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November 2021
Plan A... B... CT3...
Ethical procurement in the NHS
– time to act
Valuing ACSA accreditation: try it!
How research continues
to drive improvement in
patient care
pages 30–43
rcoa.ac.uk
@RCoANews
Bulletin | Issue 130 | November 2021
RCoA Events RCoA and the Scottish Society of Anaesthetists
rcoa.ac.uk/events Joint Winter Scientific Meeting
events@rcoa.ac.uk 24 November 2021
@RCoANews Online
NOVEMBER
Less Than Full-Time (LTFT) Anaesthetic Updates
Matters 28 January 2022
%
18 November 2021 Southampton
Anaesthetic Updates Online
3–4 November 2021
%
Joint with the Association of
Online Anaesthetists FEBRUARY
Senior Fellows Members Club RCoA and Scottish
8 November 2021
Anaesthetic Updates
Society of Anaesthetists
%
23–25 February 2022
%
RCoA, London Joint Winter Scientific meeting
24 November 2021
RCoA, London rcoa.ac.uk/events/
Anaesthesia Research
10–11 November 2021 Online ssarcoa-joint-winter-meeting
MARCH
%
Online Returning to work in anaesthesia
26 November 2021
%
Anaesthetists as Educators (AaE): AaE: Simulation Unplugged
REVISION COURSES
Anaesthetists’ non-technical skills Online
%
1 March 2022
%
(ANTS) RCoA, London
12 November 2021
Online
DECEMBER AaE: Introduction
2 March 2022
%
FULLY BOOKED Winter Symposium
2–3 December 2021
RCoA, London Primary FRCA Online Revision Course
%
Airway workshop FULLY BOOKED
15 November 2021
Hybrid, London and Online Final FRCA Online Revision Course
%
Airway Leads day
RCoA, London Annual General Meeting (AGM)
4 March 2022
Courses start December 2021
%
FULLY BOOKED 9 December 2021
Format to be confirmed
Online
Clinical Leaders in Anaesthesia Invitation only
These courses include:
JANUARY
network event
15 November 2021 Patient Safety in Perioperative ■ video lectures
Practice
%
RCoA, London ■ Powerpoint presentations
GASagain (Giving Anaesthesia 9 March 2022
Leadership and Management:
■ mock exams
Safely Again) Format to be confirmed
%
Teams chat room for discussion between trainees
%
14 January 2022 ■
17 November 2021 Leadership and Management:
Bradford ■ the opportunity to send in questions to lecturers
The Essentials
%
RCoA, London and receive feedback.
15–16 March 2022
Anaesthetic Updates AaE: Advanced Educational Manchester
18–19 November 2021 Book online now at rcoa.ac.uk/events
%
Supervision
%
National Maritime Museum, 25 January 2022
Liverpool RCoA, London
Discounts may be available for RCoA-registered Senior Fellows and Members, Anaesthetists in Training, Discounts may be available for RCoA-registered Senior Fellows and Members, Anaesthetists in Training,
Foundation Year Doctors and Medical Students. See our website for details. Foundation Year Doctors and Medical Students. See our website for details.
%
%
Book your place at rcoa.ac.uk/events Book your place at rcoa.ac.uk/events | 1
Bulletin | Issue 130 | November 2021 Bulletin | Issue 130 | November 2021
Contents
The President’s View 4
News in brief 8
CEO Update 12
Guest Editorial 14
From the editor
Faculty of Pain Medicine (FPM) 16
Faculty of Intensive Care Dr Helgi Johannsson
Medicine (FICM) 17
SAS and Specialty Doctors 18
Revalidation for anaesthetists 20
Welcome to the November edition of the Bulletin – our research issue.
Patient Perspective 22
As we hurtle towards Christmas I’m dearly hoping no one will have been redeployed, and life continues at a relatively
Anaesthesia Clinical Services
normal pace. Normally I feel reasonably confident predicting the six weeks in the future that is necessary for the
Accreditation 24
magazine, but as I write this I have to admit I don’t have much notion of what is likely to happen, but I’m going to
Presentation of Diplomates predict that we continue in relatively similar conditions that were present when I wrote this, and any further restrictive
Ceremony 2021 26
measures have been mild. COVID-19 may not be firmly in the rear view mirror, and probably won’t be for some time,
Health Services Research but we’re certainly making a decent attempt at overtaking. If the last two years have taught us anything, however, it’s
Centre Annual Report 2021 30
the importance of spare capacity in the system and our ability to expand a service without impacting on the rest of
National Audit Project 7
Guest Editorial
our work.
(NAP7): a qualitative twist 32
I recently had a heated discussion with an eminent professor of anaesthesia about the importance of research, and
Building a brighter digital
The Children’s Acute
Surgical Abdomen Programme: we both agreed that there is an urgent need to improve communication of research from the academic departments
future
in full swing 35 to the anaesthetic team on the ground. I am delighted to see that after the necessary halt during our COVID-19
NELA is 10 years old next year 36 surges, the research programmes are getting back on track in Professors Moonesinghe and Moppett’s article (page
The NELA risk adjustment 30). There is so much untapped potential for research in anaesthesia and perioperative medicine, and much we do
RCoA Digital Manager, Marc Taylor reminds us of the model: what does this mean day-to-day, and teach, that has very little or no evidence base (cricoid pressure anyone?).
importance of a digital presence and showcases the for clinicians and patients? 38
As we go into winter, our Bulletin digital offering will improve, and I want to thank Marc Taylor for his excellent work
Meet the College’s Research
latest digital offerings from the College on this project (page 14). I can’t wait to explore the new opportunities for faster publishing, while still retaining the
Team 40
Page 14 best aspects of the print version of the journal. It’s long overdue, but I hope it will be worth the wait.
An update from the SNAP-3
Trainee Lead 42 With the climate crisis and sustainability in the headlines, Dr Nur Lubis reminds us that procurement isn’t just about
Investigating emergency money (page 46). The NHS is an enormous business and carries a lot of power. We must ensure the equipment
The President’s View Health Services Research front-of-neck airways 43 we use is not only produced sustainably, but using ethical principles and fair pay and conditions for the workers
Addressing the retention producing it.
Centre (HSRC) Being an Associate Principal
challenge in anaesthesia requires Investigator: my experience 44
HSRC share some of the work Finally, our new president, Dr Fiona Donald hits the ground running in her message, and highlights our Anaesthetists
collaboration, flexibility and Caught in a bottleneck 48
that has been going on and what – fit for the future programme. Wellbeing is so much more than yoga and meditation. It’s about maintaining a stable
compassion is in the pipeline ‘Whoever’s happy will make and adequate workforce, improving retention, and training enough doctors to meet the increased demands for
others happy’ 50
Page 4 Page 30 our services. As someone who is about two-thirds through his anaesthetic career I think it’s vital to provide flexible
No such thing as a stupid enough working conditions to allow career breaks, and extend our working careers into later life. I was thrilled when
question 52
Plan A... B... CT3... Ethical procurement in
my friend Dr Michael O’Connor agreed to write about his six month move to Cornwall after a particularly difficult
Consultant-level opportunity start to his consultant career, and impressed by how flexible and accommodating his clinical director was to allow
Dr Mitul Patel and Dr Elsbeth
the NHS – time to act for Harvard Masters in
this (page 50). We are more than just pawns on the ground, we are integral to the heart of the hospital. If we are
Dyson unpack the uncertainty Quality and Safety 54
Ethical procurement plays a vital treated well, we will reward our employers many times over.
surrounding the CT3 top-up year As we were... 56
role in social sustainability – here
Page 28 College Tutors Meeting 58
Dr Nur Lubis explores what’s
Perioperative Journal Watch 61
possible
New to the College 62
Page 46
Notices, adverts and College
2 | events 63 | 3
Bulletin | Issue 130 | November 2021 Bulletin | Issue 130 | November 2021
Dr Fiona Donald
President
president@rcoa.ac.uk
In my September 2021 President’s View, I touched on how
challenging times call for kind and compassionate leadership. In
this issue I want to expand on this theme to tell you about the work
that the College is doing through our Anaesthesia – fit for the future1
campaign to support the specialty as it recovers from the pandemic.
Importantly, this campaign will help us develop further evidence
which we will use to continue to advocate for a sustainable and
healthy future for its workforce – you, our members.
Even before the pandemic started, anaesthesia was morale and wellbeing, and consequently retention.
facing a perfect storm of staff shortages, an ageing However a comprehensive and funded long-term
workforce and low morale. workforce plan for the health and care service from
government and NHS leaders is still some way off,
Our latest census published in November 20202 and while we work with Health Education England
revealed the need for a 12 per cent increase in to support its review of the strategic framework on
consultant posts and an 18 per cent increase in SAS workforce planning,4 there is an urgent need to do
posts simply to meet pre-pandemic service demand. all that can be done to keep people in work now.
And the picture is no better for anaesthetists in
training, with hundreds of higher anaesthetic The survey to the College Membership Engagement
trainees struggling to find a training post this year. Panel that we ran as part of our project on retention
told us that one in four consultants and one in
The census also showed that the anaesthetic five SAS anaesthetists planned to leave the NHS
workforce is ageing and that the 50-plus age within five years and that around one-third of
group now make up 39 per cent of the workforce, respondents said that COVID-19 made them less
compared with 31 per cent in 2007. inclined to stay working in the NHS.
Given all of the above it is not surprising that the These are stark findings and, with a challenging
priorities identified for the campaign in its first winter ahead, it’s important that anaesthetic
year are to be an advocate for an expansion of the departments continue to hold on to the spirit of
anaesthetic workforce and to address the retention collaboration and teamwork which defines them, if
The President’s View challenge. While both are extremely important, it’s they are to weather the next storm.
the latter strand of the campaign that I want to focus
The factors affecting retention
Addressing the retention challenge
on in this article, and the role that kindness and
compassion must play in finding ways to retain the The evidence we have gathered for our report
most valuable resource of the NHS: its people. has told us that the factors affecting retention are
in anaesthesia requires collaboration, This philosophy is the theme running through our
latest campaign report – Respected, valued, retained:
complex. There are:
■ individual-level factors such as mental
flexibility and compassion working together to improve retention in anaesthesia.3 wellbeing and burnout, physical issues associated
with ageing, the extent to which professionals
I recognise that excessive workload caused by feel valued and satisfied with their work, and
workforce gaps is a significant factor affecting staff family commitments and other priorities
4 | | 5
Bulletin | Issue 130 | November 2021 Bulletin | Issue 130 | November 2021
■ role-related factors such as The short- and medium-term in work. What our members have also of staff has decided to leave or retire it becomes very
Bulletin
of the Royal College of Anaesthetists
told us is that this applies to all parties. difficult to bring in the adjustments required to keep them
workload and job plans (including solutions
It’s not just up to managers to have in work. Succession planning takes time, and those career Churchill House, 35 Red Lion Square, London WC1R 4SG
working on call), plus perceived What this project has told us is that
clear policies on available flexibilities conversations need to be offered early and regularly as 020 7092 1500
autonomy in the role
improving retention is not just the job of part of yearly reviews of job plans to inform workforce
and to offer them to the workforce rcoa.ac.uk/bulletin | bulletin@rcoa.ac.uk
■ organisational/team-related factors management or government or NHS equitably, but also for staff requesting planning in departments. This is particularly important
such as organisational climate, leaders, but that we all have a part to play. @RCoANews
those flexibilities to be considerate of for mid-career anaesthetists as well as for anaesthetists
leadership, communication, team /RoyalCollegeofAnaesthetists
the implications that such adjustments approaching retirement.
morale, and supportive relationships The events of the past 18 months have
might have for the rest of the team. Registered Charity No 1013887
system-level factors such as taught us the importance of being kind The solutions I have described so far require a shift in
■
There needs to be a common sense Registered Charity in Scotland No SC037737
perceived bureaucracy, issues to each other and to ourselves, and we culture and a different approach to local workforce and
of purpose in agreeing job plans that VAT Registration No GB 927 2364 18
related to income and pensions, and have started to see the slow erosion of succession planning. There are, however, system-wide
work for individuals, departments and
concerns about litigation or risks. the stigma that can come from being issues that only government and NHS leaders can solve, President Dr Hugo Hunton
systems alike. For me, that common
open about suffering from mental ill especially around workforce pressures. In the short term Dr Fiona Donald Lead College Tutor
purpose has to be to provide the best
Work–life balance and the need for health. Resources have been made we need a year-on-year increase in higher anaesthetic
possible care for our patients while Vice-Presidents Dr Kirstin May
flexibility emerge as the two key factors available to NHS staff to support their training places to support the elective backlog recovery
safeguarding the mental and physical Professor William Harrop- SAS Member
affecting career decisions in anaesthesia. mental health, but these cannot be fully and ultimately to help fill the gaps. In the long term we
wellbeing of our workforce, but I am Griffiths Dr Susannah Thoms
The survey tells us that senior consultant effective unless we are given time to need a methodical approach to workforce planning, with
all too well aware that achieving that Dr Russell Perkins Anaesthetists in Training
and SAS anaesthetists want to stay in make use of them. I would encourage projections of supply and demand for the health and care
balance is far from easy. Editorial Board Committee
work, but often leave out of frustration you to seek help in being given such service based on population needs. I can reassure you that
at the lack of willingness to make the time despite current pressures, because Managers have a clear role in shaping your College is actively advocating for you on these issues. Dr Helgi Johannsson, Editor Pauline Elliott
adjustments they need to continue to it is clear that this is a long-term problem the culture in departments and
I hope I have sparked your interest enough to go and read Professor Jonathan Thompson Lay Committee
work safely and in a way that safeguards and that seeking a quick-fix solution will fostering respect, but at operational
our report, which makes 18 specific recommendations at all Council Member Gavin Dallas
their mental and physical wellbeing: level they are also best placed to
not ultimately benefit the NHS or our Head of Communications
levels. If you are a clinical director, I hope you will consider Dr Jamie Strachan
■ 61 per cent of consultants and SAS- patients. I know that many managers facilitate discussions with individuals
the recommendations to support your team members to Council Member Mandie Kelly
grade anaesthetists thought their and HR departments are showing great and teams. Our survey found that
stay healthy and in work for as long as possible. If you’re Website & Publications Officer
workload was sustainable with some leadership and compassion in supporting conversations about career intentions Dr Ros Bacon
not in a management role, you might want to share the
adjustments their staff, and I hope that others will and career progression do not happen Council Member Anamika Trivedi
report with your colleagues and managers and get together
30 per cent of consultants and follow their example. as frequently as perhaps they should Dr Duncan Parkhouse Website & Publications Officer
■ to discuss how you can support each other during this
SAS-grade anaesthetists said their and that, while there are examples of Lead Regional Advisor
challenging time.
workload was not at all sustainable as I have mentioned above the importance good practice, such conversations are Anaesthesia
they got older. of flexibility in supporting people to stay often left until too late. Once a member If the pandemic has shown us anything, it is that we are
flexible, agile and forward thinking. We should not allow Articles for submission, together with any declaration of interest,
rigid ways of doing things to creep back in as we emerge should be sent to the Editor via email to bulletin@rcoa.ac.uk
Key findings from survey on factors affecting retention to RCoA membership engagement panel3 from the COVID-19 crisis, but should use our skills to All contributions will receive an acknowledgement and
support each other and to help colleagues to stay in work. the Editor reserves the right to edit articles for reasons of
Why do anaesthetists retire or leave early? What would influence anaesthetists to stay in work?
space or clarity.
Anaesthetists who had retired, or recently returned after Anaesthetists of different grades said that similar things References
retiring, said that the main reasons that they left were: would encourage them to stay working in the NHS for The views and opinions expressed in the Bulletin are solely
1 Anaesthesia – fit for the future, RCoA
longer or return after retiring: (rcoa.ac.uk/anaesthesia-fit-future). those of the individual authors. Adverts imply no form of
■ not feeling valued or well supported, including
2 Medical Workforce Census Report, RCoA, 2020 endorsement and neither do they represent the view of
relationships with colleagues and managers ■ being able to work flexibly and less-than-full-time to
(rcoa.ac.uk/census-2020). the Royal College of Anaesthetists.
■ wanting to pursue leisure interests and spend time with have better work–life balance
3 Respected, valued, retained – working together to improve
family ■ reduced or no on-call work retention in anaesthesia. RCoA, 2021
© 2021 Bulletin of the Royal College of Anaesthetists
(rcoa.ac.uk/improving-retention-anaesthesia). All Rights Reserved. No part of this publication may be
■ concerns about taxes or pensions ■ contract flexibility
4 Long-Term Strategic Framework for Health and Social Care reproduced, stored in a retrieval system, or transmitted in
■ bureaucracy and leadership issues being able to adjust clinical practice or the environment
■ Workforce Planning, Health Education England (bit.ly/3CwJbDz). any form or by any other means, electronic, mechanical,
■ improving mental wellbeing, reducing stress or burnout to account for physical changes with age photocopying, recording, or otherwise, without prior
If you have any comments or questions about any of
could not sustain workload or being on call ■ having supportive colleagues and managers that are permission, in writing, of the Royal College of Anaesthetists.
■
the issues discussed in this President’s View or any other
lack of flexibility, reduced hours, breaks or leave respectful and appreciative
■ subject, I would like to hear from you. Please contact me ISSN (print): 2040-8846
lack of autonomy and respect. ■ advice about pay, pension and taxation issues. via presidentnews@rcoa.ac.uk
■ ISSN (online): 2040-8854
6 | | 7
Bulletin | Issue 130 | November 2021 Bulletin | Issue 130 | November 2021
NEWS IN BRIEF
News and information from around the College
Annual College ACSA reviewer training session Voting in the Council Election FRCA examinations update:
award nominations A half-day reviewer’s training session for all ACSA reviewers will be held on the Don’t forget to vote in the election to Council, where you’ll be adjustments to prioritisation
morning of 9 November 2021. It will cover the hybrid model of review delivery,
and validity
choosing your representatives for six Consultant places, one SAS
The College is inviting nominations for changes to the 2021 iteration of the standards and guidance on assessment for place and one Anaesthetist in Training place. Ballots will be sent
the College annual awards from 1 January difficult standards. Contact the ACSA team at: acsa@rcoa.ac.uk if you wish to attend. by email (to the address you have registered with the College)
to 31 March 2022. Fellows or Members
on 16 November and voting will close on 15 December. Council
are invited to suggest nominations for If you are not a reviewer yet but are interested in becoming one you can find out
members play a hugely important role in the working life of the
consideration on behalf of Council by the more and apply from the College website at: rcoa.ac.uk/acsa-reviewer
College and in advocating for all our members, so do get your
Nominations Committee.
vote in.
The process for nomination allows for If after 16 November you haven’t received a ballot email please
any Fellow or Member to put forward check your junk mail, and then contact: elections@rcoa.ac.uk
nominations to be considered by the including your college reference number.
College Nominations Committee. This
Committee is chaired by Dr Claire
Shannon and includes the President,
Dr Fiona Donald, and Vice-Presidents,
Professor Will Harrop-Griffiths and Dr The College is committed to delivering examinations
Russell Perkins. in the fairest and most equitable manner, during what
continue to be challenging times for the specialty. In
Past recipients are listed on the College
August the College issued an update on our progress
website and can be used as a good
to support the large number of members who require
starting point when considering for
examination places across the 2021/2022 academic year.
what award a nomination should
be submitted – to find out more Please read our full statement on adjustments to
information and to understand the prioritisation and validity at:
criteria for the awards, please look at rcoa.ac.uk/news/frca-examinations-update-adjustments-
the Honours, Awards and Prizes page prioritisation-validity
on the website at:
rcoa.ac.uk/honours-awards-prizes
Disinvestment from fossil fuel suppliers
Nominations should be proposed using
Pursuing ACSA during
The Royal College of Anaesthetists committed to disinvesting from
the Nominations Proposal Form and
fossil fuel suppliers (including oil and gas companies) by January
completed forms should be submitted
via email to: awards@rcoa.ac.uk by a pandemic 2022, if they were not compliant with the Paris Agreement under the
United Nations Framework Convention on Climate Change (2016).
Thursday 31 March 2022.
The ACSA team has released its first podcast
The Paris Agreement seeks to limit global warming to 1.5 degrees
exploring how two anaesthetic departments have
Celsius above pre-industrial levels.
continued to pursue accreditation during the
pandemic. Vice-chair of the ACSA Committee, We have been advised by our investment managers, that no fossil fuel
Dr Emma Hosking, spoke to each department’s supplier within our portfolio of financial investments has credible plans
ACSA lead to find out how the accreditation to achieve this target, we have therefore chosen to disinvest from all
process has supported quality improvement work fossil fuel suppliers as of March 2021.
and highlight how the College has adapted review delivery to support departments
during the pandemic. The podcast is available to listen at: rcoa.ac.uk/podcasts. Please read our full statement here:
rcoa.ac.uk/news/disinvestment-fossil-fuel-suppliers.
8 | | 9
Bulletin | Issue 130 | November 2021 Bulletin | Issue 130 | November 2021
NEWS IN BRIEF
News and information from around the College
Presentation of Diplomates Ceremony SALG-BIDMC Winter Symposium 2021
2021 Scholar – Round 4 Join us online for our annual two-day symposium (2–3 December)
applications now
and enjoy a lively mix of lectures, debates and interactive sessions.
The Ceremony of Presentation of Diplomates was held on Friday 10 September.
The presentation of diplomates is the most important ceremonial occasion in We have included more clinical content this year as well as a
the Royal College of Anaesthetists’ calendar. Diplomates Day is a celebration of open medicolegal session and practical tips you will be able to use in HSRC Clinical Research
those who have received the Fellowship of the Royal College of Anaesthetists your everyday practice.
(FRCA), and members of the medical profession and beyond who have served Fellowships 2022
anaesthesia and its related disciplines at the highest level. Professor Helen
Stokes-Lampard, immediate past-Chair of the Royal College of General SAFE
ANAESTHESIA
This year’s symposium will be a hybrid event with a mix of lectures
debates and interactive sessions – not to mention the return of the
We are now recruiting for clinical research fellows for
2022 to work on high profile programmes in health
Practitioners and the current Chair of the Academy of Medical Royal College Christmas Jumper competition.
LIAISON GROUP services research. Projects include the Perioperative
spoke at the ceremonies and was awarded an Honorary Fellowship for her work Find out more and book now at: Quality Improvement Programme and The National
helping to create the Centre for Perioperative Care. rcoa.ac.uk/events/winter-symposium-2021 Emergency Laparotomy Audit. Each fellowship comes
For a full round-up take a look at pages 26–27. with a clinical commitment, and we have exciting
opportunities in hospitals across the country.
In collaboration with the College and Hybrid event
the Association of Anaesthetists, the Applications will be open until Wednesday 5 January
RCoA London and online 2022 and the posts will commence in August 2022.
Safe Anaesthesia Liaison Group (SALG)
are offering a unique programme
Winter Interested future fellows can contact: hsrc@rcoa.ac.uk
for more information.
Symposium
of formal training through Harvard
Medical School that aims to develop Read more about the work from the Health
international expertise in peri-operative Services Research Centre on pages 30–43.
quality and safety. 2–3 December 2021
The successful candidates will be
provided with a fully funded place in
a Master of Healthcare Quality and
Safety (MHQS) course from Harvard
Frailty Guidelines
University, while also engaged in In September 2021, the Centre for Perioperative Care (CPOC) and the British
clinical practice at a suitable level at the Geriatric Society (BGS) published Guidelines for Perioperative Care for People
Beth Israel Deconess Medical Center living with Frailty Undergoing Elective and Emergency Surgery. Perioperative care
(BIDMC), a major Harvard Medical for people living with frailty is complex and deficiencies in current perioperative
School teaching hospital with a long pathways are well described.
tradition of clinical, academic and
Despite published interventions for frailty, an implementation gap between
research excellence in Boston’s highly
recommended care and routine perioperative practice exists. This may be a
competitive healthcare environment.
consequence of too few geriatricians, silo working and difficulties in embedding
Further information is available on complex interventions for frailty in the clinical setting, compounded by
the SALG website at: salg.ac.uk. unintended consequences of time-based targets and a lack of commissioning
Applications close Saturday 4 incentives to embed a whole pathway perioperative team. To address this
December 2021. challenge, this new guideline has been coordinated working with patient
representatives and all stakeholders involved in the perioperative care of patients
Read more on page 54. with frailty undergoing surgery.
Please visit the CPOC website to read more: cpoc.org.uk
10 | | 11
Bulletin | Issue 130 | November 2021 Bulletin | Issue 130 | November 2021
CEO Update
Embracing change and
letting our values inform
our decisions
Jono Brüün
RCoA Chief Executive Officer
ceo@rcoa.ac.uk
Over the past few months, there have been many changes at the College,
not least, in September when we welcomed in our new President, Dr Fiona .
Donald. Fiona is a formidable leader and has since her appointment, shown
channels. Her enthusiasm was As we have learned, these new skills the importance we attach to learning
real guidance and foresight. I look forward to working with her and helping her exhilarating! We know that the and capabilities can lead to exciting lessons when things have gone wrong –
to embed her caring and supportive leadership at the College, to help better pandemic has accelerated innovation developments that support you in have contributed to that process.
in healthcare, but its influence can also everything you do. However, when things
serve our Fellows, Members, and staff teams. be seen in how the College continues go wrong, as they did during the CRQ
We are always open to your
suggestions about how we can further
to embrace digital forms to deliver its exam in September, the pressure of this
Embracing change and remaining agile their training. I’d like to extend again this new COVID-era, was wonderful. advocate for you, your loved ones,
services and opportunities to you. new way of working can take its toll and
has been central to how the College my sincere congratulations to the 2020 I was struck again by how much the your professional growth, and your
negatively affect our Members in ways
has been able to serve its Members and 2021 cohort of new Fellows and pandemic has called for not only the To meet the evolving requirements of patients. Our new strategy should
that we never wish to see, and work
and there is no greater example of remind those Members who were not wider College, but individual members our Fellows and Members I am seeing enable us to listen and act, to innovate
hard to avoid at all costs. That situation
this than through my experience of able to graduate this year that we look of staff to be agile in their efforts to teams becoming better able to flex to and strive for excellence on behalf of
was heart-breaking, and we have been
the 2021 Diplomates Day, which was forward to celebrating your ceremonies best serve the membership. I was lucky meet the needs of our membership Fellows, Members, patients, and the
determined to take responsibility, learn
run in person but with a huge number with you in the near future. enough to speak with a member of the and deliver in a way that is meaningful, public in the years ahead. There is such
the lessons, and put things right in as
of complex changes to the normal Events Team who enthusiastically told personal, and smart. We are enhancing opportunity here, and I’m excited that
Whilst there were lots of masks and just and fair a way as possible for the
programme to help everyone stay me how pleased she was to again be our audio-visual capabilities, elements I will be sharing with you our thinking
elbow bumps rather than handshakes, affected candidates, as well as for future
safe. Diplomates Day is a highlight of running a face-to-face event that was of our ACSA programme are being very soon.
the day still managed to retain its magic candidates for our exams.
the College’s calendar, it’s when we so meaningful for so many people. delivered online, staff members can work
and I felt privileged to be part of such a
celebrate those Members who have During our conversation she explained in spaces that make the best sense for All these events happened as we have
celebration.
gained their Certificate of Completion how her role has changed over the them, their role, and their wellbeing, and been shaping our new College strategy
of Training and are admitted as Fellows Talking to College staff at the event, past year, from managing traditional of course our exams team continue to and values, which we will launch in
of the Royal College of Anaesthetists many of whom I’d not seen in person in-person events to developing get to grips with the hugely complicated 2022. And all these approaches –
and its faculties. This is also a day to for so many months and observing new skills in recording, editing, and task of delivering high stakes clinical our desire to support and celebrate
recognise and thank the loved ones exams to candidates who have worked with our Fellows and Members, our
the expert way in which they stage- delivering digital content through
incredibly hard to sit them. responsiveness to new challenges, and
who have supported Members through managed an event as large as this in our rapidly evolving communications
12 | | 13
Bulletin | Issue 130 | November 2021 Bulletin | Issue 130 | November 2021
Marc Taylor
RCoA Digital Manager
website@rcoa.ac.uk
Guest Editorial Lifelong Learning Platform (LLP)
BUILDING A BRIGHTER
Since the beginning of March 2021, the College’s LLP team have been working closely with
our advising clinicians and website developers to update this website in line with the new
2021 anaesthetics curriculum and the ACCS curriculum, as well as to support FICM users.
The LLP is available to all members of the College, providing e-Portfolio, Logbook and
DIGITAL FUTURE
CPD functions within the one website. It will continue to evolve over time in response to
members’ feedback and GMC direction.
ACSA portal
Like many other medical royal colleges, our digital presence is key in driving The ACSA portal launched in November 2020, providing anaesthetic
engagement with you, our Fellows and Members. Because of this, we’ve spent departments across the NHS and independent sector with the ability to track
and progress their quality improvement journeys, collaborate with colleagues,
considerable time and focus this year making some great improvements to our and engage with College ACSA staff in ways not possible before. The system
website portfolio. also provides free and instant access to the resource library, which contains
items of good practice from other departments engaged with ACSA.
Apparently, it only takes seven seconds we don’t want to be a one-trick pony). – important things that must be the
to make a first impression on another This has been our sole vision for digital core focus of any RCoA website in our
human being. Not long then, and while over the past year and it will continue to portfolio. They will give you the best user SALG
this might focus on meeting people be so as it’s so vital for digital success. experience. The new Safe Anaesthesia Liaison Group (SALG) website was launched
for the first time, the same is true for
in May, and has had positive feedback from all stakeholders. This is a
websites. The past 20+ years have At the start of this journey last autumn, Twelve months later, we’re reached an
collaborative project between the College, the Association of Anaesthetists,
shown that an organisation’s digital we were humble and realistic enough excellent point on our digital journey, so
NHS England and the NHS Improvement patient safety team. The website
presence, regardless of sector, can to recognise that many of our sites a huge thank you to everyone involved.
required an identity distinct from all its parent navigations, and needed to be
have a massive impact on its short- needed some TLC to get them up to Despite the challenges presented by the
easily understood and navigable by Fellows and Members. SALG provides
term and long-term success. Having scratch and fighting fit. Our mission pandemic, limited budget (who wouldn’t
a central reference point for patient-safety enquiries from anaesthetists and
a strong website presence can make is for our websites to be credible and want more development budget!) and
other healthcare professionals.
or break how an organisation reaches highly communicative. We need to competing priorities, we’ve pulled off
and engages with its customers. At the strive for excellent content, usability some impressive redevelopments, and
College, our customers are you, and we and accessibility. This will help us reach brand-new digital products across the FICM website
want to provide you with the best user- and engage with both current and College. Let’s take a look at each of
Only last month, The Faculty of Intensive Care Medicine – the professional and
centric digital experiences (note plural, prospective Fellows and Members them now.
statutory body for the specialty of intensive care medicine – launched their
new website. It’s cleaner, and the more contemporary look and feel provides
improved usability and accessibility for FICM’s membership of more than 3,500.
The faculty works on behalf of its members and their wider services to promote
My RCoA education and standards; influence; define national policy; and,
Last month, the College launched ‘My RCoA’ – most importantly, improve outcomes for patients and their families.
a new online portal. This new benefit for RCoA
Fellows and Members will make it easier and
quicker for you to manage the information we
hold about you. The new online portal has been Stronger than before
developed using feedback from our member Undeniably, websites have become essential to all businesses and organisations today. There is no better place to see this
surveys. We will be looking to add features than the RCoA websites, particularly with all the digital work achieved over the last year. We will continue to engage with our
over the coming years, encompassing further Fellows and Members in developing our digital portfolio. After all, these websites are there to inform and engage you. We
feedback from our members. From 2022, this want you to enjoy visiting them, find our content informative and ultimately bookmark them as they enhance your work as
portal will also provide you with easy access to an anaesthetist. On all our websites you will find some great content – news, blogs, videos, webinars, podcasts, newsletters,
BJA Education’s online content. publications and photography which are diverse, inclusive and clinically accurate. As you’d expect (and rightly so) we take this
very seriously in all our content. A high-quality digital presence is essential to the College now and going forward. We will
emerge from the pandemic with a stronger and more impactful digital presence than ever before. Keep watching this space –
there are even more exciting times ahead.
14 | | 15
Bulletin | Issue 130 | November 2021 Bulletin | Issue 130 | November 2021
Faculty of Intensive Care Medicine (FICM)
FICMLearning update
Dr Peter Hersey
Chair, FICM Education Sub-Committee
contact@ficm.ac.uk
Since announcing the launch of FICMLearning.org in last summer’s Bulletin,
the education subcommittee has continued to thrive. We are incredibly
Dr Emma Baird grateful not just to the members of the committee, but to everyone who has
Anaesthetic and
Inpatient Pain Consultant,
written blogs, e-ICM sessions or ‘cases of the month’, spoken at one of our
Preston events or recorded podcasts despite the obvious demands of the last year.
Faculty of Pain Medicine (FPM) contact@fpm.ac.uk
Since the beginning of the COVID-19 Our podcast series has been very well While undoubtedly a challenge, moving
Inpatient Pain Update
pandemic, we have seen a 39 per cent received and is approaching its 50th the FFICM course online allowed for
increase in launches of e-ICM sessions episode. During the last year there have a greater number of participants, with
and a 24 per cent increase in the been more than 10,200 downloads. excellent feedback.
number of active users on the platform. The ‘cases of the month’ have covered
Inpatient pain services have long been under-resourced and underfunded. We now have nearly 12,500 active a wide range of interesting clinical The sustainability and development
Professor Rockett’s 2017 survey of acute pain services in the UK showed that users from professional backgrounds topics and the blog has covered a of the workstreams relies on user
engagement and volunteers to produce
most did not meet the FPM Core Standards.1 In order to meet core standards, including nursing, physiotherapy, host of subjects. FICMLearning.org is
content. If you have any ideas for
occupational therapy and medicine, viewed approximately 3,500–4,000
the majority of inpatient pain services in the UK need to get more funding to and have recorded more than 230,000 times per month. content, want to know more or want
to get involved please don’t hesitate to
develop their services. Proving our worth in order to justify funding has always launches since the project’s inception.
Like others, we were forced to move email us at: contact@ficm.ac.uk.
New and original content is continuing
been one of inpatients pain’s biggest problems. to be published as well as production of
our events online. The annual meeting
Leading the Way was well attended
an increasing number of ‘learning paths’
ACSA (Anaethesia Clinical Services The other main goal of 2021–22 is to References to make it easier to signpost content
and received, and we have been able
Accreditation) is the College’s flagship improve opioid stewardship nationally. to host two successful virtual FFICM
1 Rockett M et al. A survey of acute pain on e-ICM relevant to a particular
voluntary scheme that offers quality As part of this goal, and on the back services in the UK. Anaesthesia 2017. exam preparation courses to date.
professional group or need.
improvement through peer review.2 of the publication of the Surgery and 2 Anaesthesia Clinical Services Accreditation
ACSA have invited the FPM to join the Opioids: Best Practice Guidelines,3 the (rcoa.ac.uk/acsa).
committee to help develop the inpatient FPM are carrying out a national survey of 3 Surgery and Opioids: Best Practice
Guidelines 2021 (bit.ly/3l5RoaL).
pain sections of the accreditation perioperative opioid usage. The aim will be
4 Levy N et al. An international multidisciplinary
process. If defined standards regarding to get an overview of current practice and
consensus statement on the prevention of
inpatient pain were included in the ACSA form a national strategy going forward. opioid-related harm in adult surgical patients.
accreditation, it could prove pivotal There is overwhelming international Anaesthesia 2021; 76:520-536. For further information,
in improving inpatient pain services evidence that poor perioperative opioid Find out more
please visit theat
Get invo
nationally. This is an exciting step forward, prescribing can cause harm, including
and I hope it will help us all secure the persistent opioid use.4 FICMLearning.org
section of our website:
funding we need to deliver the services
we know our patients need.
bit.ly/RCoA-Involved
16 | | 17Bulletin | Issue 130 | November 2021 Bulletin | Issue 130 | November 2021
SAS and Specialty Doctors
VASUDHAIVA KUTUMBAKAM:
THE WORLD IS ONE FAMILY!
Dr Ashwini Keshkamat
RCoA SAS Member of Council,
Dartford and Gravesham NHS Trust
sas@rcoa.ac.uk
I am not me these days, and feel torn between two worlds. Never has this support for members and colleagues report 10 lessons learnt from COVID-19 programme wins over the virus, and that,
separated from their families while they are reflections from the experiences of even if there are a few waves or ripples,
feeling been so intense in the last decade of my life here in UK than the past continued to work in the NHS across anaesthetists/intensivists, and these can they will not cause a surge that will flood
few weeks. The pandemic has affected all of us in different ways, probably the UK. probably be extrapolated to healthcare the healthcare system.
systems across the globe.2 It truly
more than we can consciously think. The College is one big family with
resonates with the ‘think globally, act
While the UK continues to recover from
members from many countries across the its surge, numbers in the subcontinent
locally’ philosophy, which is the need of
Since March last year, we have endured in and out of red lists, and with their around us. It is not just about following globe. It has indeed been an endeavour remain high, and the apprehension in
the hour.
the first wave, the peaks and troughs, healthcare systems bearing the burden the rules for our own safety, but also to support all members through the my mind continues. I’m hoping that the
the lockdowns and the restrictions. of the pandemic. about collectively working towards pandemic through various portals, be it I am writing this at a time when we are world heals soon from the pandemic,
Cogitating about the reasons for my bringing down the transmission through the COVID-19 guidelines for clinicians, enjoying the sunshine in the UK and and that all of us get the chance to unite
My heart goes out to all colleagues responsible behaviour and embracing
feelings, the one reason that struck delivery of online exams to facilitate looking forward to going back to near- with our families wherever they are.
who continue to work in situations with the scientific evidence and getting
me was that I am a British-Indian living training needs, wellbeing resources for normal life in the coming weeks, with all
limited resources, and I am extremely vaccinated when it is offered. It has References
in Kent. It is like sitting on a see-saw, all members, or taking the lead at the restrictions easing. We are also cautious
saddened by the unfortunate reality that forced us to think for the community at
where I happily swing between my global virtual conference1 and reaching about the variants and the rise in numbers 1 International Academy of Colleges of
families are facing the loss of near and large, beyond boundaries.
acquired British identity and the Indian beyond the boundaries. I believe the that is anticipated once the restrictions Anaesthesiologists, RCoA.
dear ones to this dreadful virus. It has
side. I am sure those of you with family College has indeed gone global in the ease. I sincerely hope for all countries 2 Lessons UK healthcare systems can learn
been devastating for some of us, with It reminds me of the old Sanskrit phrase from the pandemic, RCoA.
overseas, with whom we have managed last few months. The recently published across the world that the vaccination
the feeling of helplessness when we ‘vasudhaiva kutumbakam’ – meaning
to communicate through the screens
cannot be near our loved ones when the world is one family and a wonderful
of our devices over the last fifteen
they need us. demonstration of the all-inclusive
months, will appreciate the situation. As
This can be realised when
attitude needed. I believe this can be
the restrictions were easing here, many The one strong message that the realised only when we have cognitive
of you like me were looking forward pandemic has conveyed since its and compassionate empathy towards Please see our website for
we have the cognitive and
to travelling abroad to visit family and beginning is that we cannot think for
loved ones. But clearly that wasn’t ourselves alone. The choices we make
those around us and between nations. further information on SAS
It was indeed overwhelming to see
and Specialty Doctors:
compassionate empathy
the situation across the world, where and our behaviour can affect those the College president’s statement of
countries were still in lockdowns, were
rcoa.ac.uk/sas
18 | | 19Bulletin | Issue 130 | November 2021
The College has developed a toolkit that offers patients
the information they need to prepare for surgery,
including the important steps they can take to improve
health and speed up recovery after an operation.
Chris Kennedy
RCoA CPD and The Fitter Better Sooner toolkit consists of:
Revalidation Coordinator
Revalidation for anaesthetists cpd@rcoa.ac.uk ■ one main leaflet on preparing for surgery
The second anniversary
■ six specific leaflets on preparing for some of the most
common surgical procedures
of CPD in the LLP
■ an animation which can be shown on tablets, smart
phones, laptops and TVs.
You can view the toolkit here:
November 2021 is the second anniversary since CPD functionality was
rcoa.ac.uk/fitterbettersooner
launched into the Lifelong Learning Platform. Some of the advantages of this,
when compared to the former CPD Online Diary, include that you can link to We have also created printable posters, flyers and stickers
the ‘Good Medical Practice Domains’ and the ‘Domains for Medical Educators’ to help you signpost patients to the toolkit. The animation
and that ‘real-time’ reflection can get added during a multiple-day event. The can be shown on TVs in waiting areas. You can find all
PDF activity report remains available as a download for revalidation evidence. these additional resources and instructions on how to
download the animation in MP4 format (or request a
We are pleased that the CPD of this attracts one CPD credit. You can professional development needs of non-
functionality continues to be very well also generate a PDF transcript of your trainees and are targeted at a regional or version in PowerPoint) on our website here:
used, with more than 3,500 personal previous course history which can be national audience. rcoa.ac.uk/patientinfo/healthcare-professionals
CPD activities typically being added added into the document store of the
After so much disruption last year, the
and reflected upon each month, making Lifelong Learning platform, and then a Please share this toolkit with colleagues in
a total of approaching 90,000 since personal CPD activity linked to this. number of event applications being
received is now approaching pre-Covid both primary and secondary care settings.
launch. For interest, the busiest month
A key feature of the Lifelong Learning times at around 60 per month, with
so far during the past two years was
platform remains the section for CPD- the result that new CPD Assessors are
November 2020 when 5,623 personal
CPD activities were added.
accredited events, and we continue to
welcome applications for approval of
very welcome. You can find out more
on the College website at: rcoa.ac.uk/ It has been shown that
One recognised personal activity type
is the CPD online learning which is
‘virtual’ learning events – on condition
that these feature some form of
cpd-assessor this role also counts as
a personal CPD activity which can people who improve
available through BJA Education. The
website at: bjaed.org has recently
interactive learning – for example, the
opportunity for participants to be able
be recorded in the Lifelong Learning
Platform. their lifestyle in the run up
been updated and includes a wealth
of material, including every edition of
to directly ask questions of the faculty
in a scheduled panel discussion at the We hope this update is helpful, and for to surgery are much more
further information on any of the above
the journal since 2001. The most recent
articles are accompanied by a multiple-
end. Applications for the more traditional
face-to-face style events are also very please contact: cpd@rcoa.ac.uk. likely to keep up these changes
choice test, and successful completion welcome if these are appropriate to the
after surgery.
20 | | 21Bulletin | Issue 130 | November 2021
that we produce consistent, high-quality
www
patient information. It’s well worth it
because patients can trust our resources.
PE: Increasingly, people, especially Where can I find more
younger people, look for information information?
in different formats such as video,
online or social media. How has PIG Patient information leaflets and
Pauline Elliott adapted to the move away from the video resources
Chair, RCoA Lay traditional patient information leaflet?
rcoa.ac.uk/patientinfo/leaflets-
Committee video-resources
laycomm@rcoa.ac.uk EF: You’re absolutely right. The way
Patients and Carers section
children and young people consume
rcoa.ac.uk/patientinfo/resources
information has changed dramatically
over recent years. Fitter Better Sooner
rcoa.ac.uk/fitterbettersooner
Patient Perspective We enlisted the help of colleagues at the
‘THAT EXPLAINS IT!’
Royal College of Paediatrics and Child Information for children,
Health. We asked them to run a series parents and carers
of focus groups with their networks of rcoa.ac.uk/childrensinfo
children and young people to look at Centre for Perioperative Care
our patient information. They said our cpoc.org.uk
Elena Fabbrani information was good, but it needed
RCoA Policy refreshing and more video content.
PE: PIG has produced some really close collaboration between its
and Patient The College’s Patient Information Group (affectionately known great materials such as You and your I’m very pleased that we now have an multidisciplinary members.
Information as ‘PIG’) produces high-quality information materials which anaesthetic and Fitter, Better Sooner. improved suite of resources for children,
EF: I couldn’t agree more Pauline.
Manager How does the group measure the young people and their carers, including
help patients, families and carers understand and prepare for quality of the information it generates? videos for different age groups, from
PIG has been so successful because
its membership is so diverse.
procedures involving anaesthesia. young children to teenagers.
EF: There’s nothing like belonging to We are also keen to work with
NHS services are working and support patients and families In 2015 the College set up the an accreditation scheme to keep us on PE: What projects does PIG have in other organisations. We consult and
very hard to reduce waiting during this difficult time. Patient Information Group, our toes when it comes to measuring the pipeline at the moment? collaborate with other medical royal
lists, which have built up due and Dr Hilary Swales became quality! Our patient information colleges and experts from other
PE: Hi El. Thank you for talking EF: Our infographics on the risks from
to the disruption caused by the Chair and College Lead resources are now certified by the specialties and industries to make sure
with me about PIG. Could you anaesthesia has been hugely popular
COVID-19. Unfortunately, for Patient Information. PIG is Patient Information Forum Trusted that we are as inclusive as possible
explain the origins of the group with anaesthetic departments, and the
despite everyone’s best efforts made up of clinicians, healthcare Information Creator Kitemark, PIF TICK. and that we offer the latest and most
and how it’s evolved over time? Association of Paediatric Anaesthetists
many patients are waiting much professionals, lay representatives accurate information to patients.
To receive and maintain the TICK, we wants to work with us to produce a
longer than they expected for EF: Hi Pauline. The College and staff. We’re all passionate
need to demonstrate every year that version for children and young people. PE: Thank you very much El. It’s been
a range of procedures. This produced its first patient about high-quality patient
information. Under Dr Swales’ our resources meet tough standards great to talk with you about PIG. The
means it has become even information leaflet, Anaesthesia One gap is postoperative pain, so
leadership we’ve developed across ten categories, including patient group clearly has a very important role
more important to keep patients Explained, in 2003, followed by we might explore a resource around
involvement, use of plain language, in helping people understand more
informed and encourage them a series of patient information our patient information offer this, possibly in collaboration with the
and accessibility of print and digital about their health and care. Hopefully
to prepare themselves for leaflets on anaesthesia. This, further. We now have video Centre for Perioperative Care (CPOC).
information. As you can imagine, that helps achieve what everyone wants
treatment and recovery while together with the Risks associated content, FAQs, factsheets,
ensuring that we always meet the criteria PE: It seems to me that at the heart – better experiences and outcomes for
they wait. with your anaesthetic series, infographics and Easy Read, and
requires time and effort, but it also means of the PIG’s achievements is the patients and their families.
still form our stock of patient provide translations of our most
Pauline Elliott, Robert Dudgeon information resources. Dr Lucy popular leaflets in more than 20
and Irene Leeman are lay White led this initiative, and I want languages. Have a look at the
members of PIG. Here Pauline to thank her for her pioneering Patients and Carers section of the The Royal College of Anaesthetists was certified under the PIF TICK in April 2020,
talks to El Fabbrani about the work which gave us an excellent College website at: rcoa.ac.uk/ and are the first medical royal college to receive accreditation under the scheme.
group and how its work can help foundation on which to build. patientinfo/resources.
22 | | 23You can also read
