The BMA has today written to Professor Gillian Leng, author of last year’s review into physician assistants and anaesthesia assistants, to reject proposed national clinical protocols that would allow physician assistants (PAs) to see patients who have not yet been seen by a doctor.  

The drafts have only been shared with key groups, including the BMA, for comment – something the BMA objected to as it strongly favoured a public consultation. However, in the letter Dr Tom Dolphin, chair of the BMA’s council, says that the BMA and other representatives of the profession were left out of the drafting process for the proposals, which has “dramatically reduced the usefulness and credibility of the group and has ultimately resulted in unsafe and highly flawed proposals.”  

The flaws in the proposals are demonstrated by its statements that “PAs played an important role in providing consistency and continuity”, and that “PAs had regular real-time access to consultant or other senior medical oversight embedded in assessment and treatment pathways”. This position, inconsistent with the conclusions of Leng’s own report, resulted in draft clinical protocols that fail to address widespread safety concerns. 

In his letter, Dr Dolphin warns that a protocol "based on an inaccurate and partial understanding of how the PA role is used in practice is one that is doomed to repeat the same mistakes. Preserving the status quo is insupportable for doctors and patients given the safety risks.” 

“Overall,” he urges, “the proposed protocols, if enacted, would effectively enable the NHS to dangerously use PAs.” Dr Dolphin further reminds Prof Leng of the BMA’s position that “PAs must not assess, diagnose, or manage undifferentiated patients in any healthcare setting”. 

The BMA will respond officially to the consultation in due course. 

Notes to editors