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An anaesthetic preoperative assessment service should involve consultant anaesthetists and staff grade, specialty and associate specialist (SAS) doctors.^39,40,41 Dedicated anaesthetic presence in the preoperative assessment and preparation clinic is required for:

• the review of results and concerns identified by preoperative staff
• consultations with patients identified using a triage process to allow optimal delivery of preoperative...

An appropriate level of staffing and suitable facilities should be available to deliver a good quality preoperative service. Non-anaesthetist health professionals, such as, specialist nurses, pharmacy staff, allied health professionals and Anaesthesia Associates (AAs) add considerable value to the service.^40,43,44

The time allocation for staffing of the preoperative service with nurses, AAs, operating department practitioners (ODPs), healthcare assistants and pharmacy staff should be based on local data that reflect surgical case mix, acuity of patients and high risk daycase workload.^45,46

There should be a designated lead anaesthetist for this service with specific programmed activities for this role within their job plan. The lead anaesthetist is responsible for:

• the training and support of nursing, ODPs and other staff
• the maintenance of close two-way links with primary care clinicians facilitating agreed evidence based ‘fitness for surgery’ protocols between primary and secondary care...

There should be a nominated nurse, allied health professional, ODP, AAs and pharmacist for preoperative assessment.

Secretarial and administrative support should also be provided to the preassessment service.

The preassessment clinic should be predominantly led by suitably trained nurses or other extended role practitioners using agreed protocols and with support from an anaesthetist.

Local protocols should determine the grade, experience and competency based training of non-anaesthetist healthcare professionals undertaking preoperative assessments.⁴⁶ In addition , all members of the team including administrative, managerial and clinical staff who interact with the patient preoperatively should have skills in motivational interviewing and preoperative optimisation.^47,48 Courses such as ‘Making Every Contact Count’ may be helpful.

There must be the ability to provide the patient with an appropriate chaperone, as per General Medical Council (GMC) guidance on intimate examinations and chaperones.⁴⁹ When examining a patient, anaesthetists must be sensitive to what the patient may consider as intimate. This could include any examination where it is necessary to touch or even be close to the patient.

Paediatric services will have different staffing requirements, see GPAS chapter 10: Guidelines for the Provision of Paediatric Services for detailed recommendations.