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A warm welcome to our new HRSC fellows.

If there is one thing we have learnt recently, it is to make sure we engage with you, our members. We need your valuable experience and views to shape the future of the College.

How the College is run for patients, and on behalf of its members

You may remember that back in February we took a single proposal regarding governance of the College to an Extraordinary General Meeting (EGM), asking members to back a package of measures to change the governance of the College and bring us in line with the laws which govern us in our legal status as a charity.

This proposal, while receiving the majority of votes, did not get the support of the two-thirds of attendees needed to pass it. Listening to feedback after the event, we learnt that members had not felt sufficiently involved in the drawing-up of proposals and that including all the proposals in a single vote was complicated.

At the time of writing this article we can be fairly confident that we have left the worst of the pandemic behind us. However, the NHS now faces the challenge of tackling spiralling waiting times for elective surgery. Now, more than ever, it is critical that patients (especially the most complex cases) receive, wherever possible, a comprehensive preoperative assessment.

This should include information to help them prepare for their procedure, understand the risks and, through shared decision-making discussions with their healthcare team, achieve the best possible outcomes.

Despite the disruption caused by the pandemic, the College’s Patient Information Group has continued to update existing resources and produce new ones to support patients and NHS colleagues through this difficult time. We remain committed to providing evidence-based, high-quality patient information resources, and we are delighted that we have been recertified through the Patient Information Forum Trusted Information Creator Kitemark (PIF TICK) for the third year in a row.

The GMC states that ‘credentials will bring assured training and regulatory oversight to areas where consistent clinical standards, recognised across the UK, are necessary for better patient care. They will support areas of practice where patients are at risk due to workforce gaps…’

In 2018, the Faculty of Pain Medicine applied to the GMC to be one of the first five pilot credentials on the basis that:

The ACSA scheme has the concept of continuous quality improvement at its heart, and departments who engage with the scheme have to demonstrate this in order to gain and retain accreditation.

One way we drive improvements is through our annual review of the ACSA standards, where we introduce new standards to focus departments’ energy on areas of growing importance to the specialty. New standards introduced in the 2022 edition cover responsible opioid stewardship, environmental sustainability, leadership within departments, and protecting time for clinical-governance activities. Through these new standards we will also be able to collect examples of good practice, which we then share with other departments via the ACSA portal.

We have recently been adding some important updates to the Revalidation section of the College website, and we would like to draw your attention to these.

The first update focuses on appraisal: a key component of revalidation is the annual appraisal during which doctors will discuss their supporting information to demonstrate that they are continuing to meet the principles and values set out in Good Medical Practice.¹

Authors

• ​Dr Jason Williams-James, RCoA Patients Voices Member, laycomm@rcoa.ac.uk
• Dr Eleanor Warwick, ST6 Anaesthetist and Perioperative Quality Improvement Programme (PQIP) Fellow

Jason Williams-James, RCoA Patients Voices member with personal experience of surgery and anaesthesia, discusses the importance of DrEaMing with Eleanor Warwick, ST6 Anaesthetist and Perioperative Quality Improvement Programme (PQIP) Fellow. They discuss why patients, the surgical multidisciplinary team (MDT), and organisations should be interested in this quality improvement metric.

It is safe to say that the laryngoscope is one of the most recognisable tools within anaesthesia. A piece of equipment that has evolved throughout the years to be used by airway specialists, the humble laryngoscope allows us to perform one of the fundamentals of anaesthesia: to intubate an airway.

The COVID-19 pandemic has accelerated a trend within anaesthesia – a move away from direct laryngoscopy (DL) towards video laryngoscopy (VL) as the primary method of intubating the airway.¹ Indeed, from recent conversations with my colleagues about their choice of airway tool, I’ve noted a general theme: DL is fast becoming an unfavoured and unfamiliar technique for management of a patient’s airway. This sentiment was reflected in the updated Difficult Airway Society (DAS) guidelines in 2015: laryngoscopy as part of Plan A can now comprise either DL or VL attempts.²

COVID-19 has dominated and it is easy to focus on the negatives, but, as an eternal optimist, I see many positives. I had three objectives when I became dean, the first of which was to promote our specialty.

I think everyone now knows what we do and, as a result, we have increased training numbers, expanded capacity, and embedded enhanced care. My second objective was to develop international partnerships. Despite travel being restricted, embracing digital platforms afforded us the opportunity to work with the College of Intensive Care Medicine of Australia and New Zealand and the Apollo group in India.

The 2021 SAS contract reform introduced a new strategic role to support the health and wellbeing of the SAS workforce, the ‘SAS Advocate’. This role provides an opportunity to challenge the status quo, and to potentially change the culture and expectations associated with being an SAS doctor.

Perhaps the most common barrier to meaningful change is culture. Individuals and organisations can both be guilty of assuming that the status quo always exists for a reason. However, there is perhaps no more dangerous justification for continuing to do something than that ‘we have always done it this way’.