Search

When English chemist Joseph Priestley discovered ‘dephlogisticated nitrous air’, or nitrous oxide in 1772, he unknowingly revolutionised medical practice. What Mr Priestley didn’t know was the significant impact that N₂O would have on the environment.

With a lifetime of 150 years in the atmosphere and a 100-year global warming potential 10 times that of carbon dioxide, N₂O poses a significant problem.

Are we regularly bulk-buying N₂O just to leak it straight into the sky? This is not a new idea. The Nitrous Oxide Project, started in NHS Lothian in 2021 by Alifia Chakera, found that usage of N₂O in the theatre setting was much lower than anticipated, with significant wastage in the supply chain. In fact, hospitals that have undertaken similar analyses report that 95–99% of the N₂O that’s bought is wasted due to leaks in both outdated manifold systems and in piped N₂O supplies.

Authors:

• Dr Sangita Kindred, Anaesthetic Trainee, North Central School of Anaesthesia
• Dr Tim Jackson, Anaesthetic Trainee, North Central School of Anaesthesia
• Dr Kate Sherratt, Consultant Anaesthetist and North Central London Training Programme Director, 
  Royal Free Hospital

We are in the midst of a climate emergency. With record-breaking heat waves and flooding over the last few years, the danger to our patients’ health is undeniable. Even the World Health Organization described climate change as ‘the single biggest health threat facing humanity’.¹ Therefore, we have a duty as healthcare practitioners to change our practice to protect our future patients. Even the GMC has changed its guidance on ‘Outcomes for Graduates’ to reflect this need.²

Anaesthetic gases make up more than 2 per cent of the NHS’s carbon footprint, and reduction in their use is central to the NHS long-term plan to reach carbon net zero by 2045.³ Desflurane is a particularly harmful greenhouse gas, with a global warming potential over 100 years (GWP100) which is 2,540 times greater than carbon dioxide.⁴

An increasing number of residents are having children during training. While some of you might balk at the idea of combining nappies and sleepless nights with stages 1, 2 and 3 of training, others are very happy to go on this journey of paternal and professional bliss.

Many of us know that although parenting and training in anaesthesia are compatible, there are many challenges. Some of these could be addressed to the benefit of anaesthetists, anaesthetic departments and providers alike.

This galvanised us to run a national survey, looking at the impact of parenting on training in anaesthesia from both the parent and non-parent perspectives. 411 residents responded to the survey, with a higher proportion of respondents being white and heterosexual, and training less than full time. A similar proportion of men and women responded, highlighting how these issues affect everyone. We recognise that this is the opinion of one group, albeit a key stakeholder, in a complex situation.

This article highlights a few of the key findings.

The GMC has recognised that the quality of clinical care and the safety of patients are crucially dependent on the quality of training provided within the health service, not only in relation to skills and knowledge but also in relation to professionalism. The GMC has recognised for many years that trainers must be trained, accredited, supported and quality-assured.

Specialty and Specialist (SASs) and locally employed doctors (LEDs) are the fastest growing part of our workforce, with numbers increased by 40% over the last five years. Projecting forward, they are expected to be the workforce’s largest group on the GMC register by 2030 (GMC workforce report 2022). Not only will the NHS depend heavily on this part of the workforce to provide services to patients, but also to train future generations of doctors and other healthcare professionals.

The 2021 SAS contracts set a clear expectation that specialty doctors should get involved in non-clinical activities to develop their range of expertise as well as ensure their progress through the higher pay threshold. Varied and relevant non-clinical experience and activity is an essential requirement for appointment as a specialist. Our appraisal and revalidation system sets an expectation of all doctors, regardless of grade, to be active in quality improvement, and encourages teaching, leadership, management, research and innovation.

Authors:

• Dr Andrew Kane, NAP7 Fellow, ST7 in anaesthesia, South Tees NHS Trust
• Professor Tim Cook, RCoA Director of the National Audit Projects, Consultant in Anaesthetics and Intensive Care Medicine, Royal United Hospitals, Bath
• Dr Jas Soar, NAP7 Clinical Lead, Consultant in Anaesthetics and Intensive Care Medicine, Southmead Hospital, Bristol

After a delay due to Covid, we are pleased to say we are in the final stages of NAP7. The baseline and activity surveys are complete and being prepared for publication. The NAP7 panel is working hard to digest all possible learning from the case registry. Here we provide a brief update, with the full report coming in late 2023. We are hugely appreciative of the contribution of all anaesthetists.

The largest NAP yet

Perioperative cardiac arrest has seen the most cases reported of any NAP. The large number of cases reported is an indication of the ability of UK anaesthesia to successfully come together and focus on an important patient-focused issue, and also shows the incidence of perioperative cardiac arrest is greater than events forming the focus of previous NAPs.

Author: Dr Richard Knight, Retired Anaesthetist, archives@rcoa.ac.uk

In April 1982, I was grinding through a locum session in a Swedish regional hospital when my wife telephoned me to tell me that the duty officer in my UK medical unit has asked her to say a single word to me – the super-secret word designating the necessity to report immediately to the unit. 

This was my initiation into Mrs Thatcher's plan to recapture the Falkland Islands.

Most men in the unit knew where Argentina could be found in an atlas, mainly because of the forthcoming football tournament starring Maradona. This had not been the situation when Dr David Owen as Foreign Secretary, had put the unit on stand-by to repel invading Guatemalans from entering British Honduras. Then, the staff sergeant was compelled to send his wife to the NAAFI to buy an atlas.

After days of packing and repacking equipment, the unit was trucked to Southampton to join 2 Para on board a North Sea car ferry. Cabins were allocated, in the best military tradition, by rank, but in reality were all the same tiered bunks. The major in the overhead bunk was to read and reread his copy of Herodotus, in Greek.

Authors:

• Dr Ros Bacon, Chair, RCoA Equivalence Committee
• Dr Ashwini Keshkamat, Deputy Chair, RCoA Equivalence Committee
• Dr Derek McLaughlin, Deputy Chair, RCoA Equivalence Committee
• Mr Russell Ampofo, RCoA Director of Education, Training and Examinations
• Ms Claudia Moran, RCoA Head of Training

Email our Equivalence team

The College is responsible for ensuring that anaesthetists meet the standards for Specialist Registration with the General Medical Council (GMC) and that UK and international medical professionals who seek independent practice in the UK have the necessary knowledge, skills and experience (KSE).

The increasing number of Certificate of Eligibility for Specialist Registration (CESR) applications and the GMC’s implementation of new regulatory pathways have presented challenges for the Equivalence Committee. The Equivalence Committee is committed, on behalf of the College and members, to maintaining standards. This article explores the proactive steps being taken by the College to support the Equivalence Committee and enhance the process of assessing CESR applications.