Nine in ten doctors think PA model poses patient safety threat

The majority of doctors believe that the way physician associates (PAs) work ‘present a significant risk to patient safety’, a BMA survey has found.

The doctors’ union said it received over 18,000 survey responses which showed that doctors are reporting ‘overwhelming concern’ about patient safety due to ‘the current ways’ of employing PAs and anaesthesia associates (AAs).

In all, 87% of doctors who took part said the way AAs and PAs currently work in the NHS ‘was always or sometimes a risk to patient safety’ and 86% reported that they felt patients ‘were not aware of the difference between these roles and those of doctors’.

Earlier this week, the Government confirmed it will lay legislation this week to allow the GMC to begin the process of regulating PAs and AAs.

But the BMA raised concerns about the legislation saying it thinks this ‘will add further, dangerous confusion’ with patients being left under the impression that they have seen a doctor when they haven’t, and asked doctors to write to their MP to challenge the decision.

The union said that over 10,000 doctors have so far written to their MP to urge them to oppose the change.

One GP who responded to the BMA survey said: ‘I work as a long-term locum in a GP practice. Part of my role is to supervise [the PA].

‘[They] are without doubt the most worrying person I have ever had to supervise in over 30 years as a GP.

‘Their basic knowledge is poor, they are unable to present a coherent history and examination, unable to formulate a differential diagnosis. Patients frequently believe they have seen a doctor.

‘I will no longer sign off on any prescription for the PA without reassessing the patient myself. It is only a matter of time before a patient comes to serious harm at their hands.’

BMA council chair Professor Philip Banfield said: ‘Doctors have been growing more and more worried about the consequences of the Government’s plan to expand the number of PAs and AAs in England. Here, at last, are numbers that show the shocking scale of that concern.

‘If well-defined, associate roles can play an important part in NHS teams, but the Government has refused to give associate roles that definition.

‘Patients deserve to know who is treating them and the standard of care they are going to receive.

‘By blurring the lines and allowing a situation where PAs can act beyond their competence without the public understanding what they are qualified to do, both professions are demeaned and risk losing crucial public trust.

‘This week Government has continued to press ahead with plans to regulate PAs as if they are doctors – using the GMC.

‘At every stage we have been clear that the GMC is the wrong regulator for medical associate professionals: it is the body for regulating doctors, which these staff are not.’

The BMA’s GPC for England also 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.

Emily Chesterton died in November 2022 after suffering a pulmonary embolism. She had made an appointment at the Vale Practice in Crouch End, in North London, after feeling unwell for a few weeks and reported calf pain and feeling breathless, and saw a physician associate at the practice.