BMA calls for inquiry into PAs replacing doctors on rotas

The BMA has called for an independent inquiry into the use of physician associates (PAs) on medical rotas in place of doctors.

The union said that health secretary Victoria Atkins must launch the investigation ‘to get to the bottom of the scale’ of the issue across the NHS, as doctors have been reporting instances where gaps in medical rotas are being filled by PAs.  

This is happening on top of NHS England ‘investing heavily’ in the use of PAs in primary care, ‘instead of qualified experienced doctors’, the BMA added.

On Friday The Telegraph reported  on leaked rotas from more than 30 hospitals showing physician associates taking on doctors’ shifts.

This coincided with new NHS England guidance to ‘emphasise that PAs are not substitutes for doctors’, as they are ‘supplementary members’ of the team and they ‘should not be used as replacements for doctors on a rota’.

BMA chair of council Professor Philip Banfield said: ‘We know from our members’ experiences that hospitals are putting physician assistants on medical rotas, in place of medically qualified doctors.

‘This is on top of NHS England investing heavily in the use of physician associates in primary care, instead of qualified experienced doctors.

‘In our view, Victoria Atkins now has a duty to patients and a duty to medically qualified staff – doctors – to establish how widespread this practice is and more importantly, stop it.’

He said that ‘anecdotal evidence’ from BMA members also indicates that ‘staff who are not medically qualified are being used in place of ones who are’.

‘We know the NHS is experiencing is a devastating workforce crisis, but this is not the way to solve it,’ Professor Banfield added.

Earlier this month, the BMA published new scoping guidance saying that PAs should never see ‘undifferentiated’ patients in a GP setting.

BMA GPC England chair Dr Katie Bramall-Stainer told Pulse: ‘The BMA’s guidance is clear that it is not safe for medical associate professionals (MAPs) to see undifferentiated undiagnosed patients.

‘This guidance is helpful, as not having a defined scope of practice has contributed to confusion around what MAPs can and cannot do. Now we have guidance, we would commend it to practices, PCNs and supervising GPs.

‘It is clear that the PCN contract specification for 2024/25 must be updated to reflect this, and we shall be putting this to NHS England and the DHSC, and publishing our own guidance for practices and PCNs next month.’

The BMA said it is keen to work with NHS England and the Royal Colleges to implement the scoping guidance, so that doctors, other medical staff, and NHS trusts across the country ‘have a shared understanding of the PA role’.

With this guidance in place, anyone seeing a PA being given responsibilities ‘inappropriate for their training’ will have ‘firm grounds’ to challenge it and ensure that standards of patient safety are upheld, the union said.

Professor Azeem Majeed, head of the Department of Primary Care & Public Health at Imperial College London, said he would support an independent inquiry into how PAs are working in hospitals and also in general practice.

He told Pulse: ‘It’s very concerning to hear about the use of PAs on medical rotas in NHS hospitals. PAs cannot prescribe or order radiological investigations, so this will limit how effectively and safely they can work in this capacity, where timely prescribing and diagnostic procedures are essential.

‘Such an inquiry would provide valuable insights and evidence-based recommendations to guide policymakers, healthcare leaders, and professional bodies in making informed decisions about the role of PAs in the NHS.’

Surrey GP partner Dr Dave Triska told Pulse that an inquiry ‘absolutely needs to happen’ as doctors were ‘repeatedly assured’ that PAs are not replacing doctors.

He added: ‘The botched rollout of PAs is now causing considerable distress to that cohort of PAs now in practice, as doctors rightly demand to have safe scope of practice for them.’

Tower Hamlets GP Dr Selvaseelan Selvarajah also welcomed the BMA’s call for an independent inquiry.

He told Pulse: ‘PAs are not doctor replacements and must always be in complimentary roles and work under the supervision of a senior doctor at all times.

‘So, I would welcome BMA’s call to clarify and address the concern about PAs embedded in doctors rotas.’

Legislation bringing the PA role under GMC regulation has recently passed through Parliament, and will come into force at the end of this year, despite attempts to kill it. 

But earlier this month, the RCGP changed its stance on the regulation after a vote argued the GMC is the wrong body to take on the job.

PAs have been around since 2003, however the role has expanded over recent years, and last year NHS England committed to increasing PA training places to over 1,500 by 2031, bringing the workforce to 10,000 by 2036.

Last year, the BMA called for an immediate pause on all recruitment of physician associates across general practice, and a survey found that almost 90% of doctors think PAs pose a patient safety risk.