Skills for Health: Medical Associate Professions Career Development Framework

In February 2024, the Royal College of Anaesthetists responded to the Skills for Health public consultation on the draft Career Development Framework for Medical Associate Professions (MAPs).

In responding to the consultation, we sought the views of representatives from across the anaesthetic community, including Council Members, our Anaesthetists in Training Committee, the Clinical Leaders in Anaesthesia Network (CLAN), College Tutors, and Regional Advisors. Our response was also informed by the views of the wider membership and PatientsVoices@RCoA.

The College was represented on the Task and Finish Group to guide development of the Career Development Framework, which began in early 2023. While we can see the value in having such a Framework, the College does not support the Framework as currently proposed. We have urged Skills for Health to significantly revise both the content and timing of the Framework for the reasons summarised below.  

While career development for MAPs is important to consider and define, it should not precede regulation and scope of practice.

Regulation of MAPs is expected to begin in December 2024 and will provide statutory safeguards for patients by applying rules around training, registration, governance and fitness to practise. The College is developing a comprehensive scope of practice for anaesthesia associates (AAs) – in consultation with stakeholders – to take effect when statutory regulation of AAs is in place.

It is essential for patient safety that scope of practice is set by the medical profession and not by employers, so that MAPs are not asked to perform tasks beyond their capabilities, and there is standardisation in patient care.  

With this in mind, we think the Framework must be revised based on feedback from the consultation, but also that its publication should be postponed to ensure alignment with scope of practice (once agreed), and the guidance, processes and policies that accompany regulation.

The Framework includes supervision arrangements beyond those the College considers safe and practical.

AAs are a supervised workforce therefore it is not appropriate for the role to have a career pathway in which the top tiers do not require close supervision. Tiers 3 and 4 as currently proposed in the Framework contradict the College’s position on the supervision of AAs and therefore cannot be mapped to clinical anaesthetic capabilities for AAs.

Similarly, terms such as ‘clinical leadership’ are potentially misleading when applied to a supervised workforce which is not qualified to lead clinical practice. Such leadership is the role of doctors, and the Framework does not sufficiently differentiate between the role and responsibilities of MAPs and that of doctors or other members of the anaesthetic team.

The Framework does not address how career development for MAPs should be balanced with that of other members of the team, for example in relation to the training and development needs of doctors in training, the needs of supervising consultants and SAS doctors and the capacity of trainers.   

Anaesthesia requires specific skills which are not addressed in the Framework.

The Framework appears focused on PAs with insufficient consideration of the specific requirements related to AAs. The four tiers proposed do not align with the level of training received by AAs and lack detail and clarity, including about progression between tiers. They may set unrealistic expectations of what can be safely delivered by both MAPs themselves and employers.

The titles proposed for the different tiers are potentially confusing for patients, who need to understand the role of MAPs and how they are different to doctors. While we understand the Framework is designed primarily for employers, it would be beneficial to all stakeholders for it to demonstrate more obvious alignment with the needs of patients.