Anaesthetic staffing and work in the north-western RHA.

During 1977-8 we made a detailed study of anaesthetic staffing and work in the North-western RHA to help provide a rational basis for allocating additional posts. We submitted a full report to the RHA and the main findings are summarised in the table. The threefold variation in operations performed shows that more sophisticated data than overall hospital catchment population figures are required to estimate the current demand for anaesthetic services in the operating theatre. Whether this demand is appropriate is, of course, another question. The number of anaesthetists of all grades (excluding clinical assistants), estimated as the total number of available whole-time equivalent "pairs of hands," varied from 6-8 to 18 1 per 200 000 hospital catchment population in non-teaching areas and districts, and was as high as 31 7 in one of the teaching areas. An approximate indication of the individual case load for anaesthetists in the operating theatre was obtained by dividing the annual number of operations by the available number of whole-time equivalent "pairs of hands" (including clinical assistants). The lowest figure, 566 operations per anaesthetist per year, was seen in a non-teaching district with a high proportion of cardiothoracic work. Elsewhere, the range was from 773 to 1469 in non-teaching areas and districts. Similar variations were noted by the Association of Anaesthetists1 in its report on manpower and staffing in 17 districts in England. Its figures suggested that work loads increased in proportion to distance north of the Wash but we have observed the same range in a single region. There was no clear relation between the average number of patients anaesthetised and the amount of work that might have made particularly heavy demands on the anaesthetist -cardiothoracic, neurosurgical, and major paediatric surgery; epidural analgesia; intensive treatment, or pain clinic work. In some cases anaesthetics had to be given in six or seven different hospitals and these might be several miles apart. For various reasons, emergency work might be done in two or three hospitals each night and there were sometimes outlying maternity units. These geographical considerations were an important factor in determining the efficiency with which an anaesthetic service could be provided. There was a wide disparity in the anaesthetic services available for maternity work in the region. In many areas and districts only a small number of obstetric epidurals were given and the main anxiety was that once a service was initiated the consequent demand would overwhelm the available staff. Many requests for additional registrars were based on the desire to initiate or expand epidural services.