Anaesthetists United

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Anaesthetists United is a UK medical advocacy group formed in June 2023 by Ramey Assaf and Richard Marks. It brings together about 20 anaesthetists who opposed the planned expansion of physician assistants in anaesthesia (now called physician assistants in anaesthesia, or PAAs) as proposed in the NHS Long Term Workforce Plan. The group drafted motions and pushed for an Extraordinary General Meeting (EGM) of the Royal College of Anaesthetists (RCoA), which was held on 17 October 2023. They also campaigned on issues around how anaesthetists are trained. Anaesthetists United became an incorporated company on 1 July 2024 and has two directors.

Main goals and actions
- The group aimed to raise three main topics at the RCoA EGM: anaesthesia associates (the PAAs), rotational training, and national recruitment to specialty training.
- Members proposed six resolutions focused on anaesthesia associates and the broader anaesthesia training pathway.

About anaesthesia associates (AAs)
- AAs were introduced in 2004 as non-medical staff to help administer anaesthetics. Since December 2024 they have been regulated by the General Medical Council.
- Training for AAs is a two-year postgraduate Master’s program. Eligibility typically requires a science degree or relevant healthcare experience.
- As of July 2023, 164 AAs were listed on a voluntary register. The scope of practice was last agreed in 2016 and did not cover all areas of anaesthesia; some employers expanded scope under local safety rules.
- The role’s name has changed several times: from Anaesthesia Practitioner to Physician’s Assistant (Anaesthesia), then to Anaesthesia Associates, and after the Leng Review in 2025 it was renamed to physician assistant in anaesthesia (PAA).

Recruitment and governance
- National recruitment for anaesthesia training has been run by the Anaesthetics National Recruitment Office (ANRO) for about 15 years. In 2021 Health Education England began a review after scoring errors in recruitment, and ANRO has faced scrutiny since.
- Anaesthetists United called for a vote of no confidence in ANRO and suggested regional (rather than national) recruitment and reduced rotational training to improve trainee quality of life.

Campaign methods and results
- The group used AI-generated images and social media (including X and Reddit), featuring a six-fingered man in purple scrubs, to spread its message.
- An online petition collected signatures, with more than 700 by 31 August 2023, leading to the EGM.
- The EGM on 17 October 2023 drew up to 1,500 live attendees and more than 4,900 votes. A full recording is available on the RCoA website.
- The campaign received national media attention amid broader debates about expanding the medical associate workforce and concerns about patient safety. The case of Emily Chesterton, discussed in Parliament in July 2023, was cited in coverage.

Aftermath and commentary
- Anaesthetists United announced it would stop activities on 18 October 2023. The RCoA said it would consider members’ views.
- A 2024 analysis in the British Journal of Anaesthesia questioned the cost-effectiveness of AAs, arguing they would only be economically viable if their pay were less than about half of the salaries of their medically qualified supervisors. The article noted that currently the comparison is complex because supervision in practice is provided by consultants.