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Elderly patients presenting for elective surgery frequently have pre-existing comorbidities that require careful review and perioperative planning. As such, the preassessment service for elective patients should be consultant led, ideally by anaesthetists with an interest in, and appropriate experience in, delivering anaesthetic care to orthopaedic patients.^{12, 14}

All anaesthetists should be fully familiarised with all remote areas of anaesthetic provision, e.g. as part of their induction process, prior to undertaking anaesthetic procedures in that location.⁵⁶ This should include familiarisation with the layout of the hospital and the location of emergency equipment and drugs, access to guidelines and protocols, information on how to summon support/assistance, and assurance...

In order to maintain the necessary repertoire of skills, consultant anaesthetists and SAS doctors providing a head and neck service should have a regular commitment to the specialty, and adequate time should be made available for them to participate in a range of relevant continuing medical education activities, including simulation, human factors and team training.^7,43,44

There should be multidisciplinary input for the preoperative assessment of high risk patients such as patients with cognitive disorders, chronic kidney disease, diabetes mellitus and ischaemic heart disease.^50,65 The anaesthetist should be involved in preoperative optimisation and prehabilitation plans.^60,62

All anaesthetists who provide elective or emergency care for infants, children or young adults should have training in advanced life support that covers their expected range of clinical practice and responsibilities.^51,52 These competencies should be maintained by annual training that are ideally multidisciplinary and scenario based.⁵³

All anaesthetists must undertake at least level 2 training in safeguarding/child protection, and must maintain this level of competence by annual updates of current policy and practice and case discussion.^59,60 Safeguarding resources to support learning can be found on the RCoA website (www.rcoa.ac.uk/safeguardingplus).

The paediatric anaesthetist should consider the patient’s age and physical capacity, the complexity of the procedure and the status of the surgical facility before administering anaesthesia. Children with learning and/or communication difficulties requiring sedation or anaesthesia should be cared for as per the recommendations of GPAS Chapter 10: Guidelines for the Provision of Paediatric Services.³⁹

Audit programmes should be developed locally but should include continuous audit of transfer of neuroscience patients, neurocritical care capacity and demand, rates of unplanned admission and readmission to the intensive care unit, and the caseload of anaesthetists in training, among others. In general, local practice should be audited against compliance rates with national and expert consensus guidelines.^5,41,53

The experience and expertise of the anaesthetist assessing the patient preoperatively should be appropriate for the complexity and level of risk of the patient.⁴⁶ The decision to operate on high-risk patients should be made at a senior level, involving surgeons and those who will provide intra and postoperative care.^4,5,19

To maintain the necessary repertoire of skills, consultant anaesthetists and SAS doctors providing a head and neck service should have a regular commitment to the specialty. Adequate time should be made available for them to participate in a range of relevant continuing medical education activities, including simulation, human factors and team training.^7,43,44