Responding to the Independent review of the physician associate and anaesthesia associate roles: final report, conducted by Professor Gillian Leng CBE, BMA Scotland council chair Iain Kennedy said: 

'While the Leng review considered the position in England, many of the issues it raises with these roles are very similar to those in Scotland.

'In our correspondence on this issue, the Scottish Government has acknowledged as such, so we would urge they pay close attention to this publication and its recommendations. Indeed, given we believe the Leng review does not make sufficient recommendations to protect both patients and doctors, the Scottish Government needs to go further, in particular on implementing a national scope of practice.

'We have consistently raised the issue of the inappropriate title of "associate" given to these roles with the cabinet secretary, and the blurring of lines and confusion caused.

'This report clearly backs that up, so this change needs to happen urgently and formally, starting with significant efforts by employers to better inform patients about who is, and who is not, delivering their care during each and every interaction.

'While GMC regulation issues are reserved, we are clear that there are serious issues raised in this regard by Leng and why the GMC continued to blur the lines between doctors and non-doctors by using Good Medical Practice to cover them all, exacerbating confusion for doctors and patients. As the report notes, professional standards should be presented separately to reinforce and clarify the differences in roles.

'We are in agreement that these roles should not be the first person seeing undifferentiated patients coming straight through the doors in any clinical setting – there must be clarification and action if needed in Scotland to ensure this cannot happen.

'A major flaw in the report is it failure to call for a nationally set scope of practice, which would end the current post code lottery where local decision making decides what these roles can and cannot do. In our view that remains inherently unsafe for patients, with simply unacceptable levels of variation.

'The Scottish Government has the opportunity to do better here and act to protect patients and doctors by not simply relying on employers to decide what is safe for these roles, and what isn’t. Such clarity would also help those performing those roles, giving them the confidence they are acting within their competence and training.

'We will be writing urgently to the cabinet secretary to ask him to pursue this safer course and instate a nationally set scope of practice across specialties. The BMA’s safe scope of practice guidance is available to help with this. We will also be emphasising our ongoing concerns with these roles.

'At the heart of this is the crucial issue of patient safety in Scotland, so the Scottish Government must act now to ensure the risks associated with how these roles are finally properly mitigated. Without that, any use of these roles by boards across Scotland will continue to pose a major threat to the safety of patients in Scotland’s NHS.'

Notes to editors

The BMA’s submission to the Leng Review can be found here

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