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Anaesthetists who do not have regular children’s lists but who do have both daytime and out of hours responsibility for providing care for children requiring emergency surgery should maintain appropriate clinical skills. There should be arrangements for undertaking regular supernumerary attachments to lists or secondments to specialist centres. The Certificate of Fitness for Honorary Practice ⁶⁰ may facilitate such placements...

A designated pharmacist should be available to provide advice and input into anaesthetic and preoperative assessment. This level of input may range from ad hoc advice through to designated preoperative assessment pharmacists, preferably with prescribing rights, who can undertake medicines reconciliation, produce perioperative medication plans and provide specialist advice.

There should be funding and arrangements for study leave such that all consultants and career grade staff who have any responsibility to provide anaesthesia for children are able to participate in relevant CPD that relates to paediatric anaesthesia and resuscitation and to their level of specialty practice. Individual CPD requirements should be jointly agreed during the appraisal process.

The establishment of regional networks for paediatric anaesthesia should facilitate joint CPD and refresher training in paediatric anaesthesia and resuscitation. Where appropriate, joint appointments may be considered, allowing designated anaesthetists from non-specialist centres a regular commitment within a specialist centre in order to maintain and develop skills.

Hospitals should define the extent of elective and emergency surgical provision for children, and the thresholds for transfer to other centres.

Each hospital should have a multidisciplinary committee for paediatric care to formulate and review provision. This committee should involve anaesthetists, paediatricians, surgeons, emergency department representatives, senior children’s nurses, managers and other professionals, such as paediatric pharmacists. In some hospitals, this will also include PICU physicians.

The multidisciplinary committee should be responsible for the overall management, governance and quality improvement of anaesthetic and surgical services for children, and should report directly to the hospital board.

The opinions of children, young people and their families should be sought in the design and evaluation of services and future planning.⁶²

All hospitals that provide surgery for children and young people should have clear operational policies regarding who can anaesthetise children for elective and emergency surgery. This will be based on ongoing clinical experience, the age of the child, the complexity of surgery and the presence of any comorbidities. ^8,15

In all centres admitting children, one anaesthetist should be appointed as clinical lead (see glossary) for paediatric anaesthesia. Typically, they might undertake at least one paediatric list each week and will be responsible for co-ordinating and overseeing anaesthetic services for children, with particular reference to teaching and training, audit, equipment, guidelines, pain management, sedation and resuscitation.