We are calling on the College to change its policies on Anaesthesia Associates, Rotational Training and Recruitment.
In order to comply with College regulations, the motions we are submitting have to formatted and laid out in a certain way. So apologies for the dry and pedantic wording.
Introduction
We believe that in recent years the College has lost direction in achieving its charitable objectives. The following proposals, both as a whole and piecemeal, readjust the College strategy to fit more in line with the objectives for which it was established.
Anaesthesia Associates
We recognise the dedication and personal contributions made by individual Anaesthesia Associates (AAs) across the NHS.
Proposed expansion of AAs
We note with concern the proposed 10-fold expansion of the AA workforce, as outlined in the NHS Long Term Workforce Plan published in June. We believe this expansion is misplaced and that further expansion of AAs would not be in the best interests of trainees or patients.
We further note the College’s recent workforce report, stating that “…unless urgent action is taken, the UK will be 11,000 anaesthetists short by 2040”. In overtly supporting the proposed expansion of AAs, in a financially constrained NHS, the College is actively hindering the urgent action required.
Consultant anaesthetists have key roles in all areas of perioperative practice, and have undergone a more rigorous, broad and prolonged training. An expansion of AAs would implicitly lead overall to a less-skilled workforce, something that is completely at odds with the College’s charitable aims. In contrast, the protection and benefit of the public, a cornerstone of its objectives, are best met by a replete and well-trained workforce.
Resolution 1
The Council is advised to ask the Clinical Directors network to pause recruitment of AAs until the proposed RCoA Survey and Consultation is complete and the impact on doctors in training has been assessed and reviewed.
The Council is advised to ask the College Tutors (CTs) and Regional Advisors (RAs) to ensure that doctors-in-training are given priority over AAs in their exposure to training opportunities. If CT/RAs find that is not the case then they should feed this information back to the Training Department, in order that the training capacity of that hospital be reviewed.
Supervision of AAs
We note and reaffirm the current stated College position that AAs should always be supervised by a named and readily-available Consultant Anaesthetist, and consider that this requirement is inviolable. We believe that individual hospitals should not unilaterally waive this requirement. We also believe that if it is necessary for AAs to work outside their initial scope of practice (as currently defined in Appendix E: AAGBI and RCoA Executive Summary: Scope of Practice for a PA(A) on qualification), then they should be directly supervised by a Consultant, physically present in theatre throughout (Level 1), and that this requirement should be inviolable.
We believe that this is essential to maintain the highest possible standards of professional competence in the practice of anaesthesia.
Resolution 2
The Council is advised to amend the Guidelines for Provision of Anaesthetic Services (GPAS) the Anaesthesia Clinical Services Accreditation (ACSA) and other relevant College documents to make it clear that local opt-outs from the College’s position on the supervision of AAs are not approved by the College.
Information for Patients
We believe that patients should be informed preoperatively when an AA could be involved in their care, be made aware that an AA is not a registered medical practitioner, and be told who their responsible Consultant Anaesthetist will be. This is a key plank of the College’s charitable aim of educating the public in all matters relating to anaesthesia. NICE guidelines, as we were recently reminded in Parliament, make it clear that the onus is on the individual professionals to properly explain their role to patients, especially if there is a likelihood of this not being automatically understood.
Resolution 3
The Council is advised to ratify as a professional standard the need to inform patients, when applicable, that an AA could be involved in their care, that an AA is not a registered medical practitioner, and who their responsible Consultant Anaesthetist is.
Rotational Training
We acknowledge that the impact and effects of short-term rotational training for doctors in training posts has changed over the last 20 years.
Such placements may create a sense of isolation and transience, affecting morale and workplace cohesion. Unfamiliarity with local processes and protocols is a hindrance to doctors in maintaining the highest possible standards of professional competence, which is one of the College’s charitable objectives. Furthermore, unfamiliarity with the educational needs of individual doctors on short-term placements has, anecdotally, resulted in preferential allocation of valuable educational opportunities to permanent staff.
Short-term placements may have significant and detrimental consequences on the family life of doctors, especially those with caring responsibilities and health issues.
We consider that more could be done to ensure that the importance of stability and the educational and personal benefits offered by longer placements are taken into account when considering the need for breadth of experience.
Resolution 4
The Council, together with the Education, Training and Examinations Board, is advised to fully consider the personal impact of rotational training, to work with the relevant stakeholders to reduce the need for any short-term placements of under 1 year except in situations where experience cannot be gained without rotating (e.g. cardiothoracic anaesthesia), and to present a report on their progress at the College Tutors Meeting in June 2024.
National Recruitment for Doctors-in-training
We note with great concern the findings of the multiple systematic failures, as described in the Significant Incident Report (SIR) of December 2021, and the considerable delay and reluctance in releasing this report. Ensuring that the best candidates are appointed into training posts, and that HR processes are as good as possible, are prerequisites for ensuring the highest possible professional competence. The College also has a public duty, in the light of the privileged and confidential information that it holds, to ensure that any breaches of the GMC’s Good Medical Practice and Leadership and Management for all Doctors are acted upon.
Resolution 5
The Council is advised to:
- Make necessary enquiries in order to acquaint itself with the reasons for the delay in publishing the SIR report, and discuss its findings.
- Consider whether there is any evidence, on the basis of the report, 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.
- Consider whether or not it still has confidence in the leadership and senior management of the Anaesthetic National Recruitment Office (ANRO).
Regional recruitment
We believe a strong case can be made for recruitment at a regional or local, rather than national level, using the present metrics for assessment. Benefits may include local consultant buy-in and better information and choice for applicants
Resolution 6
The Council is advised to set up a group, together with any other stakeholders it sees fit, which may include the Academy of Medical Royal Colleges, to investigate whether a centralised national recruitment centre is in the best interests of our specialty, to explore the legal and practical possibilities of recruitment at a regional level, and to present a report on their findings in due course.