Anaesthesia Practitioners: the English Perspective

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Anaesthesia Practitioners the English Perspective

• Nicolas Fauvel
• Chelsea and Westminster Hospital and
• North West London Anaesthesia Practitioner Cluster

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Phase Roll-out

• Phase 1 5 trainees started 2004
• Phase 2 34 trainees started 2005
• Phase 3 8 trainees started 2006
• Phase 4 ? trainees to start 2007

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Training for what core role?

• A non-medical member of the medically led
  anaesthesia team.
• Undertaking some aspects of preoperative
  assessment, per-operative management and
  immediate postoperative care, under the
  supervision of suitable medical anaesthetists.

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Training for what core role?

• Supervision means direct supervision during
  induction of anaesthesia and termination of
  anaesthesia delivery, and clinically appropriate
  indirect supervision at all other times.
• Specific exceptions
• See Curriculum Framework - June 2005 page 49

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Course delivery

• Clusters - NHS Trusts and SHAs
• working in consort with
• HEIs (Universities) and RCoA
• Birmingham, Edinburgh, Hertfordshire,Hull

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Course structure

• 2 years training and 3 month probationary period
• 12 x 2 month modular structure
• Assessed continuously and on a modular basis
  within the workplace and by the University
• Assessed by nationally moderated examination at 8
  month and 24 months

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Qualification

• PGDip in Anaesthesia Practice
• awarded by the relevant University in
  collaboration with RCoA
• Successful candidates to have privilege of
  Affiliate Member (Clinical Practice) of the
  RCoA

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New Graduate AP experience and skills

• Basic anaesthesia knowledge and skills gained in
  approximately 600-800 cases covering the core of
  the range seen in the first two years of SHO
  training
• Intermediate level airway, venous and arterial
  line placement skills, similar to SHO level

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New Graduate AP experience and skills

• Knowledge and skills to recognise and diagnose
  the major complications occurring during the
  maintenance phase of anaesthesia, and to initiate
  a first response.
• Key professional attitudes and behaviours

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Experienced AP skills

• Higher level of competence in the basic and
  intermediate level skills
• Personal development of task-based extended role
  through locally clinically-governed training

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Potential use of AP skills

• Skill-based tasks, e.g.
• intermediate airway management
• venous line placement
• basic problem-solving for epidural infusions etc.

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Potential Pitfalls

• The core role envisages work within the theatre
  environment, facilitating the team approach
• Working in remote sites puts a strain on
  supervision systems - as we know!

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Potential Pitfalls
Trainee Medical Anaesthetist
Anaesthesia Practitioner
Dont make the mistake of observing only the
intercept and therefore thinking that the two
knowledge and skill sets are interchangeable!
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Avoiding Pitfalls

• Careful integration of APs within the hospital
• Careful attention to skill matching for
  particular tasks
• Robust support and supervision

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Challenges

• Moving beyond training to integration within the
  workplace
• To ensure that service directors and all
  anaesthetists understand what APs might
  contribute
• To sustain AP education
• Professional Regulation
• CPD

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