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In non-paediatric centres, appropriate immediate neurocritical care facilities should be available for all children until they can be transferred to a specialist centre.

Any autonomously practising anaesthetist working in neuroanaesthesia must undertake continuing professional development (CPD) in neuroanaesthesia and must have sufficient regular programmed activities within this field to ensure that their specific skills and experience are maintained.²⁷

Departments should consider providing newly appointed consultants with a mentor to facilitate their development especially in a sub-speciality they may have limited experience.

Consultant anaesthetists who provide out of hours cover to the neuroscience unit but do not provide neuroanaesthesia in working hours should be able to demonstrate the maintenance of appropriate skills and knowledge through regular clinical involvement and CPD.

Elective neuroanaesthesia for highly specialised procedures that have limited case numbers (e.g. craniofacial procedures, awake neurosurgery and deep brain stimulation) should be provided by a dedicated subgroup of neuroanaesthetists within the department to ensure that they are able to treat sufficient numbers to maintain their competence in these areas.

The use of simulation training for critical incident scenarios should be available to all members of the multidisciplinary team. Examples include the cardiopulmonary resuscitation of patients not in the supine position, patients with their head pinned, or where anaesthesia is being provided in an isolated site.³¹

As anaesthetists in training spend limited time in the specialty, departments should facilitate the delivery of structured training programmes, developed by the school of anaesthesia.⁵

Anaesthetists in training should be encouraged to attend other training opportunities within the neuroscience unit, such as grand rounds, radiology and pathology case conferences, and morbidity and mortality meetings.

Fellowship posts should be identified to allow additional training for those who wish to follow a career in neuroanaesthesia or neurocritical care.³² Such posts should provide similar or enhanced levels of teaching, training and access to study leave as regular training posts.

Standardisation of the handover process can improve patient care by ensuring information completeness, accuracy and efficiency.^44,45 The use of perioperative care bundles should be considered.⁴²