Physician associates take up GP training opportunities, BMA warns NHS England

Physician associates are taking up training opportunities that could be offered to GPs instead, the BMA has warned.

In its submission to NHS England’s review of all postgraduate medical training, including GP programmes, the union warned that PAs and anaesthesia associates are ‘taking training opportunities that could be offered to medical students or doctors’.

It also said that competition for specialty training places is ‘unsustainable’, and that as specialty places remain scarce, there should be ‘a form of UK graduate prioritisation’ that also ‘protects’ international medical graduates (IMGs) already working in the NHS.

NHS England announced earlier this year that England’s chief medical officer Professor Sir Chris Whitty and NHSE’s national medical director Sir Stephen Powis will oversee the review, which was prompted by ‘concerns from resident doctors’.

GPs and relevant organisations were asked to share their views as part of a call of evidence last month.

On PAs taking up training opportunities, the BMA said that doctors should be given ‘first right of refusal’ for any training opportunities ‘over non-doctors’.

The submission said: ‘Physician associates and anaesthesia associates (PAs and AAs) are taking training opportunities that could be offered to medical students or doctors.

‘A 2023 BMA survey found that almost 70% believed that training PAs and AAs somewhat or very negatively impacted doctors’ training.

‘The BMA supports doctors being given first right of refusal for any training opportunities over non-doctors.’

It also pointed to data showing that in 2019 there were 19,675 applications to specialty training and that this has risen to 33,108 in 2025.

It added: ‘Similarly, the competition ratio has risen from 1.9 in 2019 to 4.7 in 2024 and is likely to increase again for 2025.

‘Subsequently, many trainees are finishing the foundation programme and then becoming stuck outside of the training pathway, unable to secure a training post.

‘As specialty training places remain scarce, the BMA has called for a form of UK graduate prioritisation that also protects IMGs already working in the NHS.’

It comes after last month GP leaders criticised BMA resident doctors for supporting a ‘protectionist policy’ around specialist places, arguing that it disadvantaged IMGs. 

LMC representatives from around the UK voted in favour of asking GP committees to ‘distance themselves from the protectionist policy passed by the BMA resident doctors committee’.

The policy, passed in March by the BMA Resident Doctors Committee (formerly the Junior Doctors Committee) during a meeting, demanded that the UK governments ‘implement a specialty training recruitment process that lawfully prioritises medical graduates from UK medical schools’, to tackle high competition ratios.

As a result of this, later this month BMA representatives will vote on whether UK medical school graduates should be ‘prioritised’ ahead of international graduates for foundation programme posts and speciality training.

The BMA’s submission added: ‘Given the dire need for additional consultants and GPs, now and the future, denying thousands of UK doctors a training place to advance to this level after investing in the initial stages of their medical training makes little sense for either patient health needs or doctor
wellbeing and retention.’

It also said that GP registrars have highlighted ‘particular issues with study leave policy’.

‘Currently, these trainees do not have access to the “uncapped” study budgets that other residents do and (under the current policy) opportunities for learning are limited,’ the BMA added.

Pulse has contacted NHS England for comment.

The national review of postgraduate training will cover:

• placement options
• the ‘flexibility’ of training
• ‘difficulties’ with rotas, control and autonomy in training
• and the ‘balance’ between developing specialist knowledge and gaining a broad range of skills.

The call for evidence which the BMA responded to formed part of the first phase of the review, which will report ‘in summer 2025’. The second phase will make recommendations based on the evidence received.