“Anaesthesia associates” with only two years of training are allowed to “bend the rules” by carrying out complex procedures normally reserved for doctors, the Telegraph can reveal.
The doctors’ assistants helping to clear the NHS backlog made the claims at a recorded recruitment event hosted by Lancaster University, a clip of which has been obtained by the Telegraph.
In the clip, which has since been removed from the university’s website, two assistants who are employed full-time by two separate NHS trusts spoke openly about administering general anaesthetic while “unsupervised”.
On Sunday a group of doctors calling themselves Anaesthetists United, who are campaigning to curb the rise in “anaesthesia associates” (AAs), raised the alarm, sharing clips of the recruitment video on social media.
One member, Dr Richard Marks, a consultant anaesthetist, told the Telegraph: “The trouble is, expanding the number of associates seems to have been sold to the public as a way to get people with less training to do minor tasks so the doctors can concentrate on the difficult stuff.
“But this Lancaster footage has blown that argument out the water.”
The university is one of three appointed to train AAs and is at the heart of ministers’ ambitious plan to increase the number of assistants tenfold to 2,000 by 2036-37.
Since Covid lockdown began, the number of people waiting for treatment and surgery on the NHS has spiralled to more than seven million.
With not enough doctors available to carry out the work, ministers are ramping up numbers of non-medically trained assistants, with “physician’s associates” (PAs) being the largest cohort.
Among medical specialties, opposition to the expansion of the role is growing, reaching a tipping point in anaesthesia.
Unlike doctors and nurses, associates remain unregulated. Anesthetists United claims that ministers have opted for a “short-term fix” at the expense of patient safety.
It pointed out that the recording shows associates working far beyond the scope of practice that the Royal College of Anesthetists (RCoA) agreed in 2016.
One of the AAs featured in the clip, who is also trained as a nurse, said that the role “is limited in its scope at present and different trusts will use you in different ways and will ‘bend the rules’ in different ways.”
The two assistants’ autonomous work appears to be a clear breach of the RCoA stipulation that they can only assist in theatre while “under the supervision of a consultant anaesthetist at all times”.
The associate and nurse said of being responsible for her own “list” or schedule of patients requiring procedures: “I do my own unsupervised lists for vascular access and I’ve also done my own lists, inducing, maintaining and reversing anaesthesia.”
The other AA said that he was “currently doing a ‘solo’ regional vascular access list”.
This work appears to breach other conditions in the scoping document – while one consultant can work across two operating theatres simultaneously, they must “directly supervise” the start and end of the procedure.
The document also says that associates are “not qualified to undertake: regional anaesthesia/regional blocks”, a technique in which part of the body is numbed using a nerve block.
But the second associate claims to have taught other unqualified AAs how to administer these blocks.
“I deliver a lot of regional anaesthesia, teaching a regional course, and involved in teaching, or at least in the past, taught PAs and ODPs [operating department practitioners] and student AAs,” he said.
The associates also claim that there is an official distinction between what newly qualified anaesthesia associates are able to do and what “experienced” ones can do post-qualification.
But this is not a position supported by the RCoA, which said that it does “not support” AAs acting in roles beyond the 2016 “scope of practice” while the profession remains unregulated.
Where these “enhanced roles” exist, Dr Fiona Donald, the president of RCoA, told the Telegraph that it was the responsibility of hospitals to “have robust local governance arrangements in place to ensure patient safety”.
In the footage the associate and nurse working mainly in Blackpool claims to carry out “one-lung ventilation” , a highly skilled procedure, and to discuss “do not resuscitate” orders with patients.
Dr Donald stressed that “[a]naesthesia is a doctor-led specialty and some of the comments made in the video appear to describe the sort of complex decision making and patient-critical procedures that should remain the remit of doctors with the appropriate training, skills and experience.”
Doctors will vote on the issue of anaesthesia associates at an extraordinary general meeting of the RCoA meeting next month.
A spokesman for NHS England North West said that the anaesthesia associates “featured in this video acted in line with Royal College of Anaesthetists guidance”.
It is understood that the regional team acknowledges that this statement is directly contradicted by the college’s.
Lancaster University asked that it be made clear the anaesthesia associates who gave presentations had not studied at the institution.
They said that the footage was taken down out of a “duty of care” and said they “stand by the quality of our teaching, value the contribution AAs make and look forward to the outcome of the EGM on Oct 17”.