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Authors:

• Dr Hannah Headon, Medical Education Fellow, King’s College NHS Foundation Trust, Anaesthetics South East London
• Dr Christopher James, ST6 Anaesthetics, Guy’s and St Thomas’ NHS Foundation Trust
• Dr Kate Millar, ST4 Anaesthetics, Guy’s and St. Thomas’ NHS Foundation Trust
• Dr Joseph Lipton, Consultant Anaesthetist   Guy’s and St. Thomas’ NHS Foundation Trust

On 10 June 2022, the sun was shining and I was on my way to present at the RCoA’s College Tutors’ Meeting in Cardiff, feeling increasingly nervous and eager to share our hard work. 

However, my nerves were misplaced: the meeting was extremely friendly and our project, ‘The birth of the generic professional capabilities learning hub’, was well received – to the extent that it came second in the competition for the Singhota Family prize, awarded in memory of Dr Jasjot Singhota.

Authors:

• Dr Hamish McLure, Medical Director (Professional Standards and Workforce Development) and Consultant Anaesthetist, Leeds Teaching Hospitals NHS Trust
• Dr Natalie Drury, Consultant Anaesthetist and Anaesthesia Associate Lead, Leeds Teaching Hospitals NHS Trust

The pandemic has generated a staggering backlog, with more than 7 million patients waiting for care. In order to treat these patients in a timely way, we need to increase our work rate beyond pre-pandemic levels but with our current workforce and model of care, this will be difficult. 

Fatigue, burnout, repeated acute illnesses and a punitive tax system mean we have a fragile workforce with minimal capacity or interest in additional work. RCoA workforce data shows little to be optimistic about, with a projected gap of 11,000 anaesthetists by 2040. This demand cannot be met without a massive increase in training numbers. Given the pressures in virtually every other specialty, this is unlikely.

We hope you will find this information useful in helping all anaesthetic staff within your department access the educational supervision or mentorship they require.

Introduction

In addition to consultants and doctors in formal training, anaesthetic departments frequently contain SAS and Locally Employed Doctors. SAS doctors are employed on national SAS contracts, the current of which are ‘Specialty Doctor’ and ‘Specialist’. Locally employed doctors (LEDs) are employed on non-national Trust-derived contracts. LEDs have multiple titles including ‘Clinical Fellow’ and ‘Trust Doctor’. Medical Training Initiative (MTI) doctors are also commonly employed as LEDs and form part of this latter group. 

Within this combined cohort are doctors at all stages of their careers, with individual development needs. To maximise the potential of the existing anaesthetic workforce, it is imperative that these doctors are offered support to achieve their potential and reach their career goals. These goals may include broadening their role into non-clinical domains, (re)entering formal training, becoming consultants through the GMC Portfolio Pathway or becoming Specialists. 

In Scotland there stands a national gap in clinical governance which results in blind spots and potential risk to patients. This article explores why Scotland is missing out and what needs to be done next.

Our nation is ideally placed to perform and contribute to UK-wide audit. The population size, the uniform governance structure, and the infrastructure and expertise should lend themselves to a world-leading approach to clinical audit and outcomes.

Despite this, Scotland doesn’t participate in an important programme for ensuring standards and safety in anaesthesia in the UK. The Safe Anaesthesia Liaison Group (SALG) is a long-standing collaborative project between the Royal College of Anaesthestists (RCoA) and the Association of Anaesthetists. Established in 2008, it aims to provide a central repository for anaesthesia-related patient-safety incidents. SALG then analyses, prioritises and takes appropriate action on reported incidents.

Returning to work following a prolonged period out of training is daunting, whether that be due to parental leave, sick leave, carer’s leave or for Out-of-Programme time. 

Anaesthetists in training know all too well the stresses that come with frequently rotating between different hospitals and departments, with three- and six-monthly rotations being quite the norm in some deaneries.

Having a child is a life changing experience, and many would hope that their place of work remained constant throughout the beginnings of parenthood. Frequent job rotations with a diverse curriculum to work through means trainees are potentially carrying out their return to work in a new environment while juggling the stresses of childcare and pressures of getting back up-to-speed at work.

Mrs Shivalkar was a 78-year-old patient with debilitating co-morbidities scheduled for elective revision hip surgery at a stand-alone surgical unit without Level 2 or 3 care facilities. 

The surgical procedure was prolonged, and intraoperatively there was prolonged significant hypotension. In recovery this hypotension continued, but despite this the patient was discharged to the ward, where she sustained cardiac arrest. 

After delayed transfer to a facility with critical care, she was found to be in multiple organ failure with a profound metabolic acidosis, leading to a further cardiac arrest from which, tragically, she died.
The coroner, finding concerns regarding preoperative risk assessment and poor communication between the surgical team and anaesthetist, issued a Report to Prevent Future Deaths to the RCoA and the Royal College of Surgeons for action.

In a recent correspondence, I wrote: ‘So many ideas flying around in my head (ADHD). I need to pin them down, put them in order (ASD), and get started (ADHD inertia). I’m over the “I’m broken” phase and now feel that my mission before I finally retire is to help others realise they’re not broken either’.

Why? A Bulletin article entitled ‘Equality, diversity and inclusion (EDI): what it means to the College’¹ with no mention of neurodiversity! The College wants to ‘develop a dataset of the profile and diversity of their membership and workforce’, but without neurodiversity questions I feel excluded!

One in a hundred young people have an autism spectrum disorder (ASD); 10 per cent of these may become high-functioning adults.² Between three and six per cent of children have attention deficit hyperactive disorder (ADHD), and for one in seven of these ADHD will continue into adulthood.³ Also, adults with ASD are more likely to have ADHD!² Everyone has individual attributes and characteristics. Experience of autism is also unique; this is the power of neurodiversity. Some professions, for example aerospace, screen positively for autistic traits⁴ – methodical, attention to detail, ability to hyperfocus, pattern recognition, visual memory, and novel approaches to problem solving. 

Authors:

• Dr Andrew Kane, NAP7 Fellow, ST7 in anaesthesia, South Tees NHS Trust
• Professor Tim Cook, RCoA Director of the National Audit Projects, Consultant in Anaesthetics and Intensive Care Medicine, Royal United Hospitals, Bath
• Dr Jas Soar, NAP7 Clinical Lead, Consultant in Anaesthetics and Intensive Care Medicine, Southmead Hospital, Bristol

After a delay due to Covid, we are pleased to say we are in the final stages of NAP7. The baseline and activity surveys are complete and being prepared for publication. The NAP7 panel is working hard to digest all possible learning from the case registry. Here we provide a brief update, with the full report coming in late 2023. We are hugely appreciative of the contribution of all anaesthetists.

The largest NAP yet

Perioperative cardiac arrest has seen the most cases reported of any NAP. The large number of cases reported is an indication of the ability of UK anaesthesia to successfully come together and focus on an important patient-focused issue, and also shows the incidence of perioperative cardiac arrest is greater than events forming the focus of previous NAPs.

Read the latest letters submitted by members in October's Bulletin.