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This article looks at why the NHS needs international medical graduates (IMGs) and why we need to do better at integrating them into the workforce to maximise their contribution.

The General Medical Council’s Workforce report 2023 emphasises that the current reliance of the NHS on IMGs will continue in the future, despite an expansion of medical school places. The GMC predicts that almost a third of all doctors will be IMGs by 2036. It declares that the ‘integration and retention….must be improved’ and describes as essential that these colleagues are ‘welcomed into supportive teams’.

The way we welcome our international colleagues not only determines the extent to which they can contribute safely to the service, but also how easy it is to recruit and retain them. Our attitude should include a willingness to learn from their previous expertise and their ability to look at our services with fresh eyes.

Find out the latest appointments approved, and with sadness we record the deaths of some of our fellows. 

As the season of spring gently unfolds while I write this here in London, there is a sense of renewed fervour for times to come. I have the pleasure of celebrating two ‘New Years’ annually, a uniqueness which I have always appreciated for one reason – however the Gregorian new year starts, I have another to bring optimism, since once again find myself looking ahead to Tamil New Year on 14 April – Puthandu Vazthukal to all those celebrating this.

New chapters of professional life transitioning from one season to another is the subject of an article by Dr Lauren Elliott and Dr Nipun Agarwal, who eloquently detail the range of experiences that come towards the end of training – the consideration of location, colleagues and job plans blends excitement with an understandable anxiety. For those wanting to understand more about navigating this juncture in a career in anaesthesia, I wholeheartedly recommend the College’s Preparing for CCT and beyond podcast series as a supplement to the piece in this edition of the Bulletin.

Anaesthetists in training, whatever route they are taking, are the future of our specialty. This is a guiding principle of the College and it cuts across all aspects of our work.

I have always been incredibly impressed by the professionalism, compassion, skill and knowledge of the anaesthetists in training I work with and, as a prospective service user, I can see that the future is bright but that we need to play our part by supporting you to realise that promise.

I hear many positive things from anaesthetists in training, ranging from what you love about the job, to your well-deserved pride in your achievements and your commitment to supporting your patients and colleagues. But I also hear the negative aspects. I hear you when you tell me about training interrupted by the pandemic and the unaddressed trauma from that time. Or how your life and career have been impacted by frequent rotations, exam pressures or difficulty securing a higher training place.

Credential

Pain Medicine has now reached a milestone, and for the first time ever doctors trained in specialist pain medicine will be able to have this recognised by the GMC. The credential curriculum is now approved by the GMC and has been developed to take into account the different specialty backgrounds that doctors may come from, providing detailed information for both trainers and trainees alike. Credentialing will be integrated into the CCT curriculum for anaesthetics but will also open the route of training in other specialties.

Although many ICM doctors-in-training (DiTs) are now either training in ICM alone or with another partner specialty, just under half of our future ICM workforce are working towards a dual CCT with anaesthesia. 

Furthermore, many intensive care units around the UK rely on the knowledge, skills and experience brought by our anaesthetic colleagues in order to provide high-quality, patient-focused care. 

Consequently, anaesthetists will continue to hold a critical role in training the intensivists of the future.

These colleagues are easily recognised and often appreciated but, with the merry-go-round of training and rotational placements, attaining formal acknowledgement of their work can be overlooked. 

We recently took steps to nominate our College tutor and were delighted when he received a President’s Commendation from our College.

Several years ago, Dr Minich took over the school-wide final FRCA teaching programme. With his dedication and blindingly structured approach, it quickly became clear that we were fortunate to have an excellent educator in our midst. To say we all benefited from the provision of exam-practice resources and Dr Minich’s efforts coordinating hours of SOE practice feels like an understatement; it simply does not portray the level of help and support Dr Minich provided to the trainee body preparing for the exams.

It’s a sad truth that necessary change sometimes only comes in the aftermath of something going terribly wrong.

When I see a family that has suffered a tragedy calling for change – and it often seems to be a family campaign that makes the difference – I find myself in awe of their courage. Stephen Lawrence’s family working for a more equitable society, Molly Russell’s family calling for greater online safety and support for young people, Natasha Ednan-Laperouse’s family campaigning for better food labelling to protect allergies. I also wish that they’d never had to find themselves in that position.

It's also associated with other risk factors for poor outcomes, including multimorbidity, sarcopenia and disability. Despite the prevalence of these conditions, current perioperative pathways are not always tailored to high-risk, older surgical patients, resulting in unacceptable variation in access to and quality of care across the UK. 

Comprehensive geriatric assessment (CGA) can be used to assess and optimise frailty, multimorbidity and other age-related syndromes, reducing postoperative morbidity and mortality with proven cost-effectiveness. Implementing CGA-based perioperative services is therefore key in delivering high-quality and cost-effective care of older people undergoing surgery.