We are delighted to see the RCoA statement on their responses so far to the six motions we proposed and that were passed at the EGM – and the progress that the College is making.

We recognise that progress on some of the six is inherently slow. We have every confidence that the College are working hard to enact the changes that almost 5,000 of us called for – while at the same time continuing to run their other essential activities such as exams and events.

Looking at our motions in turn, we are delighted to see:-

• An affirmation that trainees must take priority for training opportunities
• A clear escalation pathway (through training leads) is in place for reporting and taking actions on breaches of this priority, and
• A proposal to amend the Guidelines for the Provision of Anaesthetic Services (GPAS), the Anaesthesia Clinical Services Accreditation (ACSA) and other relevant documents to make it clear that local opt-outs from the College’s position on the supervision of AAs are not approved.

Where any breaches of AA supervision do occur, we consider the CQC are the other body to be notified. There is a blog post explaining this, and a link to the form for reporting any concerns about a service you work for.

We also support the notion of well-managed ‘grandfathering’ for those individuals currently performing high-quality care in situations that may, in future, become out-of-scope as a result of these changes.

The planned recommendation for the College to issue guidance on how members of staff should identify themselves to patients is very welcome. 

We remain disappointed that the GMC are permitting decisions on AA scope-of-practice to be decided by the employer as well as by the College, which we think will lead to AAs being pressured into taking on cases that they would not feel comfortable with, and we would like it clarified that this is unacceptable.

And a pause in the recruitment of AAs

Our first Motion asked the Council to pause recruitment of AAs. It feels like we’re getting there and that the message is truly getting through.

As evidence, we were leaked an email recently from a CD saying it would be  …  useful to reassure you that because of the reasonable concerns that you all raised we …. have agreed that we will pause our support to host …. individuals [AAs] whilst we await further recommendations…..

But it has been slow and frustrating. Part of the delay has been in resolving the detailed logistics of what precisely a ‘pause’ actually means. Some people considered a ‘pause in recruitment’ to mean a pause in offering posts to new AA graduates – others considered it to mean a pause in the training of new students – and the College has adopted the second approach.

Our Motion didn’t exactly define the term ‘pause’ and we appreciate that it takes time to resolve the legal and financial risks and liabilities, as well as any possible implications for the College’s Charitable Objects. The Universities will now be looking at their plans, and considering whether they should review their course prospectus. They will be thinking about the number of predicted job opportunities,  especially for courses that do not award transferable qualifications.

They will also need to ensure their advertisements do not put forward an unrealistic expectation of what applicants may end up doing in terms of scope of practice. We have already seen university promotions being hastily withdrawn as the disparity with reality becomes more obvious. 

And an aside – we’re glad to hear the College takes its Charitable Objects seriously, because we are currently looking at the Charitable status of the GMC. Their own Charitable Objects make it clear that they were granted charity status solely for carrying out activities relating to Registered Medical Practitioners. And yet they have spent £millions on activities related to AAs and PAs. We believe that this action breaches those objects.

We have written to them, but have been unsuccessful raising the issue with either the GMC itself or with the Charities Commission. Our most recent legal advice has been that although we may be able to challenge this in a Tribunal it is likely to be protracted – and even if successful the GMC would have changed their charity objects by the time the case was finally heard.

Rotations, Recruitment, ANRO

College Working parties and appropriate workstreams are taking these forwards. It will be a few months before they can show tangible results. We are grateful that the College is pushing, on behalf of its trainees, for Lead Employer status. The planning of rotations is ultimately done at a very local level, with the College simply setting the general principles for balance and flexibility.

Our 5th Motion asked the College to consider whether or not the Significant Incident Report about ANRO showed that HR records were not kept clearly and accurately, whether or not adequate auditing and benchmarking systems were in place, and whether or not staff had the necessary knowledge, skills and training to carry out their roles.

We recognise that many of the problems that our trainees have experienced with ANRO stem from it being under-resourced and under-staffed, and we are glad to see that pressure from the College is leading to these being addressed. There is no viable alternative to ANRO, under the present centralised process, so the aim remains to improve rather than replace. And to make the process more human and more personal.

But many of the errors listed in the SIR report were made at a more senior and managerial level. The issue here is one of management. The GMC has, of course, issued its own guidance on Leadership and Management for all Doctors, and the motion asked the College to consider these in particular.

Proud to be Anaesthetists

The issue of Associates was unheard-of 6 months ago – but to many of us within Anaesthetists United it is an existential crisis in medicine.  Are we too late in making a fuss? Is it a fait accomplis?  Certainly with PAs that might prove to be the case – the expansion in AAs hasn’t been as rapid yet.

We are proud that we were the first specialty to take a stand on this issue. The BMA has now come alongside us.

Other Medical Royal Colleges are in discussions with their Members/Fellows about holding EGMs. Though we wonder whether the Academy of Medical Royal Colleges has fully grasped the issue and the magnitude of what is going on. A statement from their President recently told the public that what PAs should be doing right now is taking blood, putting up drips, doing ECGs and other low-level tasks.  Is that really it? The Academy claims to … ensure doctors are central to the debate on how, where and what care is delivered. And by whom. Is it trying hard enough?

All of us at Anaesthetists United would like to put on record our immense thanks to the staff at the RCoA – the CEO, President, Council and the many staff and volunteers – for supporting our EGM and taking it forward. 

And thanks to all of our supporters and best wishes for the New Year.