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The role of non-physician providers of anaesthesia: a systematic review. BACKGROUND: With increasing demand for surgery and a predicted shortfall in the number of medically qualified anaesthetists in the UK, it is important to consider the role of non-physician providers of anaesthesia (NPAs). We performed a mixed-methods systematic review on the roles of NPAs, commissioned by the UK Royal College of Anaesthetists. METHODS: We systematically searched electronic databases and synthesised reports on different NPA models of working, the cost-benefit case, and their impact on existing and future workforces. We updated an existing Cochrane review on their impact on patient safety and outcomes. RESULTS: Searches identified 6644 unique records; 56 were included in this review. In high-income countries, there are different models of working with NPAs. NPA scope of practice varies, as do requirements for supervision. Most published literature focuses on nurse anaesthetists who, in some countries, can practice independently. Updated evidence on patient safety suggests there is little to no difference in patient mortality when comparing nurse anaesthetists with physician anaesthetists. However, there are contradictory findings relating to the frequency of complications. No studies evaluated NPAs that are not nurses, which could limit applicability to the UK context. All included studies had serious risk of bias, so results should be interpreted with caution. CONCLUSIONS: There is limited evidence relating to NPA working models, their impact on patient outcomes and on the wider workforce, and the cost-benefit case. Reports comparing the independent practices of nurse anaesthetists and physician anaesthetists appear to be of limited applicability in the UK context.