Employing physician associates (PAs) ‘does not mitigate the need for more GPs’ and other practice staff, a health minister has admitted.
During a debate in the House of Commons on Wednesday evening, MPs discussed the role of PAs in the NHS, following controversies around a statutory instrument (SI) which will allow the GMC to regulate them.
The Anaesthesia Associates and Physician Associates Order 2024 will establish the GMC as the statutory regulator for AAs and PAs, meaning they set out the standards for their practice, education and training and operate fitness-to-practice procedures.
The order received approval by the House of Commons on 22 January after only being debated by the delegated legislation committee but will now go before the full chamber of the House of Lords, following concerns raised by doctors leaders.
Both the Doctors’ Association UK and the BMA had complained about the lack of debate in Parliament before the SI was approved and the DAUK said it was considering a legal challenge. The BMA took out adverts to bring attention to the low-key parliamentary process applied.
During the debate, health minister Andrew Stephenson said that the role of physician associates ‘is in no way a replacement for that of any other member of the general practice team’.
He said: ‘Physician associates can help to broaden the capacity and skills mix within a practice team by helping to address the needs of patients in response to the growing and ageing population, but let me be clear that the employment of PAs does not mitigate the need for more GPs, nor does it remove the need for other practice staff.’
Tory MP for Central Suffolk and North Ipswich Dr Daniel Poulter, a NHS consultant psychiatrist who tabled the debate, told MPs that while he worked alongside ‘some very competent’ PAs, there is ‘a high degree of variability in their training and skills’.
He also told MPs of an incident where he was ‘forced to directly intervene to prevent patient harm’ in the presence of a PA.
He said: ‘Only last year, I was forced to directly intervene to prevent patient harm following a paracetamol overdose by a patient who attended A&E.
‘The physician associate incorrectly informed me that they did not require N-acetylcysteine treatment because their liver function test was normal, in spite of the fact that they were over the treatment line as a result of their paracetamol overdose.
‘Of course, at that time, the patient’s liver function tests were normal, but they would not have been for very long. The consequences of that diagnostic decision by the physician associate could have been fatal.’
He added that the ‘key issue’ that many PAs ‘do not know or have the self-awareness’ to understand the limits of their knowledge and practice.
‘But this is perhaps understandable in a health system that fails to adequately regulate and indeed define its scope of practice,’ he added.
Dr Poulter highlighted some concerns around patient safety raised by the BMA and told the chamber the PAs have been employed in the NHS in roles ‘that stretch far beyond that original remit’ and in many cases ‘they appear to be working well beyond their competence’.
He added: ‘When consultant time is taken by supervising physician associates, that is to the detriment of training and supervising junior doctors. That has not yet been addressed or even considered in the NHS England workforce plan.’
Mr Stephenson responded that the role of a physician associate ‘is to work with doctors, not to replace them’.
‘Roles such as physician associates, who remain supervised by doctors, play an important part in NHS provision, and it is therefore right that we include a range of roles and skills in our multi-disciplinary teams that can offer personalised, responsive care to patients,’ he said.
In a letter to the Royal College of Physicians yesterday, NHS England reiterated its position on employing PAs.
It said: ‘PAs are not a substitute for doctors; they are trained to work collaboratively with other health professionals as supplementary members of a multidisciplinary team.
‘PAs must always work within a defined scope of competence; they are not independent medical practitioners and must be supervised appropriately by doctors.
‘Employers must ensure that the supervision of PAs is never to the detriment of doctors, and patients must always receive clear and accurate information about who is treating them and making decisions about their care.’
A BMA survey of 19,000 doctors has shown that 72% of doctors do not support the future regulation of PAs and AAs by the GMC.
Meanwhile, the GMC said it will add an alphabetical prefix in order to distinguish PA GMC numbers from those of doctors, however the Government has rejected calls to rename PAs.
It reads as if Dr Poulter has either been seriously misquoted, or does not understand the relationship between himself and his PA. Dr Poulter does not ‘work alongside’ PAs at all, he is responsible for supervising every action of His PA, ensuring that His PA is sufficiently trained and experienced for what Dr Poulter supervises His PA doing, and Dr Poulter tales full responsibility for all actions, inactions, and incorrect medical management decisions taken in the presence of his directly-supervised PA. Dr Poulter is responsible for ensuring adequate supervision of His PA, and also any other PAs with whom he comes into contact, although in the latter case he only needs to ensure that a medical colleague is supervising the other PAs sufficiently closely to prevent risks of harm to patients. So it should not have come up in Parliament.
Mr Stephenson will be well aware of the totally inadequate GMS funding offer for GPs, and of the unemployment crisis amongst newly-qualifies, salaried, and locum GPs, yet says that we need more GPs. This can only be because he thinks over-supplying the job market with even more GP-trained doctors, whilst continuing to reduce funding for practices, and promote use of cheaper staff as well, is because he wishes to impose even further pressure to reduce the remuneration to GPs, and push them all out of the NHS into private care. Can others not see this simple economic ‘supply and demand’ rule in use here?
What Dave said