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March 2018
Evidence to drive
improvement
Supporting clinical innovation in
anaesthesia
The US prescribed-opioid
epidemic: lessons for perioperative
medicine in the UK
Patient information resources
www.rcoa.ac.uk
@RCoANews
Bulletin | Issue 108 | March 2018
FICM Annual Meeting: Mind
EVENTS CALENDAR the Gap UPDATES
24 May 2018
RCoA, London
IN ANAESTHESIA,
Further information about all £180 (£90 for trainees and nurses)* CRITICAL CARE AND PAIN
of our events can be found on
our website. Introduction to Leadership and
MANAGEMENT
Management: The Essentials
www.rcoa.ac.uk/events CPD 15
30–31 May 2018 #RCoAUpdates
events@rcoa.ac.uk
credits
RCoA, London
@RCoANews 4–6 June 2018 | Royal College of Surgeons, Edinburgh
£395 (£300 for trainees)*
Our three-day Updates events are intended for doctors engaged in clinical
MARCH APRIL
UK Training in Emergency Airway
Management (TEAM)
JUNE anaesthesia, pain management and intensive care medicine (ie consultants,
trainees, staff and associate specialist grades or their overseas equivalent) who
26–27 April 2018 would benefit from a refresher of the latest updates in areas of practice they may
After the Final FRCA – Making the Updates in Anaesthesia, Critical
CPD Study Day: Managing Mass Wrexham Maelor Hospital be exposed to regularly or only occasionally.
Most of Training Years 5 to 7 Care and Pain Management
Casualties £450 Experts will present up-to-date information on a wide range of topics, informing
4–6 June 2018
13 March 2018 18 April 2018 you of updates in basic sciences relevant to anaesthesia and allied specialties.
Developing World Anaesthesia Royal College of Surgeons, Edinburgh
RCoA, London RCoA, London
30 April 2018 £490 (£370 for trainees)
£150 £200 (£150 for trainees)* Standard Trainee* Senior Fellow*
RCoA, London
Airway Leads Day Cardiac Disease All days £490 £370 £245
Airway Workshop £200
June 2018 One day £195 £150 £100
Joint RCoA and Difficult Airway 18 April 2018
See website for details
Society event RCoA, London
15 March 2018 £240 (£180 for trainees)* MAY £395 (£295 for trainees)
RCoA, London Anaesthetists as Educators: An
£150 Research Methodology Workshop Ethics and Law
Introduction
CPD Study Day
Joint RCoA, BJA and NIAA event
19 April 2018
9 May 2018
RCoA, London
5 June 2018 CARDIAC DISEASE
RCoA, London
16 March 2018 RCoA, London £200 (£150 for trainees)*
£220 (£165 for trainees)*
The Studio, Birmingham £150 (£115 for trainees)*
£200 (£150 for trainees)* Airway Management: Training the
UK Training in Emergency Airway
GASAgain (Giving Anaesthesia Trainer CPD 10
Management (TEAM) #RCoACardiac credits
Leadership and Management: Safely Again) 10 May 2018
Leading and Managing Change 11–12 June 2018 June 2018 | See website for details
20 April 2018 RCoA, London
(Success with Service Development) Solihull Hospital
RCoA, London £240 (£180 for trainees)*
£450 Patients with heart disease can present on any elective list, and also as
16 March 2018 £240 (£180 for trainees)*
RCoA, London UK Training in Emergency Airway emergencies. The aim of this two-day event is to explore areas of clinical
CPD Study Day
£220 (£165 for trainees)* Delivering Anaesthesia Safely Management (TEAM) importance for all practising anaesthetists.
12–13 June 2018
20 April 2018 10–11 May 2018 Hear from presentations from expert cardiologists, anaesthetists, and intensivists,
RCoA, London
CPD Study Day: Regional RCoA, London Royal United Hospital Bath
Both days: £355 (£270 for trainees)* who bring a truly multidisciplinary approach to complex problems and make it
Anaesthesia £200 (£150 for trainees)* £450
One day: £230 (£175 for trainees)* easier to better understand the pathophysiology of heart disease and how to
19 March 2018
manage patients with often complex problems.
RCoA, London SAS Conference: Career NIAA Annual Scientific Meeting
Airway Workshop
£200 (£150 for trainees)* Progression 21 May 2018
13 June 2018 Standard Trainee* Senior Fellow*
Joint RCoA and Academy of Medical RCoA, London
RCoA, London All days £395 £295 £195
A Practical Introduction to Quality Royal Colleges event £45 (£35 for trainees)*
£240 (£180 for trainees) One day £260 £195 £130
Improvement 23 April 2018
21 March 2018 RCoA, London
ANAESTHESIA 2018 GASAgain (Giving Anaesthesia
RCoA, London £150 Safely Again)
International Meeting of the
£150 (£115 for trainees)* 13 June 2018
Royal College of Anaesthetists
22–23 May 2018 Royal Bournemouth Hospital
British Museum, London £240 (£180 for trainees)*
*Delegates must be trainee or senior fellow members of the RCoA to be eligible for the reduced rate. *Delegates must be trainee or senior fellow members of the RCoA to be eligible for the reduced rate.
Book your place at www.rcoa.ac.uk/events Book your place at www.rcoa.ac.uk/events | 1
Bulletin | Issue 108 | March 2018 Bulletin | Issue 108 | March 2018
Contents
The President’s View4
From the editor
News in brief8
Guest Editorial12
Guidelines for the Provision of
Anaesthetic Services (GPAS)15
Anaesthesia Clinical Services
Accreditation (ACSA)16
Faculty of Intensive Care Medicine Professor Monty Mythen
(FICM)18
While financial and workforce pressures launch a nation-wide multi-stakeholder Dr Arun Sahni and Professor Ramani
Faculty of Pain Medicine (FPM)19
continue to be felt by anaesthetists initiative (http://bit.ly/2o70PfY) to Moonesinghe provide us with an
Patient perspective20 across the NHS, three things remain address the impact of fatigue amongst update on the work of the Perioperative
Society for Education in Anaesthesia constant – the support your College doctors of all specialties. The final Quality Improvement Programme
(UK)22 provides you, the need for change and activity to note in relation to support initiative (page 28) to reduce
the need for us all to ensure patient provided by your is the winter pressure postoperative complications.
SAS and Specialty Doctors24
safety remains our utmost priority. guidance (http://bit.ly/2F4N2tT)
National Emergency Laparotomy Audit Speaking of the need for change, this
developed in partnership with the
(NELA)26 The College has undertaken a will be my last issue as editor of the
AAGBI which the issue of anaesthetists
Perioperative Quality Improvement concerted effort over the past 12 Bulletin. While I’ve thoroughly enjoyed
being asked to work outside their normal
months to engage with members to the past two years of working with the
PREP-WELL: community
Programme (PQIP)28 scope of practice.
understand the pressures faced by Editorial Board and the communications
Clinical Directors’ National Executive
anaesthetists of all grades. The 2016 In this issue of the Bulletin, one important team to rejuvenate this important
prehabilitation and wellbeing Committee30
Revalidation for anaesthetists31
– 2017 morale and welfare survey
(http://bit.ly/2017-rcoasurvey) kick-
piece I encourage you to read is the link
to the Safe Anaesthesia Liaison Group’s
publication, the time has come for
fresh thinking and a new tack of
project Making sense of perioperative
medicine training32
started a year’s worth of face-to-face
Listening Events with anaesthetists in
(SALG) Patient Safety Update – this can
be found in the News in brief section
editorial ideas.
A new integrated and evidence-based model of care for patients I am very pleased that Council member
The very slow march to training across the United Kingdom on page 8. The SALG Patient Safety
prior to surgery Dr David Bogod will be taking over
a paperless NHS34 to better understand the pressures Updates contain anonymised incidents
editorial duties from the May issue. No
Page 12 they face. Combined with information reported to the National Reporting and
The Cappuccini test36 better person for the job.
gathered at the Listening Events and Learning System which are important
New membership service to attract the the findings of the above-mentioned learning opportunities for anaesthetists A final thank you to the communications
next generation of anaesthetists38
Evidence to drive The US prescribed-opioid survey, the College released in of all grades. team and Editorial Board.
Improving trainee choices December 2017 A report on the
improvement epidemic: lessons for in anaesthetic recruitment40 welfare, morale and experiences of Quality improvement and innovation
come hand-in-hand with both topics
How your College is working at the perioperative medicine in Ariana Grande: a name Manchester
anaesthetists in training: the need to
listen (http://bit.ly/moralereport). In being addressed in this issue. Dr Liam
forefront of anaesthetic research
the UK will never forget42
this report we stated that cultural Brennan discusses in his President’s
Page 4 RCoA patient information View (page 4) how the College is
The second of two articles changes are needed across the NHS
highlighting the US prescribed- resources48 working at the forefront of anaesthetic
to effectively address issues of poor
Supporting clinical opioid epidemic and the implications Reforming College Governance51 welfare and morale among doctors in research. By hosting work of the
innovation in anaesthesia for UK anaesthetists Election to Council 2018: meet the training for all specialties. internationally-renowned National
Audit Projects, Sprint National
The College has recently pledged Page 46 new members52
The College has not stopped its work Anaesthesia Projects, the National
its support and sponsorship for Perioperative Journal Watch54 there – in November 2017, a Listening Institute of Academic Anaesthesia, the
the NHS Clinical Entrepreneur RCoA patient information Letters to the Editor55 Event was held specifically for SAS Health Services Research Centre and
programme
resources New to the College57
doctors and themes identified during the the UK Perioperative Medicine Clinical
Page 44 discussion can be found on page 24. Trials Network to name a few, your
Helping you meet the challenges of As we were (or should be?)61 The College has also worked with the College takes very seriously its role in
informing patients Association of Anaesthetists of Great collaborative audit and research. It’s a
Notices and adverts63
Page 48 Britain and Ireland (AAGBI) and the fascinating read.
College events69
Faculty of Intensive Care Medicine to
2 | | 3
Bulletin | Issue 108 | March 2018 Bulletin | Issue 108 | March 2018
Dr Liam Brennan
President
As I sit down to write in January 2018 a winter storm
is buffeting both Churchill House and the NHS
in general, but with spring just around the corner
I would like to take this opportunity to focus on
sunnier horizons and discuss the College’s current
and future work in the areas of research and
quality improvement.
You will hopefully have noticed in between stakeholder organisations is
recent editions of the Bulletin an the envy of other specialities. Since
increased number of articles relating to its inception in 2008 the NIAA has
the College’s research outputs. As well distributed over £8.8 million in research
as our well-established work streams funding via its biannual grant rounds.
such as the National Audit Projects
(NAPs), we are also delivering an NHS As this edition of the Bulletin reaches
England-commissioned national audit, your mailboxes, recruitment for a new
several shorter-term projects, and our chair of the NIAA will be underway. I
own national quality improvement would like to thank the outgoing chair,
programme. We have made renewed Professor Monty Mythen, for his hard
The President’s View efforts to highlight these initiatives work during his period of office in
to our members – collaborative audit, promoting the development of academic
EVIDENCE TO DRIVE quality improvement and research anaesthesia. I look forward to working
have always been a cornerstone of with the new NIAA chair when they are
anaesthesia, and your own contributions appointed. Congratulations also to all
IMPROVEMENT
to these initiatives are invaluable. current and previous members of the
NIAA Board and Research Council,
Ten years of the NIAA and the local researchers working on
NIAA-funded projects, for laying the
How your College is
The College is proud to be one of the
four founding partners – along with the foundations the NIAA has built on over
AAGBI, the BJA and Anaesthesia – of the last decade.
working at the forefront
the National Institute of Academic
Anaesthesia (NIAA) (www.niaa.org.uk), POMCTN, HSRC and
which this year celebrates its tenth ongoing projects
of anaesthetic research
anniversary. I know from speaking to The NIAA has also overseen the
colleagues that the NIAA model of establishment of both the Health
research cooperation and co-production Services Research Centre (HSRC) and
4 | | 5
Bulletin | Issue 108 | March 2018 Bulletin | Issue 108 | March 2018
the UK Perioperative Medicine Clinical
Trials Network (POMCTN), both
hosted and administered by the RCoA.
working. 2018 to 2019 will see the
HSRC partnering with the Association of
All constituent bodies of the RCoA
research strategy have also built an
excellent working relationship with
Research is a challenging business – not only do
researchers often embark on their projects in the
knowledge that their efforts may not bear fruit, but they
Bulletin
of the Royal College of Anaesthetists
Paediatric Anaesthetists to explore the
POMCTN, the newest of these bodies, quality of care for children undergoing the Research & Audit Federation of do so in the face of constant change within both medicine
Churchill House, 35 Red Lion Square, London WC1R 4SG
launched in 2016 and now has over emergency abdominal surgery, and Trainees (RAFT) (www.raftrainees.com). and the wider field of research. The rise of ‘big data’ will no
020 7092 1500
275 investigator members. I would urge developing obstetric-based research RAFT draws together the work of the doubt fundamentally shape the delivery of healthcare over
www.rcoa.ac.uk/bulletin | bulletin@rcoa.ac.uk
you to visit www.pomctn.org.uk and get alongside colleagues from the Obstetric numerous trainee research networks that the coming decade. How can anaesthesia utilise this vast
– and growing – amount of data to improve patient care? @RCoANews
involved – we need more perioperative Anaesthetists’ Association. have sprung up across the UK in the
The HSRC will be looking at the possibilities in the years /RoyalCollegeofAnaesthetists
clinical trials in the UK to develop last several years. I recently met with the
innovative pathways and interventions to Research training and trainees RAFT leadership to discuss their projects ahead. Other exciting developments such as genomics and
Registered Charity No 1013887
benefit our patients. and those of their constituent networks, artificial intelligence also promise profound societal change
We recognise that the current Annex G Registered Charity in Scotland No SC037737
and I was inspired by the passion of our and we will be looking at the implications for anaesthesia
of The CCT in Anaesthetics has not VAT Registration No GB 927 2364 18
The HSRC (www.niaa-hsrc.org.uk) and perioperative care to decide how important it is for us
always made it easy for trainees to trainees for research. They are a credit to
coordinates a growing number of as a specialty to develop research capacity in these areas. President Jaideep Pandit Emma Stiby
undertake research. Whilst we aim to the specialty.
projects including the National Liam Brennan Council Member SAS Member
address this as part of our curriculum
Emergency Laparotomy Audit (NELA)
Future strategy Conclusion
(www.nela.org.uk), the Perioperative rewrite, plans are already underway Vice-Presidents Krish Carol Pellowe
The College’s Research Department will be expanding
with our partners in the NIAA to offer The College is involved in the strategic Ravi Mahajan & Ramachandran Lay Committee
Quality Improvement Programme (PQIP) over the coming year, with extra administrative and data
improved guidance for trainees on growth of medical research through our Janice Fazackerley Council Member
(www.pqip.org.uk), our Sprint National analytical support. We hope to be able to show you the Gavin Dallas
the possibilities for academic training close working with both the Association
Anaesthesia Projects (SNAPs) and the benefit of this increased investment later this year with Editorial Board Joanna Budd Head of
and research careers in anaesthesia. of Medical Research Charities (AMRC)
NAPs, among others. NAP6, focused better reporting and feedback on how your current – and Monty Mythen Lead Regional Communications
Projects such as NELA and PQIP also and the National Institute for Health
on perioperative anaphylaxis will report hopefully increased – participation in our research work is Editor Adviser
Research (NIHR). Our membership of Mandie Kelly
in May and we have recently canvassed provide opportunities for trainees to driving up the standards and outcomes of patient care to
the AMRC allows us a seat at the table David Bogod Mike Jackson Website &
for topics for NAP7 – watch this space. evidence meaningful participation in which we are all committed.
to help shape future research policy and Council Member Lead College Publications Officer
SNAP-2, a prospective study that quality improvement for their ARCPs.
All interested trainees should visit the focus in the charity sector. Our work with If you would like to get more involved in anaesthesia Simon Fletcher Tutor Anamika Trivedi
collected data on perioperative risk and
respective project websites. The HSRC the NIHR has, amongst other things, related research, or if you have any comments or questions Council Member Website &
outcome and critical care admission after Kate Tatham
regularly offers trainees the chance facilitated two years of the NIHR/RCoA regarding anything discussed in this article, please get in Publications Officer
inpatient, ran last year in the UK, Australia Trainee Committee
Research Award, with the next deserving touch via presidentnews@rcoa.ac.uk
and New Zealand. I was immensely to apply for research fellowships and
undertake higher degrees based on winners – including for the first time a Articles for submission, together with any declaration
gratified to see the huge enthusiasm
trainee network prize – receiving their of interest, should be sent to the Editor via email to
for the project that saw over 10,000 national projects. I know the clinical
awards at the Anaesthesia 2018 meeting. bulletin@rcoa.ac.uk.
patients being recruited to the study in leadership are rightly proud of how
existing and past fellows have blossomed Anaesthesia, perioperative medicine and
the UK alone. All contributions will receive an acknowledgement and the
whilst working on HSRC projects – pain were the fourth highest recruiting
Editor reserves the right to edit articles for reasons of space
These exceptional and ambitious specialty within the NIHR Clinical
clearly they will play an important part in or clarity.
We recognise that
projects involve thousands of local Research Network during 2016 to 2017,
the future of academic anaesthesia.
investigators, showing the scope of what recruiting more than 34,000 patients The views and opinions expressed in the Bulletin are solely
the current Annex
we can achieve through multidisciplinary into more than 50 active studies. those of the individual authors. Adverts imply no form of
endorsement and neither do they represent the view of
G of The CCT in
the Royal College of Anaesthetists.
Since its inception in 2008 the © 2018 Bulletin of the Royal College of Anaesthetists
Anaesthetics has not
NIAA
All Rights Reserved. No part of this publication may be
NIAA has distributed over reproduced, stored in a retrieval system, or transmitted in
always made it easy for any form or by any other means, electronic, mechanical,
£8.8 million photocopying, recording, or otherwise, without prior
National Institute of Academic in research funding via its
trainees to undertake permission, in writing, of the Royal College of Anaesthetists.
research
ISSN (print): 2040-8846
Anaesthesia
biannual grant rounds ISSN (online): 2040-8854
6 | | 7
Bulletin | Issue 108 | March 2018 Bulletin | Issue 108 | March 2018
News in brief
News and information
ANAESTHESIA 2018
from around the College International Meeting of the Royal College of Anaesthetists
22–23 May 2018
British Museum, London
Clinical Quality in 2018 NOT Simulation
Leads Day
LONG TO
The College’s clinical quality team is working towards the 2018 publication GO!
of the Guidelines for the Provision of Anaesthetic Services (GPAS) Over 40 per cent The College held a successful and
(www.rcoa.ac.uk/gpas) and the Anaesthesia Clinical Services Accreditation of NHS trusts/boards The countdown is well underway to our new flagship conference, Anaesthesia
engaging Simulation Leads Day at
(www.rcoa.ac.uk/acsa) standards. the Glasgow Caledonian University
in the UK 2018 on 22 and 23 May at the British Museum.
on 9 January. Hosted by the RCoA’s
With over 40 per cent of NHS trusts/boards in the UK engaged in ACSA, the are engaged
Replacing and combining the Anniversary Meeting and Summer Symposium we simulation working group chair
College’s quality improvement scheme continues to go from strength to strength. in ACSA are attracting internationally renown speakers from across the world including Professor Bryn Baxendale, simulation
The College has visited 33 departments with 18 of these having successfully
Australia, New Zealand and Singapore, Anaesthesia 2018 is set to offer a truly leads from across Scotland attended
gained accreditation and 15 more actively working toward this goal. If you are
interested in ACSA for your department, please visit www.rcoa.ac.uk/acsa or 33 departments international perspective on our specialty. to network, debate and share their
experiences of simulation in training.
contact acsa@rcoa.ac.uk to arrange a teleconference or local presentation. visited Professor Paul Myles and Professor Mike Grocott will provide delegates with the
latest updates and perspectives on perioperative medicine. Professor Jennifer Engaging speakers showcased the
To express an interest in being an ACSA reviewer, email acsa@rcoa.ac.uk. The 18 departments Weller will explore what it takes to build skilled and effective teams, presenting range of simulation programmes
next training day for reviewers takes place at the College on 12 April 2018 so do
accredited the results of her immersive simulation research. taking place across Scotland.
get in touch to book your place – we look forward to seeing you.
Dr Purva Makani, president of the
Delegates can also look forward to a series of quick-fire updates on a range Association for Simulated Practice
Be sure to read GPAS Editor Dr Jeremy Langton’s article in
of subjects including obstetric haemorrhage, paediatric airway, acute pain and in Healthcare, delivered a valuable
this Bulletin (page 15) for more information on GPAS, ACSA
head injuries. session on simulation-based
and the College’s clinical quality work in 2018. For further information
or to engage with the clinical quality team’s work across the UK contact practice and the development of
The two-day conference will close with a lively and informative debate: Professor
clinicalquality@rcoa.ac.uk national standards.
Tim Cook and Dr William Harrop-Griffiths will go head-to-head to determine if
direct laryngoscopes should be consigned to history. College lay committee members
Mr Les Scott and Mr Bob Evans
Be part of the conversation and book your place today at
SALG: Patient Safety
were also in attendance and
www.rcoa.ac.uk/anaesthesia
shared views on public and patient
Update
perspectives regarding simulation,
in particular how simulation can be
The Safe Anaesthesia Liaison Group (www.rcoa.ac.uk/salg) #Anaesthesia2018 used for communication skills. The
(SALG) has issued their quarterly Patient Safety Update, which day stimulated rich conversation
contains important learning regarding reported anaesthesia- about the benefits and challenges
related untoward incidents. of simulation, which will help the
College formulate its simulation
This update (http://bit.ly/salg-psu18) contains anonymous case strategy later on this year.
studies from April to June 2017 and includes items relating to
vascular access, delays in care and airway complications. The
College would like to bring these updates to the attention of as
many anaesthetists as possible, so please read and circulate the
document as widely as you can.
8 | | 9
Bulletin | Issue 108 | March 2018 Bulletin | Issue 108 | March 2018
British Journal of Anaesthesia
News in brief
News and information
and BJA Education from around the College
Student
membership –
On 1 January 2018, publication of the British Journal of Anaesthesia, BJA Education
and the RCoA membership magazine Bulletin transitioned from Oxford
NIAA
University Press to Elsevier.
don’t forget to get
National Institute of Academic
Anaesthesia
College fellows, members and non-member subscribers will continue to enjoy
your NUS card delivery of the printed copies, as well as online access to all three publications.
Over 100 medical students have New log in details required
NIAA’s third Annual Scientific Meeting
applied to join the College since From 1 April, fellows, members and non-member subscribers are required Celebrating its 10 year anniversary, the National Institute for Academic Anaesthesia (NIAA) will hold its third Annual Scientific
the launch of a new membership to activate their new online log in details in order to access online journal Meeting on Monday 21 May 2018.
service for undergraduates and content. Therefore, prior to 1 April, fellows and members are encouraged to
This meeting will include updates on the Health Services Research Centre, the UK Perioperative Medicine Clinical Trials Network,
foundation year doctors. activate their online journal access at either of the two new Elsevier websites: at
and a look back at the NIAA’s achievements as well as its plans for the future.
http://bjanaesthesia.org or http://bjaed.org. This will be a one-time, two-step
As part of the membership offering,
process which can be found here: http://bit.ly/BJA-BJAed-Access. The NIAA Research Award, which is presented to an active researcher demonstrating excellence in research relevant to
the College is pleased to announce
anaesthesia, perioperative care or pain, will be a highlight of the meeting.
that we are affiliated with the If you have questions about creating your new Elsevier online access, or need
National Union of Students (NUS). help to do so, please telephone the Contact Elsevier Customer Support on: There’s still (just!) time to apply – the closing date is 5:00pm Monday 8 March
This means that medical student Europe Telephone: +44 (0) 1865-843177 and US and http://bit.ly/2mBrXzx
members of the College are eligible Canada Telephone: 800-654-2452.
HSRC
to apply for an NUS extra card.
NIAA
NUS extra entitles members National Institute of Academic
Anaesthesia
to discounts from a number of Health Services Research Centre
brands online and on the high
street. You can apply online
for your NUS extra card at
http://get.nusextra.co.uk/nus-extra
For more details on the
membership categories, see
pages 38–39. NAP6 Report Launch Royal Medical
The sixth National Audit Project of the Royal College of Anaesthetists Benevolent Fund appeal
Disclosure UK
(NAP6) will launch its final report at the Royal Society of Medicine on
Every year the Royal Medical Benevolent
Monday 14 May 2018.
Fund (RMBF) (www.rmbf.org) helps hundreds
In June 2016 the Association of British Pharmaceutical Industry (ABPI) (www.abpi.org.uk) The Baroness Finlay of Llandaff will open what promises to be an of doctors, medical students and their
launched Disclosure UK (http://bit.ly/2DRpj0O) an online database showing payments and engaging and enlightening event. Register at: family members who are in serious hardship
benefits in kind made by the pharmaceutical industry to NHS staff including doctors, nurses www.niaa-hsrc.org.uk/NAP6-Report-Launch due to age, illness, injury or bereavement.
and other health professionals and organisations in the UK. This includes payments and benefits
submitted for collaborations including speaking at and chairing meetings and symposia, training NAP6 focuses on perioperative anaphylaxis. While it is rare, it Offering invaluable support, from financial
services, and participation in advisory board meetings. can be life-threatening and lead to serious complications whose assistance in the form of grants and loans
epidemiology and clinical impact are incompletely defined. NAP6 to a telephone befriending scheme, the
Information published on the Disclosure UK website includes the healthcare professional’s name, their principal practicing has collected comprehensive information concerning perioperative RMBF relies on voluntary donations. Your
address, the payment amount or equivalent benefit in kind, and the name of the pharmaceutical company. anaphylactic events, enabling the anaesthetic and allergy communities financial contributions can make a real
to collaborate in order to make recommendations for the difference to the lives of colleagues and
Disclosure data is published annually in June, one year in arrears. Data for 2017 collaborations will be public on Disclosure UK
improvement of the quality of patient care. More info can be found at their families in need. If you would like to
in June 2018. More information can be found on the Disclosure UK website.
www.nationalauditprojects.org.uk/NAP6home make a donation visit the RMBF website.
10 | | 11
Bulletin | Issue 108 | March 2018 Bulletin | Issue 108 | March 2018
Figure 1 Logic model for PREP-WELL
Guest Editorial
PREP-WELL: community
prehabilitation and
wellbeing project
Dr David Yates Professor Gerard Danjoux
Consultant in Anaesthesia and Consultant in Anaesthesia and
Critical Care, York Teaching Sleep Medicine, South Tees
Hospital NHS Foundation Trust Hospitals NHS Foundation Trust
Many patients present for surgery with poorly optimised risk factors, leading
to an increased risk of adverse perioperative outcomes. Many of these relate
to lifestyle factors (eg smoking or inactivity) which are remediable using
evidence-based interventions.1
Current pathways place the onus of The project and surgery to optimise patient fitness
(Left to right): Garry Tew (Associate patient optimisation on secondary care, through comprehensive evaluation and
PREP-WELL (Figure 1) is a community-
Professor – Exercise and Health
leaving limited time to improve patient based pilot programme designed to targeted interventions. Initially patients
Sciences, Northumbria University),
Esther Carr (PREP-WELL Project health preoperatively. Fragmented improve the fitness, health and wellbeing will be enrolled from specialties including
Manager), Robin Bedford (Health healthcare delivery creates an of patients prior to major surgery. It is vascular, upper GI, colorectal, urology
and Physical Activity Development environment that leads to patients failing funded through a Health Foundation and orthopaedics.
Manager, LiveWell centre), Gerard
to take opportunities to improve their Innovation grant, matched by South Tees
Danjoux (PREP-WELL project Any patient with evidence of unhealthy
lead), Val Jones (Exercise Referral
preoperative health. Hospitals NHS Foundation Trust, South
lifestyle behaviours or co-morbidities
Programme Co-ordinator, LiveWell Tees Clinical Commissioning Group
on initial screening will be eligible for
centre), and Craig Postgate (Senior Our team and Public Health Middlesbrough. The
Health Development Officer, participation. Patients will undergo
Our team is comprised of clinicians programme will recruit 100 patients
LiveWell centre). an ENTRY evaluation consisting of
(from primary and secondary between January and November
assessments of their smoking status,
care), physiotherapists, academics, 2018, and will be delivered at a Public
alcohol consumption, fitness, nutritional
commissioners, public health specialists, Health owned ‘Wellbeing Hub’ in
status, mental wellbeing, quality of life
health trainers and, most importantly, Middlesbrough: The LiveWell centre.
and long-term health problems which
patients! Collaboratively, we have created are known to impact on perioperative
Patients awaiting surgery are amenable
a new integrated and evidence-based outcomes (eg diabetes, frailty, obstructive
to lifestyle changes – a recognised
model of care for patients prior to surgery. sleep apnoea, chronic anaemia, etc). This
teachable moment. Combining this
with the concept of the ‘aggregation will include the use of short validated
of marginal gains’, we plan to utilise screening tools and review of recent
the redundant time between listing laboratory investigations.
12 | | 13
Bulletin | Issue 108 | March 2018
An individualised, comprehensive health resource diary for 12 weeks Guidelines for the Provision of Anaesthetic
prehabilitation plan will then be following hospital discharge to inform
constructed between the patient and the health-economic evaluation. There
Services (GPAS)
A new Editor for
the project manager, in this case an will be a follow-up telephone interview
experienced physiotherapist, to address to assess sustained changes in lifestyle
identified risk factors. Patient involvement and quality of life.
GPAS
in this ‘target-setting’ stage is crucial for a
successful outcome. Some patients may PREP-WELL has several similarities
choose to focus purely on improving to the national cardiac rehabilitation
their aerobic fitness, while others may programme, and we are working with
experts in this field to produce a bespoke Dr Jeremy Langton
opt for a comprehensive alteration to
their lifestyle. A letter will be sent to database, based on their current IT Consultant Anaesthetist, Plymouth; Editor of GPAS
the GP, and relevant secondary care infrastructure, to allow a standardised and RCoA Council Member
clinicians, detailing the prehabilitation dataset to be captured should our
project prove successful and achieve
plan and highlighting non-optimised
widespread adoption. I was appointed senior lecturer in anaesthesia (honorary consultant) in 1992,
long-term health problems. It is hoped
that earlier identification of problems will and consultant anaesthetist in Plymouth in 1995. I have a long-standing
Final thoughts
lead to earlier intervention and a better-
PREP-WELL was designed to align
interest in teaching and training, having held a number of roles, including
prepared patient arriving for surgery.
with priorities highlighted in the NHS College tutor and RCoA Examiner for 12 years. I was elected as an RCoA
Patients will attend the LiveWell centre
twice weekly for six weeks to undertake
Five-Year Forward View and the Health
Council member in 2012, and I recently served as vice-president (2015–2017).
Foundation’s Healthy Lives campaign.
structured group exercise and access We believe that our service will be one I am Associate Postgraduate Dean in GPAS standards provide the foundation GPAS will be incorporated into
services such as smoking cessation, of the few bringing together the entire Health Education South West, with for improvements in the care we provide the new College board structures,
alcohol reduction and nutritional timeline (‘before surgery’ through to responsibility for specialty training. I for our patients. I aim to develop closer reporting to Council through the
support. The project manager will ‘early after’ and ‘late after surgery’) in our have broad editorial experience, having links between GPAS and ACSA, both Clinical Quality and Research Board.
co-ordinate individual patients’ plans, College’s own perioperative medicine previously been an editor of Anaesthesia, within the College and by involving I plan to further improve GPAS
with intervention delivery supported vision document (www.rcoa.ac.uk/ and more recently Editor-in-Chief, BJA clinicians with ACSA experience chapters by reducing duplication and
by LiveWell centre staff, eg health periopmed/vision-document). Education (2010–2017). in the GPAS chapter-development overlap between chapters. In addition,
trainers. Important outcomes will include
process, making the standards robust within the technology programme,
attendance, enjoyment and exercise We are grateful to the RCoA for the It is a great honour to be appointed and practical. I also plan to improve I hope to be able to improve the
progression. Each session will finish opportunity to showcase this work at by the RCoA to the role of Editor the author guidance and to help presentation of GPAS guidelines making
with social time and optional group a recent New Models of Care event with responsibility for GPAS. This is develop a style guide across all College them more accessible and relevant to
discussion of relevant educational topics hosted by the Academy of Medical a key role that is central to RCoA professional publications. all anaesthetists.
relating to forthcoming surgery and Royal Colleges. We were delighted to be strategy (2016–2021) in setting and
longer-term health. Patients will be given one of only three teams to be named in maintaining standards. GPAS underpins
supporting information to undertake the summary blog by Louise Watson, the the Anaesthesia Clinical Services
supplementary additional activity and New Care Models programme director! Accreditation (ACSA) process, using
exercise at home. standards to drive improvements in the
Reference
quality of patient care.
Patients will complete the programme 1 Durrand J et al. Prehabilitation. Perioperative
as close to surgery as possible to Medicine Current Controversies. Springer Earlier this year, GPAS 2018 chapters
Publications, 2016:16–47.
optimise benefits. An EXIT evaluation were published, meaning that the
will be carried out preoperatively majority of chapters have now been
detailing changes in exercise capacity, through the National Institute for Health
quality of life, mental wellbeing, chronic and Care Excellence (NICE)-accredited
health conditions and adverse lifestyle development process, with the remaining
behaviours. Following surgery, patients chapters being considered for 2019.
will be offered access to supervised
rehabilitation or home-based guidance.
Patients will be asked to complete a
14 | | 15
Bulletin | Issue 108 | March 2018 Bulletin | Issue 108 | March 2018
Anaesthesia Clinical Services Accreditation (ACSA) had an opportunity to correct any Organisations also benefit from The RCoA launched ACSA in June 2013
factual aspects of the report. The ACSA contributing to and having access to the and there are now 84 departments
Thoughts from a first-time
report will soon be signed off by the ACSA library of good practice, which involved in the process, with 18 having
RCoA Accreditation Committee, and contains documents and guidance received full accreditation. The vision
will then become the property of the gathered from departments that have and hard work involved in getting to this
ACSA reviewer
participated in ACSA reviews. stage are considerable. I feel assured that
organisation we reviewed. When a
ACSA is a supportive process, which will
department achieves accreditation they The process of an ACSA review
improve patient care and experience and
receive a plaque during an accreditation is obviously challenging, but
spread good practice.
ceremony. ACSA accreditation is certainly seemed to be a catalyst
renewed on a four-year cycle, so for the anaesthetic team to work I enjoyed participating in the ACSA
Ms Jennifer Dorey continued demonstration of compliance together on quality improvement, review, and felt very much welcomed
RCoA Lay Committee against the standards is required, working with real engagement and support and appreciated by the other members
in partnership with the RCoA. from the rest of the trust. I am sure of the review team and the staff we met.
they found it beneficial and even, I look forward to my next review and
at times, enjoyable. encourage others to get involved.
18 40%
In April 2017, I was the lay member of an ACSA review team. The experience
was rewarding, enjoyable and informative. After two incredibly busy days, I felt
my contribution was very much appreciated and worthwhile.
accredited of NHS trusts/boards
The ACSA scheme is a voluntary scheme to the review dates, and arranging important to the organisation, and
run by the College, benchmarking paperwork, travel and accommodation. they really wanted to tell us their story.
hospitals actively engaged
anaesthetic departments against Later we had face-to-face discussions
standards of best practice. The Having received the self-assessment with individuals and groups, including
process is structured and supportive, document of the department to be senior clinicians, managers, nurses,
and focused on quality improvement reviewed, the review team met (online operating department practitioners and
and an ongoing partnership. for us, but sometimes this is in person) trainee anaesthetists.
to agree which standards to assess
Organisations spend several months and how. We focused particularly on After lunch, we set off on a walkabout
self-assessing against the ACSA those standards the department had visiting the different areas of the hospital
standards, followed by a two- to three- self-assessed as ‘not yet met’, and where anaesthesia is given, which are
day on-site peer review visit. From the others we wanted to investigate in many and varied. This involved lots of
beginning, the scheme has included more detail or which were of interest to walking and some dressing up in scrubs!
lay reviewers, working alongside a the members of the review team. This At the end of the day we had a debrief
minimum of two consultant anaesthetists resulted in about 70 standards in total. session for the review team, followed by
and an administrative reviewer from the Additional documentation was requested a meal in our hotel and early to bed.
College clinical quality team. for submission by the department to
supplement their self-assessment, and an The next day was more of the same,
I joined the lay committee in April 2016, agenda for the on-site visit was agreed in but on a different site, looking at pre-
and was keen to become involved in consultation with the trust’s ACSA lead. assessment, maternity and radiology
ACSA. Following a training session services, showing us how the anaesthetic To find out more about
explaining the process and practicalities, About four weeks later, we all travelled service is integrated and delivered across ACSA please visit:
and participating in a session reviewing to our hotel and met up over an all sites. After another lunch and another
one of the Guidelines for the Provision of early breakfast before setting off to
the hospital we were visiting. The
meeting with the trust’s ACSA team, we www.rcoa.ac.uk/acsa
Anaesthetic Services (GPAS) chapters, I said goodbye and were ready to leave.
first morning was mostly spent on
was ready to go.
presentations from the anaesthetic Over the next few weeks, the
The RCoA ACSA team can
The College team managing ACSA do department and meeting many people administrative reviewer put together be contacted by telephone
a wonderful job bringing together the – everyone from the porter to the chief the draft report, and we had several
review team, matching our availability executive. ACSA was clearly considered opportunities to comment. The trust
(020 7092 1697), or by email at:
16 | acsa@rcoa.ac.ukBulletin | Issue 108 | March 2018 Bulletin | Issue 108 | March 2018
Dr Andy Gratrix
FICM e-Portfolio Lead
Dr Paul Wilkinson
Faculty of Intensive Care Medicine (FICM) Chair, FPM Professional Standards Committee
e-Portfolio update Faculty of Pain Medicine (FPM)
It has been about a year since our last update regarding the FICM e-portfolio. Report from the Professional
It has been a relatively quiet year in terms
of major changes or improvements.
However, other colleges also use
NES e-portfolios, and some of these
As always, I have some thanks to express.
As part of the e-portfolio sub-committee Standards Committee (PSC)
We continue to receive feedback from have elected to look for, and have we have two trainee members, Dr Dafydd
trainees and trainers, and always try to selected other portfolio providers, which Williams and Dr Hywel Garrard. They It continues to be a great privilege to chair the PSC of the FPM, and I want to
consider all options within the framework makes the plan to move to version 3 have come to the end of their two-year
of the e-portfolio with the aim of less feasible as there must be enough term, and I would like to express my
thank all members personally for their hard work.
making the product as user-friendly and colleges and faculties moving to the gratitude and thanks on behalf of all The FPM has had a very busy period, soon be updated. Further completed changes, a paper to strengthen our
educationally beneficial to all as possible. new system to make it cost effective. the e-portfolio sub-committee for all with various important national publications include: implementation policy, and a resource
We understand the issues and burden of We are contracted to NES until the their hard work and engagement with consultations and concerns over long- to help manage opioid reduction.
■■ checklist for intrathecal pump refills
most ICM trainees in having to use two spring of 2018, and will sign a fresh the project, and for bringing a trainee- term opioids in the press. We always We have also updated many of our
different portfolio systems, and strive to contract into 2019. We continue to focused viewpoint to our work. ■■ document to help professionals advise
strive to ensure that the balance between core publications.
assist with this as much as we can. explore all options available to us with a individuals with chronic pain who drive
benefit and harm is properly understood
focus on providing the best product we I would also like to thank the FICM in the media. An opioids working ■■ updated medicine information The PSC has been involved in important
The main focus of this last year has been admin team, without whose hard work
can for our trainees and trainers within group has been established to manage leaflets, including NSAIDS national consultations involving pain
on the future of our e-portfolio. We and dedication none of this would be
our usual resource constraints. We are related work, to provide updates of the ■■ updated multi-organisational medicines and injection treatments. The
had been notified some time ago that possible – so thanks to Susan, Rohini,
currently engaging with two other Department of Health/FPM Opioids complex regional pain syndrome PSC does not support treatments that
NES (NHS Education for Scotland), the Anna and Daniel. My sincere thanks
e-portfolio systems (and their providers): aware publication, and to collaborate (CRPS) guidance have been proven to be ineffective, but
provider of our e-portfolio, intended to also goes to Pete Hersey, our deputy
the system the RCoA are developing, with outside stakeholders. we provide a voice where evidence
progress from version 2 to version 3 of ■■ guidance on extended scope
and the system which most ex-NES e-portfolio lead, without whose input has not been interpreted or applied
their system, and would therefore begin practitioners in pain.
colleges have elected to move to. We and knowledge the e-portfolio would The Dashboard of Clinical Standards has accurately, or where data is inconclusive
a new specification phase by August now been successfully tested. This allows Problems with commissioning have been
will do a full appraisal of these options in not be as good as it is today. but there is the potential to impact
2017. This was to involve a no-cost data units to undertake a self-assessment evident. An advice document to support
the spring, and feed back. negatively on patient care.
migration and was a potential opportunity As always, please contact us with any against existing core standards in pain Fellows in the commissioning process
to make some of the changes we were questions or suggestions for improvement medicine. We encourage all pain units has been made a priority. Future work Finally, thanks again for the huge collective
unable to make in version 2. and we will endeavour to reply and to use the aid, which is linked to the will include the provision of up-to-date effort of PSC members, who support an
address any issue as soon as possible. Core Standards publication which will guidance on consent following recent increasing but exciting workload.
18 | | 19Bulletin | Issue 108 | March 2018 Bulletin | Issue 108 | March 2018
PATIENT
PERSPECTIVE Mr Rob Thompson Dr Carol Pellowe
Past Chair, RCoA Lay Committee Chair, RCoA Lay Committee
Don’t quit! Keeping up the good work
I’ve worked for over 40 years in and around the NHS, and money has always During March I will be taking over from Rob Thompson as chair of the RCoA
been tight. But this time the financial pressures seem deeper and more lay committee.
stringent than I’ve ever known. I admit it will be a hard act to follow, disappeared into the mists of time. Miss tea break at 2.00pm! How one keeps
as Rob has expertly led the Committee Biggin, the matron during my training, one’s cool and provides quality care
My greater concern is the seeming What is needed now is leadership. to its membership and highlighted
Leaders fight their corner and battle for and enabled us to make a significant always insisted that we treated patients when dehydrated and hungry defeats
lack of a sense of responsibility at the the concerns of morale and
highest levels to find a way through. what they believe is right. They inspire contribution to the College’s activities. as guests in our hospital; no one ever me. However, reports from several
working conditions.
As I write, another trust chairman and encourage best practice. They I would not have been tempted to take went off duty without saying goodbye sources confirm that front-line staff
has ‘resigned’ as he does not think innovate and support new ideas. They The College has also raised its profile it on had it not been for the rest of the to all their patients, and the person in continue to provide a top-rate service
the financial regime his trust faces is are accessible and connect people. and image, as well as addressing the Committee being such an experienced charge always thanked staff for their – it’s the getting there that is the
realistic. Whatever the reasons (and I They hold the system together. governance of the charity. and cohesive group. They bring a wide contribution to the shift. Imagine my problem. Dealing with no or delayed
can hardly imagine the pressures that he range of experience in many areas, shock when on a ward, not that long
appointments, finding a hospital parking
In its own way, I believe the College These are a few examples of the including education; legal; management ago, a student arrived to get her rota
and his board face), we cannot afford to space, and not knowing where to go are
has shown some of that leadership. continuing leadership required and pharmacy, which creates interesting and greeted the staff with: ‘By the way,
lose senior people at such a demanding just some of the frustrations.
It has developed and supported the throughout the NHS – in every ward discussions and novel insights. I don’t do evenings or weekends!’ Since
time. He was an experienced operator
implementation of perioperative and department.
– a former Permanent Secretary and when did care become a Monday to So, as we start afresh in 2018, the
medicine, which could address some of As I am one of the newer members, I
boss of several local authorities. Friday, nine-to-five job? lay committee will be supporting
the pressing issues the NHS faces. And for the future ? I’m not sure we may well be unknown to many. I am
are getting our heads around the ACSA visits and bringing the patients’
As with trusts up and down the a retired nurse-lecturer, who has over Fortunately I never had to work the
Through the Anaesthesia Clinical technological developments happening perspective to the panel, in addition
country, there are too many patients, 30 years’ experience in education now standard 12-hour shift, and I do
Services Accreditation scheme, to all their other roles. Please do not
not enough money, too few staff, and all around us. The College must and research. Having trained at wonder how wise they are, especially
anaesthetic departments can measure hesitate to contact us if there is any item
a struggling local health economy. have a long hard look at the impact The Middlesex, now sadly lost in as one gets older. Whilst working for
themselves against the highest of work we can help you with.
His resignation – whatever the of things like artificial intelligence, history, I also taught there before King’s College, London I had a clinical
standards and develop services locally.
circumstances – will do nothing to fill think about their implications for the the MacDonald Buchanan School of attachment to Guy’s and St Thomas’
the rota gaps, make the finances stack The Listening Events and surveys profession, and consider how they Nursing merged into the Bloomsbury Hospitals. More than once I found
up or stop the queues forming. have brought the College closer could improve patient care. College of Nursing, which has also the nurse in charge having their first
20 | | 21Bulletin | Issue 108 | March 2018 Bulletin | Issue 108 | March 2018
An effective educational supervisor
will develop a good personal
rapport with the trainee over time
feel they need, and to help them get any as a restriction. Ensure dates and times
further support, in a non-judgemental are recorded, although the details of
and confidential way. discussions may be kept confidential.
These meetings are likely to be general
Leave it up to the trainee to disclose what
in nature, focusing on how the trainee
they wish about their GMC involvement.
is doing and identifying any problems.
The GMC may direct the trainee to
If you do make records, ensure the
provide certain information about any
trainee understands what detail is kept,
ongoing investigation to their employer,
who will see it, how it will be stored
but some details may be confidential,
and how long for, and that they are in
and they may be under no obligation
agreement with this.
to disclose these to the employer/
responsible officer/deanery, particularly if You may feel it necessary to inform
the issues are health related. colleagues about sensitive issues relating
Society for Education in Anaesthesia (UK) the process, the support they need
to the trainee in order to facilitate
from an educational supervisor will However, it is important to look together
Being educational supervisor for
adequate clinical supervision. However,
vary widely. It is important therefore at any GMC restrictions placed on their
this should be kept to a safe minimum,
that you are aware of the support practice, and these are publicly available
and not be done without the explicit
available to all doctors going through via the GMC online List of Registered
trainees with GMC restrictions
Medical Practitioners (although consent of the trainee. You should agree
GMC processes. A starting point
restrictions relating specifically to the with them what information will be
is the Doctors Support Service run
trainee’s health are not published). Then shared, and ensure that all concerned are
by the British Medical Association
aware of the need for confidentiality.
by an anonymous trainee (http://bit.ly/2B9Ex3i). a discussion should be had about how
training will fit into this, how much clinical
Navigating these issues can be tricky,
While pastoral care is part of your role supervision they require/want, who this
For all doctors, undergoing a General Medical Council (GMC) fitness to practice as educational supervisor, it is important
and advice can be obtained about
might involve, whether they need a
record keeping and supervision,
investigation is a worrying and stressful experience. For trainees, there is the added to be aware that your primary role is phased return to work, whether on-call
without breaching confidentiality from
concern of the effect the investigation and any restrictions will have on their progression to support learning and training on commitment will be affected, etc. This
the College tutor, regional advisor or
behalf of the deaneries, the RCoA, and may require discussion with the College
through training. This article aims to briefly describe how, as a good educational the GMC. You are not responsible for tutor, regional advisor, clinical director,
responsible officer.
supervisor, you can make all the difference to the trainee with GMC restrictions. co-ordinating the ‘care’ of a trainee in responsible officer, or postgraduate dean. As a trainee returning to work with
difficulty. Nor is it your role to assess However, any significant alterations to restrictions, I know how crucial a good
A GMC investigation may involve the GMC, the police, the courts, the conditions that are imposed on a doctor’s fitness to practice; this is for the GMC. training should have been discussed educational supervisor can be. Above all,
health, probity, performance or conduct deanery/Health Education England, licence to practice, or undertakings that at deanery level through the annual by listening to the needs of your trainee
occupational health, and the doctor’s are voluntarily agreed to by the doctor. First and foremost, an effective
issues, and does not occur in isolation. review of competence progression you can be an effective advocate and
own healthcare professionals. There are a large number of potential educational supervisor will develop a
A number of other bodies may be process as soon as the initial cause for significantly reduce their worries about
restrictions, which can be found in good personal rapport with the trainee
involved in investigating or supporting concern was raised. progressing in training through such a
At the end of the investigation, the GMC over time. This allows trust to build that
glossaries on the GMC website.
the doctor concerned, and these might may take no action, offer a warning, will encourage the trainee to speak about difficult time.
It is important to have regular meetings,
include the employing hospital trust, the place restrictions, impose a suspension, Due to the wide variety of issues that the issues that are worrying them. Let particularly on the trainee’s return to work
National Clinical Assessment Service, the or erase a doctor from the medical might result in restrictions, and the fact them know that you are there to listen, or at the start of a new placement. The
Medical Practitioners Tribunal Service, register. Restrictions are defined as that trainees may be at different stages in to ensure they have the support they frequency of meetings may be specified
22 | | 23You can also read
