Announcement:
An edit has been made to clarify the position of Dr Richard Marks during his podcast interview. Whilst we retain our original opinion we have, in good faith directly quoted him for accuracy.
Dear Royal College of Anaesthetists,
We, United Medical Associate Professionals (UMAPs), representing Anaesthesia Associates across the United Kingdom, wish to express our deep concern regarding the proposed framework for scope of practice of Anaesthesia Associates.
The proposed limitation of the scope of practice for Anaesthesia Associates, including restricting involvement in regional anaesthesia to fascia iliaca blocks, removing the insertion of arterial lines, and mandating direct supervision for all AAs regardless of experience at induction of anaesthesia, is a significant departure from established principles of professional practice. This represents a significant rollback from the current qualifying scope of practice set in 2016. We note that this scope was not written with AA’s or patients in mind, but the appeasement of RCoA members. We are also concerned that the operational difficulties this SOP places on employers and clinical leads, leading to increased delays for patients at a time of unprecedented waiting times for routine care.
No other healthcare professional group faces such a restrictive scope limitation. We note that Dr Richard Marks of Anaesthetists United in their PA Podcast interview (16th September 2024), stated (17m 20s) “Just on a point of detail, because the lawyers will pull me up on this if I don’t say it, we shouldn’t really be using the term scope of practice to talk about a group of people. Scope of practice applies to an individual.” He goes on to state, “What we’re looking for from the GMC is what our lawyers call Safe and Legal practice – what can the group of associates do as a cohort.”. This aligns with our legal advice, that colleges should not be using the term “scope of practice” for setting the groups ceiling of practice. We would also dispute that the current suggested limitations to practice from the college actively diminishes patient safety and should be viewed in the context of a trade dispute. The continued detriment inflicted on MAPs as a result of the misinformation around Scope of Practice is causing significant harm to both their reputation and access to care for their patients.
The recommendation to set the scope of practice below the qualifying standards set by the General Medical Council (GMC) and assessed by the Anaesthesia Associate Registration Assessment (AARA) further exacerbates this issue. This creates a two-tier system for Anaesthesia Associates, which is discriminatory causing inequality across a professional group, with the same qualification and title. It also hinders professional progression and creates inequity within departments, based solely on the date of qualification.
UMAPs is gravely concerned about the potential impact of this limited scope on healthcare services and patient access to timely and high-quality care. Restricting the scope of practice of Anaesthesia Associates could lead to delays in patient care, lengthening waiting lists, and exacerbating the government’s priority of reducing patient wait times. This can be evidenced in the RCoA State of the Nation report 2022, which predicts 8.25M operations will not take place due to a lack of qualified anaesthetic staff.
We are also disappointed that the longstanding RCoA National Clinical Lead, Association of Anaesthesia Associates (AAA) and clinical leads were excluded from providing meaningful advice and examples of good practice to the core writing groups. This suggests a lack of representation and expertise within the process of developing the proposed framework, and the Clinical Reference Group had a restricted voice.
To address these concerns, we call for the immediate establishment of a national Anaesthesia Associate clinical lead and a lead Anaesthesia Associate network hosted by the AAA or CMAPs. These initiatives would ensure that the voices and experiences of Anaesthesia Associates are adequately represented in policy development and decision-making.
Finally, we are alarmed by the risk of redundancy and lack of employment opportunities for Anaesthesia Associates. We are particularly concerned about NHS funded trainees who, at present have no prospect of employment. This is a clear indication of a mismatch between the skills and expertise of our members and the demands of the healthcare system.
We welcome the pursuit of high patient safety standards and support independent research into the role of Anaesthesia Associates and their contribution to patient safety.
In conclusion, UMAPs strongly opposes the proposed scope of practice framework of Anaesthesia Associates by the RCOA. We urge the Royal College of Anaesthetists to reconsider its approach and work collaboratively with UMAPs and other relevant stakeholders to develop a framework that supports the professional development, appropriate supervision, and recognition of Anaesthesia Associates, while ensuring the delivery of high-quality patient care.
Thank you for your attention to this urgent matter.
Sincerely,
PA Stephen Nash, Acting General Secretary
AA Gemma Halewood-Muse, Acting AA Network President
AA Paul Pharoah, Acting AA Network Deputy President
United Medical Associate Professionals (UMAPs)
