Anaesthetists United

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Anaesthetists United is a medico-political advocacy group in the United Kingdom co-founded by Ramey Assaf and Richard Marks in June 2023 to campaign against the proposed expansion of Anaesthesia Associates (AAs), as proposed by the NHS Long Term Workforce Plan.^[1] The group, composed of around 20 anaesthetists, undertook work to draft motions and submitted a requisition to the Royal College of Anaesthetists (RCoA) for an Extraordinary General Meeting (EGM) which took place on 17 October 2023.^[2][3] It successfully campaigned on issues relating to the training of anaesthetists.

Campaign issues

The main objective of Anaesthetists United was to requisition an EGM of the RCoA, with three main issues relating to anaesthesia in the UK to be discussed: Anaesthesia Associates, rotational training and national recruitment to specialty training. Six resolutions were proposed by members:^[4]

1. A pause in the proposed expansion of Anaesthesia Associates, proposed by Dr Danny Wong
2. Supervision of Anaesthesia Associates, proposed, proposed by Dr Danny Wong
3. Information for Patients, proposed by Dr Jan Hansel
4. Rotational Training, proposed by Dr Ramey Assaf
5. National Recruitment for Doctors-in-training, proposed by Dr Richard Marks
6. Regional Recruitment, proposed by Dr Richard Marks

Anaesthesia Associates

Anaesthesia Associates were introduced to the UK in 2004 as non-medically trained practitioners that administer anaesthetics. Similar to Physician Associates, they are currently unregulated. Their training consists of a two-year postgraduate course, leading to the award of a Master's degree. To be eligible to apply, they must have a previous degree in a science subject, or recognised previous healthcare experience. As of July 2023, there were 164 AAs registered on their managed voluntary register.^[5]

Their scope of practice was last agreed by the

Recruitment into the specialty of anaesthesia in the UK has been conducted nationally for the past 15 years, with the Anaesthetics National Recruitment Office (ANRO) in charge of the operational aspects of recruitment. In 2021,

Anaesthetists United employed promotional images generated using artificial intelligence algorithms such as Midjourney to run a campaign on social media platforms such as X and Reddit with a limited budget, with members volunteering their time to the effort. A six-fingered man in purple scrubs became the hallmark of the social media campaign.^[11][12] A video montage of Anaesthesia Associates talking at an event organised by Lancaster University highlighting work beyond the expected scope of practice and potential misrepresentation garnered much attention on social media.^[7][13]

An online survey was used to collect signatures from members through a campaign on social media. On 31 August 2023 more than 700 signatures were collected and delivered to the RCoA, following which the EGM was announced.

Extraordinary General Meeting

On 17 October 2023 the Extraordinary General Meeting of the RCoA was convened. Up to 1,500 members attended the virtual event live, and more than 4,900 members voted.^[14]

The full recording of the event is available on the RCoA website.^[15]

Media coverage

Throughout the campaign, Anaesthetists United and the proposed EGM has attracted national media coverage.^{[16][17][18][19][20][21][22][23][24][25][26][27][28][29]} This interest coincided with the proposed national expansion of the Medical Associate Practitioner workforce outlined in the NHS Long Term Workforce Plan^[30] and emerging accounts of patient harm associated with unsupervised practice. One such case, the death of 30-year-old Emily Chesterton, was discussed in the House of Commons on 6 July 2023.^[31]

Impact and legacy

Building on the success of Anaesthetists United, other medical professional groups in the UK, including general practitioners, radiologists, ophthalmologists and psychiatrists, have launched their own iterations of similar advocacy campaigns.^[32][33][34]

Following the success of the RCoA EGM Anaesthetists United announced it would stop its activities on 18 October 2023. The RCoA committed itself to addressing the views of the membership.^[14]

A 2024 economic analysis published in the BJA argued that for AAs to be economically viable, a salary of less than 50% of their medically qualified supervisors would be required; they note that AA salaries exceed this.^[35] The authors further argue that AAs, as currently implemented, are not economically viable, and that to achieve economic viability, they would either need to be paid less, have their autonomy increased, or "the AA programme should be terminated".

References