Anaesthetics training in the UK – pathway and progression

How to become an anaesthetist 

Embarking on a career in anaesthetics within the UK offers a clear yet competitive pathway filled with rewarding opportunities. In this comprehensive guide, we’ll explore the journey to becoming an anaesthetist, detailing the entry requirements, Fellowship of the Royal College of Anaesthetists (FRCA) examinations, and training stages – from the initial qualifications to consultant anaesthetist. Whether you’re a recent medical graduate or a doctor aiming for specialisation, understanding the anaesthetics pathway and progression is crucial.

Entry requirements for anaesthetics 

If you want to apply for anaesthetics specialist training, you will need to meet the requirements below for a chance to be accepted onto this training pathway:

  • Qualify as a doctor
  • Register with the General Medical Council (GMC)
  • Complete the UK Foundation Training Programme or equivalent

According to Health Education England (HEE), 2604 doctors applied for 545 anaesthetics ST1 training posts in 2023, giving it a 4.78 competition ratio. Those doctors joining speciality training at ST4 have a competition ratio of 1.6 with 640 doctors applying for 399 posts.

Anaesthetics training pathway 

Anaesthetics training is uncoupled, so doctors will need to apply for core anaesthetics training and, once completed, apply for entry into higher speciality training. Entry to higher speciality training is not guaranteed as outlined by the 2023 competition rations above. Anaesthetics trainees can complete their core training via core anaesthetics training (CT1 – CT2) or ACCS (Acute Care Common Stem).

Core Anaesthetics Training (CT)

Core training in anaesthetics is three years and forms the first stage of specialty training. This is a paid training job in a hospital setting, with rotations covering a range of specialties. The first year is called CT1, the second CT2 and the third CT3.

ACCS (Acute Care Common Stem)

Acute Care Common Stem is a four-year uncoupled core training programme.  The first two years are spent rotating through six-month placements in emergency medicine (EM), internal medicine (IM), anaesthetics and intensive care medicine (ICM). The third and fourth years are spent training in your chosen speciality. This is an alternative core training programme to enter Higher Specialty Training in Anaesthetics.

Higher specialty training (HST)

The final part of uncoupled training in the progression from anaesthetics trainee to consultant anaesthetist is Higher Specialty Training (HST). Upon completion of Core Training or ACCS and the relevant Royal College assessments, you will need to complete higher specialty training (ST4+).

UK anaesthetics training spans 7 to 8 years, with an additional 2 years for Foundation Training, totalling 9 to 10 years from medical school graduation to consultant.


Throughout anaesthetics training, you will need to complete the Primary and Final Fellowship of the Royal College of Anaesthetist exams to demonstrate you have the required learning outcomes to progress through critical points in the training pathway. The learning outcomes are broken down in line with the structure of the new curriculum as follows:

  • Stage 1 CT1, CT2, CT3
  • Stage 2 ST4, ST5
  • Stage 3 ST6, ST7

More information about the learning outcomes and stages can be found in the 2021 Anaesthetics Curriculum structure. Doctors who are obtaining specialist registration through the Portfolio Pathway are also eligible to sit the FRCA exam to demonstrate satisfactory progression and understanding of the curriculum. 

The FRCA Primary examinations are aligned to the core level anaesthetics training curriculum and the FRCA Final examinations are aligned to the higher or intermediate level training curriculum.

Primary FRCA examinations

The FRCA Primary includes three parts:

  • Multiple-choice question exam (MCQ)
  • Objective structured clinical examination (ISCE)
  • Structured oral examination (SOE)

To pass the FRCA Primary, you must succeed in all three parts. Each section is graded on a pass/fail basis. Upon successfully clearing all three components and achieving an overall pass in FRCA Primary, you are granted a 7-year window to complete your final FRCA examinations.

Final FRCA examinations

The final FRCA exam and second component of the Fellowship of the Royal College of Anaesthesia (FRCA) includes the final FRCA written exam and the structured oral examination (SOE). The exams must be sat in order and to achieve an overall pass you must pass both elements.

Progression in anaesthetics

Working as an anaesthetist can be an extremely rewarding and varied career. Doctors who work in the NHS will spend most time in operating theatres, intensive care units or pre-operative assessments. An NHS consultant anaesthetist will usually work 40–48 hours per week with 90% clinical activities as above and 10% time for admin, audits, or teaching.

For those who want to specialise further, there are ample opportunities including in intensive care medicine, pain medicine, neuro anaesthesia, cardiothoracic anaesthesia, vascular anaesthesia, and paediatric anaesthetist.

Anaesthetics is a great speciality for those who want to pick up extra work with private hospitals, clinics, partnerships, consortiums, and insourcing companies all requiring consultant anaesthetists. You will need to have flexibility and availability to pick up work at short notice and travel as required.

How much is an anaesthetist’s salary? 

Anaesthetists’ salaries follow the same NHS pay scales as other medical specialists from FY1 (£32,398) to an experienced consultant (£126.281) plus additional awards and applicable enhancements. Read our thorough pay scale guides for doctors in England, Wales, Scotland, Junior Doctors and NHS Consultants.

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