[PDF] Exploring professional boundaries in anaesthetics

National Institute for Health Research (NIHR)
Publication date:
31 March 2004


Anaesthetics is the largest single hospital speciality with anaesthetists being involved in the care of approximately 2/3 of all admissions to hospital. Therefore, the demand for anaesthetic manpower is very sensitive to changes in the way the NHS operates.In recent years there have been several developments within the NHS that have had an impact on staffing levels. Firstly, structured training for junior doctors means that the emphasis of their working lives is on education and not on service delivery. Coupled with this, there are now limits on the hours worked by junior doctors, which impacts on the out-of-hours resident cover as this is largely provided by trainees. In 2004 mandatory rest periods will be introduced further limiting working hours.One solution to staffing problems is to re-evaluate existing professional boundaries between clinical staff working in anaesthesia. Whilst other areas with in the NHS have seen nurses and other non physicians develop their roles, for example, the nurse practitioner in general practice, very little change in roles has taken place in anaesthetics. Unlike countries in Europe and North America, Britain has no tradition of non physicians administering anaesthetics, thus any development in this direction would be contentious.Objectives: The objectives of the study are to:- Map out models of anaesthetic care carried out in United Kingdom, Europe and North America and describe the training of staff.- To collect data on effectiveness, safety and cost-effectiveness and patient opinion.- To explore the barriers to and enablers of changes to professional boundaries in the UK.- To gather opinion on personnel specification and training requirements of future UK non physician anaesthetists.Methods: We will achieve these objectives in three ways. Firstly, we will carry out a systematic review of literature on the subject. This will involve a thorough search of computerised databases of peer reviewed and grey literature. This will reveal studies on effectiveness, safety and cost-effectiveness and provide information on models of care in the United Kingdom, North America and Europe. It will also undercover information on training programmes and the skills required of non physician anaesthetists.Secondly, we will be carrying out semi-structured interviews with individuals involved in anaesthetic care to gauge opinion on this topic. We will also collect official policy statements from the national associations and governing bodies involved in anaesthetic care in the United Kingdom.Thirdly, we intend to visit sites across the United Kingdom which have tried or are currently carrying out extended roles for non physicians in anaesthetics. We will conduct a case study on each of these sites which will in turn provide us with information on models of care, training programmes, barriers to and enablers of change and possibly effectiveness and cost-effectiveness of these working practices.We will established an expert group to provide us with an extended network of professional contacts, which will feed information about extended roles and anaesthetic opinion. The group itself will act as a quality control mechanism for the project. We envisage that the group will meet 3 times in the course of the project, but will keep in regular contact via email.Timescale: The project runs from 1st October 2002 to 30th September 2003, when the final report is due to be completed. An interim report is due to be submitted to the SDO in April 2003.