Search

The GMC has recognised that the quality of clinical care and the safety of patients are crucially dependent on the quality of training provided within the health service, not only in relation to skills and knowledge but also in relation to professionalism. The GMC has recognised for many years that trainers must be trained, accredited, supported and quality-assured.

Specialty and Specialist (SASs) and locally employed doctors (LEDs) are the fastest growing part of our workforce, with numbers increased by 40% over the last five years. Projecting forward, they are expected to be the workforce’s largest group on the GMC register by 2030 (GMC workforce report 2022). Not only will the NHS depend heavily on this part of the workforce to provide services to patients, but also to train future generations of doctors and other healthcare professionals.

The 2021 SAS contracts set a clear expectation that specialty doctors should get involved in non-clinical activities to develop their range of expertise as well as ensure their progress through the higher pay threshold. Varied and relevant non-clinical experience and activity is an essential requirement for appointment as a specialist. Our appraisal and revalidation system sets an expectation of all doctors, regardless of grade, to be active in quality improvement, and encourages teaching, leadership, management, research and innovation.

Twenty five per cent of trauma deaths are directly caused by injury to the thorax and, while a minority will require emergency surgery, up to eighty five per cent of chest injuries can be managed without the need for formal surgical intervention.¹ In these cases, rapid recognition and management of life-threatening conditions are key to successful resuscitation.

Thoracostomy (the creation of an artificial opening in the chest wall) is a procedure performed for decompression of the chest, usually by our pre-hospital, surgical or emergency medicine colleagues. It is also the first stage to placing a tube thoracostomy or ‘open’ chest drain. In the context of trauma, emergency lateral thoracostomy is indicated in the following circumstances:

• traumatic tension pneumothorax
• massive haemothorax
• traumatic cardiac arrest.

When emergency cases are booked, they must be able to access theatre in an appropriate time frame. Assessing the operational pressure on the emergency theatre is a complex calculation considerate of the number of cases booked, their acuity, and expected duration. 

The National Emergency Laparotomy Audit (NELA) uses a classification for surgical urgency based on the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) and Surviving Sepsis.¹

• 1: Immediate (<2 hours)
• 2a: Urgent (2–6 hours)
• 2b: Urgent (6–18 hours)
• 3: Expedited (>18 hours).

Dear Editor

With the start of 2024 we will each have set our own resolutions and goals for the year ahead, both personally and professionally. But to achieve these we will be relying on our healthcare system to do the same. The NHS Long Term Plan delivers many promising messages, but there appears to be an ever mounting number of constraints and challenges to overcome, too.

It goes without saying that a swift resolution to the pay dispute is essential to prevent any further distress for both staff and patients. With waiting lists spiralling out of control, the pressure on us to work harder and longer is very real. We need to collaborate effectively with non-clinicians and service users alike to come up with realistic solutions to curb the demand and supply imbalance. In the meantime everybody needs to remain proactive in taking simple measures to improve our daily working conditions and ensure we feel valued.

Have you missed a Bulletin issue or perhaps you’d like to re-read a past issue? Our full selection of back digital issues has you covered and will keep you up-to-date and informed on what’s happening in our specialty. We hope you continue enjoying your membership magazine.

Understandably, well-being means something different to all of us, but does it have more awareness and recognition than 20 years ago?

Dr Marie Nixon, Consultant Anaesthetist and Dr Thom O'Dell, ST7 Trainee discuss their experiences of wellbeing and what it means to them. 

Dr Richard Knight looks back at the turbulent 1970s – a decade well known as a time of crisis both economically and politically.

What comes to mind when you think of the 1970s? Flared Jeans, David Bowie, Dallas? Well, it wasn’t all Happy Days (forgive the pun) – this decade was also very much about skyrocketing inflation and unemployment, the Winter of Discontent, strikes, power cuts, and states of emergency.

Welcome to the Winter 2024 issue of the Bulletin. I am always filled with renewed enthusiasm at the start of a new calendar year, in part as the festive season in South Asian cultures starts in late October with the celebration of Diwali and then… well… continues! 

This is not to take away from the fact that winter within the UK National Health Service (NHS) is extremely challenging; some may say that this year, especially, is akin to walking a tight rope.

I’d like to wish you all a very happy New Year. I realise that January is a very challenging time in the NHS, with winter pressures compounded by ongoing staff shortages and sickness. And in looking ahead to some of the College’s priorities for 2024, I’d like to highlight some of the work we're doing to try to address these issues.  

The urgent need for more doctors to be able to train as anaesthetists is always the first thing I raise in conversations I have with the government, NHS England and other decision makers around the country. Last month I wrote to the new Secretary of State for Health and Social Care to set out the need to address the current shortage of anaesthestists and to outline the impact this is having on the elective care backlog, among other things. 

In the last year we have secured some incremental improvements on this front, but there is a long way to go, and we will do all we can to maintain momentum in the year ahead.

New Year is always a time of reflection, particularly as for me it is also the anniversary of my joining as CEO at the College. That is now four years ago, and I find myself looking back on the challenges the College has faced over that time, the changes that have been made and the achievements of our volunteers, elected leaders and staff team.

It has been a remarkable four years. Within a couple of months of my appointment COVID-19 hit. The challenges for our membership were enormous. The specialty was at the frontline, and anaesthetists and intensivists had to learn and adapt at pace to provide the best possible care for the patients who were most seriously ill under very challenging circumstances. The College too had to urgently adapt.

Exams, which had always been held in person, were rapidly moved to virtual platforms. It was a steep learning curve for so many of us and it didn’t all go as smoothly as we wanted, due in large part to the pressures put on so many by the pandemic. Nevertheless, I was proud of the College, its examiners and the exams team, who, along with candidates, contributed fully to the subsequent independent review of our assessment process. The review was published earlier this year. Lessons were learnt and changes have been made that have seen us continue to welcome almost 5,000 candidates per year to the College for their exams.