Operating theatres


Associates work under the supervision of a consultant anaesthetist with responsibilities such as reviewing patients before surgery, initiating and managing medications, giving fluids and blood and ensuring there is a plan for recovery and post-anaesthetic care.5 Both roles have been developed as a response


to a shortage of qualified doctors. They will not take the role of a doctor, but of a general team member – enabling the doctor to concentrate on complex patients, of whom there are an increasing number. They are not new roles and have been practising in the NHS since 2002 and 2004 respectively. What has not occurred is their formal regulation, which is now being addressed. In June 2023, data suggests there are 180 full time equivalent (FTE) qualified Anaesthesia Associates and 1,508 FTE Physician Associates working in NHS Trusts and other core organisations in England. In addition, there are a further 1,707 FTE Physician Associates working in general practice and primary care. The Long- Term Workforce Plan sets out to expand the numbers of each role by 2036 /2037 to 10,000 Physician Associates and 2,000 Anaesthesia Associates.6


This adds considerably to the


healthcare workforce over the next few years and is an ambitious target.


Regulation Regulation of the roles is set to be put in place by the end of 2024. The GMC has recently launched a consultation on the rules, standards and guidance by which it will regulate Physician Associates and Anaesthesia Associates. The consultation will run for eight weeks, closing on 20 May and will cover (in addition to standards and guidance, education and training) registration, fees and dealing with concerns, as well as fitness to practise principles. The consultation is on the GMC website.7 The scope of practise for each employee in


a Physician Associate or Anaesthesia Associate role should be determined locally. The GMC in its consultation states: “The scope of an Anaesthesia Associate and Physician Associate’s practise - it isn’t the role of the regulator to determine what tasks individual professionals can safely carry out once they are registered, because that depends on their individual skills and competence, which develop over time. “The GMC won’t determine scope of practise for Anaesthesia Associates and Physician Associates beyond initial qualification competencies, just as it is not determined for doctors. It is known that NHS England, employer bodies and Royal Colleges have begun looking at how Anaesthesia Associate and Physician Associate scope of practise may develop over time”.8 Regulation should help assure patients,


16 www.clinicalservicesjournal.com I May 2024


colleagues and employers that Anaesthesia Associates and Physician Associates are appropriately educated and qualified, can contribute safely and appropriately to the care of patients and can be held to account if serious concerns are raised. This is the underlying purpose of all healthcare professionals’ regulation and, in the future, for Anaesthesia Associates and Physician Associates too. As the number of Anaesthesia Associates and Physician Associates working in the healthcare system grows, there are wider questions being asked about their role and their place in the healthcare team. This author remembers that when Surgical


Care Practitioners (SCPs) were first being employed in the NHS, there were similar concerns. No-one knew exactly what their role might be, what the scope of practise would cover and there was nervousness about the different roles in specialties across the UK. There were accusations that some SCPs were not explaining their role to patients, especially those undertaking their own caseload and there was considerable professional jealousy demonstrated in the teams they joined. This is, of course, predictably well behind


us now, and SCPs have demonstrated just how beneficial to surgical patients and teams they can be. They are employed widely in orthopaedics, cardiac surgery, vascular and many other specialty surgical teams. The difference is that the SCPs came from already regulated professions – such as Nursing and Operating Department Practitioners. Anaesthesia Associates and Physician Associates, until December 2024, are only regulated on voluntary registers and may be described as direct entry to healthcare professions. This has opened the door for some


disgraceful behaviour and rhetoric aimed at healthcare professionals doing their best to support patient care. Within the new law for Anaesthesia Associate


and Physician Associate regulation there is a future plan to create a simpler regulation system for all healthcare professionals, which will ensure that all professions across the board can be more flexible and autonomous than the current system allows. As individual healthcare professionals


increasingly work together as part of wider multidisciplinary teams, the differences and disconnections between the way that each profession is regulated have become all too apparent. This lack of consistency and co- ordination has hampered regulators in their efforts to protect the public and support those who are regulated, to deliver high quality care. In addition, as Physician Associates become experienced in their clinical area, it is possible that they will be able to manage a narrow range of conditions, particularly chronic diseases such as diabetes, and will be able to support advanced practice, as do many advanced nurse practitioners currently. The BMA9


are demonstrating their rage at


the development of roles by publishing scope of practise guidance documents which generally narrow the roles of the two groups to tasks which are less than that practised by ODPs and anaesthetic nurses now, and advanced nurse practitioners. In my view, this reveals the level of their paranoia around the roles, the regulation and the potential of advancing practice.


Conclusion There is a great deal more detail which will, to some extent, be identified by the consultation, and there will be many interested parties willing


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