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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).

In exceptional circumstances, anaesthetists working singlehandedly may be called on briefly to assist with or perform a life saving procedure nearby. This is a matter for individual judgement and the dedicated anaesthetic assistant should be present to monitor the unattended patient.⁴

If sedation is performed without an anaesthetist present, a designated, appropriately trained individual should be responsible for monitoring the patient and keeping records. This should be their sole responsibility¹ and should comply with the hospital’s sedation policy.

A multidisciplinary team (MDT) may be required, and this may include plastic, vascular or neurosurgical surgeons for complex head and neck surgery. Anaesthetists may be required to attend MDT meetings preoperatively, and this should be included in their job plan if it forms a regular commitment.

In all hospitals undertaking major vascular anaesthesia a vascular anaesthetist should be appointed clinical lead (see glossary) to manage service delivery. This should be recognised in their job plan, and they should be involved in multidisciplinary service planning and governance within the unit.

General anaesthesia for dental procedures should be administered only by anaesthetists in a hospital setting as defined by the Department of Health report reviewing general anaesthesia and conscious sedation in primary dental care.³ 

The provision of formal and systematic training should be considered. Head and neck surgery provides an excellent opportunity for training anaesthetists in the use of advanced methods for airway management and the shared airway, including videolaryngoscopy, flexible bronchoscopic, and jet and apnoeic oxygenation techniques.