Workforce planning in Ireland – what does the future hold? | Association of Anaesthetists

Workforce planning in Ireland – what does the future hold?

Workforce planning in Ireland – what does the future hold?

In 2016, the National Doctors Training and Planning unit within the Irish Health Service Executive (HSE) developed and published their methodology for medical workforce planning in the Republic of Ireland [1]. The methodology is being used to predict the medical workforce requirements for public and private care over a defined ten year projection period. The approach consists of five phases: set the context, analyse the major drivers of change to the workforce, develop a stakeholder informed set of future workforce scenarios, analyse the future gap between the supply of and demand for staff, and, develop the workforce plan.


The National Clinical Programme for Anaesthesia (NCPA) [2] has facilitated the development of a Model of Care for Anaesthesiology to assist planning the future workforce requirements in the disciplines of anaesthesiology, intensive care and pain medicine. This work was strongly supported by the College of Anaesthesiologists of Ireland and the Irish Standing Committee (ISC) of the Association of Anaesthetists. The draft model of care, published in October 2018, sets the context and outlines a model of care suitable for the next ten years. It considers the standards required for the provision of scheduled and unscheduled 24-hour care, the need for a retrieval service, and the provision of pain medicine services nationally. It recommends engagement in quality improvement, postgraduate training and continual professional development by all anaesthesiologists. All of these are consistent with the national health care strategic plan (Slaintecare) [3].

The Model of Care for Anaesthesiology sets out the requirements to deliver safe, internationally acceptable levels of anaesthesiology care throughout Ireland, irrespective of whether the patient is being cared for in a Model 2, 3 or 4 hospital setting [4]. To provide this care, the anaesthesiology team needs to collaborate with colleagues from other disciplines, who are similarly planning for the future [5].

Evolving role of the anaesthesiologist

In the past decade the role of the anaesthesiologist has evolved from being a theatre-based specialty to one involved in critical care, resuscitation, pain medicine, the provision of anaesthesiology for radiological, cardiac and other procedures outside the theatre environment, transport of the critically ill, and responding to critically ill or deteriorating patients on wards or in the emergency department. This future orientated workforce plan considers the continued evolving role of the anaesthesiologist.

‘2 plus 2 model’ of anaesthesiology/critical care cover for unscheduled care

A comprehensive anaesthesiology/critical care service requires a team structure that enables the delivery of an elective service and an emergency anaesthesiology/critical care service on a 24 hour basis. The emergency team must be able to provide an immediate and sustained response to more than one emergency. Second emergencies – such as a category-1 Caesarean section or a cardiac arrest in the emergency department, intensive care unit (ICU), or on the wards, as well as the transfer of critically ill patients to other hospitals – can arise while the team is already involved with other operating room cases. In the context of previously published safety recommendations [6-8] the 24 hour provision of a clinically appropriate safe anaesthesiology/critical care service for unscheduled care is a major challenge. To provide such a comprehensive service in Model 3 hospitals, which, along with a critical care and anaesthesiology service may have a co-located obstetric unit with a possible addition of a trauma service, the Model of Care recommends the ‘2 plus 2 model’ of cover (two consultant and two NCHDs) for unscheduled care as the minimum acceptable cover for 24 hour unscheduled care.

In the area of particular subspecialties, such as cardiothoracic, neuro-anaesthesiology, and transplant services, the longterm national goal should be to create larger subspecialty centres, geographically sited according to population need, with clearly defined referral patterns. These centres should be staffed with an adequate number of appropriately trained subspecialty consultant anaesthesiologists, thereby providing a comprehensive 24/7 service.

Additional posts

As a first step, providing the ‘2 plus 2’ cover in hospitals in all maternity units would require an additional 74 consultant posts and 43 NCHD posts. Significant reconfiguration of services involving many of the smaller units would reduce this figure. Consultant posts in the Irish health service must be attractive and well-structured, with reasonable on-call commitments, and provide the incumbents with the opportunity to use their skills/training appropriately. The Model of Care espouses a 1 in 8 on call roster frequency and adequate non-clinical time for administrative, teaching & research activities.

The College of Anaesthesiologists of Ireland will continue to train sufficient numbers of consultants in the various subspecialty areas in order to provide the numbers required to implement the vision of this model of care.

Jeremy Smith
Clinical Lead, National Clinical Programme for Anaesthesia 

Martin McCormack
Chief Executive, College of Anaesthesiologists of Ireland


  1. Medical Workforce Planning Ireland: A Stepwise Approach (2016). 
  2. National Clinical Programme for Anaesthesia (2016) 
  3. Sláintecare Implementation Strategy (2018) https://áintecare-Implementation-Strategy-FINAL.pdf 
  4. Securing the Future of Smaller Hospitals (2016). 
  5. Health Service Executive 
  6. Association of Anaesthetists of Great Britain & Ireland. Recommendations for standards of monitoring during anaesthesia and recovery 2015. Anaesthesia, 2016; 71(1): 85-93 
  7. Association of Anaesthetists of Great Britain & Ireland and Obstetric Anaesthetists’ Association (2013). OAA / AAGBI Guidelines for Obstetric Anaesthetic Services 2013. anaesthetic_services_2013.pdf 
  8. Department of Health (2016). Creating a Better Future Together: National Maternity Strategy 2016-2026. 27.01.16.pdf