Email to training networks following publication of the NHS Long Term Workforce Plan

Published: 13/07/2023

We are listening carefully to the views expressed by members on our support for anaesthetists in training and our position on the anaesthesia associate workforce. This follows the release of our position statement on this issue, a subsequent Let's Talk event and the publication of the NHS Long Term Workforce Plan. 

We want to respond as comprehensively as possible, which takes time. We will publish a detailed response before the next Let’s Talk event on 25 July. We thank members for their feedback and their patience. 

In the meantime – for transparency – we are publishing an email sent to our training networks on 6 July 2023 (below). 

Dear all,

On behalf of the College and its Training Committee we wanted to highlight a couple of issues that have come to the fore following the recent publication of the NHS Workforce Plan for England. Whilst the RCoA have welcomed the publication of the plan to support future staffing of the wider NHS, we would like to reiterate the College’s ongoing commitment to ensuring access to high quality anaesthetic training for medically qualified physician anaesthetists in the whole of the UK.

The Workforce Plan supports an expansion of specialty training numbers which will follow on from the planned expansion of medical school places, but the timeframes are vague. This lack of clarity, alongside the published numbers of anaesthesia associate (AA) posts has caused concerns amongst trainees, trainers and the wider membership. In the light of this concern, we wanted to reinforce a number of messages that were highlighted at the recent College Tutors meeting.

1. The training and support of doctors developing a career in anaesthesia remains the primary aim of the Royal College of Anaesthetists

The College has responsibility for the setting of curricula, delivery of postgraduate examinations in anaesthesia and supporting the delivery of high-quality anaesthetic training. We hear the concerns raised by some members following the announcement of NHS England’s planned expansion of the AA programme and we can confirm that the resources of the College’s training department have not been diverted to support this pathway.

We also recognise the disruption associated with the transition to the 2021 Curriculum and can assure colleagues that the College’s training and examination departments remain focused on providing ongoing support to deliver and develop the curriculum, support training, develop the LLP and deliver the FRCA examination.

2. The RCoA continues to campaign for expansion of higher specialist training places.

The College continues to lobby NHSE, and the devolved nation equivalents, to deliver on their plan to support an increase in specialty training numbers. A significant bottleneck remains following the disruption to training caused by the pandemic and the difficulties around curriculum transition.

The lack of specific detail around post expansion in the NHS Long Term Workforce Plan means we will need to continue to apply pressure on NHSE. We have seen an additional 210 anaesthetic posts in England committed over a 3-year period, but we clearly need more to ensure that all those finishing Stage 1 training who wish to continue to ST4 and those currently outside of training who would like to re-enter, are able to do so. To do this we will need the long-term input of NHSE and the devolved nations equivalents, but in the interim we will work with Schools of Anaesthesia to:

a. better align CT1 and ST4 numbers to both reduce the current bottleneck and help streamline the programmes

b. support regions to maximise less than full time slot sharing in line with the guidance released by NHSE

c. continue to support the recognition of experienced gained outside the training programme to enable faster progression once back within it.

3. Maintaining training capacity

High quality training in individual departments requires the ongoing support of clinical and educational supervisors and College Tutors. We recognise that the capacity of these individuals to deliver training is finite. It is this capacity that has governed the number of training places awarded within Schools of Anaesthesia over the years and needs to be protected. To this end, it is vital that any decision by a department to begin training AAs includes confirmation from the College Tutor (CT) that the department has the capacity to do so whilst continuing to provide the necessary high-quality training for anaesthetists in training (AiTs).

The College Tutor should also confirm that the training of AAs will not impact on the ability of AiTs to access all aspects of the curriculum available in their department. If CTs have any concerns about their department’s ongoing capacity to train AiTs we request that they contact their Head of School and/or Regional Adviser Anaesthesia for support. This will ensure that the School of Anaesthesia is aware of any difficulties and can share details of these with the College if further support is needed. As part of this process of assurance, the College will publish guidance on the process of assessment of training capacity within a department.

4. Supervision of anaesthetists in training

Clinical and education supervision of anaesthetists in training remains the sole remit of those clinicians recognised by the GMC to fulfil this role. We are aware that in some parts of the UK experienced AAs are, supported by local governance arrangements, working beyond the current scope of practice agreed at qualification. Whilst we recognise that these experienced AAs will be supporting the delivery of anaesthetic activity and have a lot to contribute to the education of AiTs, it does not follow that they should be directly involved in the training or supervision of anaesthetists in training. Our rational for this view is focused on the following observations:

a. The current scope of practice is under review and any extended practice beyond qualification will need to be standardised and matched against a scope of practice for an extended role

b. AAs would not be expected to have an understanding of the learning outcomes of the 2021 curriculum 

c. AAs are not currently working under a regulator and as such do not have access to a regulated trainer status.

All of us at the College remain grateful for the ongoing support of the wider anaesthetic training community. We recognise that challenges remain within anaesthetic training and are cognisant of the many pressures our trainees and trainers are facing. It is against this landscape that we want to reassure you all that we remain committed to the delivery of high-quality training for doctors wishing to develop a career in anaesthesia and will do all we can to support you in the same.

Kind regards,

Dr Jon Chambers
RCoA Bernard Johnson Adviser for Training

Dr Chris Carey
Elected Council Member
Chair of the Education, Training and Exams Board

Dr Sarah Thornton
Elected Council Member
Vice-Chair of the Education, Training and Exams Board

Russell Ampofo
Director of Education, Training and Examinations