Association response to the Leng Review
The Association actively positioned itself as a stakeholder in the Leng Review into Physician Associates (PAs) and Anaesthesia Associates (AAs). We are pleased to see the review recommends our principal ask, namely implementation of the interim scope of practice for AAs, without any changes. The interim scope was developed by the RCoA, with Association representation on the writing group and it was endorsed by the Association. Adopting the scope without change was central in our discussions with the review team and it is reassuring to see that the importance of this document has been recognised.
Before we address the other recommendations of the review, it is the Association’s position that anaesthesia provision in the UK should continue to be led by and primarily delivered by doctors. We call on the Government to address the shortage of anaesthetists in the forthcoming workforce strategy as a priority.
We await more information on how the scope will be enforced and hope that the Government body that is tasked with making this happen has adequate powers to deliver this. It is vital that local organisations are unable to opt out of following the document. Going forward, we expect that working within the scope will be a mandatory stipulation in any job description for new Physician Assistant in Anaesthesia (PAA) roles.
We welcome the change of name from Anaesthesia Associate to Physician Assistant in Anaesthesia (PAA). We know from talking to patient organisations that the healthcare landscape is confusing, with many people not being aware of who they are being treated by. The move away from the term Associate avoids confusion with Associate Specialists and other roles held by clinicians. It was disappointing, but not surprising, to read in the review that not all patients are clear about the medical knowledge and expertise that an anaesthetist has. We will be looking at ways to make sure patients know this and are reassured that anaesthetists are medically-trained. We are also looking at ways to ensure the title anaesthetist is legally protected for doctors.
Any plans to develop an ‘advanced physician assistant in anaesthesia’ role need to be assessed against the current developmental needs of all anaesthesia providers – especially as medically-trained anaesthetists will be the ones providing supervision. The scope of practice clearly sets out the extent of practice that we currently approve. It is important that any additional role is developed with the agreement of those providing supervision to prevent duplication as the new role could extend what is covered by the existing scope. How the remuneration of the extended role aligns with resident doctor pay is an issue that needs to be given serious consideration.
The recommended separation of the GMC registers for PAAs and PAs from the register for doctors is an important step in helping patients identify the different roles. The recommendation around changes to Good Medical Practice complements what has already been done at the insistence of the profession, in particular the adoption of different formats of registration numbers for doctors, AAs and PAs.
We welcome the idea of a formal certification and credentialling programme for the ongoing training of PAAs. A nationally agreed and accredited programme would prevent potentially unsafe local variation and would improve consistency. It is important that anaesthetists are involved in the development of these programmes – and as the UK’s leading membership body for anaesthetists, the Association requests to be involved in this process.
As we have previously stated, it is vital that the training and development of PAAs is not at the expense of resident or SAS doctors. Indeed, developing SAS and locally-employed doctor (LED) careers would offer a more sustainable, useful and potentially more cost-effective option for growing the future workforce. Consultants and some SAS doctors are autonomous providers of anaesthesia and – unlike PAAs – require no supervision. When implementing the recommendations from this review, the Government should keep at its heart the value of training resident, SAS and LED doctors to become autonomous providers of high-quality anaesthesia.
While there is recognition in the review that training should be provided for doctors in line management and leadership, it is important to note that these are very different skills. A distinction also needs to be made between day-to-day supervision and overall supervision and between supervising a PAA and a resident or SAS doctor. The allocation of additional time for supervision is a welcome recommendation.
We note the review’s recommendation to create a faculty for PAAs within the existing royal college structure. The RCoA has currently paused its plans to create such a faculty and re-starting this work is something that will require a considered approach. We commit to working with the RCoA in this endeavour. Our members are clear that any such faculty that is developed for PAAs needs to be separately funded and not subsidised by anaesthetists.
We welcome the recommendation of a national audit of safety data. We have highlighted that current data collection is unreliable, with current theatre data systems not configured to collect information useful for safety-related analysis. The involvement of the Healthcare Quality Improvement Partnership should lead to the collection of strong safety data, which can be used as evidence for future decision-making.
We formally request to be included in the working group to be established by the Department of Health and Social Care to look at multidisciplinary models of working. With 10,000 members across the UK covering all grades of anaesthetist, our input from the beginning of this process is vital to the success of the working group.
Finally, as outlined in the ‘implementation of the review recommendations’ section of the report, we will work closely with the RCoA on the actions outlined by Professor Leng. We want the best outcomes for our members and the patients they care for and so we will be actively involved in ensuring these recommendations are delivered.