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We would like to use this Bulletin article to focus on setting up a Personal Development Plan (PDP), some guidance on what should and should not get included, and to address a query about using your PDP in the Lifelong Learning Platform. In providing this advice we are making reference to the Mythbusters¹ guidance which has been produced by the Academy of Medical Royal Colleges.

The goals within the PDP should be taken from your appraisal, and should meet your needs and the context within which you work. It is recommended that goals are developed with your appraiser using SMART (Specific, Measurable, Achievable, Relevant and Timely) objectives, and it often helps to work out how you can demonstrate that a change planned as one of your goals has made a difference, by considering its impact on patients.

In Scotland there stands a national gap in clinical governance which results in blind spots and potential risk to patients. This article explores why Scotland is missing out and what needs to be done next.

Our nation is ideally placed to perform and contribute to UK-wide audit. The population size, the uniform governance structure, and the infrastructure and expertise should lend themselves to a world-leading approach to clinical audit and outcomes.

Despite this, Scotland doesn’t participate in an important programme for ensuring standards and safety in anaesthesia in the UK. The Safe Anaesthesia Liaison Group (SALG) is a long-standing collaborative project between the Royal College of Anaesthestists (RCoA) and the Association of Anaesthetists. Established in 2008, it aims to provide a central repository for anaesthesia-related patient-safety incidents. SALG then analyses, prioritises and takes appropriate action on reported incidents.

The NIHR-HTA funded Continuous rectus sheath Analgesia in eMErgency LaparOTomy (CAMELOT) is another trial led by the Perioperative Medicine Clinical Trials Network (POMCTN) that is currently open for recruitment. 

The study aims to find out whether adding rectus sheath catheters (RSCs) to standard analgesia provides better pain relief, fewer side effects and complications, and greater satisfaction for patients undergoing emergency laparotomy. It will also determine whether RSCs are safe and cost-effective. All POMCTN trials are registered with the NIHR Associate Principal Investigator (API) scheme. In this article, one of our trainees shares her experience working on the CAMELOT study.

Authors:

• Alessandra Anzante, Employment Lead, RefuAid
• Dr Siân Jaggar, Cardiothoracic Anaesthestist, Royal Brompton Hospital
• Maria Burke, RCoA Global Partnerships Manager

World events have seen record numbers forcibly displaced from their homes – currently estimated at 103 million people.¹ According to the Refugee Council, in the 3^rd Quarter of 2022, 24,511 applications for asylum were made,² an increase of 58.1% on the previous quarter. Government statistics tell us that in 2022 74,751 asylum applications were made (relating to 89,398 people).³

A study by Deloitte in 2017 surveying Syrian refugees in Europe⁴ found that 38% of respondents were university educated, but that despite this 82% were unemployed. It highlighted language as being one of the biggest barriers to re-entering employment, despite 63% of those surveyed wanting to continue their careers in the professions for which they had trained in their home countries. In the case of anaesthetics (and medicine as a whole), there are significant challenges for them in entering UK practice.

The Anaesthetic Workforce: UK State of the Nation Report 2024 was a sobering reminder of the challenging working environment we find ourselves in. An Anaesthetic Wellbeing Network was born two years before that, meeting online for the first time in February 2022. 

It was an attempt to share ideas on how to improve the working conditions of healthcare providers within a network of anaesthetists and clinicians with an interest in this field from the Kent, Surrey and Sussex/London region. The group has proved to be very successful, and has grown, with colleagues from around the country joining virtually, every few months.

So, what have we achieved as a group and what do we hope to do next?

We hope you will find this information useful in helping all anaesthetic staff within your department access the educational supervision or mentorship they require.

Introduction

In addition to consultants and doctors in formal training, anaesthetic departments frequently contain SAS and Locally Employed Doctors. SAS doctors are employed on national SAS contracts, the current of which are ‘Specialty Doctor’ and ‘Specialist’. Locally employed doctors (LEDs) are employed on non-national Trust-derived contracts. LEDs have multiple titles including ‘Clinical Fellow’ and ‘Trust Doctor’. Medical Training Initiative (MTI) doctors are also commonly employed as LEDs and form part of this latter group. 

Within this combined cohort are doctors at all stages of their careers, with individual development needs. To maximise the potential of the existing anaesthetic workforce, it is imperative that these doctors are offered support to achieve their potential and reach their career goals. These goals may include broadening their role into non-clinical domains, (re)entering formal training, becoming consultants through the GMC Portfolio Pathway or becoming Specialists. 

Being an anaesthetist in training has always had its challenges, alongside the many opportunities and benefits offered by our specialty. However, I think that those of you currently in training are facing a particularly tough time. And without wanting to be too downbeat, I think it’s important for the College to recognise that, to reiterate our commitment to supporting you and to update you on what we are doing to try and improve your working lives.  

There could be no stronger reminder of these challenges than the fact that, as I write this, junior doctors are about to begin the first day of a 72-hour strike. Although unsurprising, the overwhelming support for industrial action among junior doctors is further evidence of just how frustrated and undervalued they are feeling. Our job is to ensure the voices of our members are heard and understood. We do value you, and while we do not have a role in negotiations about terms and conditions of employment, we have made it clear that we believe the exclusion of doctors in training and SAS doctors on the reformed contract from the government’s pay deal is likely to exacerbate the NHS staffing crisis. We will continue to make that point to the government as we advocate action to address workforce shortages and pressures.

As I write this, we are finalising the 2025 Census, which we undertake every five years to get an accurate picture of the anaesthetic workforce across the UK.  

In previous years the Census has focused on asking Clinical Leaders and College Tutors for local data about the provision of anaesthetic services to patients, the composition of the workforce and anaesthetic education and training. This year, for the first time, we are also asking all practising anaesthetists in the UK to participate in the Census and tell us about your individual experiences at work.  

The Census launches in the first week of April. By the time you’re reading this you may have already received your unique link to complete it. I know you’re all very busy but taking a few minutes to complete the Census will make a huge difference. The more we know about your working patterns and challenges, professional development and wellbeing, the more effectively we can support you and advocate on your behalf. 

VITAL is the first POMCTN-led study and a collaboration between the POMCTN (Perioperative Medicine Clinical Trials Network) and PQIP (Perioperative Quality Improvement Programme) teams. 

We aim to test whether TIVA is superior to inhalational anaesthesia in terms of days alive and at home at 30 days (DAH30), and survival and quality of recovery among patients undergoing major non-cardiac surgery. 

We have been recruiting well and have now passed the halfway point due to our fantastic sites. Here, one of our first site teams, at the Royal Marsden Hospital, shares its experience of recruiting to perioperative trials.

I started working part-time for GIRFT (Getting it Right First Time) as a POA (Preoperative Assessment) national advisor in September 2022. Most POA non-medical leads will recognise that you are often working in a silo in a POA department. While we have a number of expert multidisciplinary-team (MDT) professionals who feed into and out of the department, the core ‘everyday’ team are predominantly non-medical staff. 

It’s an area that has seen significant variation across the country, but for many POA will be the sole job for the staff who work there. The reason? They absolutely LOVE IT! Highly skilled and hugely rewarding, this area brings a huge amount of satisfaction and unity to identify potential challenges for our patients undergoing elective surgery, and is an opportunity to help educate and inform on perioperative risk. 

Post pandemic, we have seen pivotal changes to the perioperative pathway with a focus on early assessment and optimisation for patients ‘while they wait’.¹ Working for GIRFT and NHS England (NHSE) colleagues, specifically in elective recovery, has brought a new dimension to my role and, I hope, skills of influence, engagement and innovation to help drive forward the importance of all POA clinics, everywhere.