Anaesthesia Associates (AAs) are not legally allowed to prescribe drugs. They are not doctors.

However various loopholes are being used to avoid this law because injecting drugs is obviously at the centre of anaesthetics. The most widely-used of these is the use of Patient Specific Directives (PSDs).

Hospital pharmacy departments are worried about their legal responsibilities and are pushing back. AAs themselves, as well as the consultants taking responsibility for them, are also being left with uncertainty over their legal responsibilities, according to a recent Freedom of Information request .

The Deputy Chief Pharmaceutical Officer has already been asked to make a statement on this.

We are asking him now to make his statement public, so that hospitals can know what they can do with certainty and so that other healthcare workers can see the rules that govern PSDs which, presumably, will apply to them equally.

The background

A PSD is a written instruction by a prescriber for medicine(s) to be administered to a patient after he or she has individually assessed them. It needs to specify the exact dose, frequency, total number of doses and dosage intervals; detailed and dogmatic.

However in Anaesthesia, drugs may need to be given in a great hurry which precludes them from being given in a detailed or rigid manner. For example,

  • Some patients might just need a bit more anaesthetic to keep them asleep;
  • The operation may run into complications;
  • Anaesthetic complications, such as a sudden breathing crisis, may demand immediate treatment with drugs.

PSD’s were not originally intended to bypass the restrictions on AA’s supervision and yet the NHSE PA and AA Prescribing Working Group (on which the GMC has two seats) seem to be sanctioning them as a convenient way to facilitate something which may not, in fact, be legal.

The Royal Colleges themselves have no representation on this group.

The Parliamentary question

Baroness Bennett of Manor Castle did ask about this in the House of Lords debate on December 5th.

I turn to AAs specifically, and an issue of grave concern—including legal concern—that was recently raised with me. In the current regulations, AAs and PAs are not allowed to prescribe or order ionising radiation. How can someone acting as an anaesthetist not do so? Expert advice that I have received suggests that the tool of patient-specific directive, which are meant to allow a doctor to direct another professional in making a limited choice of drugs under very specific circumstances, is being used and possibly misused. I am told that PSDs are being used to provide an extensive list of drugs for AAs to choose from; in essence, that means that they are prescribing. Can the Minister comment on that?

In her reply, Baroness Merron came out with the predictable excuse that the debate has been toxic, but did not address the question about whether or not AAs are prescribing or whether the law is being misused. Perhaps she could address that point?

Our legal case

We are crowdfunding a judicial review to establish that the GMC, the medical regulator, takes moves to ensure a safe Associate practice.