Doctor leaders look at legal avenues to challenge PA legislation

The DAUK is considering a legal challenge of PA regulation plans, while the BMA has taken out adverts urging MPs to oppose the legislation.

The statutory instrument (SI) which will allow the GMC to regulate physician associates (PAs) passed the delegated legislation committee stage yesterday.

MPs on the committee questioned the Government’s failure to address concerns raised by ‘key stakeholders’ regarding patient safety, but a heath minister stressed PAs will ‘not replace’ doctors.

The Anaesthesia Associates and Physician Associates Order 2024 will establish the GMC as the statutory regulator for AAs and PAs, meaning they set out the standards for their practice, education and training and operate fitness-to-practice procedures.

Next, the SI, which refers to secondary legislation to an existing Bill, will need final approval from MPs in the House of Commons and will also be heard by the House of Lords.

But doctor leaders remain concerned about the regulations, which they have said will create confusion for patients by creating the impression that a PA is a form of doctor.

The DAUK said it is working with Anaesthetists United and ‘a leading KC’ to ‘ascertain whether there are causes for any legal challenges’.

DAUK co-chair Matt Kneale said: ‘The rollout of PAs and AAs must be paused given the amount of uproar there has been and given the amount of patient safety concerns that have been raised across the country.

‘Legislation that potentially has huge repercussions to the future health of the country should be debated in the main chambers of Parliament and not hidden away to avoid proper scrutiny.’

‘Statutory instruments are meant for technical pieces of legislation, and certainly weren’t intended for complex, controversial legislation like the regulation of potentially dangerous medical replacements.

‘DAUK is now calling on the House of Lords to really scrutinise this legislation before it’s passed into law, particularly given the serious concerns expressed by doctors over the past few months.’

An advert taken out by the BMA in today’s Guardian and on social media urged MPs to reject the legislation so as to no ‘blur the lines’ between doctors and PAs.

‘In medicine, confusion can be fatal,’ the ad warned.

‘PAs are not the same as doctors, and blurring the lines can have tragic consequences for patients who think they have seen a doctor when they have not,’ it adds.

In yesterday’s legislation committee meeting, health minister Andrew Stephenson said that ‘regulating these professions will help to increase the contribution that AAs and PAs can make to the UK healthcare sector, whilst improving patient safety and professional accountability’.

Their role is to ‘to work with doctors and not to replace them’ and they are ‘distinct, complementary and valued professionals’ who can free up doctors and consultants to spend more time ‘on complex clinical duties and decisions around patient care’, he said.

Shadow health minister Karin Smyth said: ‘There has been clearly a delay in getting to this point, and regulation is long overdue. These roles do play an important role as part of a flexible and diverse workforce, but they should never be seen as a replacement for doctors. I’m pleased that the minister has made that clear.

But she added that the Government should have addressed the concerns at an earlier stage

She said: ‘There are a number of concerns raised with me and other colleagues about the detail of this order and its implications for safety concerns that really should have been addressed earlier.’

‘It is important that the Government listens to and crucially works with patients and professionals and address these [concerns]’, she added.

Labour MP for Worsley and Eccles South Barbara Keeley, who raised the issue around PAs’ role following the death of her constituent Emily Chesterton, also address the committee.

She said: ‘There is much talk amongst GP locums of work drying up, possibly due to increasing use of the additional roles reimbursement scheme staff, which include the associate roles, to fill vacancies.

‘These are very much cheaper than employing GPs and last week, there was considerable disquiet about a Surrey practice that made its salaried GPs redundant due to new ways of working.

‘I am seriously concerned that many intelligent, enthusiastic and valuable people in training or working as GPs are looking at options outside the NHS, outside medicine, or even outside the country.

‘I’m sure the minister would agree that it’s deeply concerning when the UK already faces intense competition in other countries to retain our doctors.’

Earlier this week, the Royal College of Physicians of Edinburgh became the latest stakeholder to set out its position on PA regulation.

Among recommendations, it called for the ‘renaming of the profession to the internationally recognised term “physician assistant” to avoid confusion for the public with existing medical roles such as Associate Specialist’.

‘Patients and families should know the capability of those who meet and treat them,’ the College said.

‘Clear guidance regarding the scope and limits of the clinical practice of physician associates is essential,’ the position statement added.

‘We are deeply concerned that “scope creep” in clinical practice will rapidly develop if this does not occur, with significant potential concerns for standards of patient care and patient safety.’

The College said that ‘if the GMC becomes the regulator, the register they hold must clearly and simply differentiate doctors from physician associates’.

Last month, the GMC said it would add an alphabetical prefix in order to distinguish PA GMC numbers from those of doctors, however the Government rejected calls to rename PAs.

Last month, the BMA warned the proposed legislation ‘will add further, dangerous confusion’ with patients being left under the impression that they have seen a doctor when they haven’t, and over 10,000 doctors wrote to their MP to urge them to oppose the change.

Today, BMA council chair Professor Phil Banfield said: ‘Doctors have been raising their voices in protest at this potentially dangerous move for a long time. The BMA has heard 87% of its members report in a survey that the way PAs are currently used in the NHS is a danger to patient safety.

‘Given how understaffed and intensely pressurised the clinical environment can be, it is not always possible to offer the support and supervision that PAs need to practice safely, which is not right for the PAs as well as patients.’

In July, Pulse reported on a GP practice’s decision to stop employing physician associates after an incident of ‘poor quality’ care contributed to the death of a patient.

Dr Banfield said: ‘Last year saw stories in the media showing the grave consequences to patient safety when members of the public think they have seen a doctor when they haven’t.

‘Now MPs have the chance to listen and act on doctors’ very clear warnings. They don’t have to wave through the Government’s ill-thought through plans, plans that have taken shape largely outside of the public’s knowledge or control.

‘If they lodge their opposition and commit to a GMC that remains the sole regulator of doctors, we can retain the confidence of patients that they are being seen by fully qualified medical professionals, and that when they need a doctor that is who they will be seeing.’

The BMA’s GPC for England has called for an immediate pause on all recruitment of PAs across general practice and PCNs.