The Department of Health and Social Care recently asked the GMC to formally take on the regulation of anaesthesia associates and physician associates.
Sarah Massey, an anaesthesia associate at London North West Healthcare NHS Trust and Board member at the Association of Anaesthesia Associates, shines a light on the role and the difference regulation will make.
Anaesthesia associates (AAs) might not be the most well-known medical associate profession but we’ve been around since 2004, albeit with the name physicians’ assistants (anaesthesia) until this year. We play a hugely important role in anaesthesia teams both in and out of theatre, which is why it may come as a surprise to some that until now AAs have been working without regulation. But this is all about to change.
The recent decision that the GMC should become our regulator has been a long-fought battle and it means the importance of this role is finally getting the formal recognition it deserves.
What do AAs do?
AAs are highly skilled practitioners, delivering a range of general and regional anaesthetics for patients undergoing surgical procedures under the supervision of consultant anaesthetists.
Communication is a huge part of an AAs work and an important part of our role is to meet patients on the day of surgery, discuss their medical history and gain consent for the anaesthetic. Each patient has their own anaesthetic plan and we draw this up with the consultant.
On a typical day, an AA could be working on an orthopaedic operating list with around four patients awaiting knee replacements and one or two smaller cases. We are always supervised by a consultant anaesthetist, but they may also be supervising the theatre next door, where another AA will be working on the same or different surgical speciality, so we need to know our stuff! Perioperative care is shared with the anaesthesia and surgical teams and AAs need to be experienced in a wide range of areas in order to provide safe care for patients.
How do they train?
All qualified AAs need to complete a 27-month physician’s assistant (anaesthesia) postgraduate diploma before joining the anaesthetic team.
Access to training is available for registered healthcare professionals, for example nurses or operating department practitioners, with a minimum of three years’ experience or biological/biomedical science graduates with a 2:1 (hons) or higher.
Trainees are all based within a hospital, gaining experience from day one. Throughout the training AAs work through different competency modules all signed off by educational supervisors and they also sit two national exams.
What difference do they make to patient care?
Demand for anaesthetic services and routine surgical procedures is increasing nationally. Anaesthetists work with over two thirds of all hospital inpatients and ultimately the addition of AAs into anaesthetic teams will support the current workforce and help to ensure patients have access to skilled professionals at every point during their care.
How do they contribute to multidisciplinary teams?
AAs have an entirely unique role within multidisciplinary teams. Our skillset aids service provision, assists with workload and supports doctors within the anaesthetic team. Having an AA in theatre teams can help reduce theatre downtime, increasing throughput and theatre efficiency.
We all know how strained relationships can slow a workplace down and with AAs being permanent staff, our working relationships within the theatre team are well established and help towards better communication and team working. Our role is essential to establishing continuity, efficiency and a rewarding work place.
With a diverse specialist knowledge AAs also have a special role in meeting flexible service demands. With needs varying so much from hospital to hospital and tending to change over time, Trusts can use our specialist skillset to meet the particular demands of any hospital.
How will AAs benefit from the new regulation?
The recent announcement confirming statutory regulation for AAs is very welcome news. Regulation has been the main goal of the Association of Anaesthesia Associates since its inception over 12 years ago and is also strongly supported by the Royal College of Anaesthetists and Association of Anaesthetists.
Ultimately regulation of AAs will support professional standards and benefit patients. Currently we don’t know the exact number of AAs working nationally; the best estimate is around 200 qualified AAs. Whilst the managed voluntary register held by the Royal College of Anaesthetists provides a useful guide, it is unlikely to be truly representative.
Public protection is essential in all areas of medical care and services need to be patient focused. Establishing a mandatory register of AAs working across the country and developing a professional framework for working practices is vital for transparency and accountability.
Setting robust standards of practice will help to ensure a safe and effective AA workforce nationally and should support further developments such as prescribing rights and a structure for career development.
Importantly, we hope this will give doctors and other healthcare professionals increased assurance about the ways we can support them and the tasks they can delegate.
We’re already proudly represented in dozens of teams but hope to benefit many more in future.
Improving medical education and practice across the UK 
‘Anaesthetist Associates’ is a very poor name for them. They are not anaesthetists. It is also likely to be confused with the existing Associate Specialists, who are very senior doctors. Their proper name ought to be Anaesthetic Assistants.
Hi Christine, the title is ‘Anaesthesia Associate’, we never refer to ourselves as anaesthetists.
There is a small risk of confusion, however, I’d suggest that Associate Specialists will refer to themselves as anaesthetists. The AA will refer to themselves as an AA.
The ‘associate’ part of the title is already used by ‘nursing associates’ which is a regulated title now, as well as ‘physician associates’. Health Education England also refer to the AAs and PAs (and ACCPs and SCPs) as ‘medical associate professions’.
The protected titles will of course be consulted upon when the draft legislation is produced by government.
Thanks, but the term ‘anaesthetist associate’ is in fact used in the article. It will be only a few steps before they introduce themselves to patients as ‘anaesthetist’ as a shorthand.
I agree with Christine MacLeod, the word ‘associate’ is simply too vague, rather like ‘practitioner’. I’ve frequently seen nurse practitioners refer to themselves as ‘practitioners’ and the patients think they are doctors.
If roles that were traditionally assigned to doctors are going to be done by other professionals it it is only fair that our patients know that they are not doctors, particularly when the evidence base to show non-inferiority in the service is lacking. A clearer job title is therefore necessary.
Surely, an Anaesthetics Assistant is a nurse or ODP?
The proper professional description needs to reflect the SoP rather than the base profession of the particular registrant.
I believe that in Holland, they use the term ‘nurse anaesthetist’. Why not expand that to the UK. So ODP anaesthetist, Paramedic Anaesthetist, Nurse Anaesthetist etc etc. Alternatively, if people are going to get all bent out of shape over titles, what about Non-Doctoral Anaesthetist. Like Ronseal, it does what it says on the tin 😉
What was wrong with PA(A) title? I just introduce myself as part of the anaesthetics team, then proudly point out (if pushed) that I’m actually a Paramedic by profession. Works every time.
…….but you’re no longer a paramedic, are you? Are you not proud to be the anaesthetist’s helper?
I’m still a Para, and regularly work front line shifts (nights last weekend 😖), and I’m fiercely proud of being Anaesthetics ‘trained’. There’s a symbiotic relationship between the two, and both professions benefit from the other. I guard both and ‘sell’ the concept of both to colleagues almost daily.
One of the issues I have, is that the ambo service doesn’t really understand what I do, so I have managers shaking their heads and saying ‘we cant’ quite a lot. Frustrating doesn’t come close.
Christine. As a cons anaesthetist, I find all your comments verging on trolling. You appear confrontational and if I didn’t know better I would say verging on the jealous. These highly trained practitioners are not assistants in any shape or form. My AAs induce, maintain and reverse with minimal supervision, sedate with no supervision, insert central and arterial lines, work on resus teams and undertake critical care transfers with no doc.
So, the article has been altered? this does not fill me with confidence. The idea has already been placed. Please make it very clear that these folk will never, ever, call themselves anaesthetists, or use that word in any part of their introductions to patients. They must always, always, make it very very clear to patients that they are not doctors. Even if not directly asked.
I might start doing that now, just to be irksome and because I like to see people go purple with rage and indignation 😉
By the way, the model suggested of 1 anaesthetist supervising 2 assistants/associates is very, very expensive. What we really need is more doctors, in all specialties.
What we need, are more clinicians. The old guard thinking that says it must be a Doctor, Nurse, Paramedic, OPD etc has passed, and the impervious boundaries between professions is fast becoming very porous indeed.
Welcome to the future.
Appalled to read these comments. I don’t know how to reply to such utter rudeness, but it’s a the typical egotistical attitude I’ve dealt with throughout my thirteen year career as an AA. I applied for a job and all I want to do is my job, help patients and improve a service not to deal with all the politics of “offending” doctors. For the record I introduce myself, explain I will be working with your anaesthetist today…. name them and go from there. I have never claimed to be an anaesthetist nor would I want that responsibility. I never wanted to be a medic otherwise I’d have gone to med school like everyone else. Anyone can do it if the want is in them, but not everyone who applies for the AA role has a desire to be recognized as a doctor and that’s a huge misconception from the medics. I’d love to get rid of this disgusting attitude. At this point I still come up against this almost daily and it has recently got to a point where I think- I don’t come to work to have to deal with other people’s career insecurities and this consequent attitude . Its borderline discrimination. People need to catch themselves on come down off their pedestal and work as a team for the greater good of the health service and ultimately the patients. That’s the sad thing about it.
That’s the NHS for you. An accumulation of 1000 empires, being guarded by a million emperors. Doesn’t matter where you go, it’s the same. Fortunately, I have a particularly enlightened supervising consultant, which insulates me from some of the nonsense, and that’s a blessing. If it wasn’t for him, I’d be cat food in matrons office.
I’ve just written a reply, that’s waiting for mod approval, but further to that, I’d like to say that I don’t wish to be confrontational, merely highlight an observed attitude within the wider NHS. An example of that is with moving trusts. I went to another trust for 13 months, so was effectively working in Anaesthetics at 2 simultaneously. One day at my usual trust followed by 3 at another. Ion know my one day, it was ‘crack on’ and the other it was ‘you can’t do things because you haven’t done our course’. Absolute nonsense born out of some weird pseudo-tribalism.
It was akin to me having and Anaesthetics nurse / ODP or even PA(A) in the back of the Ambulance and telling them they can’t use the ventilator. Madness.
The term associate is confusing to members of the public. If these “AA” individuals are assisting a medically trained professional then they should have the title “assistant” somewhere or should use this term to patients so as to make absolutely sure there is no confusion or misinterpretation. This is exactly the situation when i had my physiotherapy from the “physiotherapy assistant” under the direction of my qualified physiotherapist.
Please be clear with nomenclature so as not to confuse patients. I hope this is an oversight and not a deliberate attempt to mislead the public.
That’s slightly different though, because the public knows that a physio is not a Doctor.
The issue is that in an Anaesthetics environment, where all wear scrubs and look the same, there can be confusion. I just introduce myself as part of the anaesthetic team. If pushed (or people notice my ID) I’ll happily say that I’m a Paramedic, and work as a consultant’s assistant in Anaesthetics. I’ve never yet had someone get all freaky on my, because I’m not a Doctor.
I can’t help feeling that this ‘them and us titles thing’ is creating an issue where one doesn’t in all honesty, exist.
I think there is a bit of confusion here as to what the role actually involves. A good indication of a jobs skill and educational requirements in the NHS is to look at the pay band. To use your own example- a physiotherapy assistant is on a pay grade 2 or 3, supervised by a qualified physiotherapist on a pay band 5-7 depending on seniority. To be a physiotherapy assistant you need GCSES. In comparison, anaesthetic associates need a primary degree and a post-graduate diploma and start at a band 7, with most working at a level of 8a. Therefore the role has absolutely no comparison to the level physiotherapy assistant. This level of skill and training is reflected in the title, we do not work solely as assistants! The role we play in a patient’s perioperative care is explained to the patient when we are preassessing them and introducing ourselves prior to their surgery. In my experience, patients are more than satisfied with our explanation of our role and the level of care they received.
Great article Sarah. I don’t know why we are debating the title yet again. Surely the focus should on the fact that we are finally going to be registered and positive benefits that will bring. However I will say, anaesthetic associates are highly skilled, educated professionals who regularly work without direct supervision. An ‘assistant’ title is not reflective of the role, and references such as ‘anaesthetist’s helper’ is demeaning of the education, skills and years of training we have put in.
I 100% agree totally with clarity. You should know at all times who is treating you and who is supervising them in ALL professions. I for one make that very clear. To be fair, if you asked most members of the public, sometimes they do not know if a student physio/med student etc has been involved with their treatment or a qualified professional. It’s a simple introduction issue here not a title. Some people I know don’t even know what a consultant is or does.
Honestly if you ask any of the AA’s, I’m sure by this stage we have had so many titles they would welcome any title if it means acceptance to let them get on with the career they actually enjoy.
I’m not usually confrontational in the slightest either Rob, but I have had my fair share of the attitude towards the role over the years. If this was all about the name -pick something else if it is going to make public and doctors feel at ease.
However, I guarantee you it’s not all about the name. It’s about insecurities and grandeur, and I would just like to point out I am in no way saying this is everyone’s general attitude.
It’s just one more Issue. My point being I don’t hold any importance in what you want to call me, it’s about being treated as a person trying to do a job I was employed for.
Not as “these people” and comments like:
“Please make it very clear that these folk will never, ever, call themselves anaesthetists”
“Are you not proud to be the anaesthetist’s helper?”
-Are you actually serious? It’s offensive.
It makes me feel like a criminal for studying and trying to make a difference and improve healthcare access for patients.
I did my exams in the Royal college of anaesthetists, London. Examined by anaesthetists who deemed me competent enough to do the job I am more than capable of doing, I passed multiple OSCES just like the junior doctors. I’ve trained some of them and they are usually very appreciative of us and our knowledge in the anaesthetic setting. I don’t just exist and run about hospitals pretending to be an anaesthetist. I am a healthcare professional.
I’m not going to let this be the misconception of the role as suggested by Christine’s comments.
I have had enough of the nonsense and it should not be tolerated by any organization or by anyone and therefore I’m just commenting as ultimately I found Christines attitude intolerable. It needs to stop. Point blank.
Brilliantly put !
The whole title nonsense is often simply due to egos of the opposite party. Very silly as the NHS is no longer just doctors and nurses. There is vast roles and without one the place would fall apart very quickly. It is a team.
Agreed, but the NHS is plagued by historic tribalism which draws it position of pseudo authority my playing the patient safety card. As we used to say in my regiment, it’s utter twonk. Until these self serving barriers are removed, there’ll continue to be this passive aggressive in-fighting.