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Content Article
In this opinion piece, Partha Kar describes patient safety issues relating to a planned increase in the number of Physician Associates (PAs) working in the NHS in England. Highlighting safety concerns being raised by healthcare professionals and members of the public, he calls for a pause to the planned expansion to allow these issues to be investigated. He outlines the need for a clear scope of practice, standardised training, full regulation and clear communication with all stakeholders, including the public.- Posted
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Content ArticleIn December 2024, the General Medical Council (GMC) will start regulating physician associates (PAs) and anaesthesia associates (AAs). The GMC have developed proposed rules, standards and guidance setting out how they will regulate these professions. They have also developed draft principles that will inform the content of decision-making guidance that will apply to doctors as well as to PAs and AAs from December 2024. This consultation is about those rules, standards and guidance and those principles. It is not about who should regulate PAs and AAs. This consultation asks for your comments on the General Medical Council's proposed rules, standards and guidance that set out how they will regulate anaesthesia associates (AAs) and physician associates (PAs). The consultation is open from 26 March to 11.59pm on 20 May 2024.
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News Article
BMA calls for inquiry into PAs replacing doctors on rotas
Patient Safety Learning posted a news article in News
The BMA has called for an independent inquiry into the use of physician associates (PAs) on medical rotas in place of doctors. The union said that health secretary Victoria Atkins must launch the investigation ‘to get to the bottom of the scale’ of the issue across the NHS, as doctors have been reporting instances where gaps in medical rotas are being filled by PAs. This is happening on top of NHS England ‘investing heavily’ in the use of PAs in primary care, ‘instead of qualified experienced doctors’, the BMA added. On Friday The Telegraph reported on leaked rotas from more than 30 hospitals showing physician associates taking on doctors’ shifts. This coincided with new NHS England guidance to ‘emphasise that PAs are not substitutes for doctors’, as they are ‘supplementary members’ of the team and they ‘should not be used as replacements for doctors on a rota’. BMA chair of council Professor Philip Banfield said: ‘We know from our members’ experiences that hospitals are putting physician assistants on medical rotas, in place of medically qualified doctors. ‘This is on top of NHS England investing heavily in the use of physician associates in primary care, instead of qualified experienced doctors. "In our view, Victoria Atkins now has a duty to patients and a duty to medically qualified staff – doctors – to establish how widespread this practice is and more importantly, stop it." Read full story Source: Pulse, 18 March 2024 Further reading on the hub: Partha Kar: We need a pause to assess safety concerns surrounding Physician Associates -
Content ArticleThis Twitter thread summarises the views of Dr Ian Jackson, a retired consultant anaesthetist and former Foundation Training Programme Director, on the patient safety and training issues relating to Anaesthesia Associates (AAs). He highlights issues with the length of training AAs receive compared with anaesthetists, the difference in training individuals who have experience in healthcare and theatre roles and those who have not and the supervision model in the current AA scope of practice.
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News Article
‘First of its kind’ guidance sees BMA set out PA ‘scope of practice’
Patient Safety Learning posted a news article in News
Physician associates should never see ‘undifferentiated’ patients in a GP setting, the BMA has declared in new ‘first of its kind’ guidance. Today, the union has published a national scope of practice laying out how physician associates (PAs) and anaesthesia associates (AA) should work safely in GP practices and secondary care. According to the BMA, the guidance is different from what it describes as the current ‘piecemeal or fragmented approach’ whereby individual organisations set their own guidelines for how PAs should be supervised. In general practice, the guidance said a GP ‘should first triage’ all patients and ‘decide which ones a PA can see’, suggesting annual health checks as an appropriate contact. The union is also clear that PAs ‘must not make independent management decisions for patients’ and must be clear in all their communications that ‘they are not doctors’. Read full story Source: Pulse, 7 March 2024 -
Content ArticleLandmark national guidance outlining how MAPs (medical associate professionals) can work safely and effectively in the NHS, has been published by the British Medical Association (BMA). The association has unveiled its report Safe Scope of Practice, which sets out in highly detailed terms the responsibilities of MAPs including PAs (physician associates) and AA (anaesthesia associates). Described as a ‘first of its kind’ the report uses a traffic light-style system to illustrate what clinical duties MAPs should be able to carry out, as well as those responsibilities from which they should be prohibited. The guidance also sets out six general principles for how MAPs should be deployed in primary and secondary-care settings. The guidance comes as the Government continues to press ahead with its plans to have PAs regulated by the GMC despite intense opposition to such a move from the BMA.
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News Article
Medical leaders back rise in number of physician associates
Patient Safety Learning posted a news article in News
Medical leaders support a planned increase in the number of physician associates (PA) in the NHS. But the British Medical Association (BMA) is concerned about a new law allowing the General Medical Council (GMC) to regulate PAs, who must be supervised by a fully qualified doctor. The doctors' union says it blurs the lines between doctors and PAs and could risk patient safety. Two families whose relatives were seen by PAs want the roles defined. The NHS has 3,286 PAs, who assist healthcare teams and are not authorised to prescribe or request scans. PAs and anaesthetic associates (AA) qualify after a funded two-year master's degree. They often have a science undergraduate degree, but that is not a prerequisite. Their role includes taking medical histories, conducting physical examinations and developing treatment plans. Like PAs, AAs are healthcare professionals who work as part of a multidisciplinary team with supervision from a named senior doctor. The Academy of Medical Royal Colleges said on Tuesday that it welcomes a push to increase the number of PAs in the NHS, but that it is "vital" that there are clear guidelines on how they are deployed. Read full story Source: BBC News, 5 March 2024 -
News ArticleGPs do not ‘face huge amounts of complexity’ and most of their appointments are ‘incredibly straightforward’, according to a former Conservative health minister. Speaking to BBC Radio 4 last week, Lord Bethell defended upcoming legislation that will bring physician associates (PAs) under GMC regulation, which could be struck down by the House of Lords this evening. Both the Doctors’ Association UK and the BMA had previously complained about the lack of debate in Parliament. Discussing the role of PAs on Friday, Lord Bethell said he had not seen ‘any evidence’ of patients being confused about whether they were seeing a doctor or an associate. "GPs don’t face huge amounts of complexity. Most interactions are incredibly straightforward. Certainly my own experience over the last 20 years of going to my GP, it really hasn’t required 10 years of training to deal with my small problems," he said. Lord Bethell added: ‘When they are complex, they should be escalated. But there’s a much wider group of people who have professional training who should be respected, celebrated – they shouldn’t be denigrated, they shouldn’t be in any way patronised by other professionals.’ Read full story Source: Pulse, 26 February 2024
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News Article
Physician associate law may confuse patients, says BMA
Patient Safety Learning posted a news article in News
The House of Lords is being urged to throw out plans for non-doctor associate roles to be licensed by the same body as doctors. Under a planned new law, physician associates (PAs) will be regulated by the General Medical Council (GMC). The British Medical Association (BMA) believes this could lead to patients confusing the different roles, which it says could have "tragic consequences". There are about 3,200 PAs working in GP surgeries and hospitals in England, with 10,000 more planned in the next decade or so. They were introduced to help doctors with their work - examining and diagnosing patients and discussing treatments with them - although PAs are currently unregulated. Unlike doctors, they do not have to hold a medical degree, but they usually have a degree in a life science and have to undertake a two-year training course. The BMA, the union representing doctors in the UK, believes that regulation by the GMC could lead to a "blurring of the lines" between PAs and doctors. In an open letter to the House of Lords ahead of a debate on Monday, the BMA's chairman Prof Phil Banfield said: "PAs are not doctors. They do not hold a medical degree and are not medically trained, despite misleading statements made by some. "We know that patients are already confused about telling the difference between PAs and doctors, and this legislation will make this problem worse. "Keeping the GMC as the regulator exclusively of doctors would mean we retain the clear distinction between doctors and PAs." Read full story Source: BBC News, 25 February 2024 -
Content ArticleThe Government plans to expand physician associate (PA) and anaesthesia associate (AA) roles and to establish the General Medical Council (GMC) as their statutory regulator. There has been concerted opposition to the plans by groups including the Doctors’ Association UK (DAUK) and the British Medical Association (BMA). Earlier this month, the House of Lords sent the draft legislation to the main chamber for proper scrutiny, stating that this was the procedure when an issue "is politically or legally important or gives rise to issues of public policy". In this Medscape article, Dr Sheena Meredith outlines the Government's proposals and why the issue has become so contentious.
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News Article
Physician associates increase doctors’ workloads, survey finds
Patient Safety Learning posted a news article in News
Working with physician and anaesthesia associates actually increases a doctor’s workload rather than freeing up time to focus on care of patients, a BMA survey finds.1 The association surveyed more than 18 000 UK doctors to inform its position on physician and anaesthesia associates. Some 55% (7397 of 13 344 who responded to this question) reported that their workload had risen since the employment of medical associate professionals, with only 21% (2799 of 13 344) reporting a decreased workload. The House of Lords will shortly consider legislation to regulate physician associates under the General Medical Council rather than the Health and Care Professions Council. Read full story (paywalled) Source: BMJ, 2 February 2024 -
News Article
Physician associates accused of illegally prescribing drugs and missing diagnoses
Patient Safety Learning posted a news article in News
Physician associates have attempted to illegally prescribe drugs at dozens of NHS trusts and missed life-threatening diagnoses, a dossier claims. Doctors working across the country claim patients’ lives have been put at risk by physician associates (PAs) who they say have failed to respond appropriately to medical emergencies – alleging more than 70 instances of patient harm and “near misses”. The Telegraph has seen responses from more than 600 doctors to a survey on PAs run by Doctors’ Association UK (DAUK), a campaign group. The data suggest that at over half of England’s hospital trusts, doctors are being replaced by PAs on the rota, despite associates only completing a two-year postgraduate course and having no legal right to prescribe. A spokesperson from the Department of Health said their role “is to support doctors, not replace them”. The Telegraph has interviewed more than a dozen surveyed doctors, as well as other clinicians worried about patient safety. At Dudley Group NHS Trust, one junior doctor said a PA had missed an “obvious heart attack” on an ECG, having “just signed it as if it was normal”. A clinician in primary care alleged PAs repeatedly misdiagnosed a patient’s metastatic cancer as muscle ache – despite blood results that were “tantamount” to a cancer diagnosis. They said: “The patient could have been saved eight months of pain; their life could have been prolonged.” Read full story (paywalled) Source: The Telegraph, 27 January 2024 -
Content ArticleThe Royal College of Physicians of Edinburgh has released a statement on their position on the specific role of the physician associate.
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Content ArticlePlans to increase their number in England to plug workforce gaps have been criticised – but their work is valued by hospital colleagues. Sammy Chan is very proud to be a physician associate, despite the controversies. “I find it particularly rewarding because I get to build relationships with patients,” she said. Chan works in respiratory medicine, mainly in outpatients. As well as more routine monitoring of patients and booking scans, she has been trained to perform chest drains and to insert pleural catheters. “While it’s quite emotionally challenging, it’s nice to be a constant presence on their journey,” she said. Chan is one of 40 physician associates employed at the Royal Berkshire foundation trust in Reading. Introduced nearly two decades ago, physician associates have some medical training but are not doctors. They can take medical histories, carry out physical examinations and help develop treatment plans – but cannot prescribe medicine or order X-rays. The NHS aims to increase the number of physician associates working in England from about 4,000 to 10,000 to help plug widespread gaps in the workforce.
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News Article
Physician associates aren’t doctors and shouldn’t be regulated as such, says BMA
Patient Safety Learning posted a news article in News
Senior doctors are urging MPs to reject government plans to regulate “physician associates”, whose growing use in the NHS has divided the medical profession. The British Medical Association has said that allowing the General Medical Council (GMC) to regulate physician associates (PAs) would “blur the lines” between doctors and non-doctors. Many medics are opposed to the increased use of PAs, who they fear patients will wrongly see as doctors, even though they do not have a medical degree. They have expressed concern that letting the GMC – which regulates doctors – regulate PAs from April, as ministers plan, is “potentially dangerous” because it could confuse the public, diminish the status of doctors, and leave patients at risk of being treated by someone without the appropriate skills. The BMA is running advertisements in the Guardian and on social media asking MPs on a Commons committee examining the plan to vote against it when they consider it on Thursday. “PAs are not the same as doctors, and blurring the lines can have tragic consequences for patients who think they have seen a doctor when they have not,” the adverts say. Read full story Source: The Guardian, 18 January 2024 -
News Article
Public confused over physician associates working in NHS, research finds
Patient Safety Learning posted a news article in News
Many people are deeply confused about the growing number of “physician associates” in the NHS and wrongly assume they are doctors, research suggests. Around 4,000 physician associates work in the NHS in England. Ministers and health chiefs plan to increase the figure to 10,000 to help plug widespread gaps in the NHS workforce. However, there is widespread confusion among the public about their role and relationship with fully trained medics, according to a survey commissioned by the British Medical Association (BMA). A quarter of the representative sample of 2,009 people erroneously believed that a physician associate was a doctor, while a fifth made the same mistake about “physician assistants”. Many respondents thought that a physician associate was more senior than a junior doctor, even though only the latter have a medical degree. The expansion of physician associates has prompted a backlash by grassroots medics. They fear patients will be misled into thinking they have seen a doctor despite physician associates not having the same skills and training. The government has moved to try to quell criticism of physician associates by legislating to ensure they are regulated by the General Medical Council (GMC). Read full story Source: The Guardian, 13 December 2023 -
News Article
Patient safety boost as medical associates to be regulated
Patient Safety Learning posted a news article in News
Physician Associates (PAs) and Anaesthesia Associates (AAs) will soon be regulated by the General Medical Council (GMC), improving patient safety and supporting plans to expand medical associate roles in the NHS to relieve pressure on doctors and GPs. The government will lay legislation this week to allow the GMC to begin the process of regulating medical associates, who are medically trained healthcare professionals who work alongside doctors to care for patients. The GMC will set standards of practice, education and training, and operate fitness to practice procedures, ensuring that PAs and AAs have the same levels of regulatory oversight and accountability as doctors and other regulated healthcare professionals. The regulations will come into force at the end of 2024. Physician Associates and Anaesthesia Associates are already making a great contribution to the NHS, supporting doctors to provide faster high quality care for patients. This new legislation paves the way for these professionals to be held to the same strict standards as doctors, boosting patient safety. Regulation and growth of these roles will support plans to reduce pressure on frontline services and improve access for patients. Health and Social Care Secretary, Victoria Atkins, said: "Physician Associates and Anaesthesia Associates are already making a great contribution to the NHS, supporting doctors to provide faster high quality care for patients. This new legislation paves the way for these professionals to be held to the same strict standards as doctors, boosting patient safety. This is part of our Long Term Workforce Plan to reform the NHS to ensure it has a workforce fit for the future." Read Press release Source: The Department of Health and Social Care and The Rt Hon Victoria Atkins MP, 11 December 2023 -
Content ArticleIn this blog, Dr Nadeem Moghal looks at the recent case of a 30 year-old patient who died after a physician associate (PA) at her GP surgery failed to diagnose her with a pulmonary embolism. He outlines a recent debate about the role of PAs in general practice and why employing them has become an attractive option for GP partnerships, which run as businesses. He highlights the need for PAs to be adequately trained and supervised to ensure patient safety and argues that the role is here to stay as PAs play an important role in tackling gaps in the NHS workforce.
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Content Article
RCGP: Physician Associates update (October 2023)
Patient-Safety-Learning posted an article in GP and primary care
Physician associates (PAs) support doctors in the diagnosis and management of patient. They are often employed in general practice as members of the multidisciplinary team, trained in the medical model. This update outlines the Royal College of General Practitioners' (RCGP's) policy position on PAs. The RCGP sees PAs as having an enabling role to play for general practice, but highlights that they must always work under the supervision of GPs and must be considered additional members of the team, rather than a substitute for GPs. -
Content ArticleThere’s been much discussion in the press and on social media about the role of physician associates and anaesthetic associates. Who exactly are they, and how are they trained? The Department of Health and Social Care says that they’re “trained in the medical model”—but what does this actually mean? Helen Salisbury gives her thoughts in this BMJ opinion piece.
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News ArticleHealth Education England (HEE) and NHS England have warned BMA that its stance on medical associate professionals (MAPs) is impacting NHS relationships and patient confidence. HEE published an open letter to the BMA in response to the union’s call to halt recruitment of MAPs – which includes physician associates (PAs) working in general practice – until regulation is in place. The BMA Council passed a motion calling for a halt to recruitment of MAPs two weeks ago, on the grounds of patient safety. This followed a previous motion to that effect from its GP committee for England earlier this month. Proposing to bring forward a planned meeting with the BMA to discuss the matter, HEE’s letter said: "This continuing public discourse around MAPs is impacting relations between your members and their MAP colleagues, the health and wellbeing of MAPs already working in the NHS, and potentially the confidence of patients." HEE chief workforce, training and education officer Dr Navina Evans and NHS England medical director Sir Stephen Powis argued in the letter that evidence shows "MAPs are safe", and that they "increase the breadth of skill, capacity and flexibility of teams" and reduce workload pressure on other clinicians. ‘Any issues of patient safety identified resulting from MAPs ‘must be addressed in the same way we would any other profession’, the letter added. Read full story Source: Pulse, 27 November 2023
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News Article
Concern after unqualified medics given senior Birmingham hospital roles
Patient Safety Learning posted a news article in News
Medics who are not qualified doctors have been used in senior roles at Birmingham Children's Hospital. Physician associates (PAs) have worked as the responsible clinician in the liver unit with a consultant on call. The RCPCH said it had heard the concerns of its members and the need for a clearly defined physician associate roles and training pathways. The doctors' union, the British Medical Association, called for a delay on recruitment of PAs until the group was properly regulated and supervised. The trust running the hospital said the physician associates did not work in isolation and only did the role with the right level of experience. Introduced in 2003, the PA role involved supporting doctors so they could deal with more complex patient needs. Usually, physician associates have a science degree and do a two-year post-graduate qualification. They are not doctors and are not allowed to prescribe drugs. The role is currently unregulated with the government planning legislation for regulations to be introduced before the end of 2024. PAs have worked at Birmingham Children's Hospital for 10 years but the BBC saw rotas which show them on tier two - normally a rota for senior doctors called registrars. PAs were not allowed to work unsupervised overnight and there were consultants on call at all times to offer advice, they said. Dr Fiona Reynolds, the trust's chief medical officer, insisted the safety and quality of care offered to children, young people and families remained a priority for everyone at the trust and would not be compromised. "Although small in number, [the PAs] skills and dedication to offering the best for our patients complements that of their colleagues in all fields - all of which are hugely valued by our trust," she added. Read full story Source: BBC News, 21 November 2023 -
News Article
BMA calls for immediate pause on recruitment of physician associates
Patient Safety Learning posted a news article in News
The BMA has called for an immediate halt to the recruitment of Medical Associate Professionals (MAPs) in the UK including Physician Associates (PAs) and Anaesthetic Associates (AAs). Doctors from across the UK who make up the BMA’s UK Council have passed a Motion which calls for the moratorium on the grounds of patient safety. They want the pause to last until the government and NHS put guarantees in place to make sure that MAPs are properly regulated and supervised. The move follows a number of recent cases in which patients have not always known they were being treated by a physician associate and tragically have come to harm. Professor Phil Banfield, BMA chair of council, said: “Doctors across the UK are getting more and more worried about the relentless expansion of the medical associate professions, brought into sharp focus by terrible cases of patients suffering serious harm after getting the wrong care from MAPs. Now is the time for the Government to listen before it is too late. We are clear: until there is clarity and material assurances about the role of MAPs, they should not be recruited in the NHS. “We have always been clear that MAPs can play an important part in NHS teams, and doctors will continue to value, respect and support individual staff they work with. But MAPs roles and responsibilities are not clearly defined. We are seeing increased instances of MAPs encroaching on the role of doctors; they are not doctors, do not have a medical degree and do not have the extensive training and depth of knowledge that doctors do. As doctors, we are worried that patients and public do not understand what this could mean in respect of the level of experience and expertise in care they receive. “The General Medical Council is the exclusive regulator of doctors in the UK. Adding staff who are not doctors and do not have a medical degree to the GMC register brings into question the competence and qualification of the whole medical profession. The Government may view this as a price worth paying for a shortcut to solving the workforce crisis they have presided over. We know otherwise. GMC regulation of MAPs will only add to the confusion and uncertainty that patients face. “Ministers may hope that by using secondary legislation, which may not even require the vote of MPs, they can avoid raising the alarm. But patients want doctors to remain doctors, regulated by a dedicated body, and they have a right to have confidence in the expert medical care they receive. There must be no doubt that when a patient goes to see a doctor, they are going to see a doctor. This blurring of roles and the confusion caused to patients must stop now.” Source: BMA, 16 November 2023 -
News Article
GP leaders in England call for a pause in recruitment of physician associates
Patient Safety Learning posted a news article in News
The BMA’s GP committee for England (GPC England) has called for an immediate pause in the recruitment of physician associates (PAs) in general practice. In an emergency motion passed on 2 November the committee expressed “concerns over the increasing trend of PAs being used to substitute GPs” and called on practices and primary care networks to stop PA recruitment “until appropriately safe regulatory processes and structures are in place.” GPs and GP registrars were also reminded that they can refuse to sign prescriptions and turn down requests for investigations made by PAs. Read full story (paywalled) Source: BMJ, 3 November 2023 -
Content ArticleRecently, in the wake of growing unrest, plummeting morale, and industrial action, doctors have created an increasingly hostile narrative towards physician associates (PAs) on social media and raised repeated concerns about their impact on patient safety and training opportunities. In this BMJ opinion piece, David Oliver looks at the recent history to understand how we got here and discusses why we need a mature debate about these matters otherwise interprofessional solidarity and multidisciplinary team working could be harmed by the degree of vitriol and resentment.
