Update on implementation of the 2023 EGM resolutions

Following last year’s Extraordinary General Meeting, we committed to implementing the resolutions carried and keeping members updated on our progress.

We would like to update you on the most recent decisions and outputs from this ongoing work, following our last update in May 2024 and Council and Board of Trustee meetings in July. These are detailed in full below and include:  

• Cochrane Response has published A systematic review of the role of non-physician providers of anaesthesia, commissioned by the College.
• We are developing an updated position on the anaesthesia associate (AA) role.
• The College will not proceed with plans to develop a Faculty of AAs at this time. Council will remain responsible for providing leadership and guidance on the education, training and professional development of AAs, advised by an AA Committee.
• Our work to develop a scope of practice for AAs continues and we will share a draft for consultation with members in due course.
• We have published Principles to guide healthcare professionals on how to introduce themselves.
• Our rotational training working group has published its report, Minimising the impact of rotational training within the anaesthetic training programme.

Assessing the evidence of the impact of the anaesthesia associate role

In February 2024, the College requested a pause in the recruitment of new student AAs while we undertook an assessment of the impact of the AA role.

The pause remains in place, and we would like to remind members that it applies to recruitment of new, student AAs who have not yet been appointed. It doesn’t apply to student AAs who are enrolled on courses or already training, or to qualified AAs. We remain fully supportive of AAs who are currently training or working in the NHS and who are providing a valuable contribution to patient care. Hospitals can still recruit to vacant posts for qualified AAs, continue to train existing student AAs and recruit student AAs into substantive posts once they qualify. 

Our assessment of the evidence has included consideration of the findings from our member survey and an independent literature review commissioned by the College and conducted by Cochrane Response. We have also continued to listen to patient perspectives, member views and the advice of external stakeholders. Our primary goal has been to prioritise patient services and safety, aligned to our charitable duty to act for the public benefit.

The findings from our member survey, published in April 2024, reinforce the case for a pause in recruitment of new student AAs. Members reported significant concerns about the AA role and NHS England’s proposals for an expansion in AA numbers. These concerns relate primarily to aspects of patient safety and quality of care and to the impact of the AA role on training opportunities for anaesthetists in training.

The independent literature review conducted by Cochrane Response reviewed the evidence on different aspects of non-physician providers of anaesthesia internationally. The review highlighted the limited evidence base, particularly in the UK context. As such, we do not consider the existing literature sufficient to help us answer questions about the AA role in relation to patient safety and outcomes, cost effectiveness or impact on other members of the workforce. Cochrane Response’s report has yet to be peer-reviewed but is available as a preprint on the Open Science Framework website.

Taking all of this into account, we are now developing an updated position on the AA role.  

Leadership and guidance on the AA role

Another outcome of our evidence assessment and consultation to date is that Council and the Board of Trustees have decided not to proceed with plans to develop a Faculty of AAs at this time. To do so would not be consistent with the pause we have requested in recruitment of student AAs or the views of our membership as expressed through the EGM process and member survey.

We believe it is in the best interests of patients and the specialty for the College to continue to provide leadership and guidance on the education, training and professional development of AAs, including responsibility for the curriculum, access to our Lifelong Learning Platform and matters relating to appraisal and revalidation. For the last few years, this work has been led by an AA Founding Board comprising Council members and representatives from other relevant organisations, although all decisions relating to AAs have been subject to agreement by Council.

Since we have decided not to establish a Faculty of AAs at this time, the AA Founding Board will become an AA committee that provides information to AAs and other stakeholders and advice to Council. This will ensure that Council continues to benefit from valuable stakeholder input and that AAs have representation within the College. 

We emphasise that we want AAs to retain affiliate membership of the College. They are working hard to care for patients in a profession they have entered in good faith and we need to recognise the impact the current situation is having on them. All members of our teams must feel supported and valued.

We are continuing our work to develop a scope of practice for AAs, to take effect in 2025 once regulation begins. We will share a draft of the scope of practice for consultation with members in due course.

Principles to guide healthcare professionals on how to introduce themselves

Alongside the work mentioned above we have been considering how we can help avoid any unintended confusion for patients about the experience, qualifications and roles of the healthcare professionals involved in their care. As a result, we have published new Principles to guide healthcare professionals on how to introduce themselves.

These principles have been developed by our Ethics Committee in consultation with our patient representative group, PatientsVoices@RCoA, approved by Council and supported by the Association of Anaesthesia Associates. The principles have been informed by a resolution passed at the EGM relating to information for patients. They build on our longstanding guidance that patients must be appropriately informed of who will be managing and overseeing their care, which is also a principle of the GMC’s Good Medical Practice.

Minimising the negative impacts of rotational training

Our work to reduce the negative impacts of frequent rotations on anaesthetists in training is being led by a working group with representation from Council (including anaesthetists in training), Training Programme Directors, the Association of Anaesthetists Trainee Committee, the Faculty of Intensive Care Medicine and the proposer of the EGM resolution on rotational training. The working group has produced a report of its work, Minimising the impact of rotational training within the anaesthetic training programme.

Anaesthetists in training and trainers have raised concerns over the impact frequent rotations are having on the educational effectiveness of placements as well as on the wellbeing and quality of life of anaesthetists in training. The working group responded to these concerns by reviewing the background to, and impact of, rotational training in the context of the 2021 anaesthetics curriculum. Drawing on these insights, the working group has made recommendations for minimising the frequency and negative impact of rotations.

The report explains the recommendations in full, but in summary:

• Schools of Anaesthesia should review both the number of rotations required to complete each stage of training and the provision and delivery of educational supervision. They should also take steps to give anaesthetists in training as much advance notice of rotations as possible and, where possible, greater choice in their rotations.
• The RCoA should continue to explore appropriate flexibility within the curriculum and to review the support and training available to College Tutors and Educational Supervisors in the delivery and requirements of the 2021 curriculum. The College should also continue to engage with NHS England’s Enhancing Doctors Working Lives Workstream.
• NHS England, HEIW, NES and NIMDTA should implement the recommendations from ‘improving the working lives of doctors in training’ as a matter of priority. They should also ensure appropriate administrative support is provided to their Heads of School and Training Programme Directors.
• Departments of Anaesthesia, Clinical Directors and College Tutors should ensure they are implementing best practice in the delivery of induction and rota management. Departments should also undertake a review of the availability of rest facilities, post-shift accommodation, access to study leave, access to parking, accuracy of payroll and access to hot and cold food 24/7.

Work to implement the recommendations for the RCoA is already underway. In relation to flexibility, we have proposed to the GMC that flexibility be introduced to enable some aspects of the Stage 3 curriculum to be brought forward into ST5 if that enables an anaesthetist in training to remain in a post longer, on the understanding that the remaining aspects of the Stage 2 curriculum are completed before the end of ST6. We have submitted this guidance to the GMC for approval and will publish it in due course.

Throughout this process we have benefited from discussion with our training networks, particularly at the College Tutors meeting in June. Their feedback has shaped our final report and we will continue to work closely with them to ensure the report’s recommendations are implemented. We also thank the College’s Anaesthetist in Training Representative Group who provided feedback on their experiences of rotational training, some of which we have used in the report as examples of best practice.

Recruitment

We are continuing to offer support to the ANRO team and closely monitor the recruitment processes and performance as they recruit much-needed additional staff. We are also continuing our exploratory work with relevant stakeholders regarding national versus regional recruitment and determining the best approach for anaesthetics.

As ever, I am grateful to everyone who has contributed their time and expertise to our work to implement the EGM resolutions as we have sought to listen and respond to our membership. I also thank the many members whose continued involvement in other areas of work enables us to deliver on our core objectives across training, education, assessment and research in the best interests of our membership, the specialty and patients.

Dr Fiona Donald
President and Chair of the Board of Trustees