Update on implementation of resolutions carried at the EGM 2023

Following discussion at November’s Council meeting, we have further developed our proposals for implementation of the resolutions carried at the EGM held on 17 October. These were discussed again at our Council and Board of Trustees meetings in December.

We would like to update you on our progress and the decisions made so far. Our intention remains to act upon all the resolutions, in recognition of the concerns expressed by members.

In doing so, we must ensure our actions align with the College’s charitable duty to act for the public benefit. We are also required to carefully consider the risk of legal liability that may result from any actions taken in response to the resolutions, and to seek appropriate advice. Therefore, our progress in relation to resolutions 1 and 2 may be slower than some members would like. I want to reassure you that taking this work forward is a priority for us.

Resolution 1: Proposed pause in the expansion of anaesthesia associate numbers

The College remains fully supportive of current student and qualified anaesthesia associates (AAs) who provide a valuable contribution to the anaesthetic team and to patient care. It is important to recognise the impact the ongoing debate has had on them, both personally and professionally.

If formally approved by trustees following receipt of forthcoming legal advice, we will write to our clinical leaders network to request that:

• They pause all further recruitment of new, student AAs while the College undertakes further research regarding the impact of the AA role. This will consist of analysis of the results of our member survey, an independent academic literature review, evidence gathering and consultation, as well as discussions at the AGM in December 2024.
• The duration of the pause is expected to be at least until regulation of AAs has been implemented.

• The requested pause will not apply to student AAs already in training or to qualified AAs. We will advise hospitals that they 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.

• In making this request we will stress that patient needs and safety should remain the priority. We will also request that clinical leaders continue to show support for the AAs in their hospital and to facilitate good professional relationships between all members of the team.

In January, we will write to our College Tutors and Regional Advisors Anaesthesia to reiterate our request that the training of anaesthetists in training is prioritised over the training of AAs.

• The training and support of doctors developing a career in anaesthesia remains the primary aim of the College. The letter will reaffirm our advice that training for anaesthetists in training should be prioritised over training for AAs.
• The letter will also provide a formal process for departments or individuals to follow if they perceive training capacity to be insufficient or to report any negative impact on their own training.

Resolution 2: Supervision of anaesthesia associates

We recognise that trusts have employed AAs and developed enhanced roles and local governance as a means of providing services to patients in response to the increasing demand for anaesthetic services. In considering this resolution we have conducted a rapid assessment of the potential impact on patient care, including surveying clinical leaders, which has informed our proposals for implementation.  

In addition, we are continuing our work to develop a comprehensive scope of practice for enhanced roles, to take effect when statutory regulation of AAs is in place.

Subject to forthcoming legal advice we will:

• Amend the Guidelines for the Provision of Anaesthetic Services (GPAS), the Anaesthesia Clinical Services Accreditation (ACSA) and other relevant College documents to make it clear that local opt-outs from the College’s position on the supervision of AAs are not approved by the College and that no further enhanced roles should be developed until regulation is in place and a scope of practice beyond qualification has been written.

• We would be in breach of our duty as a charity if preventing AAs currently undertaking enhanced roles from doing so caused detriment to patient care. For enhanced AA roles where this applies, we will provide definitive standards and rules, for example to maintain 2:1 supervision and rapid availability of the supervisor when undertaking general anaesthesia or sedation.

Resolution 3: Information for patients

While this resolution aligns with current College policy and guidance, we are taking additional action to avoid any unintended confusion for patients. We will develop supplementary guidance on how all members of the anaesthetic team should introduce themselves and the titles they should and should not use. This guidance will be informed by principles proposed by our ethics committee.  

Resolution 4: Rotational training

We understand the profound impact that postgraduate rotational training can have on anaesthetists in training. Incorrect pay, difficulty in forming effective working relationships with colleagues, frequent relocations and very short rotations with little educational benefit are impacting the wellbeing and financial stability of anaesthetists in training.

This resolution aligns with work already underway by the College and our trainers, including the efforts of our training networks to collaborate and create rotations that benefit anaesthetists in training and support their learning.  

Following the EGM we established an internal working group, which to date has sought input from Regional Advisors, the Anaesthetist in Training Representative Group, and the Clinical Leaders in Anaesthesia Network. Over the next six months we will:  

• Expand the working group to include representation from a wider group of stakeholders.
• Publish guidance to provide suggestions as to how schools/regions can minimise the frequency of rotations.
• Collate feedback, challenges and good practice from across the UK.
• Continue to press for Lead Employer status in all regions.
• Consider and consult on proposals to enhance flexibility between Stages 2 and 3 of training before presenting them to the GMC for approval.
• Consult with the Improving Doctors Working Lives Group.
• Provide an update to the Conference of Postgraduate Medical Deans in relation to the negative impact of short-term rotational training.
• Present a report on our progress to the College Tutors Meeting in June 2024.

Resolution 5: National recruitment for doctors-in-training

We continue to be deeply concerned about the systemic failures in the recruitment processes overseen by ANRO and ultimately by the Medical and Dental Recruitment and Selection Committee (MDRS). These processes have significant impact on doctors’ careers and personal lives and repeated errors are simply not acceptable.

Despite pushing forcibly and persistently for publication of the findings of the Significant Incident Report we were unable to persuade NHSE to publish. We do not consider the reasons given for this to be satisfactory, but we view the change of stance evident in the timelier publication of the report into the subsequent incident as an improvement. Both reports have been discussed at two Council meetings and we are seeking an urgent response from MDRS on a number of issues, including the timescales for recruitment of new staff to the ANRO team.

Council members are not currently confident in the ability of ANRO to deliver recruitment services to the specialty without the agreed recruitment of additional staff. On balance, however, and taking into account the significant risks associated with seeking alternative recruitment solutions, we are of the view that the best way to address the current, repeated issues is to continue to work with ANRO in the short term to try and improve services, and to keep performance under review.

Resolution 6: Regional recruitment

The College is committed to supporting fair and equitable recruitment processes that provide a level playing field for our members. 

Following the EGM we established a working group, which we will now expand to include representation from a wider group of stakeholders. Over the next six months we will:

• Consider the evidence base and the advantages and disadvantages of regional recruitment, including requesting input from MDRS on whether centralised national recruitment is in the best interest of our specialty.
• Consult further with stakeholders, including the Academy of Medical Royal Colleges.

As this work progresses, we want to reiterate that all our members are dedicated people who work hard to care for patients in the NHS. We appreciate there are different views and as a College we welcome challenge and understand we will face criticism. However, some of the language and behaviours that have emerged on social media are unacceptable. The impact on individuals’ wellbeing has been significant and harmful. While I realise this debate is wider reaching than our membership, I ask that we all play our part by behaving in a professional manner and facilitating good working relationships between all members of our teams.

Member engagement continues to be an essential and valuable part of this process and I thank everyone who has contributed so far. We will keep you updated on our progress.

Dr Fiona Donald
President and Chair of the Board of Trustees