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If the consultant on call is not a neuroanaesthetist, there should be a clearly defined and understood process for the provision of specialist advice from neuroanaesthesia colleagues. Where possible, local arrangements should be considered to facilitate this telephone advice in non-neuroscience centres when required.

An anaesthetic preoperative assessment service should involve consultant anaesthetists and staff grade, associate specialist and specialty (SAS) doctors.^5,6,51 Dedicated anaesthetic presence in the preoperative assessment and preparation clinic is required for:

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

Each hospital should have agreed written policies, protocols or guidelines, following national guidelines where these are available, covering:

• the time allocated for the anaesthetist to undertake preoperative care in both outpatient clinic and ward settings. Job plans should recognise an adequate number of programmed activities^5,6
• preoperative tests and investigations^52,53
• preoperative blood ordering for potential...

Every obstetric unit should have a designated lead anaesthetist (see glossary) with specific programmed activities allocated for this role.

The lead obstetric anaesthetist should be responsible for the overall delivery of the service, which includes ensuring that evidence-based guidelines and protocols are in use and are up to date; monitoring staff training, workforce planning, and service risk management; and ensuring that national specifications are met, and auditing the service against these agreed standards, including anaesthetic complication rates. 

Business planning by organisations and anaesthetic departments should ensure that the necessary resources, including enough time, are targeted towards preoperative assessment. This should include administrative support at an appropriate level.

The lead obstetric anaesthetist should ensure representation of the anaesthetic department at multidisciplinary meetings for service planning, e.g. labour ward forum.²⁴

The lead obstetric anaesthetist should ensure that there are ongoing quality improvement projects in place to maintain and improve the care in their units.²⁷

As a basic minimum for any obstetric unit, a consultant anaesthetist should be allocated to ensure consultant cover for the full daytime working week (that is, ensuring that Monday to Friday, morning and afternoon sessions are staffed).²⁴ This is to provide urgent and emergency care, not to undertake elective work.

In busier units, increased levels of consultant cover should be considered, reflecting the level of consultant obstetrician staffing in the unit.²⁸ This may involve extending the working day to include consultant presence into the evening session and/or increasing consultant numbers.