The anaesthesia associate (AA) role should be ‘terminated as economically unviable’, new economic modelling has suggested.
A study in the British Journal of Anaesthesia, published earlier this month, looked at the economic consequences of expanding the AA role in the NHS.
The researchers concluded that in order to make economic sense, AAs should be paid less, given more autonomy, or the programme ‘should be terminated’ altogether.
According to the Government, AAs, like physician associates (PAs) who work in general practice, are ‘trained to the medical model’ but must always be supervised by a fully trained doctor.
Legislation which will bring both AAs and PAs under GMC regulation is currently making its way through Parliament, but has been criticised by doctors, with one group looking at a potential legal challenge.
AAs are qualified to administer anaesthesia under supervision, and the Royal College of Anaesthetists has endorsed a model where one anaesthesia doctor supervises two AAs across two operating lists.
The study argued that for this model to be economically viable, AAs should be paid less than 50% of the supervisor’s salary.
If the supervisor is a specialty and specialist (SAS) doctor, AAs should therefore be paid less than £40,000.
However, the authors found that actual advertised AA salaries ‘greatly exceed this, with even student AAs paid up to £48,472’.
They said: ‘In summary, for the UK to transition in an economically viable way to the new working model there seem to be only two rational choices: (1) either maintain these high AA salaries and maximise AA productivity to justify them; or (2) reduce AA salaries to economically justifiable levels.’
But the researchers highlighted that these options could have ‘profound’ medico-political consequences.
‘A final option is of course to recognise all these realities and limitations, and to conclude that the UK AA programme, as it has evolved, is in fact economically nonviable and to terminate it,’ they added.
The study also suggested that service pressures could have superseded the need to be economically viable.
‘This lack of economic rationale undermines the driver that led to the creation of AAs in the first place, which was to limit or reduce costs. However, this original cost-saving objective may have been later supplanted by the now greater and urgent need to undertake the work, regardless of cost.’
The statutory instrument (SI) which will allow the GMC to regulate PAs received approval by the House of Commons on 22 January after only being debated by the delegated legislation committee.
But the order will now go before the full chamber of the House of Lords, ‘on the ground that it is politically or legally important or gives rise to issues of public policy likely to be of interest to the House’.
The statutory instrument which will allow the GMC to regulate AAs and PAs received approval by the House of Commons on 22 January after only being debated by the delegated legislation committee.
But the order will now go before the full chamber of the House of Lords, ‘on the ground that it is politically or legally important or gives rise to issues of public policy likely to be of interest to the House’.
READERS' COMMENTS [9]
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I recall the days when untrained G.Ps gave the anaesthetic———–HAIR RAISING
Many GPs were indeed trained in anaesthetics, but from about 1991, it became impossible to do a single 6-month post in anaesthetics to gain suitable experience, because all the JD posts available were mopped up into Anaesthetist training programmes.
It looks like anothe poorly-thought-through idea was fully finded and implemented without an adequate assessment and pilot.
There is still a huge difference between Anaesthetic Assistants and GPs : Anaesthetic Assistants can work alongside Consultant Anaesthetists who can move between Theatres during the less active parts of anaesthesia, whereas GPs only have 8-9 minutes to do the whole history-assess-diagnose-explain-manage-and opportunistic extras thingy.
It would be really nice to have someone available to steer the patient through the less clinically valuable times of the consultations, but this comes down to basically getting undressed and dressed, and on and off the couch for examinations. It is not the same sort of job at all as an Anaesthetic Assistant.
The problem with Anaesthetics is that at one point a lot less Consultants were produced, indeed a lot less Rs and SRs too, meaning that the reason for having Assistants was not economic at all, but manpower needs.
The assessment of utility in General Practice is entirely different.
What is now most important is that we combine ensuring the salary of Doctors on the training schemes is higher than Student Assistants’ salaries, or there will not be enough Consultant Anaesthetists in the future (as has already happened), whilst at the same time ensuring that those Assistants promissed into a career post have suitable future career prospects.
Given the knowledge and skills needs of the job, and service needs too, it would seem likely that conversion to fully-fledged Doctor training ought to be within the capacity of the vast majority of them (or they should not be given the responsibility they already have !
GPs is a different matter entirely – this country needs more GPs, and much more funding to the GP system to recover from the abuse of the last 20 years and the mismanagement of relationships and workload by upper NHS manageemnts.
I don’t want to be that anaesthetist. Supervision means you are responsible if things go wrong.
Can we have assistant MPs and halve the number of MPs They May behave more professionally in debates in Westminster unlike today 21/2/23
If somebody is putting me to sleep I damn well want that person to be a senior doctor not an “associate”. All these associate roles exist because of recruitment policy by the DoH over many years, we have too few doctors. Like triage, remote consulting, PAs, paramedics going home visits… all unsafe, all sub-standard, all a symptom of crap DoH policy and planning. Incompetence at the highest level of government now coming home to roost and making medial practice increasingly unsafe for patients.
Well there’s no cost saving.
They’re not as qualified.
They can’t work on their own (or at least shouldn’t, but we all know what happens in a busy hospital when there’s an emergency and the supervising Anaesthetist who is also on call goes to resus…..)
The only reason to do this….? Political, of course.
So why are SAS doctors having to pay double the GMC fees of PA when they can earn less than PAs?
Are PAs getting regulation light? Or are doctors GMC fees now subsidising PAs too
Cannot get more doctors? No problem, just do it like the plastic police and get some community officers in unifom who do not have any real powers to arrest people to trick the public. Arrests are not made and diseases are not cured. Wondering why the waiting lists keep increasing. There are no short cuts.
None of this matters if you are wealthy and in good health.