Executive summary

This Senior Leader Engagement Visit (SLEV) to anaesthetics and core anaesthetics at Queen’s Hospital sought to meet with the Trust’s Senior Management team and educational leads to gain an understanding of improvements made within the department and to gain sufficient assurance that these improvements were sustainable.

The NHS England review panel felt that the discussion with the Trust was positive, with the department demonstrating an enthusiasm to make changes and facilitate improvements to anaesthetics training. The changes made to leadership in the department and wider hospital was also felt to have had a positive impact on training.

Overall, the panel found that the right processes were put in place to make improvements to anaesthetics training, which included improvements to clinical supervision and reporting systems; handover and team-work; educational supervision and feedback and; teaching and training.

The panel assigned provisional Intensive Support Framework (ISF) ratings for the following programmes:

• Anaesthetics: ISF 1
• Core anaesthetics: ISF 1

NHS England’s Education Quality team will monitor the sustainability of these improvements via Mandatory Requirements on the Quality Management Portal (QMP) which can be found towards the end of this report. 

Review overview

Background to the review

This Senior Leader Engagement Visit (SLEV) was initiated in response to negatively outlying 2024 General Medical Council (GMC) National Training Survey (NTS) results for specialty higher and core anaesthetics training at Queen’s Hospital, with the specialty training results demonstrating a deterioration from the 2023 survey. The Trust’s subsequent self-report on these results and their latest responses to existing open actions on NHS England – London’s Quality Management Portal (QMP) in September 2024 did not provide sufficient assurance that improvements already implemented or planned across the department were sustainable.

Anaesthetics training across the Trust was subject to an education quality review in March 2022 due to negatively outlying results for the specialty reported in the 2021 GMC NTS. GMC NTS results further deteriorated in 2022 and at an SLEV in September 2022, concerns were raised that the department was not engaging with the necessary quality improvement activity to close the outstanding actions from the March 2022 review. As a result of this, the GMC formally placed the specialty under Enhanced Monitoring.

A Work Programme Meeting in February 2023 and subsequent submission of evidence to the QMP demonstrated some improvements. A follow-up Learner Review in June 2023 also indicated positive change. However, the 2023 GMC NTS once again reported negatively outlying results for core anaesthetics training at Queen’s Hospital in particular (2023 GMC NTS results for specialty higher anaesthetics training at Queen’s Hospital demonstrated some improvement since 2022).

In February 2024, NHS England-London met with both core and specialty higher DPTs based in anaesthetics at Queen’s Hospital during a Learner Review. Whilst the panel noted some further areas for improvement, overall DPTs were relatively content with their training placements and the specialty was taken out of GMC Enhanced Monitoring in March 2024.

Subsequent to these visits, there has been a significant number of changes in the clinical and educational leadership in the department. An SLEV was therefore planned to discuss the previous challenges identified within the department with the new leadership and set a direction of travel for improving results within the department.

Who we met with

Education team

• Chief Medical Officer
• Medical Director
• Two Anaesthetics College Tutors
• Co-Director of Medical Education
• Two Deputy Directors of Medical Education
• Director of Chief Medical Officer Team and Research
• Clinical Lead for Critical Care
• Anaesthetics General Manager
• Critical Care and Anaesthetics Manager
• Head of Postgraduate Medical Education
• Head of Undergraduate Medical Education and NHS England Quality Lead
• Critical Care and Anaesthetics Manager
• Medical Staffing Coordinator

Review panel

• Dr Louise Schofield, System Dean – North East London. Education Review Lead.
• Dr Aasifa Tredray, Head of the London School of Anaesthesia. Specialty Expert.
• Dr Marina Choudhury, Stage 1 Anaesthetics Training Programme Director, South East London. External Specialty Expert.
• Nicole Lallaway, Education Quality Coordinator. Education Quality Representative.

Review findings

The NHS England review panel heard that there was a significant change in leadership within the anaesthetics department and the wider hospital, which was felt to have had a positive impact on anaesthetics training. The panel were pleased to hear that the two new College Tutors felt well supported by the Trust and Postgraduate Medical Education (PGME) department to lead on the proposed changes.

The anaesthetics College Tutors delivered a presentation on the work undertaken to improve training for anaesthetics and core anaesthetics resident doctors (RDs) at Queen’s Hospital. The panel heard that a local ‘exit’ survey was undertaken of 18 Anaesthetics RDs, of which the results largely reflected the GMC NTS 2024 results, and the department planned to repeat the ‘exit’ survey at the end of the rotation in August 2025 to understand if the proposed changes had made improvements to training.

The department identified key areas requiring improvement as follows: clinical supervision and reporting systems; handover and team-work; educational supervision and feedback and; teaching and training.

Clinical supervision and reporting systems

The Trust reported that it had devised multiple actions to improve clinical supervision and management of the rota and the rota system, which included the College Tutors having direct daily oversight of the allocations list to ensure that RDs were paired with appropriate consultants and Specialty and Associate Specialist (SAS) doctors with a keen interest in training. The panel heard that the allocations list was accessible via mobile phone and that it was simple to move around consultants and RDs as appropriate. The College Tutors also received support in this work from the Medical Staffing Coordinator who was developing an understanding of rota allocations. At present, the Trust had two mechanisms available to use for the rotas, one being health rostering and the other on google documents, and it was felt that these sometimes did not work well in conjunction with each other. The panel also heard that in other hospitals across the UK, anaesthetics departments used the CLWRota system in addition to the health roster. The anaesthetics department felt they would prefer to have one single online rota system and were in discussions with IT to understand if this could be built into the health roster. However, if this was not possible, the Trust reported that they would consider using the CLWRota system as well as health rostering to align with what other hospitals were doing in anaesthetics.

The panel heard about improvements made to the experience of RDs working in the ‘6042’ role. It was reported that previously this role was felt to be challenging with limited support to RDs who were required to respond to airway concerns within the hospital. It was reported that this role was going to change and move towards Intensive Care Unit (ICU) supervision. The Trust reported that the 6042 role was undertaken by a RD from grade core training year 2 (CT2) or above, and they usually had completed at least 15 months of anaesthesia training before taking on this role. It was reported that there was a clinical supervisor available to provide support to that role in the day-time by overseeing lists and elective theatres, and that out of hours support was provided by 2 SAS doctors. It was also highlighted that RDs were able to access support by a clearly identified shift leader for each shift, and that there was other support available by other RDs during the night, with 2 RDs working in obstetrics, 2 RDs in theatres and one other senior RD working in the anaesthetics department.

Handover and teamwork

The Trust reported that handover during the changeover of shifts was now mandatory and joint handover between the day consultant, RD and incoming night RD took place at 8:00am and 8:00pm. This joint handover also included obstetrics and ICU in addition to anaesthetics to provide a more holistic debrief at the end and beginning of each shift. A standard operating procedure (SOP) for escalating clinical concerns was also to be introduced within four months of the quality review, to ensure that RDs were aware of the process for escalating concerns if handover SOP was not being followed correctly.

Educational supervision

The Trust reported that there were 25 Educational Supervisors (ES’) working in Anaesthetics, and that this number was likely to decrease in the coming year as work was undertaken to ensure the right Clinical Supervisors (CS’) and ES’ were working within the anaesthetics department. In addition, it was reported that the department aimed to recruit more newly qualified consultants as ES’, with 4 new ES recruited recently and an additional 4 expected to join the department by 2025.

The panel heard that there was a plan in place to ensure CS’ and ES’ had a keen interest in education and developing the anaesthetics RDs. This involved the introduction of a learning agreement between supervisors and RDs, which empowered RDs to identify what they aimed to learn during each shift. The department also introduced an escalation protocol for RDs who had difficulty meeting regularly with their ES’, of which ES’ were expected to meet with their allocated RDs at least once every 3 months. The panel heard that supervisors were expected to attend a minimum number of Local Faculty Group (LFG) meetings and Annual Review of Competency Progression (ACRP) panels, and that there was a yearly appraisal for each consultant with a section on educational supervision. An audit would be undertaken to monitor the engagement of supervisors with the learning agreement, and it was reported that if ES’ fell short of the requirements of the role, discussions would be undertaken with them to understand if they were suitable educators for anaesthetics training.

Teaching and training

The Trust reported on improvements made to the delivery of teaching and training for RDs. Regular list-based teaching was implemented based on the learning agreement between supervisors and RDs and RD-led ‘learning from the shop floor’ was encouraged by the department as well. It was also reported that there was a monthly obstetrics and anaesthesia journal club available for RDs to attend and the department organised fortnightly simulation-based sessions. The panel also heard that there was a monthly local anaesthesia teaching session which had protected time in job plans for RDs to attend, and this alternated between Monday and Friday afternoons. It was reported that these sessions were well-attended, and that the consultants were keen and involved in the programme. A 30-minute block at the end of each session was available for RDs to feedback any concerns about their training directly to the College Tutors.

The Trust reported that LFG meetings took place every 6 weeks, and this was open to all RDs rather than just RD representatives. It was recorded for those who could not attend, and actions discussed at these meetings were allocated specified timelines to work towards.

The NHS England review panel felt that the meeting with the Trust and departmental leadership was a positive discussion, and that it sounded like the right processes were put in place to make improvements to the experiences of those working within the Anaesthetics department at Queen’s Hospital.

Areas that are working well

Areas for improvement

Mandatory requirements

Report approval

Report completed by: Nicole Lallaway, Education Quality Coordinator
Review lead: Dr Louise Schofield, System Dean – North West London
Date approved by review lead: 19 December 2024

NHS England authorised signature: Dr Elizabeth Carty, Interim Local Postgraduate Dean
Date authorised: 15 January 2025

Final report submitted to organisation: 4 February 2025