Over half (55%) of doctors think physician associates (PAs) increase their workload, while only a fifth (21%) found it decreased, according to a large BMA survey.
The doctors’ union surveyed 19,000 doctors on their experience of working with PAs and anaesthesia associates (AAs), finding Government promises they would free up time void.
BMA Council chair Professor Phil Banfield said that while NHS England ‘tells us that PAs support doctors in the diagnosis and management of patients, supposedly giving doctors more time to deliver the high-quality care only they can give’, the ‘reality appears to be the exact opposite’.
‘Too many doctors are telling us that working with PAs is instead draining their time and energy. The responsibility for signing off prescriptions and ensuring the PAs are working within their proper scope of practice quite rightly falls on the supervising doctor, but also those doctors working alongside them; as scope has inappropriately crept ever further it has made far more work for doctors than it has saved.’
Survey question in full
In general, has the employment of PAs or AAs in places you have worked reduced or increased your workload?
|
ANSWER CHOICES |
Number |
Percentage |
|
Increased a lot |
2,909 |
21.8 |
|
Increased a little |
4,488 |
33.6 |
|
No change |
3,148 |
23.6 |
|
Decreased a little |
1,967 |
14.7 |
|
Decreased a lot |
832 |
6.2 |
Source: BMA Doctors’ survey – conducted 9-27 November 2023
The same survey previously revealed that 87% of doctors said the way PAs and AAs currently work in the NHS was always or sometimes a risk to patient safety.
The survey also found:
- 86% of doctors reported that they felt patients were not aware of the difference between these roles and those of fully qualified doctors, showing the immense scope for patient confusion about the level of care they are receiving.
- Nearly 80% of doctors stated that they were occasionally or frequently concerned that a PA or AA they worked alongside was working beyond their competence.
The BMA has already called for an immediate pause on recruitment of PAs and AAs on the grounds of safety concerns.
The BMA’s GPC for England also called for an immediate pause on all recruitment of PAs across general practice and PCNs.
The statutory instrument (SI) which will allow the GMC to regulate physician associates (PAs) received approval by the House of Commons last week.
The Anaesthesia Associates and Physician Associates Order 2024 will establish the GMC as the statutory regulator for PAs, meaning they set out the standards for their practice, education and training and operate fitness-to-practice procedures.
The next step for the piece of legislation will be scrutiny by the House of Lords.
Professor Banfield said: ‘The House of Lords will soon have a chance to oppose damaging legislation that aids that blurring of lines by regulating PAs under the GMC, the doctors’ regulator rather than the more appropriate Health and Care Professions Council.
‘The Government and NHSE should be instead ensuring that PAs return to their original purpose of supporting, not replacing doctors, so that doctors can get on with utilising the diagnostic and treatment skills they have spent so long at medical school gaining their expertise in.
‘Their scope should be strictly defined and, to ensure patients are not confused, the title returned to the more accurate “physician assistant” – then they can play their valuable role in supporting the delivery of NHS care safely.’
The Doctors’ Association UK has said it is considering a legal challenge of the regulation plans, while the BMA took out adverts urging MPs to oppose the legislation.
And the BMA’s doctor survey showed:
- 72% of doctors do not support the future regulation of PAs and AAs by the GMC.
- 80% of doctors felt that PAs and AAs would be more appropriately names ‘assistants’ than ‘associates’, as they were in the past.
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.
In full: The BMA’s demands regarding PAs
-
There should be an immediate halt to the recruitment of Medical Associate Professionals (MAPs) in the UK, including PAs and AAs on the grounds of patient safety (as called for by the BMA in November 2023). Long term expansion plans for the roles must be paused.
-
All legislators must oppose the Anaesthesia Associates and Physicians Associate Order 2024. The House of the Lords must vote against it in the days ahead. MAPs should be regulated by the Health Care and Professions Council, as called for by the BMA in response to the original DHSC consultation on regulation in 2017.
-
The titles should revert to physician assistant and physician assistant (anaesthesia) / anaesthesia assistant to avoid public confusion.
-
The scope of the roles should be strictly limited to the original intention of supporting doctors with administration tasks and a defined range of low-risk clinical tasks
-
The UK has a severe shortage of doctors. This should be urgently addressed by fully funding increased specialty training places and opening Additional Roles Reimbursement Scheme (ARRS) funding to GP recruitment.
-
Training opportunities for doctors must be protected. Doctors and medical students should be prioritised for all clinical and training opportunities. This means that within a department/practice any procedure, clinic opportunity, or other structured learning event must be offered to doctors first before being offered to non-doctor staff. The training of physician associates and anaesthesia associates must not compromise the training of current or future doctors
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MAPs should not be utilised on any level of doctor rota or perform, train in, or consent to invasive or life-threatening procedures. They should not be receiving any specialty referrals or be in roles requiring them to give specialty advice. They should not make unsupervised treatment decisions or management plans. They must work under direct on-site supervision at a level commensurate with their qualification and not be using on-the-job experience to work beyond their formal level of qualification.
Source: BMA
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READERS' COMMENTS [10]
Please note, only GPs are permitted to add comments to articles
You’ve got your own clinic to run. PAs keep disturbing you increasing the stress and clinical risk and passes the bug to you, suddenly you realize you are actually doing 2 clinics instead of 1. No thanks. They are regulated by the GMC so they should sort themselves out.
We have PAs. The first 6-18months is net loss due to the supervision time. After 18months of mentoring and supervision they are quite helpful (only 15mins of GP time required per half day of PA) but then they often leave to somewhere better paid. They have a place but really I would equate the first 1-2yrs as proviolsional bit like F1/F2 Dr’s are. We keep the PAs as funded by ARRS money otherwise they would not be cost effective.
How many P.A.s will stay if Appraisal and Revalidation are imposed on them?———-just a thought
The only solution that practices have had, when they have come under scrutiney due to patinet harm (with the Partners taking the responsibility even if they had nothing to do with the patients hurt), is to fire all PAs . As the risk remains when any are employed of them working well outside their remit and not being a suitably trained to do the job of a doctor. Its a big no from me and all I work with.
Bears Sh88 in the woods again then.
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Good old days.
I find the current demonisation of PAs extremely distasteful.
Most are hard working clinicians who saved many a Partnership from oblivion several years ago at the height of the recruitment crisis when expensive adverts for GPs saw no applicants.
Now that the Locum gravy train has stopped, PAs are seen as convenient scapegoats, and are being unfairly berated as unfit to do the job.
The truth is that a decent PA, properly trained and supervised, can deal with relatively simple minor illnesses, triage urgent cases, and the GP debrief time is a small price to pay for a vital and much appreciated (by some of us) commodity.
And Pharmacists; “we have found 58 patients who need their emollient brand changing . . . “.
And somebody is paying for them £50k per year for this nonsense.