The College is fully committed to supporting current student and qualified AAs who provide a valuable contribution to the anaesthetic team and to patient care.

In February 2024 we requested that clinical leaders pause recruitment of new student AAs while we undertake further research on the impact of the AA role. We also requested a pause in development of enhanced roles for AAs until regulation is in place and a scope of practice beyond qualification has been developed.

These requests were made in response to concerns about patient safety expressed by members through an Extraordinary General Meeting held in October 2023. 

Pause in recruitment of new student AAs

The pause applies to the recruitment of new, student AAs who have not yet been appointed. It does not apply to student AAs who, at the time of the request to clinical leaders, were enrolled on courses or already training, or to qualified AAs. Hospitals can still recruit to vacant posts for qualified AAs, continue to train existing student AAs and recruit student AAs into substantive posts once they qualify.

The duration of the pause will be at least until the start of regulation for AAs, which is expected to be December 2024. Regulation will provide statutory safeguards for patients by applying rules around training, registration, governance and fitness to practise for all AAs in the UK. 

Pause in development of enhanced roles for AAs

We define enhanced roles as those that extend beyond the scope of practice for an AA on qualification, as set out in the 2016 guidance: Planning the introduction and training for anaesthesia associates. 

We recognise that some trusts and health boards have developed enhanced roles for AAs and local governance as a means of providing services to patients in response to the increasing demand for anaesthetic services. However, the College has not supported enhanced roles for AAs while they remain an unregulated workforce.

We have therefore requested a pause in development of enhanced roles for AAs until regulation is in place and a scope of practice beyond qualification has been written. The College is currently developing a comprehensive scope of practice for enhanced roles – in consultation with stakeholders – to take effect when statutory regulation of AAs is in place.

In making this request, we are mindful that we would be in breach of our duty as a charity if preventing AAs currently undertaking enhanced roles from doing so caused detriment to patient care. For existing roles where this applies, AAs can continue in their role provided that supervision does not exceed 2:1 and the supervising consultant is available within two minutes when undertaking general, neuraxial or regional anaesthesia or giving sedation. For such exemptions, we strongly recommend that clinical leaders review relevant local governance processes and arrangements, including professional liability, and ensure they are supported by the hospital’s Executive Board.

The College’s position on enhanced roles and supervision is reflected in recent updates to the Guidelines for the Provision of Anaesthetic Services (GPAS). The GPAS references in the relevant ACSA standard have also been updated.

Training existing student AAs

Current student AAs can continue to be trained to meet all the competencies and learning outcomes in the draft AA curriculum so that they can meet the standards required to qualify and register with the GMC. This includes receiving training in elements of regional anaesthesia, specifically simple peripheral blocks and spinal anaesthesia. This training should continue to be provided under 1:1 consultant supervision.

However, once qualified, AAs should not deliver regional anaesthetic services, or any other extended roles (please note the exceptions to this for some AAs already in post as outlined in our letter to clinical leaders). Their practice should remain within the 2016 scope of practice until the College has defined a scope of practice beyond qualification and regulation has been implemented.

We recognise that training AAs to perform procedures they cannot undertake once qualified is difficult for departments and for AAs themselves. We are currently developing a scope of practice for enhanced roles – in consultation with stakeholders – to take effect after statutory regulation of AAs is in place.

Please note that all guidance on this page is subject to change and may be updated and refreshed to align with the changing nature of the Medical Associate Professions programme.