Lady Fern – Athyrium filix-femina

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.

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