The experience of working with anaesthesia associates in the United Kingdom and the impact on medical anaesthetic training

Abstract

Anaesthesia Associates have been established in the UK for over 10 years, but without statutory regulation. Renewed interest surfaced based on a widening gap between patient need and workforce supply in the UK and established advanced practice non‐doctor roles within healthcare systems elsewhere. However, there are no robust data on their impact on patient or hospital outcomes, or training opportunities for medical anaesthetists, and perceptions of the profession within the anaesthetic community are mixed. This paper describes an investigation into the demographics and scope of practice of Anaesthesia Associates in the UK in 2017, and the experience of working together as an anaesthetic team. Through qualitative interviews, we explored the role and relationships, the impact on medical anaesthetic training and ideas about future development. The overall experience of working with Anaesthesia Associates was positive. Successful integration requires understanding of the educational needs and competencies of all. Future development relies on strong leadership and robust patient outcome and efficiency measures. Interviewees strongly supported statutory regulation, which was agreed by the government in 2019 but not yet implemented. Anaesthesia Associates were seen as a benefit to anaesthetic departments and as such may provide part of the solution to the prevailing workforce issues in UK Anaesthesia, further critically challenged by the SARS‐CoV‐2 pandemic.

Factors influencing the development, recruitment, integration, retention and career development of advanced practice providers in hospital health care teams: a scoping review

“…Organisational policy and arrangement also influenced all stages of APP role management. These included developing and updating governance, policies and protocols such as job descriptions [ 50 , 75 , 85 , 86 ], employee management such as recruitment and onboarding processes [ 31 , 86 – 89 ], line management structure, workspace, rota and pay arrangements [ 85 , 90 – 93 ], opportunities for APP to engage in different specialty clinics and other opportunities [ 42 , 94 , 95 ] but also to ensure clinical training resources and opportunities are not taken away from medical doctors [ 89 , 96 , 97 ]. These often require a significant amount of resources and time investment to fully develop [ 98 – 100 ] and support [ 42 , 49 , 93 – 95 , 101 ] APP roles and communicate transparently with the existing staff.…”

Experiences and perceptions of working with Anaesthesia Associates: a survey of UK anaesthetists in training

“…A 2015 trainee survey conducted by the Group of Anaesthetists in Training of the Association of Anaesthetists found that 82% of the 399 trainee respondents were concerned by the perceived negative impact of AAs on postgraduate specialty training [23]. A separate qualitative study which interviewed 7 anaesthetists in training in one health board found largely positive feedback [9]. A number of other peer reviewed articles make reference to the impact on anaesthetists in training from AAs.…”

“…The introduction of AAs was initially met with concerns regarding safety as well as the impact on anaesthetists in training [9,10]. This impact has not been thoroughly studied since their introduction [11].…”

“…The planned increase in the number of AAs [12], which includes fully funded training places, is an opportunity to shape the work of this professional cohort to add diversity and flexibility to the workforce, without duplicating the anaesthetist's role. The lack of evidence regarding the impact of AAs on the training experiences of anaesthetists leaves uncertainty as to how this may affect the physician anaesthetists of the future [9]. We aim to increase this evidence base by asking UK anaesthetists in training about their experiences of working with AAs, and the effect of upscaling this professional cohort.…”

Why anaesthetists are calling for an extraordinary meeting on anaesthesia associates

“…Do anaesthesia associates put patients at risk? The UK only has a small number of associates at present, and economic analyses and studies of patient safety outcomes are lacking 4. Rather than carrying out these assessments and basing the NHS’s workforce plan on evidence, it seems that NHS England is taking a gamble on safety.…”