The majority of MPs are probably unaware of the issue of AAs – possibly confusing them with another usage of the initials AA – although they may have seen us on the front page of the TImes. We are hoping to raise awareness with them of why this issue matters so much. Each of us can contact our personal MP, based on where we live and/or work, and some MPs will be sympathetic to our views.

Its easy to do, and there are several websites such as theyworkforyou that make it even easier.

We would particularly ask you to do this if your constituency is Worsley and Eccles South (Barbara Keeley) or Colchester (Will Quinn). The two of them had a full and frank discussion in Parliament about Physician’s Assistants, and the tragic case of Emily Chesterton, which you can read here.

We encourage you to share your own thoughts and experiences  when you write, but feel free to use this template as a starting point for your correspondence.

Dear [Insert MP name here],

I write to you both as a constituent and doctor working in the NHS, with my concerns regarding the implications of the recently published Long Term NHS Workforce Plan (June 2023) – specifically the proposals to substantially increase the Anaesthesia Associate (AA) numbers tenfold to 2000 by the year 2036/37.

We are all acutely aware of the issues our NHS faces, and I welcome the recognition of these issues that this Plan offers. However I believe the solutions proposed by the Government are both short-sighted and dangerous for patients.

Anaesthesia Associates are non-medically trained practitioners, who deliver anaesthesia following a two-year course. In comparison, medical practitioners who administer anaesthesia typically do so following a four-to-six year medical degree and two years of Foundation Training, after which they enter anaesthetic specialty training. Doctors will provide anaesthesia throughout this seven year training pathway, ending as consultants. Anaesthetists are involved in almost all areas of the hospital, and are responsible for the care of critically unwell patients, provision of pain relief for pregnant individuals, and the safe perioperative care of patients undergoing all kinds of surgery. Two-thirds of patients will require the services of an anaesthetist during their admission.

At present, the Anaesthesia Associate workforce is very small – there are approximately 180 in England. However, the strict conditions in which their work was intended to be carried out are already being bypassed.

I am specifically concerned about the following implications of this expansion, which I would like to relay to you:

  • The erosion of the high standards that are required when providing anaesthesia. Patient safety is paramount, and the practice of anaesthesia requires a comprehensive understanding of physiology, pharmacology, and equipment, built on up to eight years of prior medical training. A two-year course cannot adequately prepare someone to cope with the aging and ailing population in England, as outlined in the 7th National Audit Project by Royal College of Anaesthetists.

  • Obfuscation of the role of the AA towards patients. As I am sure you are aware, impersonation of a doctor is illegal under the Medical Act (1983). I have been concerned to hear of instances where AA’s hide their role, or mislead patients as to their role. Given recent events including the tragic death of Emily Chesterton from Salford, who believed she was being treated by a doctor, I am concerned this behaviour may become more widespread.
  • Competition with existing Anaesthetists-in-Training, who require the highest possible exposure to training opportunities their workplaces can offer in order to adequately prepare them for out-of-hours work with distant consultant supervision, and later independent practice as consultants themselves. The way in which money has been diverted into training AAs, when we already have a shortage of anaesthetists, seems illogical.
  • Expansion of AAs in favour of Anaesthetists-in-Training and Locally Employed Doctor posts. Each year, hundreds of doctors fail to obtain specialty training posts due to artificially imposed limits by NHS England. These doctors are able to work to a higher level than AA’s, with broader skillsets, yet they are overlooked. I cannot understand the desire to expand AA numbers when a ready-made workforce exists. The Royal College of Anaesthetists predicts a shortage of 11,000 consultants by 2040. This gap has not been addressed by the Plan.

Ultimately, the expansion of associate roles in the NHS, including AAs, seems a deliberate attempt to cut corners and deliver ‘medicine on the cheap’ with less qualified practitioners. I believe no role can replace that of a doctor, and if we are to return the NHS to its former glory as number one healthcare system in the world, we must invest properly in medically trained doctors to deliver expert care. This is especially true in Anaesthesia, where the control of one’s airway, breathing, circulation, and pain is handed over in full to another person.

An Extraordinary General Meeting of the Royal College of Anaesthetists has been called to discuss these issues, amongst others. This meeting will take place on the 17th October 2023 and I will be following this closely. I implore you to do the same and to raise awareness of this issue with your colleagues; political support is likely to have a significant positive impact on our campaign to challenge these dangerous changes.

As my MP, I would like to see you advocate for the delivery of anaesthesia to remain the domain of physicians. I strongly oppose the plans to increase AA numbers for the reasons I have outlined. I would like to see

  • The question of AAs raised as a Parliamentary Question
  • The Health and Social Care Select Committee asked to examine the clinical effectiveness of lesser trained, lesser skilled alternatives to doctors
  • The National Audit office asked to look at the costs to the NHS and the subsidies that have been given to the GMC, RCoA, Trusts and asTraining Bursaries

We cannot compromise on patient care or the training of future consultants by expanding the numbers of a non-medical workforce at the expense of hundreds of fully qualified and highly skilled doctors.

Should you wish to discuss further, please do not hesitate to contact me.

Yours Sincerely,

[Insert name here]