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Two months ago, we published an updated UK State of the Nation report, providing a comprehensive overview of the anaesthetic workforce, retention challenges, and future projections. The NHS urgently needs more anaesthetists. 

Increasing demand – driven by factors such as an ageing and growing population – combined with an inadequate supply of anaesthetists due to insufficient training places and poor retention, has exacerbated the shortfall. This gap has grown from around 1,400 anaesthetists in 2020 to 1,900 in 2022 (15% below what is needed to meet demand).

We need to act on this and aim to build on progress from the last few years. Our first State of the Nation report, published in 2022, along with a wider programme of influencing work, helped secure government funding for an additional 70 ST4 anaesthetic training places each year from 2022 to 2024 in England. This helped to reduce the bottleneck between core and higher anaesthetic training, with the number of applications per place dropping from 2.67 in 2021 to 1.64 in 2024. In Wales, six new higher anaesthetic training places were granted in 2023; in Scotland, six new places were granted in 2024. However, many more are needed to address the workforce shortfall.

The Nuffield Department of Anaesthesia in Oxford is the largest clinical department in our trust. We are based across five different sites, with more than 200 anaesthetists. Our department has a strong history of engaging in national projects, including the National Audit Projects (NAPs). 

One component of the latest NAP (NAP7) was a baseline survey of all anaesthetists in the UK. We identified that tracking and responding to more than 200 survey participants posed a significant challenge. In this article, we seek to describe how technological solutions can aid participation, compliance tracking, and survey administration.

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.

I write this month’s President’s View in the week following the death of Her Majesty Queen Elizabeth. On behalf of the College, I extend our condolences to the Royal Family. I hope that the expression of admiration and love felt for the Queen worldwide has been of some comfort to them. Her Royal Highness the Princess Royal has long been a dedicated and supportive patron of the Royal College of Anaesthetists, and our thoughts are with her at this time of personal sadness, with which many of us can empathise.

My first President’s View features edited highlights from a podcast I recorded with fellow Council Member and Bulletin Editor Dr Ramai Santhirapala. We discussed several topics including questions submitted by our membership engagement panel. 

You can listen to the full conversation on our Anaesthesia on Air podcast. I also recommend that you take a moment to watch or read the CEO update, in which Jono Brüün provides an update on recent decisions about Churchill House and finding a new home for the College.

Dear Editor

Arterial cannulation is a frequent practice that comes with its own set of risks and complications. We would like to report an incident that occurred in an obstetric HDU involving bleeding from an arterial catheter that could have led to severe complications.

A radial arterial cannula was inserted due to development of postpartum haemorrhage, cardiovascular instability and the need for massive blood transfusion. While the patient was monitored in HDU, an emergency call went out alerting the team about an arterial bleed possibly due to the patient’s positioning. The midwife present in the room applied manual pressure to the bleeding site with gauze. The anaesthetist on call asked what happened while taking over the manual pressure and explained to the patient that the insertion site needed to be inspected.

Questions around financial viability, impact on relationships with the ‘parent’ College, and loss of corporate strength are all concerns I’ve heard following FICM’s statement. 

You might be interested to know that they were also the exact ones expressed at the time the Faculty of Anaesthetists went through their own journey.¹ The journey leading to the formation of the RCoA was not without setbacks and differences of opinion. Faculty board are cognisant of that history, and so are mindful that for our part discussions leading up to our separation are based in a friendly and constructive spirit.

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.

A novice anaesthetist will face a range of new environments, technical skills, knowledge, people and equipment. It is easy to feel that ‘the glass is starting to overflow’. However, an understanding of cognitive load theory can be used to optimise complex learning tasks. 

It’s beneficial for all anaesthetists to manage cognitive load at work, but also for anaesthetists to implement these principles when teaching in theatre.

Cognitive load theory has been developed from the Modal model of memory described by Atkinson and Shiffrin. This details how information is received, encoded, stored and retrieved during learning (see An illustration of the Modal model of memory by Dr Thomas Walters). Incoming information is consciously held and processed within working memory, before being encoded into long-term memory. Working memory has a limited capacity, and information within it is transient and forgettable. Once encoded into long-term memory, information is organised in schema, with a seemingly unlimited capacity. Working memory can hold five to nine pieces of information at a time. However, if required to process this information, capacity is significantly reduced.