Initial response to the Independent Review of Physician and Anaesthesia Associate Professions

The report of the Independent Review of Physician and Anaesthesia Associate Professions has been published. The review was commissioned by the Secretary of State for Health and Social Care and led by Professor Gillian Leng CBE. 

I want to assure members and the public that College Council will carefully consider both the review’s findings and the government’s response. We will publish a full response once Council has discussed the recommendations at its meeting on 10 September and any decisions have been approved by our Board of Trustees. 

We recognise the importance of this report. Our decision to respond after a full discussion at Council is to ensure proper scrutiny and robust governance.

Scope of practice and clarity for patients  

We welcome the recommendation that anaesthesia associates (AAs) ‘should continue working within the boundaries set in the interim scope of practice published by the Royal College of Anaesthetists’. 

This is a clear endorsement of our Interim AA Scope of Practice as a safe and appropriate framework for the contribution of AAs to high-quality anaesthetic care in the NHS. We expect all departments that employ AAs in the UK to continue implementing the interim AA scope of practice, which is endorsed by the Association of Anaesthetists.  

We also support the recommendation to rename the role as ‘physician assistants in anaesthesia’ to provide greater clarity for patients and the public. 

Other recommendations – including those relating to credentialling, career development, ongoing monitoring of safety and professional standards (establishing a faculty) – will be considered in full by Council before we respond.  

Recognition of anaesthetic training challenges

We are encouraged that the Review recognises a key issue we have consistently raised: there is no shortage of doctors wishing to train in anaesthesia, but the number of funded training places is insufficient. This is a critical constraint on patients’ access to timely surgical care, and we hope to see it addressed in the government’s forthcoming 10 Year Workforce Plan. 

It is also positive that the review recognises the need for the College to play a central role in defining the structure of the anaesthetic workforce. Anaesthetists must be directly involved in workforce planning if care models are to be safe, sustainable and professionally supported.  

Pause in the recruitment of new student AAs

We ask that the pause in recruitment of new student AAs remains in place until Council has responded fully. This pause, which we requested in February 2024, was in response to concerns raised by members. 

Our engagement with the review 

The College engaged fully and transparently with the review at every opportunity, with input from Council. Our priority throughout was to ensure informed, evidence-based consideration of the AA role – recognising its distinction from the PA role – and to ensure our members’ voices were heard. 

Our evidence submission was directly informed by member input, including findings from our survey, the Interim AA Scope of Practice consultation, and work arising from resolutions carried at our Extraordinary General Meeting in 2023. We also submitted commissioned evidence, notably a systematic review by Cochrane Response on the role of non-physician providers of anaesthesia.  

I represented the College at stakeholder meetings Chaired by Professor Leng as well as at a meeting convened by the Academy of Medical Royal Colleges. Council members also requested and attended a dedicated discussion with Professor Leng focused on the AA role. 

In addition, we encouraged all our members to submit evidence to the review and to participate in an engagement webinar dedicated to the AA role, arranged at our request, to ensure the issues raised were those that mattered most to our membership.  

This review, and the steps we take next, are important to us all. Please be assured that the College’s response will be carefully considered and focused on what matters most: patient safety, support for the anaesthetic workforce and professional standards. 

Dr Claire Shannon
President and Chair of the Board of Trustees