President's News, May 2019

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I am delighted to let you know that on Monday we launched the Centre for Perioperative Care (CPOC). The launch of CPOC got our annual flagship conference Anaesthesia 2019 off to a great start and what followed was a very productive and informative three days. Many thanks to all involved.

CPOC is a new major collaborative initiative led by our College - a cross-specialty centre dedicated to the promotion, advancement and development of perioperative care. Our aim is for CPOC to be truly multi-disciplinary. You will note that in its title we refer to ‘care’ rather than ‘medicine’. We strongly believe that it is only by working with all healthcare professionals in the perioperative pathway, that the seamless journey for the care of patients from the moment that surgery is contemplated through to their full recovery can this be achieved.

Our CPOC partners include the Royal College of Surgeons of England, the Royal College of Physicians of London, the Royal College of Nursing, the Royal College of General Practitioners and the Association of Anaesthetists. We also have had excellent engagement and constructive input from NHS England, equivalent bodies in the devolved nations and patient representative organisations. The outputs of CPOC fit squarely with the aims of the NHS England’s Long Term Plan and the College will continue to work alongside NHS England to ensure that the optimisation of perioperative care is positioned as a practical delivery mechanism for the priorities set out in the plan. We will also explore how we can work with the devolved nations’ health initiatives such as Realistic Medicine in Scotland and Prudent Healthcare in Wales.

The UK is leading in this area and we should continue to build on this momentum, as we strongly believe it is the right thing to do for patients. Whilst our College will oversee the governance and administration of CPOC, we recognise that, like the perioperative pathway, it can only be a true success when the entire perioperative clinical spectrum is involved.

This was reflected in our panel discussion at Anaesthesia 2019 where we discussed the vision for perioperative care. We were pleased to have in attendance RCoA Council member Professor Mike Grocott, NHS England and NHS improvement’s Celia Ingham Clark, the Royal College of Physicians of London’s David Oliver, anaesthetist and founder of EBPOM Professor Monty Mythen and Professor Denny Levett from the University of Southampton. I am pleased this level of engagement, collaboration and endorsement from senior figures and organisations has set a positive tone for the future work of CPOC.

Good perioperative care should improve a patient’s experience of care, including satisfaction with and quality of care. Perioperative pathways should lead to the improved health of populations, including returning home or to work and quality of life, and reduce the per capita cost of healthcare through improving value. The establishment of CPOC will allow us as a specialty and as perioperative physicians to drive the improvements needed in this area for the 10 million patients who undergo surgery every year in the UK. Surgery is a ‘teachable moment’ for patients where lasting positive lifestyle changes, such as smoking cessation, weight management, or psychological support services can be made. Helping patients take control of their health in this way is an empowering way for them to prepare for surgery and improve their risk of complications afterwards.

The launch of the Centre for Perioperative Care marks an important milestone in the evolution of this vision. I pay tribute to the hard work of my predecessors Dr Liam Brennan and Dr JP van Besouw who both played pivotal roles in helping bring CPOC to fruition.

As we progress with CPOC, a new and bespoke CPOC web presence will be developed over the coming months. More details on this will be included in subsequent newsletters. In the meantime, please follow us on Twitter at @CPOC_News and email cpoc@rcoa.ac.uk with any queries, questions or suggestions that you may have.

RCoA President and Vice-President Elections

Following the completion of our 2019-2020 elections for President and Vice Presidents Dr Fiona Donald (Southmead Hospital Bristol) and Professor Mike Grocott (University Hospital Southampton NHS Foundation Trust) have both been elected Vice-Presidents for a first year with effect from September 2019.

I am honoured to be re-elected for a second year as your College President and look forward to working with both Mike and Fiona over the next year. I would also like to thank outgoing Vice-Presidents Dr Janice Fazackerley and Dr Simon Fletcher for their unwavering support to me in their first year of my presidency.

Finally, I would also like to recognise the College staff who continue to support those acting in officer roles at the College, as well as our members at large.

The Cappuccini Test

A highlight of Anaesthesia 2019 was the launch of the Cappuccini Test, devised by College Council member Dr David Bogod. The Cappuccini Test was named after Frances Cappuccini who died of anaesthetic complications in 2012. David developed a test of the robustness of consultant supervision of anaesthetists in training and junior SAS anaesthetists, the lack of which was one of the key factors leading to the tragic outcome in the Cappuccini case.

The Cappuccini Test comprises six questions:

To the anaesthetist in training or junior SAS doctor working alone:

  • who is currently supervising you?
  • how do you get hold of them?

The answer to question two is then used to try to contact the supervisor:

  • was contact successful?

The supervisor is then asked:

  • who are you supervising?
  • what are they doing at the moment? (for anaesthesia, what surgical specialty are they working with?)
  • if they needed your help, would you be able to attend?

The Cappuccini Test is simple, suitable for those training to carry out as part of their audit roles. It is effective, enabling quick and easy detection of communication or identification problems. It is powerful, going straight to the heart of what is certainly an important safety issue in the NHS. It is generalisable, easily adapted for roll-out to other specialties. It is measurable, giving easy-to-understand results which can be re-tested to show the impact of interventions. It is robust, testing the supervisory pathway at all points. It is non-demanding, easily achievable as part of a routine audit programme. It is cost-effective, the test itself and most interventions being at or close to cost-neutral. It is educational, carrying within it an important patient story with safety as its key. And, finally, it is empowering, giving trainees and theatre staff a voice and a role in safety improvement.

It is my hope that this important test will be applied and widely adopted in hospitals to help improve the safety of patients.

Infographic for patients is embraced by the anaesthetic community

The College has published an infographic for patients – Common events and risks in anaesthesia.

Illustrating risk with an infographic is a helpful way for patients of all reading abilities to understand complex information. The risks associated with anaesthesia are generally poorly understood by many patients – equating this to occurrence in a group of people as we have done with the risk scale in this resource can be very helpful.

Discussion of the common events and risks associated with an anaesthetic is an essential element of informed consent. The infographic is a summary of the common events and risks that healthy adult patients of normal weight face when having a general anaesthetic for routine surgery. Patients can read the infographic before they meet their anaesthetist in order to be better informed when they discuss their anaesthetic requirements and their individual risks.

Each patient may have significant additional risks depending on their health and type of surgery - this resource can help open up discussions about specific risks and we are pleased that the specialty has welcomed it.

The infographic has proven extremely popular across the College’s social media platforms and the College is pleased that it has been so well received by the specialty for being a useful and informative tool.

For further details on specific risks, patients can be signposted to the risk leaflets series on the patient information area of the College website.

Lifelong Learning: don’t forget to download your e-Portfolio

The final anaesthetists in training will be moved over to the Lifelong Learning platform this August. Therefore, 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.

New collaborative grant for UK and Ireland research

The British Journal of Anaesthesia (BJA) and the College of Anaesthesiologists of Ireland (CAI) wish to draw attention to a new Collaborative Research Grant they will be offering jointly as part of the National Institute of Academic Anaesthesia’s (NIAA) 2019 Grants Round 2.

This award of up to €100K per year will be made available to support and stimulate collaboration between investigators in the Republic of Ireland with investigators in the UK (including Northern Ireland) to conduct excellent research in anaesthesiology, critical care and pain medicine. The BJA/CAI Collaborative Research Grant will be offered initially in 2019 using NIAA Grants Round 2. The call will be published in July 2019 with a closing date to applicants of 20 September and a Grants Committee date on 4 December 2019.

Full details available here - start preparing your application now!

SNAP wants ideas that pop!

There is still time for you to submit a topic proposal for the next Sprint National Anaesthesia Project, SNAP3! SNAPs are short observational clinical research studies that aim to recruit a large number of patients from as many NHS hospitals as possible in a short timeframe. The latest RCoA blog, which comes from our Head of Research, James Goodwin, discusses the criteria for and best way to approach your submissions.

Visit the HSRC website and submit a proposal to hsrc@rcoa.ac.uk by Friday 31 May 2019.

Are you interested in the Children’s Acute Surgical Abdomen Programme?

CASAP, the HSRC’s first paediatric initiative, will soon begin data collection. CASAP aims is to characterise the type and quality of care being delivered to children undergoing urgent/emergency abdominal surgery (including appendectomy).

If you think your hospital could usefully contribute, please look at our list of participating sites and, if you are not represented, contact us.

College endorses new report to help uphold the safe delivery of paediatric ENT surgery in the UK

The College worked with ENT UK, the British Association for Paediatric Otolaryngology and the Association of Paediatric Anaesthetists of Great Britain to set up a working group to examine the need for onward referral or transfer and establish a National Strategy for Paediatric ear, nose and throat (ENT) Surgery in the UK. The College has just endorsed the working group’s report outlining a national strategy for the safe delivery of Paediatric ENT surgery in the UK and recommend that secondary centres continue to deliver paediatric ENT surgery where possible. The hope is that the recommendations of this report will support them in doing this and in continuing to provide a high quality and safe service. The College also recognises this by increasing anaesthesia training in the new curriculum as it shows our specialty’s leadership. We look forward to working with other surgical specialties to draw up similar guidance.

In recent years there has been a significant change in UK practice of Paediatric ENT surgery with many more children being referred to tertiary centres. This strategy has a number of unintended consequences.  Patients and families are travelling further for treatment, incurring both social and financial cost. Fewer procedures are being performed in secondary care centres, which can result in reduced confidence in dealing with both elective and emergency paediatric cases. Tertiary centres are now commonly being faced with a situation where they have no beds to accept specialist referrals as emergencies. Waiting lists are increasing in tertiary centres.

Anaesthesia 2020 – register now and save 10 per cent

After Anaesthesia 2019 sold out with over 400 delegates across an extended three day programme, we are pleased to share details about next year’s Anaesthesia 2020. The conference will be held outside of London for the first time at the iconic home of Manchester United football club – Old Trafford in Manchester on the 18 to 20 May 2020.

Register now for the conference and you will save 10 per cent with our early bird discount for the first 100 places. We will keep you posted on speakers as they are added to the programme, but don’t delay in booking your place.

Still time to register for Updates in Anaesthesia, Critical Care and Pain Management 17–19 June 2019

The three day Updates in anaesthesia event in June has a packed programme of interesting speakers who will help you understand the latest developments in our specialty, including:

  • Dr Michael Swart - Choosing wisely: just because we can, does it mean we should?
  • Professor Mike Reed - Scaling up for safety: the lessons learnt from a hip fracture quality improvement programme
  • Dr Rohit Juneja - TIVA
  • Dr Nuala Lucas – obstetrics

Learn from today’s thought leaders on how best to combat some of the key challenges you may face in your anaesthetic practice. Connect with, and question, specialty experts, discuss your experiences with peers, and bring back new ideas that will improve your own practice.

College Update events sell out fast so book your place now.

Don’t miss our new live Regional Anaesthesia Masterclass – 4 June 2019

Few places remain to watch live interactive demonstrations of how to perform chest blocks and shoulder surgery at our first Regional Anaesthesia Masterclass. The event will include the pros and cons of using regional anaesthesia safely. The event will provide an in-depth look at the latest research as well as looking back at past regional anaesthesia in order to learn lessons today.

Time will be given to network with other anaesthetists about some of the hot topics around regional anaesthesia, including optimising patient access, attitudes to blocks and the pros of giving a general anaesthetic. You will come away from the day better informed on the latest thinking behind regional anaesthesia and a renewed confidence about achieving positive patient outcomes whilst using it.

This event is filling up fast so book your place on the 4 June Regional Anaesthesia Masterclass now.

CPD in the North East

Join us in Hull for a day of world-class anaesthetic learning to aid your revalidation and improve your patient outcomes – view the full programme and hear about the following topics as well as meeting other like-minded anaesthetists:

  • dealing with difficult patients
  • processed EEG monitoring
  • enhanced maternal care
  • what’s new in regional anaesthesia?

Apply to join the Women in Intensive Care Medicine Emerging Leadership (WICMEL) Programme

The Faculty of Intensive Care Medicine (FICM) is excited to launch the Women in Intensive Care Medicine (WICM) Emerging Leadership Programme. A brand new initiative to develop and hone leadership skills for female consultant and staff/associate specialist grade doctors working in the specialty. To find out more and how to apply please see the FICM website.

In 2016, the Women in Intensive Care Medicine subcommittee was formed with the aim of addressing the gender imbalance to secure diversity of our critical care teams. One long-term goal is to reach a point where leadership composition at the Faculty represents membership composition.

The Women in Intensive Care Medicine Emerging Leadership (WICMEL) Programme is a new initiative aimed at female consultant and staff/associate specialist grade doctors (applicants must be a fellow, associate fellow or member of the Faculty of Intensive Care Medicine.)

The programme includes mentoring from senior members of the Faculty alongside an Open University short course (fully subsidised by FICM) on developing a leadership style. The aim of the programme is to allow the WICMEL Fellows to engage with Faculty activities and in doing so, enhance their own leadership skills, with the aim of becoming involved in leadership positions within FICM, or their own organisations.

Applications close Midnight 15 June 2019.

NHS England & NHS Improvement National Specialty Advisor for Perioperative Care role

NHS England and NHS Improvement are inviting applications for a National Specialty Advisor for Perioperative Care. The closing date for applications is 4 June.

NHS England and NHS Improvement came together on 1 April 2019 as a new single organisation. The NHS Long Term Plan focuses on delivering integrated care to patients at the local level and NHS England and NHS Improvement felt that coming together would best deliver this as a single integrated organisation.

NHS England and NHS Improvement are now seeking to recruit highly effective National Specialty Advisers to support the National Clinical Directors and Medical Directors to provide clinical advice and leadership in a variety of areas – one of which is perioperative care.

GMC Welcomed and valued guide

The GMC has published their updated Welcomed and valued guide, which provides advice for educators on how to support disabled learners, and those with long term health conditions. It is important for disabled doctors and students to have a more accessible and supportive training experience, so they can meet the required learning outcomes and have fulfilling and sustained careers in medicine. The guidance has been developed to help do this and the College fully supports this guidance.

The College Shop

Led by our commitment to environmental responsibility, we are pleased to announce that our College Shop now stocks items such as eco-friendly College branded travel cups and water bottles.

As well as being useful and attractive items, these are a great way to show your involvement with, and commitment to, the College and the specialty.

Alongside our traditional offers, the College Shop now also includes: a compact umbrella that opens and closes at the touch of a button and a useful shopping trolley key ring token always at hand when a £1 coin isn’t.

If you wish to make a purchase please visit the website.

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