Author: Dr David Selwyn, Director, Centre for Perioperative Care

It began with a ‘huddle’ in a venue close to Red Lion Square, a spark of an idea among a group of forward-thinking, like-minded individuals. Perhaps the beginning of a new specialty, initially termed ‘perioperative medicine’. At the time, this idea also received support from the RCoA president as a key future direction for the College.

So, why were we huddling in central London? Back in 2012, a seminal publication appeared in the BJA questioning where the specialty of anaesthesia was headed. Many now see this as the turning point that catalysed the evolution of, as we now call it, ‘perioperative care’.

Seven years later, the Centre for Perioperative Care was officially launched in London at Anaesthesia 2019 – an initiative hosted and largely funded by the RCoA, with simple yet laudable aims – to champion the voice of our patients, bring organisations together, transform traditional ways of working and integrate services through true multidisciplinary collaboration. I was honoured to be appointed its inaugural director.

Today, CPOC is a powerful vehicle for transformational change. It places patients at the centre, promotes shared decision-making, addresses health inequalities, and challenges traditional siloed specialties. It is considered a key direction for the College.

CPOC represents a fundamental shift in NHS thinking, from fragmented care to integrated, whole-pathway approaches that re-engineer services around patient needs. Language plays a vital role (‘care’ not ‘medicine’, ‘centre’ not ‘faculty’, and ‘director’ rather than ‘clinical director’) in ensuring inclusivity, neutrality, and credibility in political spaces. CPOC is not synonymous with perioperative care, nor vice-versa, but it is the engine driving the transformation our patients need and deserve.

Early days of CPOC

Our first year focused on building governance and structure for CPOC. We appointed a decision-making ‘board’ comprising high-value professional stakeholders, a CPOC advisory group of patient-facing and interested organisations, outstanding deputy directors, and a patient representative. All of these are from parent specialties outside anaesthesia to ensure crucial diversity of thought and consideration.

During the Covid years, CPOC adapted and grew. It rapidly became the national voice of perioperative care, influencing policy and shaping national clinical direction.

My recent highlights

While producing guidelines and resources is a core output, developing a network of perioperative leads and enhancing patient-facing materials has been a major step for such a lean organisation. All key resources have been reviewed and refreshed in the past year. We’ve also adopted a more impact-focused, interactive approach, highlighted by tools like our Obstructive Sleep Apnoea guidance and SipTilSend campaign.

Workforce issues currently challenge us all across the NHS, and CPOC has supported 12-month fellowships to develop and grow future leaders in perioperative care. Sadly, due to funding constraints, these posts will potentially end in August 2026. However, we are working hard to source sustainable funding for the future of the fellowships.

Recent substantial projects have included the development of a medical perioperative care curriculum and a nursing, AHP curriculum, aimed at building a skilled, high-quality workforce for the future.
Newer resources include our seven key interventions aimed at minimising patients’ complications and length of stay. This change in health messaging to one of approaching society with joint ownership of our own healthcare, has been picked up in the recent NHS England Fit For the Future: 10 Year Health Plan. The plan details the three big shifts- from hospital to community, from analogue to digital and from sickness to prevention- aimed at curing our ‘sick society’.

While CPOC is a four-nation organisation, its early focus was on England. During Covid, we expanded links with Scotland and Wales, where perioperative networks are now maturing. Recognising the importance of developing future leaders, we have actively strengthened our partnership with Trainees with an Interest in Perioperative Medicine (TRIPOM), and also responded to requests from surgical residents for perioperative sessions at the Surgical Research Society (SRS) and affiliated meetings. Adding a second surgical voice to the CPOC board has enabled production of co-developed resources, including guidance on expected team behaviours.

What next for CPOC

Huge challenges remain to realising the true opportunities afforded by perioperative care for our patients, our organisations and our future. Engaging GPs is vital to tackling health inequalities and improving access – core aims of the triple shift. I am pleased that the RCGP has made prevention a strategic priority and is committed to deepening its collaboration with CPOC.

A key area of recent development is CPOC’s growing global presence. Building on a longstanding partnership with the Australian and New Zealand College of Anaesthetists (ANZCA), CPOC joined ANZCA, the American Society of Anaesthesiologists (ASA)  Centre for Perioperative Medicine (CPMed), The Perioperative Quality Initiative (POQI), American Society of Enhanced Recovery (ASER) and Evidence Based Perioperative Medicine (EBPOM) at this year’s EBPOM World Congress to co-produce and sign the London Declaration, which calls for a global initiative to advance the perioperative care movement. We will be talking about it later this month.

While I am sad to step away from CPOC – particularly that amazing buzz generated by working with a truly high-performing team of experts, and especially the unsung College staff who, in the background, bring everything together and make everything work. It is pleasing that the recent director recruitment generated high-calibre interest and an excellent new director. I’m very confident that Professor Denny Levett will continue to drive CPOC forward.

As for my legacy, there’s so much to be proud of already. CPOC is amazing. And, particularly during these turbulent NHS times, it gives real hope for our patients and the future of our specialty. Let’s never lose sight of or focus on that.