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For children, a staff member with an advanced paediatric life support qualification or an anaesthetist with paediatric competencies should be immediately available.^31,32

There should be sufficient time before an operation for the anaesthetist to conduct a satisfactory preoperative assessment. If this does not happen, it is possible that surgery may be delayed or postponed. The provision of a good preoperative assessment and preparation process should minimise this.

An appropriately skilled and experienced resident anaesthetist should be available at all times to care for postoperative and emergency patients. The experience and skills necessary to provide this cover are not usually found in training grades below ST3.⁵

Patients requiring burn or plastic surgery procedures should be managed by anaesthetists who have an appropriate level of training in this field, have regular commitment to the burn and plastic surgery specialty, and have acquired the relevant knowledge and skills needed to care for these patients.

Hospitals should provide scheduled local anaesthetic lists, using a dedicated area for initiating and assessing local nerve blocks. Organising cases in this way fosters the development and maintenance of expertise in the anaesthetists and support staff, and minimises delay between cases.

Cardiac and thoracic anaesthesia is a ‘key unit of training’ for intermediate level training in anaesthesia.⁶¹ Trainee anaesthetists should be of appropriate seniority to be able to benefit from this area of training.

A process should be in place for the formal assessment of anaesthetists prior to allowing them to join the on-call rota for obstetric anaesthesia with distant supervision.^89,91

An anaesthetist should be included in the multidisciplinary team (MDT) antenatal planning of management for women with complex medical needs.⁴ Planning should include consideration of the woman’s wishes and preferences.

If complaints are made about aspects of care, a consultant anaesthetist should review and assess the patient’s complaint, discussing her concerns and examining her where appropriate. This should be documented. Referral for further investigations may be required. 

Consultant anaesthetists who provide out of hours cover to the neuroscience unit, but do not provide neuroanaesthesia in working hours, should be able to demonstrate the maintenance of appropriate skills and knowledge through regular clinical involvement and continuing professional development (CPD).