S Cook - imageThe 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.