President’s blog January 2016

Captain’s log, rather President’s blog star date 2016 number 1. The long awaited Star Wars movie is out and by all accounts a great success. In addition I understand a new Star trek on the way. Great for those of us who enjoy a bit of sci-fi!

I started writing this is the middle of the festive season which is always an interesting time for many reasons. It’s a time of many different emotions and activities. Hopefully somewhere amongst it one can get time to ponder the whys and wherefores of the past year and the year to come. I fortunately managed to indulge in a bit of this.

I started thinking about the flag change. Chatting to people, I get the sense that most are unsure of why, but did have an opinion on which of the new flag options they thought the best. From a non-robust personal poll I get the sense that middle-aged New Zealanders will vote for change, but the older and younger amongst us will not and that probably very few will actually bother to vote at all. I have also indulged in some flag history which is fascinating. I quite like the very first flag with the St. George cross and personally I would be happy to see the Union Jack go.

Well the year is now well under way and as always the holiday seasons rapidly fades into the past. What is on the horizon of the NZSA this year? There are a number of things but arguably the elephant in the room is the revision of the Medicines Act 1981.

Non-Anaesthetist Sedation: Firstly, in regard to supporting the national bowel screening programme. There are some interesting parallels with the flag; a very mixed response from our community which I think reflects the inherent dilemmas. Does one support the adoption of a lesser standard to enable a greater good, or does one not and become a block? There is merit in both responses. As your executive we have thought it best to remain engaged with the process in the hope that we can have some influence on optimising the outcome. I think that by having input into training this group of nurses we will increase the standards and facilitate patient safety, as currently those overseeing the sedation for colonoscopies have had little or no formal training in sedation or risk quantification.

At the same time we need to advocate for more anaesthetic involvement and enable higher risk patients the opportunity of general anaesthesia. In other words, advocate for the model that occurs more commonly across the Tasman. Thank you again for participating in the survey we sent out. The results reflected the diversity of opinion but also gave valuable feedback for our discussions and I have had some useful conversations with members as a result. On the key question of whether members would be willing to contribute to training at a national and/or local level for

non-anaesthetist sedation providers, it was almost a 50/50 split. So although no definite answers the survey has been very useful.

On the related topic of sedation by non-anaesthetists physicians; this is occurring very commonly and usually without problem. However, as always some push the boundaries and there have been issues both from over-sedation and local anaesthetic toxicity. As a result there maybe more regulation introduced and anaesthetic input/oversight may become more common.

Review of the Medicines Act 1981

I’d like to give you a heads up on a topic that will probably over shadow all others this year and one which we will be putting some time into.

This is the legislation that deals with prescribing and dispensing and is to be repealed and replaced. The first draft was published late last year and we submitted our comments on that in January. There will be another opportunity for comment in the middle of the year. The new Bill is expected to be introduced to parliament late this year and progress through the parliament process in 2017. The proposal is a lean, principles-based Act containing only the central regulatory requirements, with details contained in regulations and subordinate instruments. This is a useful development and will improve patient access to medicines in a timely and convenient fashion in the general practice setting.

I have spoken to GP’s who think this a useful progression. However, the current wording raises a number of concerns for us as anaesthetists, in particular that it may enable nurse anaesthesia. This is a very complex issue and I will provide more details as time goes by. As mentioned my intention here is to give you a heads up.

I think the most constructive pathway for the NZSA is to have input into the supporting legislation I have mentioned, and in particular to advise on competencies required to provide modern safe anaesthetic practice. In addition we will highlight the narrow therapeutic index and abuse potential of anaesthetic drugs and therefore a need for restricted access.

In summary, in my opinion this revision will modernize prescribing legislation. The key to its success will be in ensuring the supporting documentation and regulations are robust and safe. However, from an anaesthetic perspective it introduces a potential pathway for non-medical anaesthesia providers which will clearly bring with it some anxiety for New Zealand anaesthetists. So on the one hand it brings the potential for reduced regulation, but on the other hand there is the realisation that the administration of anaesthesia comes with potential for great harm. This is a real push-me-pull-you scenario and as always we welcome your feedback on this issue to inform our approach.

Clearly this development is concerning and we will be watching this space very closely.

As always, may the force be with you.

David