Search

Authors:

• Dr Hugh Tulloch, CT3, Medway NHS Foundation Trust
• Dr Samantha Black, RCoA Patient Information Lead
• Dr Caroline Pocknall, Consultant Anaesthetist, Ashford and St Peter’s Hospitals NHS Foundation Trust
• Dr Caroline Ellis, CT2, Ashford and St Peter’s Hospitals NHS Foundation Trust

Prehabilitation is a collection of methods that aims to improve outcomes in surgery by optimising the patient’s condition prior to their operation.^1,2 Increasing surgical wait time has led to calls for a change in the perception of waiting lists to seeing them as ‘preparation lists’. Preparation is multifactorial, and one aspect of it is psychological prehabilitation.³ Research into psychological prehabiliation has identified modifiable characteristics in patients and shown that targeted interventions can improve their experience and surgical outcomes.^1,4

One such modifiable characteristic is preoperative anxiety, which has been shown to be linked to increase in postoperative pain and increased length of stay.^2,4 The first Sprint National Anaesthesia Project (SNAP-1) indicated that, for patients, anxiety was the worst part of having an operation.⁵ While high-quality evidence is missing from the literature, a 2016 Cochrane meta-analysis did identify improvements in surgical outcomes as a result of psychological interventions.⁴

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.

Authors:

• Dr Samantha Black, RCoA Patient Information Lead
• Dr Lucy Connolly, Clinical Trust Fellow, Medway NHS Foundation Trust
• Elena Fabbrani, RCoA Patient and Public Involvement Manager

Over the past months, the patient information team has been busy creating new resources and collaborating with a wide range of partners to create innovative content to help you meet the challenges of preoperative assessment.

Helping you ‘make every contact count’

A child presenting for surgery provides an excellent occasion for health promotion, with the results of the PErioperAtive CHildhood obesitY (PEACHY) study showing that 24% of children presenting for surgery are overweight or obese. It has never been more important to address the physical health of children at every opportunity, ‘making every contact count’, especially in light of the surgical backlog and our ever-growing waiting lists that we are all too aware of.

Authors: 

• Dr Ishan Wijesinghe, Registrar Anaesthetics, Medway Maritime NHS Foundation Trust
• Dr A C Ruwanmali De Silva, Consultant Anaesthetist, Medway Maritime NHS Foundation Trust

We’re very proud that Medway Maritime Hospital's CEPOD team recently achieved notable recognition for their quality-improvement project with the highly commended prestigious national HSJ Award. This accolade highlights the innovative efforts aimed at enhancing patient safety and outcomes in emergency surgical care.

Dedicated operating theatres for emergency surgery, often referred to as CEPOD theatres, were introduced in the early 1990s to enhance the quality and safety of emergency surgical care. However, the efficient use of CEPOD theatres remains a persistent challenge. The process of ensuring that emergency patients are taken to the theatre promptly and safely is highly complex and depends on a multitude of factors. Our project at Medway Maritime Hospital sought to identify specific inefficiencies within this process and aimed to implement targeted improvements to optimise the utilisation of theatre time.

We conducted our quality-improvement project in two phases.

We continue to welcome applications for CPD accreditation of courses and events, and those that are approved are featured in the Lifelong Learning Platform (LLP) and on our website.

During 2023 we have received more than 950 applications for CPD accreditation. The numbers received by month were typically between 70–80 applications, but the months of March and September were particularly busy with 112 and 92 respectively received. This is an increase by more than 50 when compared against the same reporting period from last year.

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.

During 2024, almost 7.4 million unique actions were completed within it, while the LLP support team closed 17,000 emails, ensuring that customer service remains our top priority. The LLP serves more than 25,000 users, with many of these being anaesthetists in training.

The LLP team has been busy delivering a range of webinars and workshops as part of our commitment to helping and supporting doctors on their individual and collective training paths. One important webinar was a pre-ARCP preparation workshop held in January 2025, with trainers and trainees contributing useful guidance, information and top-tips to navigate the process. This supplemented previous introductory guidance covering reviewing the curriculum and creating ESSRs, HALOs and SLEs.

CESR (Certificate of Eligibility for Specialist Registration) programmes now called the ‘portfolio pathway’ have become popular among many trusts. With more than 2,000 LED & SAS doctors in the UK, there is a growing need for structured CESR programmes to ensure a successful application via the portfolio pathway. 

In 2019, we initiated the CESR programme at Addenbrookes Hospital. This is a three-year structured programme based upon the RCoA curriculum for already experienced anaesthetic CESR aspirants, with dedicated educational supervision and an ARCP-like process. Now, with six years of running, the programme has proved to be an excellent platform for achieving successful registration on the GMC specialist register, as it mirrors the GMC and RCoA requirements for CESR. So far, five out of six CESR fellows have been successfully appointed to substantive consultant posts within the UK.

In the last Bulletin, I talked about the work done to complete a major review of our supporting information for appraisal and revalidation. The updated documentation is available on our website, and this article provides some extracts on the guidance for collecting colleague and patient feedback.

For collecting patient feedback, the key principles from The GMC’s Guidance on Supporting Information for Revalidation can be summarised as follows.

The anaesthetic department at the Royal Devon and Exeter Hospital started a mixed social hockey team during the summer months. Critics who preferred non-team sports argued the organiser was trying to boost his weak CV prior to future consultant applications, but the main aim was always to have fun!