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PAs aren’t the enemy – this is a systemic issue

PAs aren’t the enemy – this is a systemic issue

Editor Jaimie Kaffash argues that the toxicity of the debate around physician associates is detracting from the structural problems

I’ve always believed that ‘punching down’ is reprehensible. And the whole debate around physician associates does make me feel uncomfortable.

I say this having run a seven-part analysis and investigation into the role of physician associates in general practice – the vast majority of which is critical of the move to increase their number.

I stand by all our conclusions: that PAs are being used as cheaper alternatives to GPs; that their lesser training poses clinical risks, both in terms of missing red flags and practising more defensive medicine; and that they aren’t actually particularly efficient in reducing GP workloads or providing patient care.

But I also agree with shadow health secretary Wes Streeting – this debate has become toxic. This is, as he says, due to a ‘failure of leadership and not listening to doctors and allowing this toxic culture to erupt’.

This toxic culture has led to a focus on individuals – on vocal PAs and vocal doctors. Yet this is not about individuals, it is about systemic issues around safe practice and the systemic underfunding of the NHS. And although I am writing this about PAs, these arguments can apply to any member of a multidisciplinary team.

On safe practice, the truth is, I don’t feel qualified (ironically) to say what, if any, specific tasks PAs can undertake in an MDT. But what I do know is that the PA role – like any other clinical role – should be defined by what tasks its least competent, fully-qualified practitioner can do. And when looked at in these terms, the role is very limited.

A number of the GPs we spoke to had the attitude that the role is problematic, but their own PA was very good. But with the lack of regulation, and any worthwhile scope of practice, GP practices are deciding themselves what roles their PAs can take on.

I am not normally in the habit of saying GP practices should have restrictions on the way they operate. But in this case, I really think it will benefit everyone – including practices, PAs and patients – to have strict regulations in place on their scope of practice. 

Then we get to the systemic underfunding of the NHS. Because the reason that practices are utilising PAs beyond their competence is because they have little option. Many can’t afford GPs. Our exclusive analysis revealed that the lowest paid practices rely most heavily on PAs. In other words, PAs are taking on tasks because there is no one else to do them.

One solution, as I have argued before, is to include GPs in the additional roles reimbursement scheme. (We could even go back to the days when all practice staff are paid for centrally – but that is an argument for another day).

But whatever payment mechanism is in place, it doesn’t make up for more funding – which practices desperately need.

It is almost certain that Mr Streeting will be the next health secretary, and I hope he follows through on the comments he made at the MJA event earlier this week.

He said that PAs do have a role to play in an MDT, and I will have to take his word for it, and that he will increase general practice funding. We will remove the toxicity from this whole debate if he is able to follow through with both these promises. The ball is (likely) in his court.

Jaimie Kaffash is editor of Pulse. Follow him on X (formerly Twitter) @jkaffash or email him at



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

David Church 19 June, 2024 9:48 pm

Totally agree. PAs took on the roles/training commitment on a promise, and have been severely let down by the people who organised and developed PAs without thinking it rhough or consulting with the others who would be affected and already had responsibility for overseeing education and training. The real target for criticism is not PAs themselves, but the people who set up their own empires to create and rule PAs in opposition to Doctors, and we seem to know who they are, and they would not be ‘punching below’, but are significantly higher up and should have provided a much better example and role model, instead of massaging their own egos and bank balances by exploiting evrybody else, PAs and Doctors !

Yes Man 20 June, 2024 10:27 am

Also agree. Those responsible for all this mess will have a private GP on speed dial. Wankos.

Nathaniel Dixon 20 June, 2024 12:59 pm

The latest in a long line of toxic issues in the NHS, anyone remember remote consults by default and how messy that got? The pattern is always the same push an idea very hard, very far and very fast. You then get an inevitable backlash and u-turn. Nothing is ever learnt by those running/ruining the NHS and progress can never be made in this environment. This is just one more example of an ever repeating pattern.

Shaba Nabi 21 June, 2024 6:19 pm

At last – a sense of perspective within this sorry affair

So the bird flew away 21 June, 2024 10:40 pm

Is there anything a PA can do that a trained ANP in general practice (or nurse specialist in hospital doing endoscopies, for example) can’t do? The ANPs I’ve worked with over the last 10 years have been fantastic at first contact consultations and they’ve already had many years of NHS nursing experience prior to that plus they understand the NHS, uncertainty and when to ask the GP. I trust them.
I’ve never been rude about PAs in any of my posts but I think the recent expansion in numbers has not only been done without due diligence but also as a cynical divisive ploy by the Tawdry party.
DOI my wife’s a practice nurse…