Legislation bringing the physician associate (PA) role under GMC regulation has passed through the House of Lords, despite attempts to kill it.
Last night, peers debated the Anaesthesia Associates and Physician Associates Order 2024, which has already been rubberstamped by the House of Commons.
Former Green Party leader Baroness Natalie Bennett had proposed a ‘fatal amendment’ to stop the order’s progress through Parliament, based on concerns that it represents a significant constitutional change without the necessary parliamentary oversight.
The BMA and the Doctors’ Association UK backed the move, having also expressed serious concerns about PAs being regulated by the GMC.
However, due to lack of support from other peers, Baroness Bennett was forced to withdraw the motion at the end of the debate, meaning the order has been approved.
The BMA said this decision was ‘extremely disappointing’ as the legislation will ‘blur the lines between PAs and doctors’.
In response to Baroness Bennett’s fatal amendment, as well as concerns from Baroness Finlay of Llandaff and Baroness Brinton, health minister Lord Markham asserted that the Government has consistently consulted with ‘a wide and diverse range of interested parties’ and that the GMC ‘is the right regulator for these roles’.
He told peers: ‘The assessment of the appropriate regulatory body for AA and PA regulation was completed in 2019 following a public consultation.
‘The majority of respondents to that consultation were in favour of the GMC taking on regulation, including the professional bodies representing the roles and the medical royal colleges, including the Royal College of Anaesthetists, the Royal College of General Practitioners and the Royal College of Physicians.’
Lord Markham also sought to ‘be clear’ that associate roles are not intended to replace doctors.
‘AAs and PAs are distinct, complementary and valued professionals who, under appropriate supervision, can enrich the workforce skill mix, freeing up junior doctors and consultants to spend more time using their specialist skills and training to focus on complex clinical duties and decisions around patient care.’
Baroness Bennett expressed concerns about patient confusion regarding different roles in the NHS, quoting the mother of Emily Chesterton, who died in 2022 after seeing a PA at her GP practice and who had not been aware that her appointments were not with a doctor.
On the issue of supervision and patient confusion, Lady Finlay, who is a palliative medicine doctor and RCGP fellow, said blurred lines between PAs and doctors are ‘misleading’ to those outside the NHS.
She said: ‘A case of non-accidental injury in a child has been brought to my notice where the expert evidence was provided by a physician associate whose relevant experience is unclear at best.
‘This blurring is misleading to non-medical professionals, including the police, judiciary and legal professionals.’
Lady Finlay also urged the GMC to combat confusing advertisement of PA courses.
‘The GMC must tackle the inappropriate way that some courses are advertised, which state that they train PAs “to work as a safe and competent medically trained healthcare professional” or to “be a medically trained, generalist healthcare professional” — which sounds awfully like a GP to me.’
Arguing for the legislation, Lord Hunt of Kings Heath, a Labour peer, criticised campaigners who list the errors made by PAs.
He said: ‘What would happen if we asked people to report mistakes made by F1 medics each August? The
BMA is playing with fire in the campaign it has adopted of putting these poor professionals, who are doing their best, in this frame.
‘I protest about this and the general lack of medical leadership from the profession when it should have been defending the associates.
‘The way it has run away from this issue has been a disgrace. It will find that its lack of leadership and strength will bite it in future.’
He also said the Government’s plans to increase PAs – to 10,000 by 2036/37 – ‘seem very modest’ and encouraged the health minister to ‘revisit that’.
Meanwhile, former health minister Lord Bethell spoke in favour of the motion, saying it would help to ‘increase primary care capacity’ and ‘improve the lot of our hard-pressed GPs’.
Last week, ahead of this debate, Lord Bethell claimed that GPs do not ‘face huge amounts of complexity’ and that most appointments are ‘incredibly straightforward’.
READERS' COMMENTS [14]
Please note, only GPs are permitted to add comments to articles
It is all about “blurring lines of responsibility”. Just like the pharmacy 1st scheme, they will take the money from primary care, pretend to do a job and pass the work and the blame to us. Don’t use them or train them.
This is why most people are starting not to pay the royal colleges who supposedly represent us. Sold down the river by the same people who don’t see any patients but sit in high towers. Would they all be happy seeing a PA for their complex problem? It looks like in the future they won’t have much choice.
It’s like taking your car to a local car mechanic vs the main dealer (due to costs).. scrap that analogy, its like being forced to see a bicycle repair shop instead of a car mechanic, because your insurance says so.
Lord Hunt is so blasé he wipes away medical safety without a second thought. All errors are not the same, and none have been compared or quantified here. Physician Associate errors are inherent to a role in which graduates are untrained for the complexity of medical knowledge and experience which they trained to acquire. Doctors make errors with fewer holes in knowledge and the breadth of medical training – often in cases where a doctor is exposed to levels of risk beyond their acquired competence. Worryingly, PAs seem only too keen to dress and behave as doctors. Only a moron or a liar would blame the ‘vested interests’ of doctors. Which is it?
Whenever I am working alongside a P.A. it feels as if the surgery is never ending
We were doing very well without PA APS and pharmacy first.. money could have been use to help junior doctors
Really struggling to understand why those who have concerns about Physician Associates are arguing that they should not be regulated.
Plenty of doctors work with nurse practitioners, specialist nurses, non consultant doctors, doctors in training positions, psychologists, specialist radiographers etc etc. All have different competencies. The important issue is whether there is oversight, support and clear lines of accountability and responsibility.
There is a difference between a dysfunctional department / practice and no supervision, or supervision under duress, and willing departments / practices that are happy to employ and supervise PAs as part of their team.
Conflating regulation and registration with supervision under duress looks more like medical protectionism than a patient safety issue.
c’mon you lot, see the positive side. at least they got the sector about right. could have asigned regulation to DVLA or gas safe register. Plus it’s not like a PA will be given authority to hold GMS contract tomorrow- or is it??
I have been trained on a 4 year GP training programme in Scotland, commuting to the South Coast of England the whole of this time, where my family lived. Not only I’m not legally allowed to work in a GP surgery because I marginally failed the CSA but if I decided to apply again for GP training, I wouldn’t even be allowed to apply.
As a group of doctors in similar position, last year, for the second time in 9 years, we met with the RCGP representatives who from the start rejected any attempt to even consider any change to current regulation.
I am amazed at the readiness of the authorities to regulate and welcome to work in GP practices, a group of professionals who are not even medically trained.
It’s stunning.
Correctly utilised now that it has been ratified to some extent, there will be a role for PAs within practice if preferred generally for cost savings by some practices. As the regulation of PAs and oversight of the PA role is with the GMC, this should, I expect routinely involve the supervising GP accepting jointly culpability for any patient harm in line with the benefits of the reduced costs of the PA, reduced workload for the GP/practice employing them and increased profits for the GP/practice and the patient being offered a PA by the practice instead of a doctor in the first instance. The balance seems basically to be the personal preference of the GP/practice having the resources and being prepared to supervise the PA in return for cost savings and the perceived increased profit/risks associated with a PA versus the increased cost but greater autonomy /reduced risks/wider knowledge/greater consistency of educational background of a GP. I prefer the latter but choice and decision making has always been a part of General Practice.
@Liliana Ples, sounds terrible that more help wasn’t given to you by the RCGP.
Perhaps Pulse could do a piece on your story and simultaneously highlight the seeming hypocrisy of the RCGP regarding their “enabling” attitude to PAs, as previously mentioned by Dr Bramall-Stainer in Pulse….
The GMC literally exists to differentiate between people who are allowed to practice autonomously as a doctor, and those who aren’t. It is literally their raison d’etre.
Of course PAs should be regulated – but there are other regulatory bodies to do this.
The failure of politicians to recognise and act on this is appalling: alas, at this point I have no faith a labour government will be better than the current incompetents.
BMA – where is Plan B?
Time for government to fund our GMC fees as it is no longer a medical regulator for GPs but for the wider profession. They have been taking money to persecute GPs for years, as they don’t support GP as they are there to look out for patients not GPs
And to supervise the PAs we will have protected time, out are we going to do our clinics and AT THE SAME TIME supervise our colleagues???? Same old same old