SAS and ACSA
Author: Dr Jon Chambers, Chair, ACSA Committee
As the Anaesthetic Clinical Services Accreditation (ACSA) programme reaches its 12th anniversary in 2025, we’re working to ensure that it continues to support engaged departments in delivering high-quality, safe, and effective anaesthetic care to patients.
The evidence base for ACSA remains (the now AI searchable) Guidelines for Provision of Anaesthetic Services (GPAS) – a resource that covers all aspects of the organisation, planning and delivery of anaesthetic care.
ACSA standards undergo a three-yearly cycle of review as part of a process to ensure that they remain relevant and reflective of the current requirements of all anaesthetic departments. The 2025 review has first led to the integration of Domain 5 standards (specialist standards) into Domains 1–4 to guarantee that all aspects of anaesthetic care delivered by a department are included in the review. It has also led to the introduction of new standards where evidence has been presented or where a gap has been identified. When new standards are introduced, it’s essential they are supported by the evidence contained within chapters of GPAS.
Details of the changes to the ACSA standards for 2025 can be found on our website.
ACSA, the SAS anaesthetist and the Good Department
The latest GPAS chapter to be written and published, entitled ‘The Good Department’, covers all aspects of the leadership and management of the anaesthetic workforce, including the support required to help a department function well. It is from within this chapter, along with the work done by our SAS committee and the SAS Collective, that an additional two ACSA standards have been developed. Like all new standards, they will be introduced as Priority 2 for the first year (not required for accreditation), then will become Priority 1 (required for accreditation) in late 2026.
New standards
The first of these new standards (4.3.3.8) relates specifically to the employment of anaesthetists who are either not on a consultant contract or who don’t have a national training number (on the Doctors in Training (Junior Doctor) contract 2016).
The department has processes in place to regularly review Specialist, Specialty, Locally Employed Doctor and Fellow posts, to ensure that they best support the individual and contribute to career progression.
Evidence required: verbal confirmation of processes from the clinical director and relevant staff groups.
For this group, commonly known as SAS anaesthetists, there are nationally recognised contracts which provide support and guidance on hours, supervision and career development. This new standard encourages clinical leaders to ensure that all anaesthetists working in their department have an appropriate contract. This requirement will best support them in continuing to develop themselves as anaesthetists and progress their careers in a direction that supports their own goals and ambitions.
The second new standard (4.3.3.9) focuses on the opportunities available to the SAS and locally employed doctors within a department.
All anaesthetists within the department (including Specialists, Specialty, Locally Employed Doctors and Fellows) should be provided with the support to enable career development. This should include, but isn’t limited to, educational supervision, pastoral care and access to study leave.
Evidence required: Evidence of opportunities for education supervision, opportunities for leadership and educational roles, and mentorship programmes (if available) should be provided. Specific groups should be interviewed about their practices and training.
We often recognise educational supervision as a staple of training for anaesthetists who have a national training number. However, this support isn’t often available to those who are aiming to progress through a different path. Both are equally deserving of the support. In addition, many experienced SAS colleagues are well-suited to taking on roles in leadership and education. The availability of these opportunities will form part of the review process.
Other changes for 2025
Standard 1.2.1.9 – Policies are in place for the management of perioperative allergy, including referrals to allergy clinics where appropriate.
Domain 1
- Standard 1.2.1.7 – Where appropriate, anaesthetists contribute to multidisciplinary team discussions within relevant patient pathways.
- Standard 1.2.1.8 – Guidelines are in place for the prevention and management of postoperative cognitive dysfunction and postoperative delirium.
Domain 2
- Standard 2.1.1.18 – Specialised monitoring and equipment appropriate to the surgery undertaken is available, with staff who are trained and competent to use it. This is adequately maintained.
Domain 4
- Standard 4.3.3.6 – Anaesthetic provision for elective subspecialist surgery is delivered by a group of consultant or autonomously practising anaesthetists who maintain current competency in that subspecialty area.
- Standard 4.3.3.7 – Those consultants or autonomously practising anaesthetists who provide emergency cover to subspecialty clinical areas, but who do not undertake regular anaesthetic practice in that subspecialty, have time to attend appropriate CPD and attend subspecialty surgery lists in a supernumerary capacity.
The ACSA standards are designed to be accessible and deliverable in all departments of anaesthesia throughout the UK. We anticipate that the changes made in 2025 will enable departments to continue to best support their staff in the delivery of high-quality care for patients.
ACSA standards