Abstract
In this month’s issue, Scott Bevan, an Anaesthesia Associate from Manchester University NHS Foundation Trust, gives us an important insight into the factors that must be considered when deciding which drugs to administer to our patients during general anaesthesia. We are all familiar with the role of anaesthetists, operating department practitioners (ODPs) and anaesthetic nurses in caring for our patients during surgery, but for many healthcare professionals and patients there is little knowledge about the role of the Anaesthesia Associate (AA). However, this role is not new in the NHS. The role of Physicians Assistant (Anaesthesia), or PA(A), was introduced in the United Kingdom in 2004, and the University of Birmingham developed the first training programme for the role. The aim of introducing PA(A)s was to provide more resilience and flexibility in anaesthetic departments, which traditionally relied on consultant and trainee anaesthetists for service delivery, and many hospitals took the opportunity to successfully integrate PA(A)s into their anaesthetic departments.
In 2019, PA(A)s were re-named as Anaesthesia Associates (AAs). In response to the NHS long term workforce plan, it was recognised that there was a need to train more Medical Associate Professionals (MAPs), and training courses were developed at University College London (UCL) and Lancaster University Medical School. This expansion in training coincided with the introduction of legislation to enable MAPs to be regulated by the General Medical Council (GMC). This regulation took effect in December 2024, and all practicing AAs must be registered with the GMC by December 2026. The training courses recruit registered healthcare professionals with at least 3 years clinical experience (often from ODP, nursing, or paramedic backgrounds) and biomedical science graduates with at least a 2.1 honours degree. Students are trained according to a curriculum developed by the Royal College of Anaesthetists (RCoA) and GMC. During the training programme they learn about the basic sciences that underpin anaesthesia (e.g. anatomy, physiology, pharmacology and basic chemistry and physics), while simultaneously developing clinical skills in assessing patients, performing medical procedures (e.g. airway management and intravenous access), and managing emergencies. Students build a portfolio of workplace-based assessments, alongside a logbook of cases and feedback from supervisors, colleagues, and patients. Depending on which course they take, they may also complete a dissertation project. On completion of training, they must pass the Anaesthesia Associate Registration Assessment (AARA) to be registered with the GMC and work as a qualified AA.
Qualified AAs work under the supervision of a consultant anaesthetist to care for patients during the perioperative period. They may work directly with an anaesthetist in a 1:1 model, or they may work in a 2:1 model where one consultant supervises 2 AAs or one AA and one resident doctor. AAs are trained in preoperative assessment, induction and maintenance of general anaesthesia, sedation, basic regional anaesthesia, and spinal anaesthesia, and as such can work in a wide variety of surgical specialties. An interim national scope of practice for AAs was published by the RCoA in 2024.
Despite the increase in training, numbers of AAs remain relatively low; in April 2024 there were approximately only 200 AAs in the United Kingdom. This reflects a small proportion of the anaesthetic workforce, since at the same point there were approximately 11,000 consultant anaesthetists and 5,000 resident doctors training in anaesthesia. However, despite this, the role has created a significant level of controversy among the medical profession. This culminated in an independent review of Physician Associate and Anaesthesia Associate roles, which was conducted by Professor Gillian Leng and reported in July 2025. The review found no concerns regarding patient safety and recommended a change in the name of the role to ‘Physician Assistants in Anaesthesia’. It also made important recommendations regarding credentialling, career development and workforce planning.
Scott’s article demonstrates that AAs make an important contribution towards anaesthesia and perioperative medicine, beyond direct patient care. AAs contribute to academic and quality improvement work, national audit projects, training, and management. I hope you enjoy reading his case report, and that it helps you to have a better understanding of what happens at the ‘head end’ during surgery.
