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An in-depth economic analysis by a multi-national research group has concluded that the productivity gained by using Anaesthesia Associates in operating theatres are very modest and do not justify the salaries currently being paid.

Anaesthesia Associates (AAs) are trained, skilled practitioners who work within the anaesthetic team under the supervision of a consultant anaesthetist. They were introduced in 2004 and are now established in many NHS hospitals. The recent NHS Long Term Workforce Plan recommends expanding the AA programme.

The new work, led by Professor Jaideep J Pandit, Professor of Anaesthesia at Oxford University and Consultant at Oxford University Hospitals NHS Foundation Trust, overturns the assumption that AA expansion is cost-effective.

Working with colleagues from the Universities of Vermont and Alabama (USA), Pandit's team identified the lack of economic modelling from the NHS. They first estimated the maximum productivity gains achievable through employment of this relatively new staff group. 'In one model of work, AAs could assist with the turnover of successive surgical cases in theatres', said Professor Pandit. 'However, we already know from a large NHS study of over a million operations that such gap times constitute less than 15% of the scheduled list times, so the maximum productivity gain would be this percentage, and so the economically viable AA salary would be just 15% of the supervisor's'.

Theoretically, the most productive way of working (supported by the Royal College of Anaesthetists) is a 1:2 ratio of one medically qualified anaesthetist supervising two AAs across two theatres. The supervisor can be a Specialty or Specialist (SAS) doctor - not always a Consultant. 'For this model of work, the productivity gain could be an extra 50%, which economically justifies an AA salary of 50% of the SAS supervisor's, which is no more than ~£40,000', concludes Professor Pandit.

When the team next analysed actual salaries being paid, they discovered that they were far in excess of this financially viable envelope; up to £65,000 in many cases. Even student AAs with no clinical responsibility, are being offered salaries of £45,000.

'The current model of work or employment does not represent value-for-money, cost savings or proportionate productivity gains for the NHS', says Professor Pandit. 'There are broadly two options – either terminate the AA programme as financially unviable. Or, conversely, increase the autonomy of AAs such as to maximise their productive potential and justify these high salaries. We recognise that each of these has enormous medico-political consequences.'

The paper explores several ways in which increased AA autonomy could be achieved, including staffing ratios of 1:3 or higher. 'However, increased AA autonomy means more supervision responsibilities, which will be a pay driver for consultants and AAs', notes the research team. It is also noted that several staff groups now oppose expansion and increased autonomy for AAs.