Letter to Clinical Leaders in Anaesthesia Network regarding the recruitment of PAAs

We have written to our Clinical Leaders in Anaesthesia Network (CLAN) today with an update regarding the training of Physician Assistants in Anaesthesia (legally known as Anaesthesia Associates).  

We have published the letter because we want to remain open with members about our work in response to the Extraordinary General Meeting (EGM) in October 2023, and, more recently, following the publication of the Leng Review.  

As requested by members at the EGM, in February 2024 we asked Clinical Leaders to pause recruitment of new student PAAs and the development of enhanced roles until:

• Further research regarding the impact of the PAA role had been completed  
• A scope of practice beyond qualification was developed
• Regulation of the PAA role is in place.  

After careful review at its November and December meetings, Council now considers these conditions to be met. This means Clinical Leaders should resume autonomy for decisions relating to the recruitment of PAAs within their departments. 

Safeguards in place

Our primary goal is to prioritise patient safety. Our letter to CLAN explains how we reached this decision and the safeguards we have put in place. We will continue to monitor the situation closely.

In summary:

• Both our own assessment and the Leng Review concluded it was difficult to draw generalisable conclusions about the PAA role from the existing evidence. However, Council considers the Scope of Practice to provide sufficient safeguards for PAAs to contribute to high quality anaesthetic care. We expect all departments employing PAAs to implement it.  
• The College continues to provide leadership and guidance on the education, training and professional development of PAAs. We remain fully supportive of PAAs currently training or working in the NHS. They are providing a valuable contribution to patient care and we welcome them as affiliate members of the College.  
• However, we do not support, or see any justification for, rapid expansion of the PAA role. Any future requirement for PAA training posts should be determined locally, based on a Clinical Leader’s intention to employ PAAs after training and in line with the Scope of Practice. Clinical Leaders should only initiate PAA training if they have the intention, capacity and appropriate skill mix to employ them once they qualify.  
• As part of our workforce-planning responsibilities, we have surveyed Clinical Leaders to understand current demand for the PAA role and the potential impact of resuming training. Responses indicate that demand is low (fewer than 20).  
• Our letter to CLAN sets out requirements that must be met before any PAA training is undertaken, including a review of local training capacity to ensure that the training of anaesthetists will not be impacted, and the need for the support of the consultant community in the department.  
• Our key workforce priority remains sustained expansion in the ability to train more anaesthetists. This is essential to address workforce shortages, reduce patient waiting times and ensure sufficient educator and leadership capacity in the specialty. We will continue to advocate for this at every opportunity. 

More broadly, we are working with the Department of Health and Social Care (DHSC) and the Leng Review team on the Review’s recommendations, which require further detail and discussion with stakeholders, including NHSE, the GMC and the Association of Anaesthesia Associates, as well as with our members.  

We are grateful to our members and other stakeholders for their ongoing engagement in this work. We will continue to be open and responsive to your views and keep you updated.