April 2018

Suicide
When someone is driven to take their own life, it is tragic and is also devastating for those around: family, friends and colleagues. Many of us have known someone close who has committed suicide. Doctors in general, and particularly anaesthetists, are recognised as being at greater risk of suicide than the general population. Recently, Dr Kate Harding, a GP whose anaesthetist husband Richard took his own life, bravely describes her experience of coming to terms with his death in two articles in The Guardian and the BMJ. The Association is concerned by Kate’s story and other reports of suicide amongst anaesthetists. We have been discussing what to do about the subject for some time and have recently convened an expert group to discuss how the Association might respond in terms of support for those affected by suicide and thinking about possible guidelines to help individuals and departments. An expert working group has been formed, and as a first step, a survey is planned for later this year that will seek anaesthetists’ experience of suicide in colleagues. Further detail of how to respond to the survey will follow in the coming months.

Dr Bawa Garba
Much has been written in recent months about the Dr Bawa Garba case since the GMC won its High Court Appeal against the independent Medical Practitioners Tribunal ruling not to erase her from the medical register. I don’t intend to revisit the genuine concerns over the possible disclosure of written reflections and the harm the GMC handling of the case has done to the medical profession’s confidence in its regulator.

My main concern about the case is the harm that the original conviction of Dr Bawa Garba for gross negligence manslaughter could have on patient safety. Medical error is recognised as the third highest cause of death behind cardiovascular disease and cancer. It is estimated than more than 250,000 people die in the US as a result of medical error, and we have no reason to believe that the proportionate numbers are any better in the UK. If we are to reduce this shocking statistic, we need to better understand medical error through striving to learn from mistakes. This requires moving from a culture of blame to one where healthcare workers readily admit their mistakes and learn from errors. If the courts are to prosecute individual clinicians for their genuine errors, how can we encourage people to own up to their mistakes?

From what I know of the circumstances around the tragic death of Jack Adcock, Dr Bawa Garba made errors in his management, but how many of us could say that we would not have made similar errors in the pressured situation she found herself when we were at a similar level of training and experience? It is likely that Jack’s death could have been avoided but it was not solely Dr Bawa Garba’s fault that he died; the failure of the hospital to provide adequate manpower and supervision, to provide a proper induction to a doctor returning from maternity leave to a new strange hospital, and failures of the IT system, all contributed to his death. Why the criminal justice system contrived to hold Dr Bawa Garba to account, and not the many hospital and system problems is unclear. One thing is certain; a court of law with its adversarial legal system is not the best place to unravel the complexities of medical error.

It is not that healthcare workers should be immune from prosecution but that we need a justice system that prosecutes malicious or reckless behaviour, not genuine errors that any one of us could make under the difficult, prevailing conditions that we often face.

Unless we get this right medical error will continue and possibly increase in the face of defensive clinical practice. We have just submitted our response to the Williams Review into gross negligence manslaughter in healthcare.  You can read our response here.

What’s in a name?

anaesthetist at monitor in operation room

What should we call ourselves: Anaesthetist or Anaesthesiologist? Worldwide, the prevailing term is Anaesthesiologist (with or without the diphthong). I used to be opposed to the term as an “Americanism” but my view is becoming eroded by the increasing number of countries adopting Anaesthesiology to differentiate physician anaesthetic providers, and to use the term Anaesthetists for non physician providers. If I were to call myself an anaesthetist in the US, people would think that I am a nurse anaesthetist. Last year the World Federation of Societies of Anaesthesiologists (WFSA) issued a position statement that made it clear that the term Anaesthesiologists referred to physician anaesthesia providers, while acknowledging that in some countries such physicians were called Anaesthetists. Those countries include the UK, Ireland, Australia and New Zealand. Now it looks like that list is becoming shorter. The Australian and New Zealand College of Anaesthetists is looking to change its name to “College of Anaesthesiologists” (read about it here) and I have heard rumours that the College Anaesthetists in Ireland is considering the same. It looks as though the UK will be the last bastion for “Anaesthetists”.

I tested the stomach for change a couple of months ago on Twitter and didn’t get a huge response but those that I did get were against change. So should we change, particularly now that we have anaesthesia delivered by PA(A)s who are non physician anaesthesia providers? Or perhaps we should just leapfrog and lead the world in becoming “Perioperative Physicians”? Mmmm…

Forthcoming events

This week the Association is holding an International Reception to highlight some of our international work and in particular the Ugandan Fellowship scheme. A recent paper in March Anaesthesia evaluated the Ugandan Fellowship and demonstrated the success of the programme. In the last 10 years, by partnering with local professional organisations and providing modest financial scholarships to help young Ugandan doctors to train in anaesthesia in Uganda, the scheme has helped to greatly increase the numbers of physician anaesthetists in Uganda. But the evaluation demonstrated more than just improved manpower; there was also greater access to safer surgery and improved standards of patient care.

Dr Emily ayhew

On Friday, 18 May, the Association’s Heritage Centre are holding an evening event “The Guinea Pig Club”, celebrating the pioneering work of Archibald McIndoe, maverick plastic surgeon during and after the Second World War. We welcome back Dr Emily Mayhew, author and military medical historian, who will be talking about the “Clubs” enduring legacy and inspiring member stories. This special “Anaesthesia Lates” coincides with the Heritage Centre’s new Brave Faces exhibition and the popular Museums at Night week. It should be a great evening.

 

 

 

 

January 2018

This is my first blog of 2018 and I wish you a happy and productive New Year.

The New Year has got off to a flying start with the Association’s Winter Scientific Meeting (WSM) in London and a special one at that as we celebrated its 30th year, the first being in 1988. We received several congratulatory e-mails from members who remembered that first WSM London held at the Royal College of Surgeons. Many recalled the discussions at the Association Council when it was first suggested by the President, Professor Michael Rosen. The proposal was met with a degree of scepticism from other members of the Board – “who’d want to attend a meeting in London, in January?” However, saying “no” to Michael Rosen was never an easy task; the meeting went ahead, was a great success and the rest is history. The meeting was moved five years later, in 1993, to the Queen Elisabeth II Centre in Westminster where it has remained since. So, this year also marked 25 years at the fantastic venue that is the QEII.

WSM London 2018 (Churchill auditorium)

Enough of history, what about the conference itself? It was a great success with over 900 delegates in attendance and many excellent lectures and had a real buzz during the breaks. There was a special theme this year with more lectures on workplace issues and wellbeing than usual and of particular relevance with so much pressure on our under resourced and overworked NHS. The WSM London dinner was a little different this year. The formal black tie dinner at the Savoy has been popular for years but we thought it would be good to experiment with something different. The event was held on the other side of the river at the gallery of the Festival Hall with stunning night views of London. It was a lot less formal without a black tie in sight and a great opportunity to chat with other guests. The buffet finger food was followed by a Silent Disco – you wear headphones and tune in to a choice of three channels each playing a different selection of music (I plumped mainly for the “sounds of the 60s”) and just dance, regardless of whether those around you are listening to the same music or not. It may sound bizarre but it really is great fun and all sorts of people admitted afterwards that they’d joined in and danced for the first time in years!

WSM London 30th celebrations

WSM London 2018 30th celebrations

WSM London 2018 30th celebrations

One of the things that I particularly enjoy at WSM London is the Honours and Awards ceremony when the outstanding achievements of some individuals are celebrated. A particular favourite of mine is the Evelyn Baker Award, which was instigated in 1998 by Dr Margaret Branthwaite and dedicated to one of her former patients at the Royal Brompton Hospital. The award is intended to recognise anaesthetists who do not have a national profile but are recognised locally as superb clinicians, wise and great communicators with both patients and colleagues; our true “unsung heroes”. Individuals are nominated by their colleagues and the award is always hotly contended. This year’s worthy winner was Dr Michelle Soskin and you can read her inspiring citation together with others who gained awards in 2017 here.

Dr Michelle Soskin receiving the Evelyn Baker Award WSM London 2018 from Dr Paul Clyburn (WSM London 2018)

Innovation in medicine is essential if patient care is to improve, and for that reason in 2012 the Association under the guidance and inspiration of Dr Bernie Liban introduced an award for Innovation in Anaesthesia, Critical Care and Pain. Each year, there is a session at the WSM London for the shortlisted contenders to present their innovation. The winner is announced on the last day of the conference and gives a short presentation of their innovation. I would like to congratulate this year’s winner, Dr Chris Evans, for his Little Journey App, which is a virtual reality preparatory tool for children undergoing ambulatory surgery.

Dr Chris Evans receiving the 2018 Award for Innovation in Anaesthesia, Critical Care and Pain from Dr Paul Clyburn (WSM London 2018)

I also wish to congratulate all 142 trainees who presented such great posters at the WSM. The abstracts are published in an open access on-line supplement of Anaesthesia and can be viewed here. I’d encourage you all to take a look as there are some excellent poster abstracts.

I find myself quite busy at an Association conference and even when free to attend the lectures, as luck would have it, there are two simultaneous lectures I wish to attend. Fortunately, most are filmed and made available to view a couple of weeks later on Learn@AAGBI. This really is a fantastic resource for AAGBI members, who can watch lectures that they were unable to attend in the comfort of their own homes with something to sustain them in their hand (a cup of tea or coffee, of course). I often find that the speaker explains something that I don’t quite understand and wish I could get them to repeat it. With Learn@AAGBI that can be done with ease by hitting the pause/rewind button. Learn@AAGBI now has over 600 lectures from educational events since 2011 all neatly organised by event or subject.

As far as e-education is concerned, AAGBI is not standing still and continues to introduce innovative improvements. Although Learn@AAGBI videos have been available for some time, it is worth reporting that the videos can now be accessed by smart phone or tablet using an app. In addition, the app will allow you to download the lectures so that you can watch them “on the move” when there is no Wi-Fi. Another innovation is the broadcasting of webinars. The first one a few months ago was on ‘Optimising Patients before Surgery’ and attracted around 100 delegates. You may be wondering: what is a webinar? Basically, it is live on-line lectures where you hear the speaker who can also display slides or other media. There is a chair or facilitator who can moderate questions from the audience submitted by means of a typed ‘chat box’ feature. The result replicates a live mini conference apart from not seeing the other members of the audience and without the hassle of travelling to the venue as all can be accessed from your own computer in work or home. The event is recorded and therefore can be viewed at your leisure later if there are things you missed or wish to repeat. The intention is to run six more webinars in 2018, the next one in February is titled ‘Translating Alien Ideas into Patient Safety Advances’, further details here.

Another first for AAGBI was the live streaming of a lecture during WSM London2018: the Archie Brain eponymous lecture ‘Fact and Fallacy in Peri-operative Research’ given by Prof Michael Avidan. On the day, 24 people watched the live streaming, most from overseas. This is a fairly modest number but there were some encouraging twitter streams and it gives an opportunity for growing this innovation in the future. The stream was recorded and is still available for the next few days by clicking here.  It’s a great lecture, so why not take a look.

Prof Michael Avidan, presenting the Archie Brain lecture ‘Fact and Fallacy in Peri-operative Research’, which was also live-streamed from WSM London 2018

All these developments make getting CPD locally and even from your own home possible with the advantage of saving cost and travel time. However, there is something special about actually being at a conference like the WSM London and catching up with friends not seen for some time and discussing professional issues with colleagues from around the UK and beyond.  One delegate, in describing the event said that it felt just like family.

 

 

October 2017

Annual Congress and Linkman

I always enjoy our Annual Congress as it has a great atmosphere and vibrancy and this year was no exception. It was held in Liverpool at the end of September and was a great success with around 700 delegates attending. The programme was excellent but a particular highlight was a keynote lecture from Professor Sir Harry Burns, a surgeon who had previously been the chief Medical Officer for Scotland. He gave an interesting perspective on the link between poverty and poor health, worldwide. If you weren’t there to hear Sir Harry, AAGBI members can catch up by watching the lecture on Learn@AAGBI, just login and watch here. All the other lectures (and more) are available to members to watch in the comfort of your own home. As usual, the poster and oral presentations were of a high standard and I congratulate the prize winners. This year’s Congress Dinner was in the impressive Anglican Cathedral. Following the traditional drinks reception in the Lady Chapel, we processed into the main Cathedral, beautifully lit to guide our way to the Well for our dinner. The enormity of the Cathedral’s space coming from the relatively small chapel is quite striking and to complete the atmosphere, Widor’s Toccata was being expertly played on the largest pipe organ in the UK. It was the start of a truly memorable evening. Following dinner we danced the night away to a Beatle’s tribute band – what else could it be in Liverpool!

Annual Congress auditorium at the ACC Liverpool

Dr Surrah Leifer receives her award at Annual Congress 2017 Dr Surrah Leifer In recognition of her contribution to training in anaesthesia and to the GAT Committee

Charity bike ride and progress with fundraising

For the sixth time in a row, a group of intrepid cyclists made their way to Annual Congress under their own (pedal) steam by cycling the 230 plus miles from London to Liverpool over 3 days to raise money for charity. This year, 22 cyclists set off from 21 Portland Place and raised over £8,000 for AAGBIs own charity, SAFE Africa. The ride was great fun with the usual social camaraderie, and on the afternoon of the last day, the group greeted the final leg – the Mersey Ferry – with tired legs but good spirit. We relaxed that evening in a Liverpool hostelry but were interrupted by about 200 new medical students all sporting the same bright yellow T shirts with their first names, home town and favourite activity written with marker pen on their backs. It is good to see that medical students still have risqué imaginations, as displayed in some of their favourite activities written on their backs. Late September, it has to be Freshers’ week. Thus, these students were on an orientation tour of the best places to eat and drink (cheaply), guided by older hands. They stayed for about 40 minutes, were good fun and not yet too drunk. Some even gave generously of their beer money to our SAFE Africa!

SAFE Africa cyclists (including me) depart from AAGBI Headquarters bound for Liverpool

230 miles later we arrive in Liverpool for Annual Congress 2017

 

Global anaesthesia and e-SAFE launch

To celebrate the launch of a second edition of the successful e-learning resource, e-SAFE, the Royal College of Anaesthetists (RCoA) held an event at Red Lion Square on World Anaesthesia Day (16 October). e-SAFE has been produced by a collaboration between AAGBI, e-Learning for Healthcare (e-LH), World Federation of Societies of Anaesthesiologists (WFSA) and RCoA. The programme was excellent and included, Lord Crisp, Andy Leather (Lancet commission co-chair), and Tulip Mazumdar (BBC Global Health reporter). The audience were well informed and included many recognisable faces involved in Global Health projects.

Key points that emerged during the day included:

• An acknowledged lack of affordable surgical/anaesthesia resources in low and middle-income countries (LMICs) as highlighted by the Lancet commission.
• The value of partnerships, which amongst other things can support and develop local leadership.
• Helping to build local capacity.
• The need to break through “silo activity” and produce better coordination and collaboration.
• Need for top down pressures (through engaging with overseas’ ministries and using UK advocacy to apply pressure), as well as bottom-up pressures (empowering and developing local leaders and societies/institutions to bring about improvements).
• UK Government is changing attitudes to overseas aid – looking to support developments that benefit both recipient and benefactor.

Talking about these problems is good, but better is to start acting on these issues. I liked Lord Crisp’s final word: “…..global health partnerships should be fun.”

Coffee and a Gas

We know that morale amongst our trainees is probably at an all time low – increasing work pressures and an imposed contract are just some of the reasons for this. When I was a trainee, I could always tap into the support of colleagues by popping to the doctors’ mess when I had a free moment. I am sure that the loss of such facilities has contributed to the poor morale. The AAGBI’s Group of Anaesthetist in Training (GAT) Committee have come up with a simple but potentially powerful idea to help support our trainees. On Stress Awareness Day (1 Nov), GAT is launching the idea of an informal get together to chat and unwind over a cuppa with the aim to promote community and wellbeing, naming such events ‘Coffee and a Gas’. This initiative is being promoted directly to individuals and department of anaesthesia, and via social media. If locally successful, we hope that such informal “get togethers” will become a regular event. After all, it’s always good to talk.

Fatigue and sleep lack

I have written before in these blogs about the AAGBI’s fatigue project, which is trying to change culture around fatigue, sleep disturbance and the effects of shift work on us all. This work continues and is now backed up by some educational resources available on the AAGBI website. The whole issue around the effects of fatigue and disturbed sleep patterns has had extra publicity in the last few weeks by the announcement that this year’s Nobel prize for medicine has been awarded to Young, Rosbash and Hall for their work on elucidating our circadian rhythms. Their work has highlighted the importance of sleep – the optimal amount and at the right time. We cannot expect anyone to work night shifts without allowing for the effects on our biological clocks. Society needs to understand that flipping back and forth between day and night work for short periods does not suit our natural sleep patterns and leads to significant reductions in performance. Safety critical industries, and I include health care in this, need to take account of this biological imperative and take a more flexible approach to shift work and ensure that we optimise shift patterns, allow proper rest periods during shifts and ensure that people are discouraged from driving home if they are tired. The latter requires the provision of post shift rest facilities. In healthcare professions the safety of our patients depends upon a change in our attitudes towards proper rest and effective shift rotas. The educational resources are about to be sent out throughout the NHS as part of our awareness raising campaign. We encourage all members to join us in educating and informing colleagues about the impact of fatigue, as we aim to change the culture in the interests of patient safety and doctor wellbeing.

August 2017

It’s been a busy couple of months.

Common Issues Group
June was the annual meeting of the (Anaesthesia) Common Issues Group or CIG. What is the CIG? It was established in 1997 to facilitate communication between the main Anaesthetic Societies Association of GB and Ireland, US, Australia and Canada. Thus, the founding members were the AAGBI, American Society of Anaesthesiologists (ASA), Australian Society of Anaesthetists (confusingly also ASA), Canadian Anaesthesiology Society (CAS) and the International Anaesthetic Research Society (IARS). The latter body withdrew in 2005 and the four remaining societies were joined by the South African Society of Anaesthetists (SASA) and New Zealand Society of Anaesthetists (NZSA) in 2013. Each of the four original societies takes it in turn to host the meeting, usually around one of their big meetings. This year it was the turn of Canada and they hosted the meeting in Niagara, just before their annual congress.

As this was my first meeting as AAGBI President, I have been reflecting on the CIG’s purpose and relevance. After all, getting senior officers and chief executives from six national societies to travel long distances has to be justified, both in time and cost. My conclusion was that despite marked differences in our health care systems, we were still able to find a number of important common issues to discuss including: drug labelling and drug supply shortages, critical incident reporting, workforce issues, managing frailty, and different models for perioperative medicine. But talking and informing each other doesn’t necessarily lead to change and improvement. I was quite optimistic when there was agreement to follow up some of our discussions and work further together on a number of issues. Positive outcomes in terms of action were:

• Establishment of a joint working group on drug labelling and packaging.
• AAGBI’s National Essential Anaesthetic Drug List (NEADL) to be shared and developed collaboratively.
• Share our respective e-learning resources.
• Develop and learn from each other’s experience and approach to advocacy.

This latter topic was lead by the AAGBI but the ASA (US) brought their own slant on the subject by introducing the concept of Professional Citizenship. I’m not sure that the words easily translate across the Atlantic but the basic concept is sound and has some resonance with me. It is basically promoting and instilling pride and professionalism within our specialty and taking personal responsibility in our work and profession. I think it also means not leaving the solving of problems to others, whether it is colleagues in your workplace or our national organisations. We shouldn’t just be saying: “what’s my Clinical Director/ the Association (or College) going to do about this problem?”, but ask: “what can I do to help my Clinical Director/the Association (or College) solve/highlight this problem?”.

Left to right: Presidents of ASA (US), ASA (Australia), CAS, NZSA and AAGBI relax at annual congress dinner

GAT Annual Conference 2017
I was extremely proud to welcome the GAT annual conference to my home city of Cardiff last month. For once the infamous Welsh weather did not let me down and I thought the glorious sunshine we experienced showed the magnificent Cardiff City Hall at its best…and the scientific programme was excellent, too. I enjoyed all the fun events though I did find helping to judge the “Bake Off” entries a cake too far and had to go and lie down afterwards! This year, GAT celebrates the 50th Anniversary of the Association having a dedicated Trainee Committee. We should be grateful to our predecessors who had the foresight in 1967 to establish the “Associates in Training Group”. This metamorphosed by way of the “Junior Anaesthetists Group” (JAG) into today’s Group of Anaesthetists in Training (GAT). I fondly remember attending my first JAG meeting in Southampton in (I think) 1982, as my first introduction to an Association meeting – It was great fun and the rest is history.

GAT Annual Scientific Meeting July 2017 in the grand Assembly Room of Cardiff City Hall

Back to this year’s meeting: the highlights included an interactive Question and Answer session where delegates quizzed, directly or via the Conference App, the Irish and Royal College Presidents, Chair of GAT and me about a range of issues including trainee and consultant contracts, the impact of PA(A)s (physicians’ assistant (anaesthesia)) on training, promoting the importance of our specialty to the general public. We didn’t manage to answer all the submitted questions but hope to publish soon on the GAT web page of the AAGBI website some of these questions with responses from the panel members.

There were excellent oral scientific presentations and the winning entry by Dr Jon Holland presented some of the results of a national survey of anaesthetic trainees on the effect of fatigue. The survey was simultaneously published online early in Anaesthesia (read survey here) together with an accompanying editorial by Dr Mike Farquhar (read editorial here). These publications, which highlight the problems of excessive fatigue after night shifts, attracted national press interest.

GAT Cardiff marked the end of Emma Plunkett’s term as an excellent Chair of GAT.  I wish Emma every success in her new Consultant post. Sad that it is to see Emma and other members of the GAT Committee leave, it was good to welcome Deirdre Conway as the new GAT Chair – a worthy successor who I am confident will continue Emma’s great work.

Outgoing GAT Committee Chair Dr Emma Plunkett presenting Dr Deirdre Conway with her GAT Chair medal at the GAT Annual Scientific Meeting in Cardiff, July 2017

Past President’s lunch
A few weeks ago we welcomed back to 21 Portland Place, former Presidents of AAGBI for a celebratory lunch. Also joining us were the current officers of GAT – the future of our specialty. It was great to see the Past Presidents and they were very interested to hear about recent developments at the Association. In turn, it was fascinating to hear their stories and experience of leading the Association in previous years – many of the problems and issues we think are unique to our time are just ones that come around again and again. The current success of the Association is built on the strong foundations that these and other Past Presidents and Officers put in place.

AAGBI Presidents past and current with new GAT Committee Chair Dr Deirdre Conway (centre) and GAT Vice Chair Dr Victoria McCormack (right) at the recent AAGBI Presidents lunch.

Fundraising for SAFE Africa
Following on from the successful fundraising for Lifebox (Lifeboxes for Rio), the Association of Anaesthetists has launched a new fundraising campaign for SAFE Africa. Read more here.  Once again leading up to Annual Congress, this year in Liverpool, a group of intrepid anaesthetists (and others) will be cycling the 219 miles from 21 Portland Place to Liverpool to raise money for SAFE Africa (cycle ride details can be found on the AAGBI website). It will be great fun and I am already in training for the ride. If the prospect of dressing up in Lycra and joining 30 similarly clad sweaty adrenaline pumped people fills you with dread, or simply you are unable to make the ride, please support a colleagues by making a donation in their name here. Alternatively, you can encourage me to make it to Liverpool by donating here.

Early morning start for last year’s AAGBI fundraising cycle ride.

Dr J-P Van Besouw
I finish with the recent sad news of the passing away of J-P van Besouw, the Immediate Past President of the Royal College of Anaesthetists (RCoA). J-P was a towering figure in Anaesthesia and lead the recent modernisation of the RCoA and many of its developments including the Perioperative Medicine programme. He will be missed by many of us. In J-P’s memory, the family have designated the AAGBI’s charity – SAFE Africa as it accords with J-P’s passion for education and training in low-resource countries. Donations in memory of J-P can be made here.

 

May 2017

Once again as I write this, we hear of the horrific bombing at the Manchester Arena. Words fail to describe the sadness we all feel for the victims, many of them young children, and their grieving loved ones. We’re also hearing of the heroic behaviour of the Manchester community in rallying around the victims and the many acts of kindness. Once again I wish to pay tribute to the emergency services and healthcare professionals who are caring for the many injured – I only wish that they were not needed. This week the AAGBI issued a statement in response to Monday’s attack at the Manchester Arena, you can read it here.

Ten days ago I attended and spoke at the annual conference of the Association of Physician Assistants (Anaesthesia) or PA(A)s. The title of my talk was “The anaesthetists’ marmite view of PA(A)s” – hardly a title designed to win friends at a conference of PA(A)s. However, my intention was not to alienate PA(A)s but to help them understand why there are such polarised views about them among anaesthetists. What exactly are PA(A)s and why were they introduced? Until 2003, the UK, in contrast to the US and much of mainland Europe, had anaesthesia given solely by specialised doctors i.e. a physician delivered service. In 2003, PA(A)s were introduced in response to continued concerns that a shortfall in anaesthetic manpower, further hampered by a reduction to trainee working hours, would be insufficient to meet the growing surgical demand. They were recruited from other healthcare professions (nurses and ODPs) and science graduates. PA(A)s receive  27 months of training and they work as part of a physician-lead anaesthesia team, supervised directly and indirectly by a consultant anaesthetist.

Since 2003, their number has gradually increased to around 150 though they remain < 1% of the anaesthetic workforce. Perhaps predictably, as individual PA(A)s have gained experience, they have extended their practice beyond that originally defined by the scope of practice at qualification. This organic development is not recognised by either the AAGBI or RCoA, and is covered by local governance arrangements https://www.aagbi.org/news/joint-statement-rcoa-and-aagbi-scope-practice-physicians-assistants-anaesthesia. An additional concern is that PA(A)s are not yet a regulated healthcare profession, though all PA(A)s are encouraged to provide their details to a voluntary register held by the RCoA.

So why are PA(A)s marmite to anaesthetists? Why do they polarise views? Many anaesthetists who regularly work with PA(A)s recognise their value within the anaesthesia team: improving the delivery and efficiency of their service. They have successfully used them to expand and introduce services to provide regional anaesthesia, central line insertion and conscious sedation to patients, all with good audited outcomes. On the other hand, there are anaesthetists who see PA(A)s as the “thin end of the wedge” towards establishing independent, non-medical anaesthetists along the lines of CRNA nurse anaesthetists in the US and a threat to the profession. Some also believe that the training of PA(A)s reduces training opportunities for anaesthesia trainees.

Of course the majority of anaesthetists are like myself and have no experience of working with PA(A)s and are therefore poorly informed about how they may enhance services or whether they pose a risk to our profession. What is the future of PA(A)s? A priority is for them to become a regulated healthcare profession. Only then can sensible role extension be properly standardised and sensibly regulated. It is also important to the anaesthetic profession to ensure that workforce planning is able to meet current and future surgical demand.

Pulse oximetry has become an essential part of monitoring in developed countries and contributes hugely to the safety of anaesthesia. However, in low income countries, pulse oximeters are scarce. The Lifebox charity has made its prime goal to ensure that patients in such countries benefit from pulse oximetry during surgery by donating oximeters and providing the training to use them effectively. A recent groundbreaking study published in Anaesthesia (read the study here) demonstrates the impact on patient safety of the introduction of Lifebox pulse oximeters with appropriate training in their use in Malawi: Further information here. Thus, confirming what we all believe – that Lifebox’s work is saving lives.

Lively panel discussion (L-R) Professor Roger Kneebone, Dr Emily Mayhew and Col Duncan Parkhouse

Welcoming a sell out house to the second Anaesthesia Heritage Centre Lates event at 21 Portland Place

Last Friday, the Heritage Centre of the AAGBI hosted a Museums at Night event. Dr Emily Mayhew, the well-known medical historian and author gave an entertaining and informative talk on the impact of changes to medical practice as a consequence of the Afghanistan campaign and drawing parallels with medical advances during the First World War. Emily was then joined by Colonel Duncan Parkhouse for a fascinating panel discussion expertly facilitated by Professor Roger Kneebone and answering questions from a diverse audience. We learned how improvements to the survival of blast injured soldiers came through improved self aid by soldiers and by bringing experienced anaesthesia lead teams (Medical Evacuation Resuscitation Team: MERT) to the battlefield so that advanced resuscitation could be started early while evacuating the injured to Camp Bastion. An excellent and entertaining evening!

March 2017

Sleep is essential to our wellbeing. It is well known that lack of appropriate sleep and fatigue impairs our performance and that is why in safety conscious airline and road haulage industries, pilots and lorry drivers have enforced rest breaks. You wouldn’t dream of boarding a plane if you suspected that the pilot had been awake all night, so why has this safety culture not prevailed in the NHS? We are programmed to be awake during the day and sleep at night, so why do we expect trainee doctors to flip back and forth between day and night shifts without taking into account the natural circadian rhythm that makes it difficult to remain fully awake at night. In addition, the progressive change from on call to shift working has seen the removal of rest rooms where staff could have recuperating naps during quiet periods. I have even heard stories of hospitals where resting is actively discouraged or even a disciplinary offence. This requires a change in culture and we must:

• be aware of the dangers of working while fatigued, threatening both patient safety and our own health.
• appreciate the importance of restorative sleep in preventing fatigue.
• promote ways that minimise the impact of shift work on our sleep pattern in order to remain alert during a shift.
• All this requires education of both doctors and their managers. It also needs employers to provide adequate rest facilities during night shifts and afterwards so that the shift worker does not drive home while fatigued putting themselves and other road users at risk.

Last Friday, 17th March, was World Sleep Day, intended to draw attention to the importance of sleep to all of us. The AAGBI fatigue project group that I wrote about last month used this event to promote their work and issued a statement which can be found at here

I am often asked about what’s new in the AAGBI. Well, what is really new is the publication this week of our Long-Term Strategy, which sets out our vision and aims for the next few years. We are interested in your views and want you to comment so that we take these into account. So, down load it now (http://www.aagbi.org/about-us/long-term-strategy), read it and comment. Your feedback is welcome to honsecretary@aagbi.org.

I read last week about the Government resetting targets for A&E waits. Like many of you, my head dropped into my hands. Without going into the pros and cons of targets, my despair is that the Government seems to believe that by setting targets alone, things will improve. They just don’t seem or want to understand that the real problem is the increasing pressures on our NHS. These include falling bed numbers, an inability to discharge elderly patients into the community because of inadequate social care, and from an ever-increasing patient demand and expectation.

What is needed is an acceptance that the NHS is under resourced and under funded for what it is expected to deliver. We know that we come well down the league of developed countries for per capita healthcare spending. If the Government can’t afford to fund the NHS adequately from general taxation, we need an open and public debate on where the money should come from. Continuing to expect the NHS to meet pubic expectations with inadequate funds is not an option.

Living and working in Wales, I remain a spectator to the progress of the 44 area based Sustainability and Transformation Plans (STPs) in England. These are intended to prioritise (sounds like rationing) and streamline (and inevitably reconfigure) local NHS services. I have several concerns:

• are they joined up in their planning of services, as inevitably the services they are planning will cross boundaries and affect services in neighbouring areas?
• is there the inevitable over emphasis on saving money, given that there is difficulty with balancing budgets?
• is there appropriate consultation with clinicians and the public?

If you work in England, I encourage you to find out what is happening in your area; who is involved and make representation to be consulted appropriately. Even when clinicians are consulted, anaesthetic and critical care services are frequently neglected – surprising when you consider the variety of services with which anaesthetists and critical care doctors interact with and influence.

As I was writing this blog, news broke about the attack on Westminster Palace. My immediate thoughts were for the victims and their families: PC Keith Palmer and the innocent members of the public, many of them visitors, who were so tragically killed or seriously injured by this cowardly terrorist attack. Despite the tragedy, it was heartening to see the professionalism shown by the emergency response teams and healthcare staff who received and cared for the victims at St Thomas’ and other supporting hospitals.

February 2017

One of the great pleasures of being President of the AAGBI is being invited to attend events that celebrate something special. And so it was that last month I was fortunate to be the invited guest of the Coventry Anaesthetic Course Faculty Dinner at the Hilton Metropole Hotel in Birmingham NEC. I was only vaguely aware of the excellent work of the Coventry group: mainly courses for FRCA exam preparation (my son had attended the primary course and felt it greatly contributed to his subsequent success). The course dinner is held annually to thank the hard working courses’ faculty. I was honoured to help with the giving out of awards to the faculty (you can see some of the photos taken below). We had an excellent meal and a very enjoyable evening. I congratulate the Coventry Anaesthetic Courses on their successful educational events and hope they will continue their superb work.

Faculty members receiving their award from AAGBI President, Dr Paul Clyburn

 

 

 

One of the things that concern us at the AAGBI is the risk that anaesthetists (amongst other workers) face when they have to drive home after a busy night shift. Eighteen months ago, Ronak Patel, an anaesthetic trainee was tragically killed, having fallen asleep at the wheel driving home after a night on call http://www.mirror.co.uk/news/uk-news/exhausted-doctor-killed-driving-home-8402981. Sadly, Ronak’s death was not the first of such tragic deaths, but has served to focus on the risks of driving while fatigued. A recent BBC South documentary highlighted these risks:  https://www.facebook.com/BBCSouthToday/videos/1257344837689437/

A project group involving, AAGBI board members, GAT (AAGBI’s trainee committee) and the RCoA trainee committee are working on changing the culture around managing fatigue – of both individuals and organisations. This will involve bringing together existing knowledge and information into an educational package to ensure that individuals and employers are educated about fatigue and the practical steps that can be followed to reduce its effect. The group have also facilitated a survey of anaesthetic trainees looking at individuals’ experience of driving after a night on call, their understanding of the risk and the facilities available at their hospital to sleep before driving home. The survey is complete and is currently being analysed.  The project is well underway and we should start to see the fruits of their labour over the coming months.

January 2017

Blwydden Newydd Dda – Happy 2017 to everyone!

2017 has begun with huge pressures on our under-resourced, understaffed and overworked NHS. The Red Cross has referred to the situation in Emergency Departments as a humanitarian crisis and although this is vehemently refuted by the Government, the NHS England chief executive, Simon Stevens, has spoken out about the underfunding of the NHS. With this background, we hear that some trusts have cancelled elective surgery in order to cope with the emergency pressures. In addition, some anaesthetists have been asked to work outside their usual scope of practice. As a result, the AAGBI, together with the RCoA, have issued a joint statement to advise and support members who find themselves in such a situation.

December 2016

Last month, I wrote about visiting Chicago for this year’s ASA meeting when the local baseball team (the Cubs) won the World Series. The following week, Chicago witnessed another piece of sporting history when the Irish rugby team, playing at home in Chicago (I know, strange), ended the All Blacks’ record, equalling a run of 18 consecutive wins. Interesting, then, to be visiting Dublin the following weekend and see another nation buoyed by its sporting success. The annual visit to Ireland for a joint meeting with our Irish Standing Committee (ISC) and to attend the members general meeting is a highlight of the AAGBI calendar, when we are reminded exactly what the “I” in AAGBI stands for. The meeting was a great success, including an address from the new Irish Minister for Health, Simon Harris.