Anaesthesia Associates (AAs) are highly trained healthcare professionals, part of the multi-disciplinary theatre team led by a Consultant Anaesthetist. They care for patients undergoing many aspects of anaesthetic care; before, during and after operations or procedures. (1)
When the original pilot scheme and training programme was developed in 2003, the roles title was ‘Anaesthesia Practitioner’ however this title was also used by anaesthetic nurses and operating department practitioners. To differentiate the role the title ‘Physicians’ Assistant (Anaesthesia)’ was adopted. This was in part to help aid regulation of the profession by creating a distinct identity. It also harmonised the title with that of ‘Physician Assistants’ (now known as Physician Associate) a similar sounding but distinct professional group
The prefix of ‘Physician Assistant’ it not used by any other role working at a senior clinical level. In fact, many roles working in a non-clinical or significantly less clinical responsibility are using this title.
‘Associate’ as a role title is now more widely utilised in the NHS. During public consultation in regard to statutory regulation the PA(A) role was organised into a group call the Medical Associate Professions comprising of PA(A)s, Physician Associates (PAs), Advanced Critical Care Practitioners (ACCPs) and Surgical Care Practitioners (SCPs).
Through a membership consultation and vote and input from HEE and the RCoA, the Association determined that PA(A)s would become AAs.
Individuals who have completed either the university of Birmingham’s Anaesthesia Associate Post Graduate Diploma, UCL’s Anaesthesia and Perioperative Science MSc or Lancaster University’s Postgraduate Diploma in Anaesthesia and Peri-Operative Sciences (PGDip AaPOS)
Please note these are distance learning courses and so can be undertaken at any hospital within the UK.
As there is currently no regulator to assess equivalence, individuals wishing to work as AAs, with qualifications from outside the UK, would have to be individually assessed by the University of Birmingham, UCL or Lancaster University.
The role encompasses pre-, intra- and post-operative care. Working under the overall supervision of a consultant anaesthetist, the AA may participate in:
Assessment of patients before the operation to check their health status and discuss pre and post-operative care. The AA may organise additional investigations and/or treatments (specific to individual AAs competency) to optimise the patient before their surgery.
Planning of anaesthetic care for patients (to be agreed with the consultant anaesthetist who oversees and is responsible for patient care)
Delivery of anaesthetic or sedation
Assessment of patients after the operation to ensure that they are recovering well
Resuscitation in case of an emergency.
Some departments train experienced AAs to perform nerve blocks or other monitoring procedures for some operations (this is subject to local agreement).
There are good case study examples on our ‘Useful documents page’:
AAs are nationally banded at band 7. However, approximately half of AAs are paid at band 8a. Higher banding is usually awarded to experienced AAs, whose scope of practice is broader and may take on other responsibilities.
Most jobs in the NHS are covered by the Agenda for Change (AfC) pay scales. This pay system covers all staff except doctors, dentists and the most senior managers. Staff in the NHS will usually work a standard 37.5 hours per week. They may work a shift pattern. (1)
Trainee AAs can be seconded, paid a nominal trainee salary e.g. £15,000 per annum or paid a percentage of the top of band 7 as per AfC.
Anaesthetists are specialist doctors. Anaesthesia Associates are not doctors, and work under the overall supervision of a consultant anaesthetist.
It is important to highlight however, that whilst not a doctor, an AA is expected to deliver the same standard of care as that which would be expected from an Anaesthetist. Successful completion of one of the UK recognised Postgraduate Diploma/MSc and competency assessments, adherence to local policies and governance and the overall supervision of the relevant Consultant Anaesthetist ensure that AAs practise to this high standard.
AAs may come from a nursing, operating department practitioner or science graduate background.
Currently there is no evidence that AA’s negatively impact Anaesthetists in training (AiT) however it is acknowledged that further research is needed in this area. Since the roles introduction over a decade ago, data show that AAs may enhance the working arrangement of members of the perioperative team which they join, whilst improving efficiency and maintaining high standards of patient safety is steadily accumulating. (4,5,6)
There is of course concern that AAs could potentially affect AiT’s. Appropriate rota allocation to ensure adequate opportunities during trainee’s rotations at hospitals empolying AA’s is necessary to ensure that they are not negatively impacted. Trainee’s should have sufficent protcted learning and departments are encouraged to liaise with local college tutors to help accomodate this.
No significant issues have been reported through normal educational channels to the Royal College of Anaesthetist.
There is of course concern that AAs could potentially affect junior doctor training. Supervisors and local departments are encouraged to monitor any affects and take measures to ensure AAs have no adverse effect on training. We would expect in most departments, AAs would be able to positively influence junior doctor training.
As with all NHS employees, AAs are covered by vicarious liability. This means all acts or omissions by an AA would be indemnified by their employer. To protect both patients and themselves, AAs should only work within a scope of practice agreed by their employer.
Individual indemnity may be purchased by AAs from various medical defence unions.
As of 2015 the only Higher Education Institution (HEI) offering the AA Course is the University of Birmingham, although other HEIs may be prepared to set up or reinstate courses should demand increase. Information as to the teaching and educational facilities required can be obtained from the course administrator.
Students eligible for entry into an AA programme derive from two sources:
■ Clinical NHS staff who have demonstrated their ability to work at degree level and will usually have had at least three
years’ experience in theatre practice.
■ Biomedical science graduates with no previous clinical exposure.
Details of requirements for eligibility to the AA programme are available on the Birmingham University website
Prior to accessing the course some students will be required to develop their knowledge and skills via university modules or the Accreditation of Prior Learning process (APEL/APL) to prepare them for entry to the course. (3)
The programme requires a training position at a sponsor Trust and they are usually advertised nationally on NHS jobs.
Following qualification as an AA becomes more experienced their scope of practice and level of supervision may extend depending on local agreement, education and competency assessment. As advised by the RCOA in the above document this would require local governance, agreement and monitoring.
A named and available supervising consultant anaesthetist is always required.
For introduction of AAs into your hospital to be successful, it is important for all those involved to be absolutely clear as to the reasons behind the initiative, what is required of them and what support will be available.
Successful training requires a firm commitment from the existing department of anaesthesia to provide consistent high class teaching over the entire duration of the course and beyond, into service delivery as post-graduate practitioners. (3)
AAs cannot currently independently prescribe medicines.
AAs are trained and able to administer all medicines in routine use in UK anaesthesia practice using a standard prescription or Patient Specific Directive. This includes intravenous opioids and sedatives.
Patient Specific Directives (PSD) – many AAs use PSDs to administer a whole range of medicines with indirect/distant supervision. This involves a prescription for most commonly administered drugs, for a specific AA to administer to a specific patient.
Independent prescribing rights for AAs are expected after a regulatory register has been established. A separate legislative process will be required for this.
Prescribing is a high-risk activity, therefore, only some statutorily regulated healthcare professionals are undertaking this activity. It is not a reflection of knowledge or competency per se.
Anaesthesia is already a highly specialised area of medicine. However, even within this AAs work in a range of sub-specialist areas, such as cardiothoracic anaesthesia, neuro-anaesthesia, interventional radiology, ‘block’ rooms, CPEX clinics, research and teaching.