The College is fully committed to supporting current student and qualified physician assistants in anaesthesia (PAAs; legally known as anaesthesia assistants) who provide a valuable contribution to the anaesthetic team and to patient care. 

In February 2024 we requested that clinical leaders pause recruitment of new student PAAs while we undertake further research on the impact of the PAA role. We also requested a pause in development of extended roles for PAAs until regulation is in place and a scope of practice beyond qualification has been developed. 

These requests were made in response to concerns about patient safety expressed by members through an Extraordinary General Meeting held in October 2023.  

Pause in recruitment of new student PAAs

The pause applies to the recruitment of new, student PAAs who have not yet been appointed. It does not apply to student PAAs who, at the time of the request to clinical leaders, were enrolled on courses or already training, or to qualified PAAs. Hospitals can still recruit to vacant posts for qualified PAAs, continue to train existing student PAAs and recruit student PAAs into substantive posts once they qualify. 

We expect the pause in recruitment of new student PAAs to remain in place at least until the Leng review has been completed and the RCoA has had the opportunity to review the report and recommendations. GMC regulation took effect from 13 December 2024 and provides statutory safeguards for patients by applying rules around training, registration, governance and fitness to practise for all PAAs in the UK.  

Pause in development of enhanced roles for PAAs

All departments who train and employ PAAs in the UK should implement the PAA Scope of Practice 2025 which sets out clearly defined phases of practice from qualification onwards, including the levels of supervision required.  

We recognise that some trusts and health boards have developed extended roles for PAAs and local governance as a means of providing services to patients in response to the increasing demand for anaesthetic services. We also recognise that any change or limit put on extended roles in the 2025 scope of practice could have impact on the delivery of services in some areas and on the availability of those services to patients who need them. To manage and minimise this impact, we have allowed for a graduated transition to the 2025 Scope of Practice. 

Clinical leads should also ensure that continuing such roles does not impact on the ability of anaesthetists to access the training opportunities required to develop the anaesthetic workforce of the future. This will be kept under review by the Regional Adviser (Anaesthesia) network in association with the local Heads of School. 

Training existing student PAAs

Current student PAAs can be trained to meet all the competencies and learning outcomes in the draft AA curriculum noting that there may be changes and updates once it has been submitted for, and received, GMC approval. 

Of note, infrainguinal fascia iliaca block is the only simple peripheral block that PAAs will be permitted to perform under the 2025 scope of practice (excluding transition arrangements mentioned above) so trainers may wish to limit practice to this block. 

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.