Search

Welcome to the July 2023 edition of the Bulletin. As I write this, it is challenging to summarise the state of the UK NHS as anything other than the epitome of uncertainty. Yet many of us, myself included, continue to advocate for a healthcare service so close to our hearts, striving for solutions as we approach the 75^th anniversary of the NHS. 

As someone who comes from an immigrant background, I have personally witnessed sustained periods of uncertainty and instability – and, also, through creative thinking, steadfastness, and perseverance, outcomes beyond any that were imaginable. Observing generations of family, my parents included, undergo the process of building life anew including acculturation, instilled in me from a young age a strong foundation of hope that no situation is insurmountable. This hope is beyond naïve positivity, but rather is borne of a pragmatic optimism resulting from lived experience. As a specialty, we are intelligent, resourceful and innovative – we have ‘found a way’ countless times.

Authors:

• Dr Andrew Kane, ST7 in Anaesthesia, South Tees Hospitals NHS Foundation Trust
• Dr Simon Davies, Reader in Anaesthesia and Perioperative Medicine, Hull York Medical School; Honorary Consultant in Anaesthesia, York and Scarborough Teaching Hospitals NHS Foundation Trust
• Dr David Yates, Consultant in Anaesthesia and Intensive Care Medicine, York and Scarborough Teaching Hospitals NHS Foundation Trust; Honorary Senior Lecturer, HYMS
• Professor Gerard Danjoux, Honorary Professor, HYMS; Consultant in Anaesthesia, South Tees Hospitals NHS Foundation Trust

Chatting in a pub in York in 2019, Simon Davies, David Yates and Gerard Danjoux were reflecting on their academic careers to date. The three colleagues from York and South Tees Hospitals had worked together successfully since 2012, securing prestigious grant funding and delivering high-quality academic studies. Yet something was missing – strategy and infrastructure to create a sustainable programme of work and develop the researchers of the future.

As the evening progressed, more and more ideas were generated in direct correlation to the consumption of the excellent York ales!! Before the end of the evening, an idea was hatched, and the colleagues would form a new collaboration with an academic partner: the North Yorkshire Academic Alliance of Perioperative Medicine.

A new year signals a new Editor for the Bulletin, and it gives me immense pleasure to welcome you to the January 2023 edition. As I write this, the UK’s NHS is experiencing winter pressures, nurse strike action seems imminent, purple seems the new black in terms of hospital bed status, and elective surgical recovery targets seem an insurmountable challenge. It would be easy to feel discouraged, but a new year always heralds new hope.

Scrolling through the articles in this Bulletin, I am filled with delight at the examples and opportunities for change during these uncertain times. Innovation has long been the forte of our specialties – doing things differently, more efficiently, and more safely for the betterment of patient care. Whether it is the small tweaks made to TIVA settings, the slight adjustment of the ultrasound image during a nerve block, or refining the ergonomics of running an operating theatre list or ICU ward round, continuous improvement is innate to our specialties and specialists.

It has both a favourable side-effect profile compared with traditional anticholinesterases and allows for emergency reversal.

With the expiry of its original patent last year, high cost is no longer a factor prohibiting its use, which will invariably further increase. In this article, we seek to highlight the resulting increased potential for contraceptive failure and propose methods to better inform and protect patients.

The risk of contraceptive failure

Due to its ability to encapsulate progesterone – present in contraceptive pills, vaginal rings, implants and intra-uterine devices – the administration of sugammadex may reduce their biological effect and cause contraceptive failure. This was identified in in-vitro studies, using isothermal microcalorimetry, performed as part of the drug’s development. While in-vivo studies to quantify the reduction in serum progesterone concentration following sugammadex administration have not been performed, these results have shaped current manufacturer guidance.

Author: Dr Carolyn Johnston, Consultant Anaesthetist and Deputy Medical Director, St George’s Hospital; Chair of QI working group

During the early days of the COVID-19 pandemic, the UK government talked about their goal of delivering ‘shots in arms’ as the ultimate goal of the vaccine efforts. This wasn’t an exercise in expanding scientific knowledge or customising production, but the aim was clearly stated as being to deliver those advances to citizens in order to prevent them from becoming patients.

A large number of lives were saved by rapid development and national deployment of the new vaccines: the success of the vaccine programme is a reminder to us all how knowledge without application will not improve care.

The HSRC portfolio of projects creates a huge amount of knowledge that has the potential to improve care for our patients, but this knowledge remains potential unless we implement the recommendations of the various reports and use the rich datasets created to inform us of the most pressing areas for improvement in our clinical pathways.

Round one

Our path towards accreditation started back in 2014. We felt we were a good and forward-thinking department, but the challenge was (a) is it true? and if so (b) could we prove it? 

The ACSA process gave us the platform and the tools to provide assurance that we had the policies, and personnel in place, but also highlighted the gaps that had developed over the years. Our original involvement with ACSA and subsequent accreditation in 2018 was a positive experience. ACSA gave the department a common purpose and an opportunity to involve the whole theatre community in reviewing how we work and why we do what we do. We took pride in benchmarking ourselves against nationally agreed standards and opening the department up to external scrutiny. That said, our accreditation in 2018 was not the end of the story.

Authors: 

• Dr Duncan Kemp, Anaesthetic Registrar and co-creator of the NovPod
• Dr Eoin Dore, Anaesthetic Registrar and co-creator of the NovPod

This month marks a year of hard work coming to fruition since we launched the podcast ‘NovPod: A beginner’s guide to anaesthetics’. With more than 25,000 ‘listens’ in the first three months, it feels like we’ve created a practical, useful podcast that has been well-received.  So to celebrate, we’d like to take you behind the scenes to talk through how we developed the NovPod and discuss some lessons learnt along the way.

From the beginning: why did we do it?

After creating a one-off podcast for a Difficult Airway Society multimedia competition, we wanted to build on this. Our plans coincided with the renovation of the RCoA novice curriculum and so our target audience became obvious – novice anaesthetists. We reflected on our own experiences and set out to share some of the best advice we received as novices. This wasn’t from textbooks or courses, but rather the voices of the friendly registrars and SHOs who would take us aside and tell us how anaesthetics worked in practice – giving us advice and survival tips to help us grow and develop.

Since its launch in August 2018, the Lifelong Learning Platform (LLP) has undergone an unprecedented amount of change. As well as adding the new Anaesthetic and ACCS 2021 curricula in August 2021, it also supports CPD Learners for Revalidation and FICM users, and automatically updates member details via our Customer Relationship Management system.

The platform continues to receive extremely high levels of use, supporting the career lifecycle of more than 24,000 fellows and members in the UK. Currently more than 21,000 of these have used the LLP for assessments and documenting their training in general. In a typical month there will be more than 400,000 LLP user interactions, including 100,000 Logbook entries and the addition of 45,000 Workplace Based Assessments or Supervised Learning Events.

Authors:

• Dr Hamish McLure, Medical Director (Professional Standards and Workforce Development) and Consultant Anaesthetist, Leeds Teaching Hospitals NHS Trust
• Dr Natalie Drury, Consultant Anaesthetist and Anaesthesia Associate Lead, Leeds Teaching Hospitals NHS Trust

The pandemic has generated a staggering backlog, with more than 7 million patients waiting for care. In order to treat these patients in a timely way, we need to increase our work rate beyond pre-pandemic levels but with our current workforce and model of care, this will be difficult. 

Fatigue, burnout, repeated acute illnesses and a punitive tax system mean we have a fragile workforce with minimal capacity or interest in additional work. RCoA workforce data shows little to be optimistic about, with a projected gap of 11,000 anaesthetists by 2040. This demand cannot be met without a massive increase in training numbers. Given the pressures in virtually every other specialty, this is unlikely.