Who are anaesthesia associates?
This section provides information about AAs, the roles they undertake and how they work within the anaesthetic team.
Who are anaesthesia associates (AAs)?
Anaesthesia associates (AAs), formerly known as physician assistants (anaesthesia), were introduced in 2004 and the role is now established within many NHS hospitals.
AAs are not doctors. They are trained, skilled practitioners that work within the anaesthetic team under the supervision of a consultant or autonomously practising SAS doctor. AAs are part of the Medical Associate Professions (MAPs), alongside physician associates (PAs) and surgical care practitioners (SCPs).
All qualified AAs have successfully completed an anaesthesia associate training programme and are encouraged to maintain their presence on the AA Managed Voluntary Register, currently held by the RCoA.
AAs are members of the anaesthetic team, working alongside others such as consultant anaesthetists, SAS doctors and anaesthetists in training. The AA role is intended to be flexible and service orientated, to assist with the overall service requirements of a department, as additional members of the team.
What do AAs do?
AAs provide anaesthetic and perioperative patient care, usually with one consultant anaesthetist or autonomously practising anaesthetist overseeing either one or two AAs depending on patient acuity. In a 1:1 model, an AA works directly alongside a consultant anaesthetist to provide care for the patient. In a 2:1 model, one consultant anaesthetist supervises two AAs, or an anaesthetist in training and an AA, providing anaesthetic care in two adjacent operating theatres.
Depending on local needs and context, AAs play a role in preoperative assessment, provision of sedation, cardiac arrest teams, and offer a range of other perioperative and non-perioperative support. AAs may also support education for colleagues and students and are often engaged in local research projects and audits.
On qualification, the AA will be trained to core competencies in the AA curriculum, which is aligned to the GMC’s Physicians Associate and Anaesthesia Associate Generic & Shared Learning Outcomes and the professional standards in Good Medical Practice.
Please note that the draft curriculum includes elements that extend beyond the 2016 scope of practice for AAs upon qualification and therefore should not be performed in practice at the current time. Specifically, this applies to simple peripheral blocks and spinal anaesthesia. Please see our latest guidance to clinical leaders for more information about the College’s requested pause in enhanced roles for AAs.
Currently AAs practice across a broad range of specialities, including, but not limited to, day case surgery, orthopaedics and trauma, urology, general surgery, and plastic surgery. Below is the existing scope of practice for AAs on qualification, which was developed in 2016. The RCoA are currently developing a scope of practice for enhanced roles – in consultation with stakeholders – to take effect after statutory regulation of AAs is in place.
Regulation
AAs are currently unregulated. However, in 2019 the General Medical Council (GMC) was selected by the UK Government to be the regulatory body for AAs and PAs. Regulation is due to begin in December 2024 and all qualified AAs will be required to register with the GMC. Until then, all qualified AAs who have successfully completed an anaesthesia associate training programme are encouraged to maintain their presence on the AA Managed Voluntary Register held by the RCoA.
In preparation for regulation, the GMC has published a process for revalidation and the Good medical practice: interim standards for PAs and AAs and the PA and AA generic & shared learning outcomes, which newly qualified AAs must meet to be register with the GMC. The GMC, alongside partners including the RCoA, has also developed an AA registration assessment (AARA), which will be implemented after regulation begins and all qualified AAs will be required to successfully pass to register with the GMC and practice.
The RCoA welcomes regulation of this profession and sees the centralised regulation and oversight of AAs as an essential patient safety requirement. It is important that AAs have access to high quality training that meets the requirements of the curriculum and emerging GMC regulatory standards. It is also important that the distinction between AAs and doctors is clear, for example in the reference numbers allocated by the GMC, in order to give patients clarity.
Please note that all guidance on this page is subject to change and may be updated and refreshed to align with the changing nature of the Medical Associate Professions programme.
