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BMA urges NHS England to ‘immediately halt’ expansion of PAs

BMA urges NHS England to ‘immediately halt’ expansion of PAs

The BMA has called on NHS England to ‘pause’ the planned expansion of physician associates (PAs) and to adopt the union’s scope of practice nationally. 

In a letter sent today, BMA Council chair Professor Phil Banfield urged NHS England to ‘take steps to immediately halt’ the expansion of PAs until the medical profession is satisfied that ‘sufficient safeguards’ are in place. 

Last year’s NHS long-term workforce plan pledged to increase PA training places in order to reach a total workforce of 10,000 PAs by 2036 – currently, there are roughly 3,500 PAs working across primary and secondary care. 

Professor Banfield also asked NHS chief executive Amanda Pritchard to use the BMA’s recently published PA scope of practice ‘as a national tool for the NHS’ as it employs medical associate professionals (MAPs).

In March, the doctors’ union set out ‘first of its kind’ guidance for how PAs should work safely in GP practices and hospitals, arguing that these professionals should never see ‘undifferentiated’ patients

Today’s letter said there has been an ‘absence’ of nationally agreed PA guidelines ‘for too long’, and the BMA’s scope of practice aimed to ‘fill this void’.

Professor Banfield said: ‘The need for such immediate guidance has been asked for by frontline doctors. 

‘Our surveys of the current state of PA working practices have exposed large numbers of situations in which PAs are practising outside expected competencies.

‘The lack of universal quality assurance or a national governance mechanism for assessing post-qualification competencies makes it difficult for doctors to satisfy their own duties under the GMC’s Good Medical Practice. Hence, our intervention.’ 

The BMA’s GP Committee England has previously called for an immediate pause on all recruitment of physician associates across general practice and PCNs.

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Now, the BMA has highlighted the medical profession’s ‘significant patient safety concerns’ with the projected expansion of PAs outlined in the long-term workforce plan.

The union drew attention to the recently published NHS operational planning guidance for 2024/25. which asked ICBs to deliver ‘their share of the agreed increase’ to education places for physician associates. 

Professor Banfield wrote: ‘Any objective set by NHS England and the wider system to press ahead with the expansion of PAs and AAs would be in opposition to the overwhelming view of the medical profession. 

‘We ask, therefore, that you take steps to immediately halt the planned expansion of these roles until there is agreement with the medical profession that sufficient safeguards are in place to protect the public.’ 

He also said a ‘full independent investigation’ into the ‘scandal’ of hospital trusts replacing doctors with PAs on medical rotas, arguing that NHS England should take this up if the Government ‘fails to do so’. 

In response to the BMA’s letter, NHS England said it has been ‘clear’ that PAs ‘must always work under the supervision of a doctor and within the scope of their practice’.

A spokesperson said: ‘Existing guidance supports individual trusts and practices to ensure that physician associates are working safely and effectively within their scope of practice, and this is being reviewed in partnership with Royal Colleges and other stakeholders, taking on board feedback from the GMC consultation.’

Last month, a representative body for PAs warned GP practices implementing the BMA’s scope of practice of potential legal consequences, claiming that doing so could constitute grounds for an employment tribunal.

Following the publication of the BMA’s document, NHS England put out new guidance on PAs working in general practice which stipulated that GP practices must have a policy to restrict PA access to prescribing. 

Earlier this month, the doctors’ union claimed it had been ‘excluded’ from stakeholder discussions on the future of physician associate roles. 



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

Shaun Meehan 18 April, 2024 12:37 pm

The BMA are not acting in my name. Their scapegoating of PAs ignores the fact that nurse practitioners have been working for years in similar roles in primary and secondary care-and they don’t take a rigorous national examination. The first ‘person’ our elderly see in a practice are other elderly in a queue at 7.30am desperate for any appointment with anyone who will listen. The BMA is completely out of touch with the reality of our NHS. We need to work together with PAs, nurses and our team to make things better for patients not cause extreme distress to colleagues and students who deserve better.. Leadership is needed here now before the BMA destroy the reputation of all doctors.