Physicians' Assistant (Anaesthesia)

Who are Physicians’ Assistant (Anaesthesia)?
Physicians’ Assistant (Anaesthesia) (PA(A)s) were introduced in 2004 and are now established within many NHS hospitals.  PA(A)s are highly trained and skilled practitioners that work within an anaesthetic team under the direction and supervision of a Consultant Anaesthetist.  PA(A)s are fully trained professionals that have completed a Physicians’ Assistant (Anaesthesia) Postgraduate Diploma.  Please see the patient information leaflet below.  Please also note the PA(A) FAQs and RCoA and AAGBI Position Statements.

What do PA(A)s do?
The postgraduate diploma prepares and trains PA(A)s in all aspects of general anaesthesia delivery.  Some organisations have trained PA(A)s to perform regional and local anaesthesia procedures. 

Typically PA(A)s work in a 2:1 model where there is one Consultant Anaesthetists supervising two PA(A)s or a trainee anaesthetist and a PA(A) simultaneously in two operating theatres (see the PA(A) curriculum framework below).  PA(A)s are also used to reduced theatre downtime leading to increased throughput on lists and theatre utilisation, preoperative assessment, exercise testing, provision of sedation to other specialties, cardiac arrest teams, and for regional and local anaesthetic provision.

Examples of what PA(A)s do:
We cover a wide variety of specialties but there are two areas that are different from the 2:1 general anaesthesia lists we do; these being regional anaesthesia and sedation lists.  Approximately 4000 axillary 'blocks' are carried out at Birmingham Hand Centre each year, with around 75% of these being undertaken by a PA(A).  The presence of the PA(A)s in the block area has been a huge success with a greater throughput of patients and a better quality service provision overall.  As well as increasing the amount of patients operated on in the hand centre, the theatre 'downtime' has been markedly reduced and teaching of junior doctors facilitated without list delays. PA(A)s also carry out sedation for extensive burns dressings.  This is done on the burns unit, with consultant supervision from the nearby burns theatre.  This service is a welcome change from inferior analgesia for painful dressing changes and also reduces the need for patients to go to theatre perhaps three to four times a week. The benefits to the patient are huge, they remain in their heated rooms and are able to resume important rehabilitation much sooner after the procedure than they would having gone to theatre.  Therapists are also able to treat the patient whilst they are sedated; this ensures patients do not miss out on vital physio which they may do when in theatre.  A final word, the procedures carried out are underpinned by competency documents, written by the PA(A)s, approved by clinical governance and signed off by supervising consultant anaesthetists.

Toni Jenkins, Physicians’ Assistant (Anaesthesia), University Hospitals Birmingham NHS Foundation Trust


Heart of England NHS Foundation Trust PA(A)s are used in a variety of specialities, where the majority of the work they do being 2 to 1 supervision but other work includes the delivery of Sub-Tenons block for cataract surgery, on lists where there are a high number of patients with a high turnover or complex cases to enable improved theatre utilisation and present lectures to patient in our enhanced recovery pathway.

Howard Cox, Physicians’ Assistant (Anaesthesia), Heart of England NHS Foundation Trust


In our hospital PA(A)s do 2:1 working and sub-Tenon blocks, and we also run a clinic providing intra-venous regional anaesthesia for manipulation of wrist fractures for the last five years, significantly reducing waiting times for patients and releasing the on-call anaesthetist.

David Wilkinson, Physicians’ Assistant (Anaesthesia), The Royal Devon and Exeter Hospital NHS Foundation Trust


PA(A)s at SRFT are used in high turn over lists, with patients often having staggered admission later in the day, particularly on three sessions days. They help reduce turnaround time and prevent down time for pre operative assessment of patients. This leads to increased theatre efficiency and productivity.

Irfan Mehmood, Physicians’ Assistant (Anaesthesia), Salford Royal NHS foundation trust


Training and Careers
PA(A)s are qualified healthcare practitioners who are currently voluntarily registered with the Association of Physicians’ Assistant (Anaesthesia) and are invited to be Affiliate Members of the Royal College of Anaesthetists. A career as a PA(A) can begin via two routes.  The main groups of people eligible to commence training as a PA(A) are:

  • Registered healthcare professionals (examples are nurses or operating department practitioners) with at least three years clinical experience and/or degree level studies,
  • Graduates with a biomedical science or biological science 2:1 honours degree or better.

Introduction of the role and PA(A) training requires the support of individual NHS trusts or boards. 

A career as a PA(A) can begin via two routes.  The main groups of people eligible to commence training as a PA(A) are:

  • Registered healthcare professionals (examples are Nurses or Operating Department Practitioners) with at least three years clinical experience and/or degree level studies,
  • Graduates with a biomedical science or biological science 2:1 honours degree or better.

Introduction of the role and PA(A) training requires the support of individual NHS trusts or boards. 

The PA(A) postgraduate diploma is a 27 month full time course combining academic study and clinical training.  The course comprises 12 modules which introduce trainee PA(A)s to the clinical practice of anaesthesia, applied physics, the anaesthetic machine and monitoring principles.  In later modules trainees study anatomy and physiology related to anaesthesia and surgery.  The final assessments are based on the management of life-threatening emergencies and advanced practice.  Nationally recognised examinations take place at eight and 24 months.  The standards of training are high and demanding on the individual.

Training and Education
This programme is intended for existing health care practitioners or graduates with a science background who wish to work as part of the anaesthetic team.  The programme will develop a practitioner role that enables the anaesthesia team to have more staff working differently.

University of Birmingham
PA(A)s are fully trained practitioners that have completed a Physicians’ Assistant (Anaesthesia) Postgraduate Diploma.  The postgraduate diploma is studied over 24 months with an additional 3 months probationary period to be served in clinical practice.  The course comprises 12 modules which introduce trainee PA(A)s to the clinical practice of anaesthesia, applied physics, the anaesthetic machine and monitoring principles.  In later modules trainees study anatomy and physiology related to anaesthesia and surgery.  The final assessments are based on the management of life-threatening emergencies and advanced practice.  Nationally recognised examinations take place at eight and 24 months.  Weekly teaching and tutorials are delivered from a Consultant Anaesthetist and through the university e-learning interface.  A typical week may consist of 1/2-hour tutorial, two to four days in the clinical practice and the rest involving clinical skills training and self-directed study.  The standards of training are high and demanding on trainee PA(A)s.  The Royal College of Anaesthetists has duties to set the standards of the training programme and hold the 24 months Objective Structured Clinical Examination at the College.  The standards of training are high and demanding on the individual.

Assessment and Examination
Successful graduation requires passing assessments at eight and 24 months that consists of MCQ exams, Clinical skills Workbook completion, Record of In Training Experience Diary, Tutor Assessments and at 24 months the Objective Structured Clinical Examination (OSCE) that takes place at the Royal College of Anaesthetists.  Only after this are practitioners awarded the new status of Physicians’ Assistant (Anaesthesia), and are invited to become an Affiliate of the Royal College of Anaesthetists.  PA(A)s are encouraged to join a voluntary register held by the Association of Physicians’ Assistant (Anaesthesia).

 

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