Change ‘highly misleading’ physician associate title, proposes BMA

The BMA has laid down its position on physician associates, highlighting concerns around ‘patient confusion’ and an ‘unjust’ pay differential. 

There has been a ‘proliferation’ on social media of physician associates (PAs) misrepresenting themselves as GPs and consultants, according to the union. 

Based on these concerns, the BMA has called on the Government to change the names of PAs and anaesthetic associates (AAs) to their ‘original professional titles’ from before 2014 – ‘Physician Assistant’ and ‘Physician Assistant (Anaesthesia)’.

Earlier this year, a patient’s death sparked controversy over the role of physician associates and how they present to the public, and led the GP practice involved to stop employing these professionals. 

The coroner concluded that the patient received ‘poor quality’ care from a physician associate at the practice which contributed to her death by pulmonary embolism.

When raising the issue in Parliament, the local MP Barbara Keeley said the patient believed her appointments were with a doctor. 

Yesterday, the BMA said it is ‘abundantly clear that the public find the title ‘Physician Associate’ highly misleading and confusing’.

The union also emphasised its continued opposition to the GMC taking on regulation of PAs and AAs due to the ‘possibility for increasing patient confusion’, asserting instead that the Health and Care Professions Council (HCPC) should take on this responsibility.

The Department of Health and Social Care (DHSC) is currently preparing legislation for the regulation of AAs and PAs, and in May it closed a long-awaited consultation which suggested PAs could get prescribing rights in order to relieve pressure on GPs – a move the BMA has said it ‘will oppose’. 

Regulation is expected to begin ‘in the second half of 2024 at the earliest’, according to the GMC. 

In its new position statement, the BMA also criticised the potential pay disparity between PAs and junior doctors. 

It said: ‘All health professionals working in the NHS should be paid properly, but it is clearly wrong that a newly qualified doctor entering postgraduate training is paid over £11,000 less per year than a newly qualified PA, while the doctor’s role, remit and professional responsibility is far greater. 

‘We estimate that this is a 35% differential, which is manifestly unjust.’

Dr Steve Taylor, a GP in Manchester and GP spokesperson for the Doctors’ Association UK (DAUK), said he agrees with the BMA’s position and that the ‘blurred lines between doctors and PAs need to be redefined’.

He said: ‘I would say there is a place for AAs and PAs within the NHS and work within it – it’s really clear that we do need the extra staff, particularly when there’s a shortage of GPs. 

‘But what we do need is clarity in terms of who’s doing what role, particularly for patient care and patient safety.’

Dr Taylor said that PAs in GP practices should have a ‘well-defined role with a well-defined patient cohort’, and that this should be ‘pre-triage’.

However, he also highlighted that supervising these professionals results in ‘extra work for GPs’. 

Surrey GP partner Dr Dave Triska said the BMA’s statement was ‘much-needed’ and ‘reflected the feeling of lots of doctors’, and that a stance like this has been ‘sadly lacking from many of the Royal Colleges’.

He said: ‘We already have multi-disciplinary teams but the clinically responsibilities and supervisory roles within them are clearly defined, and what everyone’s been concerned about is the mission creep for these [PA and AA] roles, divorcing them from their original intent to something that we think is going to be used to cheaply replace experienced labour with people who weren’t essentially trained to do that job.’

‘I think that without having the clinical experience to know the unknowns – which is the whole point of medical training – there’s risk associated with that,’ he added.

NHS England’s recent long-term workforce plan committed to increasing PA training places from 1,297 in 2022 to 1,522 in 2031. This is part of the overarching aim to enable ‘innovative ways of working as part of multidisciplinary teams’ in order to free up clinicians’ time. 

But the doctors’ union said: ‘Their use and planned expansion challenges what it means to be a doctor, reflects how the medical profession has been devalued, and demonstrates how the health system is seeking to undermine it in favour of colleagues with less training, skills and expertise.’

In GP practices, PAs are part of ARRS and can perform diagnostic and therapeutic procedures and develop treatment plans, under supervision of doctors. 

An ICB has recently launched an ad campaign to improve patients’ understanding of additional roles in general practice in order to reassure patients they will receive adequate care from non-GP clinical staff.