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Plans to increase PA roles in Scotland must be halted, says BMA

Plans to increase PA roles in Scotland must be halted, says BMA

Government plans to ‘gradually increase’ the number of physician associates (PAs) working in the NHS in Scotland must be halted, the BMA has said.

The union said that the Scottish Government issued a letter to ‘a wide range of stake holders’ on the role of medical associate professionals (MAPs), including PAs, which pointed to 2016 guidance on the roles and also mentioned a ‘gradual increase in NHS Scotland’s MAPs workforce’.

The BMA responded to the letter saying that the Government ‘must halt’ any PA expansion plans as it fears the roles will be used to ‘paper over the cracks’ of poor workforce planning.

In a post online, BMA Scottish Council chair Dr Iain Kennedy said: ‘It must be taken as something of a step forward that the Scottish Government is at least having the discussion and indeed reiterating existing, if somewhat dated guidance, however, there are still clear and substantial concerns in the letter and the steps it sets out.

‘Prime amongst BMA Scotland’s concerns is the suggestion of an expansion of these roles while such uncertainty about them remains.

‘It’s described in the letter as a “gradual increase in NHS Scotland’s MAPs workforce”– but now is not the right time to make that step.

‘Indeed, we remain to be convinced such an expansion will at any point be justified.’

He said that BMA Scotland is ‘absolutely clear’ that increasing use of anaesthesia associates (AAs) and PAs is ‘not the right action’ or ‘in any way acceptable’ at this stage.

He added: ‘The Government must clarify what the language in the letter means urgently – including what is meant by a gradual increase – is this in absolute numbers of MAPs, the roles they can undertake or both?

‘Our fears remain that this planned expansion will be used to paper over the cracks of the frankly dire medical workforce planning that has left us in the doctor vacancies crisis we currently face across Scotland.

‘On that basis we believe they must halt any PA and AA expansion plans while the work outlined in the letter is undertaken and the full views of stakeholders sought at the very least.’

BMA Scotland is currently gathering views from doctors on the regulation of PAs and AAs in order to finalise its position.

It also said that consideration must be given to PA and AA job titles to make sure they are sufficiently distinct from doctors, and that this is a change that the BMA in Scotland believes is necessary.

An online portal has been set up by the BMA to learn more about the extent of concerns and the experiences of doctors working with MAPs and of patients receiving care.

BMA Scotland will also write to the cabinet secretary for NHS Recovery, Health and Social Care to seek clarification on the expansion of the roles.

A Scottish Government spokesperson said: ‘Physician associates are an important and valued part of the NHS Scotland workforce. 

‘As part of our National Workforce Strategy for Health and Social Care and our ongoing aim to ensure the workforce is fit for the future, the Scottish Government will continue to consider how these roles can be utilised to best effect, supervised and supported by senior medical professionals throughout their training and subsequent deployment.

‘We are clear that our approach in this space must be evidence-based.

‘We are also working with the Department of Health and Social Care and a range of stakeholders to bring physician associates and anaesthesia associates into regulation by the General Medical Council.

‘This will for the first time introduce consistent standards for education and behaviour and UK-wide professional accountability to these roles.

‘As new regulated roles are devolved by default, the necessary legislation is subject to scrutiny by both the UK and Scottish Parliaments.’

It comes after the BMA’s GP Committee for England called for an immediate pause on all recruitment of PAs across general practice and PCNs.

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.

Last week, over 2,000 doctors expressed ‘grave concerns’ about the upcoming regulation of PAs in an open letter to the GMC.


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