Who are physician assistants in anaesthesia (PAAs)?

Physician assistants in anaesthesia (PAAs, legally known as anaesthesia associates), formerly known as physician assistants (anaesthesia), were introduced in 2004 and the role is now established within many NHS hospitals. 

PAAs 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. PAAs are part of the Medical Associate Professions (MAPs), alongside physician assistants (PAs; formerly called physican associates) and surgical care practitioners (SCPs). 

All qualified PAAs have successfully completed a physician assistant in anaesthesia training programme. Regulation of PAAs by the General Medical Council (GMC) came into effect on 13 December 2024, and all practising PAAs will need to be registered with them by December 2026.  

PAAs are members of the  anaesthetic team, working alongside others such as consultant anaesthetists, SAS doctors and anaesthetists in training. The PAA 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 PAAs do?

PAAs provide anaesthetic and perioperative patient care, usually with one consultant anaesthetist or autonomously practising anaesthetist overseeing either one or two PAAs depending on patient acuity. In a 1:1 model, a PAA works directly alongside a consultant anaesthetist to provide care for the patient. In a 2:1 model, one consultant anaesthetist supervises two PAAs, or an anaesthetist in training and a PAA, providing anaesthetic care in two adjacent operating theatres. 

Depending on local needs and context, PAAs play a role in preoperative assessment, provision of sedation, cardiac arrest teams, and offer a range of other perioperative and non-perioperative support. PAAs may also support education for colleagues and students and are often engaged in local research projects and audits.  

On qualification, the PAA will be trained to core competencies in the  AA curriculum, which is aligned to the GMC’s Physicians Associate and Anaesthesia Associate Generic and Shared Learning Outcomes and the professional standards in Good Medical Practice. 

Currently PAAs practice across a broad range of specialities, including, but not limited to, day case surgery, orthopaedics and trauma, urology, general surgery, and plastic surgery. The PAA Scope of Practice 2025 was developed in consultation with members and other stakeholders in 2024. It applies to PAAs beyond qualification and includes considerations for extended roles. This scope of practice replaces the Interim AA Scope of Practice 2024, and the 2016 version. 

Regulation   

As of 13 December 2024, PAAs are regulated by the GMC. Practising PAAs will have until December 2026 to register with the GMC, after which it will become an offence for PAAs to practice without registration.

The GMC has published a process for revalidation, Good Medical Practice  and the Physicians Associate and Anaesthesia Associate Generic and Shared Learning Outcomes , which newly qualified PAAs must meet to register with the GMC. The GMC, alongside partners including the RCoA, has also developed an  AA registration assessment (AARA), which all newly qualified PAAs will be required to pass to register with the GMC and practice.   

The RCoA welcomes regulation of the PAA profession. We see the centralised regulation and oversight of PAAs as an essential patient safety requirement. It is important that PAAs 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 PAAs and doctors is clear, for example in the reference numbers allocated by the GMC (unlike GMC reference numbers for doctors, PAA reference numbers will have an A-prefix), in order to give patients clarity.   

We also recommend PAAs read our Principles to guide healthcare professionals on how to introduce themselves, which was developed in consultation with our patient representative group, PatientsVoices@RCoA.  

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.