Physician assistants in anaesthesia

What are physician assistants in anaesthesia (PAAs)?

The physician assistants in anaesthesia (previously known as anaesthesia associate) role was first introduced in 2004, and is now established within many NHS hospitals. These are highly trained and skilled practitioners that work within an anaesthetic team under the direction and supervision of an autonomously practising anaesthetist, such as a consultant or specialty and specialist (SAS) doctor.

PAAs are part of the medical associate professions (MAPs), alongside physicians assistants and surgical care practitioners.

What can physician assistants in anaesthesia do?

The role encompasses pre-, intra- and post-operative care. Under the direction of an autonomously practising anaesthetist, such as a consultant or SAS doctor, the physician assistants in anaesthesia may participate in:

• pre-operative and post-operative assessment of patients
• anaesthesia for day case surgery
• pre-operative patient pathways
• delivery of anaesthetic or sedation
• advanced vascular access.

Currently physician assistants in anaesthesia are unable to:

• prescribe
• administer and/or supply medicines under a patient group direction:

A patient group direction (PGD) is a written instruction for the supply and/or administration of medicines to groups of individuals who may not be individually identified before presenting for treatment.  Read further information on PGDs. 

Subject to locally determined governance arrangements, a PA may administer medicines under a patient specific direction. A patient specific direction (PSD) is a written instruction, signed by an authorised prescriber, for medicine(s) to be administered to a named person after the prescriber has assessed the patient. Read further guidance on PSDs.

What training and qualifications do physician assistants in anaesthesia have?

Qualifying as an PAA requires successful completion of an PAA training programme. Rather than a direct application to a university, applicants are required to obtain a student PAA role within a Trust which has secured training places for PAAs. 

Applicants are typically required to possess a biomedical science or biological/life sciences 2:1 honour degree. Alternatively they can be registered healthcare professionals (such as nurses or operating department practitioners) with at least three years clinical experience.

On successful application, student PAAs will be assigned to a university, of which there are currently three offering PAA courses, whilst continuing to work within their Trust. The PAA training course is two years and is designed around a curriculum developed by the Royal College of Anaesthetists in collaboration with the General Medical Council. 

How do physician assistants in anaesthesia fit into the NHS workforce?

Physician assistants in anaesthesia, as supplementary members of multidisciplinary perioperative and anaesthesia teams, can exert a positive impact on patients and service provision, by enabling flexibility to anaesthesia teams in service delivery and enabling consultants to manage their team more effectively. As a result of the increased workforce capacity,  theatre downtime can be reduced, and patient flow can be increased.

NHS England has a series of impact case studies looking at the roles PAAs can play within an MDT.

Further information

There are a range of resources for further information on PAAs including

• an infographic
• Health Education England – anaesthesia associates
• Royal College of Anaesthetist – anaesthesia associates
• Access a webinar about physician assistants in anaesthesia.