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Almost 14k doctors urge political leaders to address PA ‘scandal’

Almost 14k doctors urge political leaders to address PA ‘scandal’

Almost 14,000 doctors have signed a BMA letter to the major political party leaders urging action on physician associates. 

The letter, sent ahead of Thursday’s general election, expressed ‘grave concern’ about the deployment of associate professionals, and warned that PAs are working ‘in practical terms, as GPs’. 

It called for the next government to take action by implementing a ‘national safe scope of practice’ and an bringing an ‘end to widespread doctor replacement and unemployment’, while arguing that so far politicians have been ‘asleep at the helm’.

The letter was sent to Labour’s Sir Keir Starmer, the Conservatives’ Rishi Sunak and the Liberal Democrats’ Sir Ed Davey. 

The BMA claimed that the ‘worrying trend in general practice funding’ has led to ‘role substitution’, with GPs effectively replaced by physician associates.

It blamed the additional roles reimbursement scheme (ARRS) which has ‘incentivised’ practices to employ PAs while ‘denying the use of these funds to employ actual doctors’.

‘The contractual expectation is that physician associates will see undifferentiated patients and act as a first point of contact. In reality this permits physician associates to, in effect, work as a GP,’ the letter said. 

Party leaders were also warned of unemployment concerns among GPs, with many struggling to find work – a fact which even NHS England has acknowledged. 

On patient safety, the union said it has received ‘hundreds of individual reports’ of issues, such as PAs and other associates ‘failing’ to clarify their role to patients, and some ‘performing procedures beyond their level of training’.

BMA council chair Professor Phil Banfield said doctors are ‘demanding’ that political party leaders take action on the ‘patient safety scandal threatening to engulf the NHS’. 

He continued: ‘Policymakers have been asleep at the helm for years, letting us drift directly into a dangerous situation where the skills of doctors are being demeaned, devalued and even replaced. We will not let the new government formed on Friday say it was not warned.’

Professor Banfield said the letter on PAs gives politicians a ‘very clear’ way to ‘reassure the public that the NHS is safe in their hands’, given that the state of the NHS has ‘dominated’ the election campaign.

BMA key asks to political party leaders

  1. Implementation of a national safe scope of practice for MAPs underpinned by robust evidence and regulation.

  2. Amending the Anaesthesia Associates and Physician Associates Order 2024 so that MAPs are regulated by a more suitable regulator using titles that protect patients from being misled. 

  3. An end to widespread doctor replacement and unemployment.

  4. An urgent review of the long-term workforce plan to determine how MAPs can be safely utilised to the benefit of patients and healthcare systems, as well as the numbers required, underpinned by evidence.

  5. A halt to any current plans to provide MAPs with prescribing responsibilities.

  6. An independent inquiry to determine how widespread doctor substitution has become, and how this scandal has been allowed to develop without sufficient regard for patient safety. 

Source: BMA

The letter also highlighted the inefficiency of using PAs, since doctors have to take on ‘additional responsibility’ for supervising them, which is an issue Pulse explored in its recent investigation.

This is ‘contrary to the promise’ that physician associates would ‘free up doctors’ time’ by taking on simpler tasks, leaving doctors with more time for complex work, according to the BMA.

Last month, the RCGP urged GP practices across the UK to ‘halt’ recruitment of PAs until the profession is regulated by the GMC later this year.

This was based on ‘concerning findings’ from the college’s recent consultation, which found that 80% of GPs believe the use of PAs in general practices has a negative impact on patient safety.



Please note, only GPs are permitted to add comments to articles

Larry LameLamb 3 July, 2024 2:08 pm

Don’t tell me they’re going to ignore 14 thousand Drs. Just watch..they will ignore this letter and then run to blame Drs every time the appallingly managed NHS screws up. The NHS has been turned into a political PR vehicle. It’s not about health care anymore. It’s about the egos of Politicians and media sound bites. It all stinks – along with the GMC, another politicised sham

Shaun Meehan 3 July, 2024 3:19 pm

Some reality is needed. Our patients queue at 7.30 to see anyone in the practice. Most doctors do not want partnership responsibilities and the relatively few PAs projected to work ahead will only ever be 10% of doctor numbers many years away. Nurse practitioners are already more than 10% doctors and I don’t hear the BMA screaming at them in the same way. I am surprised that MAPs have not considered legal redress for the assaults on their careers and it is a testament to their professionalism that they carry on working and looking after our patients under such pressure. Thank you for what you do if you read this- you deserve better from doctors who should know the effect it has on your mental health.

Anony Mouse 3 July, 2024 11:47 pm

I agree SM. The scapegoating of PAs is most unfair. I think some people are forgetting who employs PAs – it’s GPs ! And all the unemployed GPs, who is it not employing them, it’s GPs again. The real terms reduction in the core contract is not the fault of PAs.

A B 4 July, 2024 9:02 am

PAs are not being scapegoated. That is missing the point. Pharmacists aren’t being scapegoated and nurses aren’t being scapegoated. The problem is using these roles to replace GPs. The problem is preventing GP practices from employing GPs. PAs are in the spot light because they are ‘relatively’ new and it appears that some people administrating the NHS are behaving like the role was specifically created to replace GPs. And its not that nobody wants to be a partner thats tue problem, its WHY nobody wants to be a partner? That is the problem. It isn’t the fault of flaky young GPs..its an entirely rational phenomenon because the role has been made virtually impossible. Thats what needs to be fixed. Its not your colleagues fault for being ‘lazy’ They’re simply using their heads! Screw your head on please. Coming back to PAs, the problem is the exclusion of GPs not the existence of PAs. (Although some would cynically argue their creation is virtually asking for what we have got) Divide and rule..don’t fall into the trap.