After having all six of our motions adopted by members at the EGM on Tuesday 17th October 2023, Anaesthetists United are taking a break. We have completed the task that we set out to achieve – to call an EGM and submit motions to provoke debate and to change the direction of the Royal College of Anaesthetists. Now it is time for us to return to our usual roles and resume our own lives, much of which have been put on hold.

We urge other Medical Royal Colleges to follow the lead set by the RCoA and to issue statements in support of our six motions, either through the EGM route or by a direct initiative of their Councils. Unregulated Physician Associates, with a poorly-defined scope of practice, are of great importance right across medicine. Their scale and extent of their expansion is something that the profession has sleepwalked into.

Associates are not, as the President of the Academy of Medical Royal Colleges claimed recently, just doing simple things like putting up drips. The range of tasks being done by AAs rivals that of some senior consultants – the hastily-deleted video from Lancaster University confirmed as much. The workforce arguments in favour of Associates simply do not stack up, and the deliberate delays in setting a regulatory framework or a clear scope of practice, point to more cynical motives for their expansion. Associates are unregulated, unbounded and more malleable than doctors.

Anaesthetists United came together, inspired by a Reddit post, in order to address the concerns surrounding Anaesthesia Associates (AAs), and especially their impact on trainees, the wider workforce and our patients. We knew that the Royal Colleges were one of the few bodies within the medical establishment that had any power to address these issues head-on.

Since stepping onto the field, Anaesthetists United has changed the narrative. The public has woken up, and professional bodies are reviewing their entire positions. We had taken our eyes off the ball; now it has been kicked back into play. The issue of AAs has become mainstream with people talking openly. The magnitude and level of support that was shown at the EGM is unprecedented.

The EGM

For those that missed it, or want to watch it again, a recording and voting record is available here.

Our motions

	Votes For	Votes Against	Abstentions
Motion 1 – pause expansion of AAs	4,301	538	103
Motion 2 – supervision of AAs	4,527	340	105
Motion 3 – information for patients	4,211	163	115
Motion 4 – rotational training	4,146	343	326
Motion 5 – no confidence in ANRO	4,283	86	376
Motion 6 – look at regional recruitment	3,856	481	517

We called for a pause in recruitment of AAs. When, if ever, will it be safe for that recruitment to resume? Certainly not until the scope of practice is formally agreed and enforced, the workforce calculations are redone in the light of that new scope, and arrangements are made to ensure that those currently working outside that scope are professionally and sensitively overseen.

We have called for enforcement of levels of supervision. There had been rumours that the rules on this were being widely ignored. But we were still not expecting to see the level of deliberate deception revealed in the ‘Sheffield Pirates’ letter. It is not right that a Trust can choose to simply ignore and side-step Scope of Practice. And where have the CQC – the supposed guardians of patient care – been while this is going on? Which stone have they been hiding under and why have they had so little to contribute?

Our motion on informed consent is part of a much bigger picture. GMC guidance on consent requires that patients should be told the names and roles of key people involved in their care. Misrepresentation and lack of clarity on roles has been at the heart of too many recent cases. Some progress has been made by the Royal College of Physicians with their guidance on introductions, and we hope that the RCoA will build on this foundation.

We have raised the issue of rotational training. AAs do not, of course, need to rotate in the same way as doctors since their training is inevitably narrower. Their permanence gives them a significant edge over ever-rotating trainees because they have time to bond with the team and become enmeshed into the department.

Short-term posts can sometimes be disruptive and of minimal value to trainees. Their imposition stems from a badly-designed recruitment model, which itself is based on massive units of application.

Finally, we have also seen the start of conversations to address and improve the impersonal way in which our junior doctors are recruited.

Our thanks

We are very grateful to the RCoA and especially the President and Chief Executive. We appreciate that conducting this EGM has been a great deal of work for them, and that it has disrupted some of their other important activities, We thank them for being helpful, constructive and communicative at all times. One of the hallmarks of the current Council’s tenure, and especially under Dr Donald’s presidency, has been their willingness to listen to, and act on, the views of College members; the EGM is a testament to their achievements in increasing that engagement.

And time for a break

Since our journey began, a tremendous amount of work has been done behind the scenes, all in our spare time. Having achieved our goals, it is time for Anaesthetists United to go into hibernation.

We will keep our group email (address at the foot of the page) and our Twitter DMs open for a while, and will share amongst ourselves any communications that we receive. You can also contact each of us directly on Twitter.

Richard Marks @LondonAnaesth

Ramey Assaf @ramey999

Danny Wong @dannyjnwong

Jan Hansel @VirtueOfNothing