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Dr Richard Knight looks back at the turbulent 1970s – a decade well known as a time of crisis both economically and politically.

What comes to mind when you think of the 1970s? Flared Jeans, David Bowie, Dallas? Well, it wasn’t all Happy Days (forgive the pun) – this decade was also very much about skyrocketing inflation and unemployment, the Winter of Discontent, strikes, power cuts, and states of emergency.

FICM’s Professional Affairs and Safety Committee (FICMPAS) is one of the three large committees of the FICM board. The major focuses of work are, as our name suggests, professional affairs and safety. We have seen important developments in both areas.

In safety there is a new look Safety Bulletin, developed by Dr Peter Hersey. Short; one paragraph, case-reports of safety incidents are shared with commentary and hyperlinks to additional information. The safety incidents come from the National Reporting and Learning System (NRLS), though Dr Hersey is working to be able to draw from a wider source of incidents.

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.

Wellbeing is a fashionable term at present and for some will cause instant eye-rolling. We sympathise with this reaction – the word has a lot of unhelpful connotations including, probably most problematically, that it offers yet another opportunity to fail at something else in your life. You are already overwhelmed by work and home stressors, and now you’re also not getting your wellbeing right and that’s why you’re struggling.

Please know this gentle advice comes from a place of compassion and acknowledgement of the wonderful job you all do. After everything anaesthetists have had to deal with over the last few years, we tip our hats to the courage and resilience of our profession.

Here are some top tips for anaesthetist wellbeing (in no particular order):

I am a huge fan of the Beano and sent feedback to the Royal College of Anaesthetists about a special collaborative edition I had read, Dennis has an anaesthetic. My Granny was in hospital at the time, and I was worried about her. She had broken her ankle. I read the Beano comic to help me understand and feel better about her being unwell and having an operation.

Children’s anxiety related to hospital admissions and procedures is a huge problem and affects up to 80% of children. 75% experience anxiety in the anaesthetic room, and 60% develop ‘new’ dysfunctional behaviour in the three weeks after surgery. Sadly, 12% still display this new behaviour one year after surgery. In the US, surveys show that 25% of children are held down for a general anaesthetic.

Dennis has an anaesthetic teaches children about:

• finding out about the operation
• getting ready for the operation
• having the anaesthetic and operation
• waking up and going home.

Authors:

• Dr Natalie Constable, ST6 Anaesthetic Registrar, Department of Anaesthesia, UHBW Foundation Trust, Bristol
• Dr Fiona Oglesby, ST6 Anaesthetic Registrar, Department of Anaesthesia, UHBW, Bristol
• Dr George Bainbridge, Anaesthetic Clinical Fellow, Department of Anaesthesia, UHBW, Bristol
• Dr Helen Howes, Consultant Anaesthetist, Department of Anaesthesia, UHBW, Bristol
• Dr Rachel  McKendry, Consultant Anaesthetist, Department of Anaesthesia, UHBW, Bristol

The Bristol Royal Infirmary’s Difficult Airway Response Team (DART), developed in 2017, is a successful, innovative, cross-specialty response unit designed to expedite the arrival of clinical expertise and advanced equipment to the patient’s bedside in complex airway emergencies. Five years following DART’s inception, we intend to highlight the challenges intrinsic to maintaining the service and how we have attempted to overcome these. 

Read the latest letters submitted by members in Winter's Bulletin. If you'd like to submit a letter to the editor, please email us.

Author: Dr Dave Murray, Consultant Anaesthetist South Tees NHS Trust; Chair NELA

The National Emergency Laparotomy Audit (NELA) is 10 years old this year, so this is a timely point to review progress, highlight achievements, and look at the persisting challenges ahead.

In the beginning

NELA was commissioned in 2012. One of the key pieces of evidence to support its funding was the paper published by the Emergency Laparotomy Network.¹ This observational study of more than 1,800 patients highlighted a 15% mortality rate, but with a nine-fold variation in mortality across the 35 trusts. Consultant presence was 74% for surgeons and anaesthetist presence was 64%. Half the patients were admitted to critical care, and patients returning to the ward had a 6.7% mortality rate.