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Anaesthetists should be supported in maintaining the scope of their clinical practice as required for their clinical role, including their out of hours and flexible clinical commitments.^{24, 25, 26}

There should be a minimum of one member of the recovery staff, or an anaesthetist with advanced training in paediatric life support on duty. All members of recovery staff should have up-to-date paediatric competencies including resuscitation.²⁰¹

Many procedures do not have to be performed out of hours.³⁵Anaesthetists and surgeons together should devise departmental protocols for the handling of patients requiring urgent procedures, to allow prioritisation from both surgical and anaesthetic perspectives.

The duty anaesthetist should have a clear line of communication to the supervising consultant at all times.

Cardiothoracic anaesthetists should be familiar with the normal physiological effects of pregnancy and the general principles of obstetric anaesthesia.

The anaesthetist should consider all environmental factors when planning administration of anaesthesia or sedation.

Anaesthetists with an appropriate level of training should manage patients undergoing major elective vascular surgery.

Anaesthetists with an appropriate level of training should attend patients undergoing major elective vascular surgery.

Nationally agreed key performance indicators should be used to monitor the performance of the pathways for hip fractures and major trauma and reviewed by a multidisciplinary committee including a trauma lead anaesthetist. In addition, local quality indicators should be developed proactively, to support continuing improvement of these services within organisations.

Anaesthetists must undertake at least level 2 training in safeguarding/child protection,¹¹⁰ and must maintain this level of competence by regular annual updates on current policy and practice and case discussion.114