Committee Statement
The Association of Anaesthetists (AoA) position statement on Anaesthesia Associates1 (AAs) has led to disappointment and confusion amongst AAs, their supervisors and their employers. As the AoA statement deviates from current published guidance on scope of practice2, the AA curriculum3 and the GMC entrustable professional activities4, we believe there is a need to clarify our position for the benefit of those affected by this statement.
We encourage departments of Anaesthesia to refer to the most recent publication from the RCoA following the resolutions carried at the October EGM5. Current guidelines state 2:1 working with rapid supervisor availability remains the expected standards for AAs. Enhanced roles which have been established within trusts may continue, the RCoA will be releasing further guidance and rules around enhanced roles. No further enhanced roles should be developed until regulation is in place and a scope of practice beyond qualification has been published.
In trying to address concerns raised within the anaesthetic community we must remain cognisant of the role that AAs currently fulfill within departments and also ensure patient care does not suffer. The RCoA were mindful of this, consulting employers and service providers leading to a considered approach around implementation of the EGM resolutions. The AoA statement that ‘AAs should be supervised on a 1:1 basis’ could reduce service capacity and directly impact patient care, at a time of record waiting lists. This position is without justification or consultation with AAs or employers. We would welcome a dialogue with the AoA moving forward and urge them to consider discussing this with all stakeholders and to reconsider their position regarding this long-standing model of AA working in the UK.
Delivery of anaesthesia is a pillar of the AA role. We are qualified to deliver anaesthesia under the supervision of an autonomously practising anaesthestist. Our role is based on a 2:1 model of care, this has been the case since inception of the role, agreed by all stakeholders and demonstrated in the curriculum.
The AAA will continue to collaborate with all stakeholders around the developments of all Medical Associate Professional’s. Our aim is to contribute to the provision of sustainable and high-quality anaesthesia care for patients that is fit for the future, and we will continue to work positively towards these goals.
Further to this statement we would like to respond to some legitimate concerns which have been raised and address the unfortunate and incorrect narrative ‘AAs are replacing anaesthetic doctors’, which is having far reaching implications on the morale of the wider anaesthesia workforce.
Over the last 20 years Anaesthesia Associates have been integrated into anaesthesia teams across the country. First conceived by the RCoA and other key stakeholders in anticipation of a workforce crisis as it was perceived that a non-medical practitioner would be required to assist in meeting anaesthetic service demand. On investigation it was identified that there were extensive international examples of well-established care models utilising ‘non-medical’ anaesthesia providers and the ‘Anaesthetic Practitioner’ programme was developed in 2005. Currently around 200 AAs work in the NHS. These professionals are highly skilled, they offer vital services for patients and support anaesthesia departments. Importantly when utilising anaesthesia associates, patients care remains physician-led and AAs are supervised. From our experience and feedback, this model of working is beneficial to departments and enables a flexibility and continuity in service provision, for the benefit of patients.
We are all well aware of the workforce crisis facing the NHS. The RCoA State of the Nation workforce report6 predicted 11,000 FTE workforce deficit within anaesthesia by 2040. The NHS long term workforce plan (LTWP)7 focuses on reform, building broader anaesthesia teams with flexible skills and this should be welcomed. Using AAs to expand physician-led care, not replacing doctors, but expanding their reach and allowing utilisation of their skills and experience in the most effective way. There were some concerns voiced over the LTWP projection of 2000 AAs by 2036/37, but this was later clarified in an open letter from NHSE8 to highlight these are aspirational targets and recognised the rollout of AA expansion should be guided by service requirements and training capacity assessment, to ensure training quality is maintained for all staff. We would further reinforce that, whilst AAs can complement anaesthesia delivery in many areas, not all areas would benefit from having an AA present and therefore AA deployment should be always demand led and carefully planned. AAs cannot address the anaesthesia workforce crisis in isolation. The number of anaesthetic doctors must also increase to ensure high quality patient care is maintained whilst meeting the increased demand across anaesthesia services. Anaesthetists in training must be supported appropriately to meet their training needs and AAs can and should support their opportunities to progress.
Regulation
Regulation of AAs is long overdue and the AAA has been working towards regulation of the profession since 2008. Now the AAPA order has been laid within Parliament, we are pleased that the GMC are able to begin the work on bringing AAs into statutory regulation this year. The AAA believes that the GMC are the most appropriate regulator to take this forward as AAs work within a medical specialty, are employed by anaesthesia departments and should be expected to work to the same high standards that our medical colleagues adhere to and the public should expect. We note that the GMC are listening and responding to feedback around the logistics of how this is to be implemented and we are keen to continue to work with them throughout the year.
Assessment Standards
In response to concerns raised around standardised assessment and consistency in the delivery of the curriculum, we absolutely support the implementation of rigorous standards and quality assurance of newly qualified AAs. The curriculum clearly sets out the expectations of a newly qualified AA, this is further reinforced by the anaesthesia associate registration assessment (AARA)9. ‘The purpose of the AARA is to ensure that AAs seeking registration have met a common threshold for safe practice’9, an AA will not be able join the GMC register unless this threshold has been met. Furthermore, once regulation begins the GMC will be responsible for quality assuring the AA course delivery and ensuring standards10.
Professional Body
The AAA still believe the correct professional home to oversee AAs is at the RCoA and we continue to work towards establishing a faculty within that organisation. We believe that together, we should set clear standards for how the AA role can develop in the future to support departments of anaesthesia and for the benefit of patients. In this capacity we would urge the RCoA to publish the updated ‘Planning the introduction and training for Anaesthesia Associates’ that was released as a draft prior to the recent EGM as we believe that would go a long way to help educate and inform the wider anaesthetic community around the AA role and allay some current well publicised fears and misconceptions.
Our aim remains as an Association to be a key member in establishing and maintaining the provision of sustainable and high-quality physician-led anaesthesia care in the UK, increasing both accessibility and efficiency for patients that is fit for the future.
AAA Committee
January 2024
1 https://anaesthetists.org/Home/News-opinion/News/Position-statement-on-Anaesthesia-Associates
2 https://anaesthesiaassociates.org/wp-content/uploads/2018/03/Scope-of-Practice-PAA-2016.pdf
5 https://rcoa.ac.uk/news/update-implementation-resolutions-carried-egm-2023
6 https://www.rcoa.ac.uk/sites/default/files/documents/2022-02/State-Nation2022.pdf
7 https://www.england.nhs.uk/long-read/nhs-long-term-workforce-plan-2/