AAA Statement
We welcome the opportunity within the forthcoming EGM for the RCoA to try and address some of the concerns within its membership. As the membership organisation representing Anaesthesia Associates (AAs) we felt it would be helpful prior to that date to share some information that will hopefully inform the discussions. As affiliate members of the RCoA, AAs are not permitted to attend the EGM or vote, this we fully respect as per the RCoA ordinance, but hope our position comes across via the following statement. In addition to this statement, please also refer to our FAQ section on our website. We are continuing to update this section to address some of the issues and queries raised around AAs.
The EGM has 6 proposed resolutions, these have been brought forward by the group ‘Anaesthetists United’. Three of the resolutions relate to the practise of AAs. The latter 3 motions relate to anaesthetists in training (AiT) and recruitment processes, which will not be discussed here as this is outside the remit of the AAA. The RCoA has produced an EGM briefing pack offering additional context and discussion points for each resolution. It is important to state these resolutions are advisory to the RCoA council.
Regarding these 3 resolutions, we respectfully wish to make the following statements;
Resolution 1
Proposed expansion of Anaesthesia Associates
The Council is advised to ask the Clinical Directors network to pause recruitment of AAs until the proposed RCoA Survey and Consultation is complete and the impact on doctors in training has been assessed and reviewed.
The Council is advised to ask the College Tutors (CTs) and Regional Advisors (RAs) to ensure that doctors-in-training are given priority over AAs in their exposure to training opportunities. If CT/RAs find that is not the case then they should feed this information back to the Training Department, in order that the training capacity of that hospital be reviewed.
The AAA response
We acknowledge that there is a developing crisis within the anaesthesia workforce that will require multiple responses for it to be addressed. We fully support the RCoA in their efforts to lobby for an expansion of training numbers within anaesthesia alongside an expansion of consultant and SAS numbers. Anaesthesia Associates are supervised professionals who can also contribute to the necessary workforce expansion.
Aspirations detailing an AA workforce of 2000 by 2036/37 as detailed in the long-term workforce plan is welcomed. Published qualitative evidence of good practice and implementation of the role exists and can support AA expansion. As AA numbers increase it is important to carry out quantitative research, looking at the impact on the anaesthesia team and training opportunities. The 2023 guidance document produced by the RCoA has key recommendations to support the introduction of AAs into departments. We fully recognise AA expansion has to be carefully balanced, training capacity and quality must be reviewed before and following the introduction of any role in any department.
We believe decisions around AA recruitment should remain the remit of clinical leaders who are required to address service needs at a local level and are best placed to assess local training capacity.
We oppose this resolution.
Resolution 2
Supervision of Anaesthesia Associates
The Council is advised to amend the Guidelines for Provision of Anaesthetic Services (GPAS) the Anaesthesia Clinical Services Accreditation (ACSA) and other relevant College documents to make it clear that local opt-outs from the College’s position on the supervision of AAs are not approved by the College.
The AAA response
Anaesthesia Associates are professionals who work under supervision of an autonomously practising anaesthestist. We recognise the RCoA does not currently support AA enhanced roles until statutory regulation is in place.
Since inception of the role in 2003/4 the number of AAs practising nationally has grown slowly. Over time a number of departments have developed patient centred services and pathways which rely on AAs to deliver them, with appropriate supervision. Our association has continued to reinforce the importance of local training and governance to deliver these services when they include extended practice. It is important to recognise extended practice for AAs has often been led by a service requirement, where a service need has been identified which can safely be delivered by an AA following appropriate training and departmental support.
Any amendments to GPAS or ACSA preventing departments from utilising local governance underpinning AA activity would be detrimental to current services. We feel this would have a huge negative impact on patient services, it would result in poor utilisation of a skilled workforce, impose strict limitations on AA practice and further stress anaesthesia departments.
We oppose this resolution.
Further notes;
Regulation is a critical step for our profession. It is clear all stakeholders are in support of regulation and the importance of avoiding any further delays to its delivery. Our association was formed in 2009 and our main goal was regulation, we understand its importance for patient safety, AAs and the wider anaesthesia team.
We welcome the introduction of a working group within the RCoA to begin looking at a scope of practice for AAs beyond qualification, to come into effect following regulation.
Resolution 3
Member resolution on information for patients
The Council is advised to ratify as a professional standard the need to inform patients, when applicable, that an AA could be involved in their care, that an AA is not a registered medical practitioner, and who their responsible Consultant Anaesthetist is.
The AAA Response
We agree with the principles set out in Good Medical Practice that all healthcare workers should be open and honest about their experience, qualifications and role when talking to patients. The 2024 revision of this document specifically states that it also applies to the medical associate professions. We would always expect an AA to introduce themselves by name, state their job title, supervisor and explain their role within the anaesthesia team. Furthermore, if patients ask for more information about AAs this should be provided, and if the patient wishes to also speak with the supervising anaesthetist then this must be arranged.
We support this resolution.
Final Comments
In 2001 scoping work for a ‘non-medical’ anaesthesia workforce was undertaken with the RCoA, DoH and other relevant stakeholders. This was explored due to the predicted shortfall of medically qualified anaesthetists. At that time the predicted shortfall was partly due to the expected impact of the European working time directive and from increasing demand on anaesthesia services.
International examples of ‘non medical’ anaesthesia providers were reviewed, and scoping work completed. A ‘team’ approach was deemed to be the most appropriate model for the UK rather than a more independent practitioner such as ‘nurse anaesthetists’. The ‘new ways of working in anaesthesia programme’ was established in 2003, from it came a workforce to support anaesthesia services in the UK – AAs.
It is unfortunate that the ‘institutional memory’ of such efforts and discussions has been lost along the way, partly because we remain a small or unknown workforce to many. The introduction of the AA workforce was gradual and considered. There are now clear examples of well-established teams, delivering safe patient care.
Regulation is an important next step and has unfortunately been subject to multiple delays. December 2017 saw the first public consultation on regulation of the MAP professionals. In 2019 following another public consultation the GMC was selected as the regulator for MAP’s (PAs and AAs). Throughout these processes we have had continual stakeholder support for regulation of the profession.
We remain fully committed to working with stakeholders on the implementation, role and remit of AAs. The AAA has concerns about some of the conduct on social media and believes it is not the right platform for productive discussions on these complex matters. But, as has always been the case, we welcome pragmatic evidence-based dialogue where it is conducted with civility and respect for all professionals.