National Audit Projects (NAPs)

NAPs study rare but potentially serious complications related to anaesthesia

The National Audit Projects (NAPs) are internationally recognised as important reports with potentially significant impact on anaesthetic practice and patient outcome. The topics selected for each NAP must be important to patients and anaesthetists, and be incompletely studied in incidence or nature.

NAP Logo Web Strip

The NAPs are "internationally important reports with a potentially significant impact on patient outcome and experience during and after anaesthesia and surgery" (Moppett, 2013). In addition to 'shining a light' on the topic, the NAPs include recommendations for clinical practice and research. The NAPs are intended to examine, report on and drive improvements in practice.


The NAPs collect data for a full calendar year on their respective areas of focus. The College is indebted to the legion of NAP Local Coordinators who report each case that occurs in their hospitals across the year of data collection, be it of anaphylaxis (NAP6), accidental awareness (NAP5), and so. These Local Coordinators also coordinate baseline and activity surveys in their hospitals. The Local Coordinators are the backbone of every NAP and the involvement of 100 per cent of eligible NHS hospitals is a testament to their commitment.

The majority of the NAPs have also involved collaborations and partnerships between various anaesthesia-related organisations. This principle of collaboration was begun with the RCoA working with the National Confidential Acute Pain Critical Incident Audit (NCAPCIA) for NAP3 and includes the Difficult Airway Society (DAS) for NAP4, the Association of Anaesthetists for NAP5, and the British Society for Allergy and Clinical Immunology (BSACI) for NAP6.

The RCoA and HSRC would like to acknowledge that many other organisations have also contributed significantly to the development and delivery of NAPs through their important contributions on the relevant steering groups.


There have been six National Audit Projects to date. NAP7, which will examine perioperative cardiac arrest, is currently in the planning stages.

NAP6 Report

Anaesthesia, Surgery and Life-Threatening Allergic Reactions

NAP5 Report

Accidental Awareness During General Anaesthesia in the United Kingdom and Ireland

NAP4 Report

Major Complications of Airway Management in the United Kingdom

NAP3 Report

Major Complications of Central Neuraxial Block in the United Kingdom

NAP1 and 2 Report

Supervisory Role of Consultant Anaesthetists & Place of Mortality and Morbidity Review Meetings

External Review

In 2013, Professor Iain Moppett (prior to his involvement with the HSRC) conducted an external review of NAP3 and NAP4, to which the HSRC Executive Managament Board published an official response

Professor Moppett found that the NAPs were very well run, and well received by anaesthetists in the UK and the various specialist societies. Although his report made some recommendations for improvement these did not detract from the general extremely high standard of the projects. The NAPs were found to represent excellent value for money to the RCoA, anaesthetic specialist societies and the wider NHS.


NAPs 1-4 were supported and managed by the Professional Standards Directorate (now the Clinical Quality & Research Directorate) of the RCoA. Responsibility for managing the NAPs was transferred to the NIAA Health Services Research Centre (HSRC) following its launch in 2011.

NAP5 was the first to be managed by the HSRC. Prof Tim Cook is the current RCoA Advisor for the National Audit Projects.

Would you like to find out more about NAPs?
Please visit the NAP website for more information and detailed study documentation on each project.

Professor Tim Cook
Director, RCoA National Audit Projects

Tim Cook is a consultant in anaesthesia and intensive care medicine at Royal United Hospital NHS Trust, Bath.  As well as directing the National Audit Projects, he is also the College Advisor on Airway matters.  He was awarded the Macintosh Professor of Anaesthesia by the College in 2012. Tim has worked on the National Audit Projects since NAP3. He serves on the Safe Anaesthesia Liaison Group and the HSRC Executive Management Board. His research interests include major complications of anaesthesia, airway management, regional anaesthesia and litigation.