite the almost universal use of early warning score charts) and a tendency to ‘normalise the abnormal’. The recommendation for earlier and greater senior involvement in cases reflect the gradual change towards a consultant delivered service in obstetrics.

10 years of FICM

The Faculty of Intensive Care Medicine (FICM) is 10 this year. To celebrate FICM’s first decade, the Faculty has many exciting projects on the horizon. FICM has already introduced an ICM Trainer Award for excellent training in Critical Care as the first of the FICM10 initiatives, which was won by Dr Andy Campbell.

Throughout 2020 there will be essay prizes, new work streams, new merchandise and further promotion of the specialty throughout the UK and around the globe. Keep an eye out for #FICM10 on twitter and the website for more updates throughout the year.

Response to Academy of Medical Sciences report on research

We welcome the Academy of Medical Sciences’ report Transforming health through innovation: Integrating the NHS and academia. Many of the issues raised resonate with anaesthesia, perioperative and pain medicine, in particular we have seen a reduction in clinical academic appointments of anaesthetists by UK universities, and know the challenges with combining postgraduate clinical training with research training within existing structures. Recommendations including the call for a pilot scheme for NHS consultants to be funded to deliver research within their job plans are essential if we are going to safeguard research. 

The College has several nationally coordinated and novel approaches to clinical research which provide value for taxpayer money and ensure wide participation of NHS trusts including the National Institute of Academic Anaesthesia (NIAA). Bringing together all relevant stakeholders across anaesthesia the NIAA has enabled the creation of a Health Services Research Centre at the College which has supported the delivery of several important research programmes  including the Sprint National Anaesthesia Projects, the Perioperative Quality Improvement Programme  and the HQIP funded National Emergency Laparotomy Audit.

Anaesthetists in training have also taken matters into their own hands, with the development of the national Research and Audit Confederation of Trainees and regional trainee research networks covering the whole of the UK. The development of the NIAA Perioperative Medicine Clinical Trials Network will further support our specialty’s ambitions to develop new lead researchers, while supporting clinician engagement of all our colleagues.

The continuation and expansion of these efforts is dependent on the contribution of NHS clinicians. With an increasing understanding of fatigue and burnout in NHS staff, it is clear that time must be provided within job plans to support sustained engagement.

Research and Quality Improvement

Fifth NELA Patient Report Released

I was delighted to see the release of the Fifth Patient Report of the National Emergency Laparotomy Audit just before Christmas. It is encouraging to see the reduction in 30-day mortality rates and length of hospital stay. However, we have now reached the stage where organisational change is required to see further improvements in areas like sepsis and out of hours care. 

The report was featured in The Independent and the British Medical Journal.  As ever, a huge thank you from the College and myself to the army of local collaborators and data submitters who are the beating heart of NELA. 

British Oxygen Company Chair of Anaesthesia

The National Institute of Academic Anaesthesia (NIAA) is now accepting applications for the British Oxygen Company (BOC) Chair of Anaesthesia grant from clinicians and non-clinicians who are working towards a senior fellowship or developing a credible application for a Chair in Anaesthesia (or related specialties) within the next five years. A grant of £80,000 per year (£320,000 across four years) is available. Apply here by 5pm on Friday 31 January 2020.

The NIAA is also still accepting applications for the John Snow Intercalated Awards 2020.

POMCTN Chief Investigator Scheme open

The Perioperative Medicine Clinical Trials Network (POMCTN) has opened its Chief Investigator Scheme for another round of recruitment.  The CI Scheme provides training and mentor-ship for a small number of talented individuals who wish to lead their own perioperative clinical trials. Apply by 9am Monday 27 January 2020.

SNAP3 Chief Investigator Proposals

The Health Services Research Centre (HSRC) is still accepting proposals for Chief Investigators for the 3rd Sprint National Anaesthesia Project (SNAP3). If you would like to run the next SNAP, please read the full Commissioning Brief and submit your proposal by 5pm Friday 7 February 2020.

Upcoming events

Anaesthesia 2020, Manchester, 18–20 May 2020

The deadline for the early bird discount is fast approaching!

Use code ‘Early10’ to receive 10 per cent discount when registering, offer ends on Friday 31 January 2020.

The programme has a variety of clinical anaesthesia topics, including an exciting session on the new proton beam therapy with colleagues from the Christie giving a physicist and anaesthetics view on what this means for the future.

View the full programme online now.

Anaesthetic updates, Nottingham, 31 January 2020

Don’t miss your chance to book for Anaesthetic updates in Nottingham. Dr Nagendra Prasad will lead a team of clinicians on an engaging and informative programme, exploring topics useful to your everyday practice as well as into the future.

Online registration will close on Wednesday 28 January at 5pm.

Patient safety in perioperative practice, London, 13 February 2020

Attend this event to understand the science of patient safety. We have an excellent line up of speakers who will provide a programme of different perspectives and approaches, coupled with collaboration, education and quality improvement programmes. We hope to inspire delegates to make safety the golden thread of patient care.

Leadership and Management: Personal Effectiveness, London, 19 March 2020

Join this event to learn how to perform to the best of your ability in your workplace, this event is ideal to develop the skills for you to have real impact as a leader.

At the end of the course, you will have:

  • gained insight into their own personal preferences, strengths and weaknesses
  • understand how they can improve or use their existing skills to increase their impact and effectiveness within their teams.

2020 Annual General Meeting

The College’s 2020 Annual General Meeting (AGM) will be held as follows:

Date: Monday 18 May 2020
Time: 12:30 (timing may be subject to change)
Venue: Old Trafford, Sir Matt Busby Way, Stretford, Manchester M16 0QG

Any motions for the meeting’s agenda should be submitted to the Chief Executive by midday on 3 April 2020 to: ceo@rcoa.ac.uk. A full AGM agenda will be available online the month before the meeting.

This AGM takes place as part of Anaesthesia 2020. If you are not attending this conference and wish to attend the AGM only, please email ceo@rcoa.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