|Saturday, 01 January 2011|
Dr Peter Nightingale, President of the Royal College of Anaesthetists, discusses professional challenges and priorities for his College
The Royal College of Anaesthetists (RCoA) evolved from a faculty of the Royal College of Surgeons of England into a stand-alone college and, more recently, a royal college in its own right. It represents all anaesthetists trained in the United Kingdom (and some from elsewhere), and membership stands currently at just over 15,000 Fellows and Members.
The organisation of the College has been enhanced by the development of a Faculty of Pain Medicine and, latterly, an intercollegiate Faculty of Intensive Care Medicine in conjunction with six other Colleges, including the RCSEd; both faculties are housed within the RCoA.
"The development of a national recruitment programme will ensure that those selected into anaesthetic training do so to a UK-wide standard"
The RCoA has been proactive recently in a number of areas. Of note has been the introduction of a new curriculum and the development of a national recruitment programme to ensure that those selected into anaesthetic training do so to a UK-wide standard through a transparent process of short-listing and standardised interview.
However, of particular concern to the College has been the increasing difficulty that anaesthetists have had in obtaining time away from their hospitals to undertake this, and other, College work for the wider NHS. Our Council is conscious of the fact that there is continual tension between the College’s wishes regarding such matters as CPD, revalidation, training and assessment and the inevitable impact this might have on service provision. Much of the responsibility for balancing these conflicting interests falls on the shoulders of the Clinical Director, so Council have co-opted one such to work with Clinical Directors on a number of issues.
The recent announcements from Northern Ireland and Scotland to freeze local and national excellence awards seems perverse when reading through the applications; consultants give up a huge amount of personal and family time for making sure the NHS delivers the doctors and service of tomorrow. This action may well be another nail in the coffin of professionalism and the willingness to go that ‘extra mile’.
Much time and effort has been expended within the College in following the GMC’s wishes regarding specialty-specific standards and CPD requirements for revalidation. It is somewhat of a relief, therefore, to see the GMC moving towards a much more light-touch approach.
The College’s aims for serving the professional interests of those who pay its subscription are rarely articulated directly. The College is developing a new communications strategy and hopes to have more formal links with: Fellows and Members; the Regional Advisers and others who do so much of the College’s work; the wider public; other specialty groups; and the media.
In essence, Colleges operate by the goodwill of the paying Fellows and Members (though most will receive 40% tax relief on subscriptions!). They are paying for the voice of their specialty (we are not a trade union) since subscriptions allow the College independence to guide, advise, shape policy and sometimes challenge the public and Government of the day. Fellows and Members are paying to remain largely self-regulated (there is the GMC but there is no OFDOC!) but must, I am sure, embrace revalidation to ensure we maintain our standing with the public.
The College can be justifiably proud of its recent work with the National Patient Safety Agency (NPSA) in introducing the first specialty-specific electronic critical incident reporting system and, through its Safer Anaesthesia Liaison Group, has already made a substantial impact in the patient safety arena. It is disappointing, therefore, that the College remains in the dark as to what is going to happen to this vital safety initiative as the NPSA involutes and is subsumed into the new National Commissioning Board.
As with many other specialties, the College has considerable concerns about the shape of the future workforce in England. Unlike in Scotland, where it is accepted that trained doctors will deliver service as consultants, there is a growing expectation that the on-going review by the Centre for Workforce Intelligence will recommend a more affordable solution to how CCT holders will contribute to service. At best, this will be a staged introduction to consultant practice as we know it (it used to be called the Senior Registrar grade); at worst we will see disenfranchised CCT holders forced into Specialty Doctor posts to await the rare opportunity to become a consultant as the system grows evermore hierarchical.
In the future, the College intends to build on the success of the National Institute of Academic Anaesthesia through its partnership with, predominantly, the Association of Anaesthetists of Great Britain and Ireland and the British Journal of Anaesthesia. As well as funding basic science and interventional studies, the newly formed Health Services Research Centre intends to work collaboratively with the surgical colleges to develop appropriate National Audits and Patient Related Outcome Measures.
The role of such liaisons should lead to improved peri-operative services and care for patients; from the General Practitioner’s surgery and then the Pre-operative Assessment Clinic to appropriate surgery, enhanced recovery and care pathways (including critical care and pain control) and then to appropriate recovery as needed.
In England, Mr Lansley should approve of this; the RCoA would hope that the Scottish Colleges and Government would do also.
Dr Peter Nightingale, President, The Royal College of Anaesthetists