Health Education England (HEE) and NHS England have warned BMA that its stance on medical associate professionals (MAPs) is impacting NHS relationships and patient confidence.
HEE published an open letter to the BMA in response to the union’s call to halt recruitment of MAPs – which includes physician associates (PAs) working in general practice – until regulation is in place.
The BMA Council passed a motion calling for a halt to recruitment of MAPs two weeks ago, on the grounds of patient safety (see box).
This followed a previous motion to that effect from its GP committee for England earlier this month.
Proposing to bring forward a planned meeting with the BMA to discuss the matter, HEE’s letter said: ‘This continuing public discourse around MAPs is impacting relations between your members and their MAP colleagues, the health and wellbeing of MAPs already working in the NHS, and potentially the confidence of patients.’
‘We are keen to work together to address these issues as soon as possible in the interests of patients,’ it added.
HEE chief workforce, training and education officer Dr Navina Evans and NHS England medical director Sir Stephen Powis argued in the letter that evidence shows ‘MAPs are safe’, and that they ‘increase the breadth of skill, capacity and flexibility of teams’ and reduce workload pressure on other clinicians.
‘These internationally recognised roles have been in the NHS for 20 years as part of multi-disciplinary teams under appropriate supervision, mostly by doctors,’ they said.
‘They perform specific aspects of patient care and, based on case studies, clinical and professional engagement and literature reviews, are proven to increase the effectiveness of multidisciplinary teams.’
Any issues of patient safety identified resulting from MAPs ‘must be addressed in the same way we would any other profession’, the letter added.
And it reiterated ‘next steps’ around the upcoming regulation of PAs, including:
- Work with partners to develop curricula, capability and career frameworks, CPD, assessment and appraisal standards, and supervision guidance.
- Continue to ensure expertise, infrastructure and leadership so MAPs can be effectively trained and integrated into teams, through national standards, defined scope of practice, and assessment of educational capacity.
- Remind employers about their responsibility to ensure effective and appropriate supervision of MAPs, that MAPs are shaped within an acceptable scope of practice, and they work within established guidelines.
- Continue work with the Academy of Medical Royal Colleges and individual professional bodies to respond to further concerns or issues.
The Department of Health and Social Care (DHSC) is currently preparing legislation for the regulation of both PAs and anaesthetic associates (AAs), after closing a long-awaited consultation which suggested PAs could get prescribing rights in order to relieve pressure on GPs.
This legislation is due to be laid before Parliament by the end of this year, with GMC regulation expected to begin by the end of 2024.
Last week, the GMC called on doctors to show ‘multi-disciplinary respect’ towards healthcare professional colleagues who are not doctors, after it asked NHS England to address the perception that there is a ‘plan for health services to replace doctors with physician associates’.
In full: BMA’s position on MAPs
Motion passed at BMA Council meeting 15 November 2023:
This Council is concerned that, without a clear scope of practice and an appropriate regulator, medical associate professionals (MAPs) present a clear risk to patient safety. Council instructs the BMA to:
1. Call for UK governments to institute an immediate moratorium on all recruitment and expansion of MAPs until such a time that their scope of practice is properly and nationally defined, agreed, and quality assured
2. Oppose the regulation of MAPs by the General Medical Council (GMC) and calls on the UK Government to regulate MAPs separately from doctors
3. If the GMC does regulate MAPs, demand a separate register and a separate format for GMC registration
READERS' COMMENTS [5]
Please note, only GPs are permitted to add comments to articles
No, HEE, it is not the BMA’s stance supporting truthfullness that is adversely impacting patient confidence in unqualified people who practice Medicine, it is the fault of the HEE and RCP renaming of unqualified Medical Practitioners in a way that leads to confusion about their qualifications, which is harming patient confidence in these allied health professionals trying to practice Medicine without Medical Qualification. Straighten out the naming conventions and remove the deliberate attempt to cause confusion, and the patients will increase in confidence.
So a new acronym “MAPs” blurring the boundaries even further. This continuing public discourse around MAPs use in general practice in particular regarding managing UNDIFFERENTIATED illness is matter of serious safety concern and rightly so should impact the confidence of patients in these roles. This is far more important that any damage to said colleagues egos so HEE should stop attempting to stifle/cancel this argument. HEE have a vested interest in the funding and training of allied roles so they clearly have a conflict of interest. The ground level truth is that in dealing with undifferentiated illnesses, these colleagues do not know what the do not know as they have not have medical training to GP level. Supervision in ALL cases is almost impossible and more time consuming than having highly trained autonomously working fully qualified GPs. So this direction is a risk which falls on the “supervising” GP. I have no problem with these roles if they are fully supervised in specific roles within tight boundaries but not for managing undifferentiated illness. This experiment makes a mockery out of 10 years of challenging GP training and is already adversely impacting the livelyhoods of GP colleagues. Why should anyone bother to train as a GP now in the UK?
All of the “next steps” seem to be my responsibility as a GP Partner. Funny – I don’t remember having any say in the first steps down this path…..
Employ at your own risk. You hold the can for all mistakes made , whether you saw the patient or not. GmC, NHSE , CQC and long line of lawyers will make a fortune from you and our risk your licence as well as multiple jeopardy. I would never employ one.
MAPs,PAs,GPAs, and a myriad of job titles ending in Practitioner, with a range of training and qualifications can be confusing enough for a clinician trying to get to grips with a complex patient who has had a multiple consultations and contacts. What chance do patients have? They have every right to be concerned.