Letter to Clinical Leaders in Anaesthesia Network
This letter was sent to the Clinical Leaders in Anaesthesia Network (CLAN) on 27 February 2024.
Dear Colleagues,
As you know, the Royal College of Anaesthetists held an Extraordinary General Meeting (EGM) in October 2023. Six resolutions proposed by members were carried with support from a significant proportion of our membership, including two that advise the College Council to act in relation to the recruitment and supervision of anaesthesia associates (AAs).
In recognition of the concerns about patient safety expressed by members, the College is committed to implementing these resolutions. In considering how best to do so, we have sought to prioritise patient services and safety, aligned to our charitable duty to act for the public benefit. We have consulted with stakeholders and undertaken a rapid assessment of the potential impact on patient care, including surveying clinical leaders. Following that process, we are writing to request that you:
- Pause recruitment of new, student AAs while the College undertakes further research regarding the impact of the AA role.
- Pause development of enhanced roles for AAs until regulation is in place and a scope of practice beyond qualification has been developed.
These requests are set out in more detail below.
We would also like to reiterate our support for current student and qualified AAs who provide a valuable contribution to the anaesthetic team and to patient care. It is important to recognise the impact the ongoing debate has had on them, both personally and professionally. We ask that you continue to show your support for all members of your department, including AAs, and to facilitate positive professional relationships between all members of the team.
- Pause recruitment of new student AAs
We request that your hospital pauses all further recruitment of new student AAs while the College undertakes further research regarding the impact of the AA role. This will consist of analysis of the results of our member survey, an independent academic literature review and evidence gathering and consultation leading up to our Annual General Meeting in November 2024.
This pause applies to the recruitment of new, student AAs who have not yet been appointed. It does not apply to student AAs who are enrolled on courses or already training, or to qualified AAs. Hospitals can still recruit to vacant posts for qualified AAs, continue to train existing student AAs and recruit student AAs into substantive posts once they qualify.
The duration of the pause will be at least until the start of regulation for AAs, which is expected to be December 2024. Regulation will provide statutory safeguards for patients by applying rules around training, registration, governance and fitness to practise for all AAs in the UK.
- Pause development of enhanced roles for AAs
We define enhanced roles as those that extend beyond the scope of practice for an AA on qualification, as set out in the 2016 guidance: Planning the introduction and training for anaesthesia associates. Ahead of the EGM, the College shared a draft of an updated version of this guidance, but we want to make clear that for the purpose of the requests made in this letter, enhanced roles are defined as those that extend beyond the 2016 scope of practice, rather than the ‘Role of the AA on qualification’ in the 2023 draft version of the guidance.
We recognise that some trusts have developed enhanced roles for AAs and local governance as a means of providing services to patients in response to the increasing demand for anaesthetic services. However, the College has not supported enhanced roles for AAs while they remain an unregulated workforce. In recognition of the concerns about patient safety expressed by members through the EGM process, we will shortly amend the Guidelines for the Provision of Anaesthetic Services (GPAS), the Anaesthesia Clinical Services Accreditation (ACSA) and other College documents to make clear that local opt-outs from the College’s position on the supervision of AAs are not approved by the College.
We therefore request that your hospital pauses all development of enhanced roles for AAs until regulation is in place and a scope of practice beyond qualification has been written. The College is currently developing a comprehensive scope of practice for enhanced roles – in consultation with stakeholders – to take effect when statutory regulation of AAs is in place.
In making this request, we are mindful that we would be in breach of our duty as a charity if preventing AAs currently undertaking enhanced roles from doing so caused detriment to patient care. For existing roles where this applies, AAs can continue in their role provided that supervision does not exceed 1:2 and the supervising consultant[1] is available within two minutes when undertaking general, neuraxial or regional anaesthesia or giving sedation. For such exemptions, we strongly recommend that you review your local governance processes and arrangements, including professional liability, and ensure they are supported by your Executive Board.
My colleagues on Council and I recognise that the requests made here are significant and may disrupt your planning and increase your workload. We also understand that there are uncertainties about the future and unresolved questions as the wider public debate about medical associate professions evolves. We are committed to being open and responsive as we work with our members and other stakeholders to consider what best serves the speciality, our members, the wider NHS and of course patients. Please do not hesitate to get in touch if you have any questions or would like to discuss ways in which the College might provide assistance.
Your sincerely,
Dr Fiona Donald
President and Chair of the Board of Trustees
Royal College of Anaesthetists
[1] ‘Consultant’ means a consultant or other autonomously practising anaesthetist.