AU response to AAA letter

We have had sight of a letter from the Association of Anaesthesia Associates (AAA) commenting on the motions being presented at the EGM on the 17th.

We are posting below extracts from the letter, together with our comments.

Motion 1 – on a pause in recruitment of AAs

We fully recognise AA expansion has to be carefully balanced, training capacity and quality must be reviewed before and following the introduction of any role in any department.
We believe decisions around AA recruitment should remain the remit of clinical leaders who are required to address service needs at a local level and are best placed to assess local training capacity;
We oppose this resolution.

Our comments

The AAA believe that local service leads should determine service needs. Our response to that is:

  • Until Scope of Practice is better defined it is simply not possible to determine service needs. We believe NHSEngland should make the manpower/workflow calculations that were the basis of their Long Term Workforce Plans available for scrutiny.
  • The quality of the evidence provided to support AA expansion remains poor. The oft-cited qualitative evidence is a 18 subject interview study. This should not form the only evidence base for fundamental change to the way anaesthesia is practiced.
  • We remain concerned about the impact of AA expansion on doctors-in-training and await with interest the results of the RCoA Survey.
  • We believe there is a significant flow of money from central government to develop AAs and other Associates. We consider that money would be better spent on training doctors. We also question the government’s cynical decision to bypass the strict regulation that exists for doctors and other established professions by encouraging growth of an as-yet unregulated workforce.
  • We believe SAS doctors should be further developed to deal with workforce requirements.

Motion 2 – on supervision of AAs

Since inception of the role in 2003/4 the number of AAs practising nationally has grown slowly. Overtime a number of departments have developed patient centred services and pathways which rely on AAs to deliver them, with appropriate supervision. Our association has continued to reinforce the importance of local training and governance to deliver these services when they include
extended practice. It is important to recognise extended practice for AAs has often been led by a service requirement, where a service need has been identified which can safely be delivered by an AA following appropriate training and departmental support.

Any amendments to GPAS or ACSA preventing departments from utilising local governance underpinning AA activity would be detrimental to current services. We feel this would have a huge negative impact on patient services, it would result in poor utilisation of a skilled workforce, impose strict limitations on AA practice and further stress anaesthesia departments.
We oppose this resolution.

Our comments

The AAA are calling for local governance to be the de facto guide for supervision, rather than national-accepted guidance. Our response to that is:-

  • We are surprised that the AAA oppose this motion when the College itself does not. We know of no other RCoA guidance which allows local Trusts to simply ignore College policies. 
  • We are hugely disappointed that local governance is deemed an acceptable alternative to the high standards enshrined in GPAS and ACSA.
  •  We are disappointed with the suggestion that enforcement of enhanced practice is not being considered until after regulation is introduced next year. We consider that the standards, governance and restrictions on any enhanced practices currently being delivered should be looked at by the College and the CQC immediately. 
  • We also believe that for newly-recruited AAs there should be no extension of scope of practice

Motion 3 – on informed consent

We agree with the principles set out in Good Medical Practice that all healthcare workers should be open and honest about their experience, qualifications and role when talking to patients. The 2024 revision of this document specifically states that it also applies to the medical associate professions.
We would always expect an AA to introduce themselves by name, state their job title, supervisor and explain their role within the anaesthesia team. Furthermore, if patients ask for more information about AAs this should be provided, and if the patient wishes to also speak with the supervising anaesthetist then this must be arranged.

We support this resolution.

Our comments

We are pleased that the AAA support this Motion.

We believe there are significant flaws with the wording on the current Consent Form used for surgery that seeks to deliberately evade giving this information to patients and we call on NHS England to to address this at their earliest convenience.