The Government will lay legislation this week to allow the GMC to begin the process of regulating physician associates (PAs).
The legislation will be laid before Parliament via affirmative statutory instruments on Wednesday and the regulations are expected to come into force at the end of 2024.
The GMC will set standards of practice, education and training, and operate fitness to practice procedures, ensuring that PAs and anaesthesia associates (AAs) ‘have the same levels of regulatory oversight and accountability as doctors and other regulated healthcare professionals’, the Government said.
The legislation follows a consultation which had also suggested PAs could get prescribing rights in order to relieve pressure on GPs.
However, the BMA raised concerns about the legislation saying it thinks this ‘will add further, dangerous confusion’ with patients being left under the impression that they have seen a doctor when they haven’t.
‘The blurring of this distinction between doctors and non-medically qualified professionals can, and has, led to fatal consequences,’ the BMA added.
The union asked doctors to write to their MP ahead of Wednesday, so that they are ‘aware of this issue, oppose the legislation in Parliament and force the Government to abandon its plans’.
Health and social care secretary Victoria Atkins said: ‘Physician associates and anaesthesia associates are already making a great contribution to the NHS, supporting doctors to provide faster high quality care for patients.
‘This new legislation paves the way for these professionals to be held to the same strict standards as doctors, boosting patient safety.
‘This is part of our Long Term Workforce Plan to reform the NHS to ensure it has a workforce fit for the future.’
GMC chief executive Charlie Massey said: ‘This is a welcome and significant milestone towards bringing physician associates (PAs) and anaesthesia associates (AAs) into regulation.
‘We’re pleased to support the development of these valuable professionals recognising the important role they play in the medical workforce. Regulation will help increase the contribution PAs and AAs can make to UK healthcare while keeping patients safe.
‘We are working hard to design and deliver detailed regulatory processes for registration, education, standards and fitness to practise for both professions.’
BMA chair of council Professor Philip Banfield said: ‘For the Government to call this move a “boost” to patient safety, it will feel like another slap in the face for undervalued UK doctors who have spent years patiently explaining why it is exactly the opposite.
‘At every stage we have been clear that the GMC is the wrong regulator for medical associate professionals: it is the body for regulating doctors, which these professionals simply are not.
‘For the Government to press on despite the overwhelming opposition of the medical profession and opposition from patients shows they are failing to take seriously the safety concerns that have been raised about the choice of regulator.’
Most statutory instruments (SIs) subject to the affirmative procedure are laid in the form of a draft SI and are considered by the Joint Committee on Statutory Instruments (JCSI).
Next, the SI will be automatically referred to a Delegated Legislation Committee (DLC). These committees have 16-18 members. Any MP can attend and speak but only members of the DLC can vote.
A DLC considers an SI but does not have the power to stop it. In some rare cases the SI is not referred to a committee, but is debated in the Commons Chamber if it is of particular interest.
Once the SI has been debated by a committee, it needs final approval by the Commons before being ‘made’ (signed by the Minister) and becoming law.
Health Education England (HEE) and NHS England recently warned the BMA that its stance on medical associate professionals (MAPs) is impacting NHS relationships and patient confidence.
HEE has published an open letter to the BMA in response to the union’s call to halt recruitment of MAPs – which includes physician associates (PAs) working in general practice – until regulation is in place.
GMC has also called on doctors to show ‘multi-disciplinary respect’ towards healthcare professional colleagues who are not doctors.
‘We are working hard to design and deliver detailed regulatory processes for registration, education, standards and fitness to practise for both professions.’ Who is funding this work?
Excellent point , Mark ! Please could Pulse ask the GMC if the funding for this work is being funded by medical professionals , or is it by a loan to be paid back by PAs through their registration fees in the future
Will they also be regulated as undergraduates ?
Once knew a G.P. who practised without any medical qualifications———it took the authorities 10 yrs to catch up with him
Nobody is listening to us.
Anonymous, could it be because we don’t know who you are? Your words might carry more weight if you name yourself.
This is frankly dangerous. I can’t imagine who (HEE and NHSE) thinks that implementing a system of placing people with non-medical backgrounds and 2yrs of variable skills, is an appropriate substitute for doctors.
Physician’s Associates are very evidently already acting as doctors in acute and undifferentiated roles. Since when has HEE or NHSE proven its ability to assess competence in medical versus non medical scenarios in the treatment of patients?
There is much loose talk of doctors supposedly undermining or disrespecting Physician’s Associates but no actual substance dealing with the material issues of managers believing that PAs can perform acute and undifferentiated roles as safely as trained Medics. Experienced ANPs are not the same.
There is a very clear agenda to blur the boundaries of practice which is itself dangerous and misguided.
Government and GMC are unable to distinguish between the degrees of similarity of regulations and the degree of similarity of medical practice.
The message is that anyone can do Medicine. Confusion with task-based Masters degrees as the new ‘evidence’ is classic Michael Gove: “who needs experts?”. The practice-by-design of the dumbing down and replacement of Medicine is unforgivable and it will cause mounting unnecessary harms to patients.
No Sam, I don’t think that’s the case. The policy makers don’t give a toss what a front line GP thinks.
Crazy idea but practices could stop emplying them.
Poor sods, 5 years under the GMC and half will jack it in
In contrast to the line taken by the GMC, PAs are not “health professionals”. Irrespective of whatever role they may aspire to they cannot undertake independent clinical practice. To remain within the law a supervising GP needs to oversee their patient interactions. By employing them without supervising them, its the GP whose registration will be on the line in the event of a medicolegal disaster.
Agree – that if PAs are to work alongside, and-or under the jurisdiction of the physician, then those opposed should not employ them.
If the government want’s the PAs’ level of care, they should set up and fund suitable independent clinics .
Concerning the Title: – if they are accepted to work with a physician, it should Physician Assistant, not Associate. If they are to be free-standing and independent, ‘Physician’ should not be included in their Title.
It’s not that easy to say don’t employ PAs
Most are in private company run GP practices. The ‘supervising ‘ GPs will be liable, but they only get a 10min slot for supervision (signing their drugs),
They have no say in the PA practice role or their management and supervision. The BMA should set guidelines for gp supervision time etc. We need to lead this as a group.
Physician Assistants – Yes
Physician Associates – No
And whatever they are called, they should have their own regulator; not the GMC.
Was kn the edge but Definitely moving from uk now . Rcgp and gmc can have their acronyms back .
Once more , it will not be by focussing on the PAs themselves that this can be resolved but focussing on the self interested PCN Clinical Directors and teaching practices who are paid to lead this race to oblivion for General Practice via ARRs introduction where they are not appropriate as clearly in some areas, ARRs do have value.. Each area in the UK will be able to identify small clusters of the same GP names who drift from PCN board roles to the LMC roles, RCGP roles, ICB board positions who have masterminded this wrecking ball approach to General Practice for their own personal aims. The LMC is most often a force for good as seen by the majority of its members and board but others in small number use these roles to obtain priority information for upcoming contracts and personal advancement. As with with most aspects of society where we see a decline, money and power is often the motivation even within Primary Care leadership and this should be openly and frankly pointed out where these are the significant factors.
@ win win—minor point, but———-these are initialisms
There are a number of unresolved issues, and the proposed solutions do not resolve them (and in some cases make them worse).
The title is confusing. I understand the mother in the case of the woman who died thought ‘Physican Associate’ made them sound better qualifed than a GP. Initially they were called Physician’s Assistants, but I understand some of them found the term demeaning. The latter name does clarify the role though – they were initially intended to assist the physician in the care of the patient, and not to replace the physician (which now appears to be the clear intent and is reflected in the new name).
The role in hospitals seems clear as they effectively remain under constant direct supervision, but it isn’t clear how they can function safely and remain within scope in general practice. If they see a single patient without subsequent review by a GP they are effectively working autonomously. Simple access to advice from a GP is not sufficient, in my view.
The training issues in secondary care haven’t been solved. There are lots of reports of specialist trainee unhappiness, as apparently PAs are being prioritised for training opportunities (presumably as hospital staff feel they get more from the investment as they will not rotate on in a few months).
There are pay issues – they are comparatively expensive and offer reduced productivity compared to salaried GPs (who should be paid more IMHO). Most practices would not employ them if there wasn’t the ARRS ‘bribe’ to fund them, the practices were funded properly and there were enough salaried GPs around.
There are risks of misuse of the role – I understand some hospitals have put them on mid-grade rotas to cover out of hours working.
As far as regulation is concerned, there are several other bodies who could regulate them, so why choose the GMC unless it is intended as a direct provocation to the profession? The GMC was created and literally exists to differentiate between people who are qualified to practise medicine and those who aren’t. PAs aren’t, so should have a different regulator. Seems pretty simple to me. If the GMC persist, the Colleges and BMA should insist on a different, new regulator for us on public safety grounds. Perhaps we can start again – the current GMC is heavily politicised, and a mess.
They are pushing ahead regardless. GMC you can literally piss right off.
Bring it on I say, providing I’m not responsible for any aspect of their practice..