In the United Kingdom, an anaesthesia associate (AA) is a healthcare worker who provides anaesthesia under the medical direction and supervision of a consultant anaesthetist (who is a medical doctor). [1] Anaesthesia associates are not doctors themselves, but rather enter the role by completing a 27-month full-time training programme which leads to the award of a postgraduate diploma, or alternatively a 24-month training programme via University College London leading to a master's degree. [2] The University of Birmingham, University College London and Lancaster University deliver General Medical Council approved courses to qualify and register as an AA. It is classed as a medical associate profession. To be eligible, a candidate must have a previous degree in a biomedical or science subject, or recognised previous healthcare experience in another role. [3] There is usually high demand for posts when advertised, with high application to places ratios. Recruitment is usually undertaken directly by the NHS employer, before enrolling with on a chosen course.
The role was introduced into the UK National Health Service in 2004, under the title of Anaesthesia Practitioner. This was later changed to physicians' assistant (anaesthesia), abbreviated to PA(A). The current name for the role was introduced in July 2019. [4] Despite the similarity of the name, the role was always distinct from physician assistant, which refers to a non-doctor practitioner who works in areas of medicine other than anaesthesia. [5] At present, the role is not subject to statutory regulation, meaning it is not mandatory for anaesthesia associates to be registered with any professional body. In July 2019, the UK government announced its intention to request that the General Medical Council (GMC) would in future regulate anaesthesia associates as a distinct profession. [6]
Anaesthesia Associates have worked in the NHS since 2004 in small numbers. This has included further training and assessment to allow extension to the scope of the role. Although, this role extension has never formally been endorsed by the Royal College of Anaesthetists, it was accepted as safe and reasonable with local clinical governance in place to ensure safety and quality.
The AA role is based on similar international equivalents that exist in the United States of America and European nations. The UK AA role is modelled on the equivalent role in the USA known as Anaesthesiologist Assistants. To date this model of care has been proven to be safe, with no significant safety or quality concerns presented with evidence, in the USA or UK.
Serious concerns about the lack of regulation, transparency of professional background, and scope of practise, of anaesthesia associates have been raised by Anaesthetists United, a grass-roots group of anaesthetists, triggering an Extraordinary General Meeting of the Royal College of Anaesthetists on 17 October 2023. Those calling the Extraordinary General Meeting achieved a landslide victory on all motions proposed. [7] Valid concerns have been raised by Anaesthetists United however, the concerns have not come directly from any evidenced patient safety or quality issues. There is a significant shortage of anaesthetists in the UK and relatively few training spaces compared to demand. This in part has led to concerns to be raised about AAs who featured in the NHS Long Term Workforce plan. An intention to significantly increase the number of AAs over 10 years has led to ideological concerns and perception of a threat, to how anaesthesia has traditionally been delivered in the UK.
Regulation of Anaesthesia Associates will be occurring in December 2024, following royal assent of the Anaesthesia Associate and Physician Associate Order 2024. This will include these professions having approved educational standards and become subject to fitness to practice procedures if concerns are raised. This will provide greater assurance that AAs are safe and fit to practise on qualification as defined by the GMC Anaesthesia Associate Registration Assessment.
Anesthesiology or anaesthesiology is the medical specialty concerned with the total perioperative care of patients before, during and after surgery. It encompasses anesthesia, intensive care medicine, critical emergency medicine, and pain medicine. A physician specialized in anesthesiology is called an anesthesiologist, anaesthesiologist, or anaesthetist, depending on the country. In some countries, the terms are synonymous, while in other countries, they refer to different positions and anesthetist is only used for non-physicians, such as nurse anesthetists.
A Physician Assistant or Physician Associate (PA) is a type of healthcare professional. While these job titles are used internationally, there is significant variation in training and scope of practice from country to country, and sometimes between smaller jurisdictions such as states or provinces. Depending on location, PAs practice semi-autonomously under the supervision of a physician, or autonomously perform a subset of medical services classically provided by physicians.
A nurse anesthetist is an advanced practice nurse who administers anesthesia for surgery or other medical procedures. Nurse anesthetists (NA's) administer or participate in administration of anesthesia services in 107 countries, working with or without anesthesiologists. Because of different historical backgrounds, anesthetist responsibilities and roles vary widely between countries. Depending on the locality, their role may be limited to intraoperative care during anesthesia itself or may also extend before and after. The International Federation of Nurse Anesthetists was established in 1989 as a forum for developing standards of education, practice, and a code of ethics.
The Primary FRCA is a postgraduate examination in anaesthesia, more fully called the Primary Examination of the Diploma of Fellowship of the British Royal College of Anaesthetists (RCoA).
The Royal College of Anaesthetists (RCoA) is the professional body responsible for the specialty of anaesthesia throughout the United Kingdom. It sets standards in anaesthesia, critical care, pain management, and for the training of anaesthetists, physicians' assistants (anaesthesia), and practising critical care physicians. It also holds examinations for anaesthetists in training, and informs and educates the public about anaesthesia. Its headquarters are in Churchill House, London.
The Royal College of General Practitioners (RCGP) is the professional body for general (medical) practitioners in the United Kingdom. The RCGP represents and supports GPs on key issues including licensing, education, training, research and clinical standards. It is the largest of the medical royal colleges, with over 54,000 members. The RCGP was founded in 1952 in London, England and is a registered charity. Its motto is Cum Scientia Caritas – "Compassion [empowered] with Knowledge."
The General Medical Council (GMC) is a public body that maintains the official register of medical practitioners within the United Kingdom. Its chief responsibility is to "protect, promote and maintain the health and safety of the public" by controlling entry to the register, and suspending or removing members when necessary. It also sets the standards for medical schools in the UK. Membership of the register confers substantial privileges under Part VI of the Medical Act 1983. It is a criminal offence to make a false claim of membership. The GMC is supported by fees paid by its members, and it became a registered charity in 2001.
In the United Kingdom, operating department practitioners (ODPs) are allied healthcare professionals who are involved in the planning and delivery of perioperative care. As the name suggests, they are primarily employed in surgical operating departments, but they may also work directly within a variety of acute clinical settings, including pre-hospital emergency care, emergency departments, intensive care units (ICUs), endoscopy suites, interventional radiology, cardiac catheter suites, obstetric theatres and reproductive medicine.
Emergency medical personnel in the United Kingdom are people engaged in the provision of emergency medical services. This includes paramedics, emergency medical technicians and emergency care assistants. 'Paramedic' is a protected title, strictly regulated by the Health and Care Professions Council, although there is tendency for the public to use this term when referring to any member of ambulance staff.
Stephen Nicholas Cluley Bolsin is a British anaesthetist whose actions as a whistleblower exposed incompetent paediatric cardiac surgery at the Bristol Royal Infirmary leading to the implementation of clinical governance reforms in the United Kingdom.
The Faculty of Pharmaceutical Medicine (FPM) is a faculty of the three Royal Colleges of Physicians of the United Kingdom. It is a UK-based professional membership organisation with 1,600 members; physicians with a professional interest in the speciality of pharmaceutical medicine, the science of discovering, developing and testing new drugs, their regulation, and monitoring them for safety both during development and when they are prescribed. FPM is a registered charity and ultimately exists to bring about an improvement in health in patients and the general population.
Medical regulation ensures that medicine is only practised by qualified and suitable people and can be used to prevent competition and increase financial compensation. The history of regulating doctors in the UK dates back around 600 years. The earliest licensing procedures were administered by the Church, with professional associations and universities also playing a role. Modern regulation of doctors is carried out by the General Medical Council.
The General Pharmaceutical Council (GPhC) is the body responsible for the independent regulation of the pharmacy profession within England, Scotland and Wales, responsible for the regulation of pharmacists, pharmacy technicians and pharmacy premises. It was created, along with the Royal Pharmaceutical Society, in September 2010 when the previous body responsible for regulation, the Royal Pharmaceutical Society of Great Britain, was split so that representative and regulatory functions of the pharmacy profession could be separated.
Dame Clare Lucy Marx was a British surgeon who was president of the Royal College of Surgeons of England from July 2014 to July 2017, the first woman to hold the position, and former chair of the Faculty of Medical Leadership and Management. From January 2019 until July 2021, Dame Clare was chair of the General Medical Council, the first woman appointed to that role.
George Warwick Bampfylde Daniell (1864–1937) was medical practitioner and anaesthesiologist who practised in South Africa in the 19th and 20th centuries.
Ramani Moonesinghe OBE MD(Res) FRCP FRCA FFICM SFFMLM is Professor of Perioperative Medicine at University College London (UCL) and a Consultant in Anaesthetics and Critical Care Medicine at UCL Hospitals. Moonesinghe was Director of the National Institute for Academic Anaesthesia (NIAA) Health Services Research Centre between 2016 and 2022, and between 2016 and 2019 was Associate National Clinical Director for Elective Care for NHS England. In 2020 on she took on the role of National Clinical Director for Critical and Perioperative care at NHS England and NHS Improvement.
Judith Hulf is a British anaesthetist. She was the president of the Royal College of Anaesthetists from 2006 to 2009.
Sir Donald Hamilton Irvine was a British general practitioner (GP) who was president of the General Medical Council (GMC) between 1995 and 2002, during a time when there were a number of high-profile medical failure cases in the UK, including the Alder Hey organs scandal, the Bristol heart scandal and The Shipman Inquiry. He transformed the culture of the GMC by setting out what patients could expect of doctors and is credited with leading significant changes in the regulation of professional medicine and introducing the policy of professional revalidation in the UK.
Sarah Catherine Clarke FRCP FESC FACC is a British consultant cardiologist and was the president of the Royal College of Physicians (RCP) of London between September 2022 and June 2024.
Anaesthetists United is a medico-political advocacy group in the United Kingdom co-founded by Ramey Assaf and Richard Marks in June 2023 to campaign against the proposed expansion of Anaesthesia Associates (AAs), as proposed by the NHS Long Term Workforce Plan. The group, composed of around 20 anaesthetists, undertook work to draft motions and submitted a requisition to the Royal College of Anaesthetists (RCoA) for an Extraordinary General Meeting (EGM) which took place on 17 October 2023. It successfully campaigned on issues relating to the training of anaesthetists.