BMA calls for independent investigation into hospital trusts replacing doctors with physician associates on medical rotas.

by BMA media team

Media release from the BMA

Location: England
Published: Friday 15 March 2024

The BMA is calling on the Health Secretary to launch an independent inquiry into the use of physician associates (PAs)– who are not medically qualified – on medical rotas, in place of doctors in hospital trusts in England. The Association says Victoria Atkins must get to the bottom of the scale across the NHS in England, how it has been allowed to happen and what steps must be taken to end it.

​This follows the evidence uncovered by the Daily Telegraph alongside the BMA’s own findings from its members. Doctors have been reporting instances where gaps in medical rotas are being filled by physician associates, despite Government ministers and leaders of NHS England making promises that PAs cannot and must not be used to replace doctors.

​Professor Philip Banfield, the Chair of BMA Council said: 

“It is time for the Health Secretary to launch an independent investigation to uncover the full extent of what is essentially a patient safety scandal. She has some very difficult questions to answer about how this has been allowed to happen and why patients are being put at potential risk in this way.

​“Only last month NHS England’s National Medical Director, Professor Sir Stephen Powis said in a letter ‘ PAs are not doctors, and cannot and must not replace doctors.’ What is being uncovered appears to be the exact opposite; we also 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. The anecdotal evidence from our own members, together with the reports from the Daily Telegraph are more than a cause for concern – they indicate that staff who are not medically qualified are being used in place of ones who are. We know the NHS is experiencing is a devastating workforce crisis, but this is not the way to solve it.

​“PAs do have a role to play in patient care, they are valued members of the healthcare team but they are not, and should never be used as, replacement doctors. PAs are not medically qualified and do not have the rigorous medical training or knowledge that even the most newly qualified doctor has.

​“Now more than ever do we need to see the national guidance on the role and scope of physician associates and anaesthesia associates, which we published last week, supported and adopted across the NHS until this can be addressed more fully.”

​The ‘traffic light’ system used in the BMA’s scoping document, published on 7th March, identifies what MAPs might be expected to do on their own (green), what they might do under supervision (orange) and what they must not do (red). The guidance clearly states that MAPS must never cover, share, or participate in a rota designed for doctors at any level.

​The BMA is keen to work with NHS England and the Royal Colleges to implement the scoping guidance, so that doctors, other medical staff, and NHS trusts across the country have a shared understanding of the PA role. With this guidance in place, anyone seeing a PA being given responsibilities inappropriate for their training will have firm grounds to challenge it and ensure that standards of patient safety are upheld.

Notes to editors

The full scope of practice is here

​The Daily Telegraph investigation is here

The BMA is a professional association and trade union representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.

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