Anaesthetic Practitioner Phase 2 Birmingham

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Anaesthetic Practitioner Phase 2 Birmingham
Black Country Experiences

• Dr John Carnie
• Clinical Director Anaesthetics Theatres for
  Heart of England Foundation Trust Hospitals
• Cluster Clinical lead Birmingham and Black Country

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Anaesthetic Practitioner presentation outline

• Credentials
• Rationale for Development at Local level
• Outline progress to date
• Issues / Blocks
• Solutions

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Anaesthetic Practitioner 1996
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Anaesthetic Practitioner2005
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West Midlands Cluster
Wolverhampton LMT
8 Phase 2 1 phase 1 Trainees ( Nursing /ODP
sourced )
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Management team of stakeholders for AP role
development

• Cluster Clinical Lead
• Cluster Manager
• Clinical reps, including medical trainees
• Patient rep
• Trainee or qualified APs
• PCT commissioning rep
• WDC/SHA reps
• Professional groups regional reps (RCA, AA, NATN,
  AODP)
• Higher Education rep
• Deanery Rep
• HR rep
• Agenda for Change rep

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Local Anaesthetic Service Detail
BHH Solihull Hospitals Anaesthetic Directorate
services 2 acute hospitals Service 42,000
Surgical theatre Cases on 2 sites 7,500
deliveries with 22 section rate 10 epidural
rate on 2 sites 400 ITU 800 HDU admissions a
year on 2 sites Staffing 99 WTE 37 wte
consultants 4 tiers of on call 9 wte SAS 31
wte Trainees all new contract (1B- 48Hr)
EWTD compliant 3 wte research registrars 6 wte
acute pain nurses 10 wte preoperative assessment
nurses 3 wte AP trainees
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Reasons for 2nd phase Role Involvement

• No significant negative pressures for role
  development at local level
• 100 new deal compliance with hours
• No manpower shortages
• No service cancellations
• Trainee supervision levels satisfactory
• Need for diverse manpower resource

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Supporting Reasons for 2nd phase Role Involvement

• Positive Trust/Directorate experiences with new
  roles - 10 years experience of Nurse led Acute
  Pain service , 3 years nurse led pre-op
  assessment service , 3 years of ITU outreach
  nurse led services
• Positive Phase 1 experience
• New deal trainees hours reduction measures to
  ensure rest breaks
• Future predictions of SAS and changing workforce
  demography
• Anticipated future pressures of New Consultant
  contract
• Anticipated future pressures of NHS PLAN -
  Patient Choice PBR Agenda

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Directorate IssuesService Pressures
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Anaesthetic Practitioner RoleDescription

• The AP role is a supervised directed role,
  working under the supervision of a specialist
  medical anaesthetic practitioner
• European non-medical anaesthetist model
• Not
• An independent autonomous specialist practitioner

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Anaesthetic Practitioner RolePrinciples of
Supervision

• Direct physical supervision at induction and
  emergence of anaesthesia
• Two minute availability at all times of
  supervising anaesthetist

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Anaesthetic Practitioner RoleBusiness model for
the current PBR and Patient Centred Health Service

• 12 theatre list working
• 11 complex major theatre list working
• List efficiency from improved patient
• preparation e.g. Emergency / Trauma Lists

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Anaesthetic Practitioner RoleStrategies for
acceptance of role

• Improving Working lives (IWL)
• Out of hours list support
• Weekend emergency working
• Routine evening lists

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Anaesthetic Practitioner RolePrioritiesfor
development of role

• Local Management Team
• Trainee Acceptance
• Business case development

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Anaesthetic Practitioner Supervision Priorities
safety

• Risk Management process
• Critical Incident reporting

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24 months in - Skills Knowledge Achievements

• Preoperative optimisation
• Advanced airway competency
• Advanced venous access competency
• Surgical patient monitoring skills
• Anaesthetic - Induction. Maintenance .reversal

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24 months-in Update

• Anaesthetic Professional training competition
• Not encountered
• Theatre team Conflict
• Not encountered
• Ward Staff
• Not encountered
• Surgical patient resistance
• Not encountered

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24 months-in UpdateAnaesthetic Professional
Issues
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Anaesthetic Practitioner Role Issues arising
from AP role

• Consultants
• Manpower Need
• Scale
• 12 supervision working practice
• Safety 12
• Perceived increased workload/Responsibility 12

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Anaesthetic Practitioner Role Issues arising
from AP role

• Trainees
• Training conflict

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Anaesthetic Practitioner Role Issues arising
from AP role

• Management
• ODP Working arrangements - savings

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Anaesthetic Practitioner Role Issues arising
from AP role

• Consultants
• Manpower Need
• Scale / potential of role implementation

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Anaesthetic Practitioner Manpower Predictions -
not simple!

• Consultant vacancies retirement profiles
• Consultant demography - flexible /part time
  working
• Annual Specialist registrar entrants internal
  / overseas
• Capacity need - PBR and private sector
  involvement
• Reduced Target waits opd/ surgery
• Nursing / Surgeon Manpower
• National Theatre Efficiency Profiles

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Anaesthetic Practitioner Manpower
CaseSpecialist register entries UK

• 2002 367 100
• 2003 233 100
• 2004 202 100
• 2005 342 100
• UK Consultant vacancies 2002 - 714

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Anaesthetic Practitioner Manpower Case

• 2002 - 3,800 consultants UK total
• 1974 - 2002 Percentage British medical graduates
  choosing anaesthesia 5 to 12
• 2005 - total 5894 UK medical entrants
  potential (707)

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Anaesthetic Practitioner RoleSolutions
funding of role

• Trust Business Case acceptance
• Training costs (75) SHA

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Anaesthetic Practitioner RoleHeart of England
business case submission
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Anaesthetic Practitioner Rolesolutions

• Training Profile of directorate
• Capacity Statistics
• Profile Statistics

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BHH Duty Rota
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Specialist Registrar Training record

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Anaesthetic Practitioner Time for reappraisal
?