A BMA survey of over 900 doctors working in the NHS in Wales has revealed the scale of the profession’s concerns over the use of Physician Associates (PAs) and Anaesthesia Associates (AAs) in the Welsh health service – with 80% of those who responded saying they believe the way PAs and AAs currently work in the NHS is always, or sometimes, a risk to patient safety.

In addition, 83% reported that they felt patients were not aware of the difference between these roles and those of doctors, showing the immense scope for patient confusion about the level of care they are receiving.

73% of those surveyed disapproved of Welsh Government’s plans to expand PA and AA roles in the Welsh NHS workforce.

Dr Iona Collins, Chair of the BMA’s Welsh Council said:

“Patients should know who is treating them and what level of care is reasonable to expect from each of those roles.

“Currently, there are reports of confusion, whereby patients do not appreciate that the person treating them is not, in fact, a medically-qualified doctor.

“In addition, doctors in training report that they are forced to compete with AAs and PAs for educational opportunities – after so many years of gruelling study and significant student debt, these doctors report feeling both demoralised and betrayed. There is insufficient time for doctors to deliver NHS care and also train two separate professions.

“We are clear that expanding the GMC’s remit to regulate PAs and AAs is inappropriate, because regulating these professionals together adds to the current confusion regarding practise scope and levels of responsibility. The BMA maintains that these new roles, who depend on doctors' supervision to deliver safe supporting care, should be regulated by the Health and Care Professions Council (HCPC) instead, for the sake of role clarity.

“We are calling on patient safety grounds, for a change to the professional titles of PAs and AAs to physician assistant and physician assistant (anaesthesia) or anaesthetic assistant to stop ongoing confusion for the public. 

“We remain very concerned regarding the planned expansion of these roles in the Welsh NHS– while doubts about scope, impact on doctor training and confusion with the public are far from resolved.

“We are asking for Welsh Government and NHS in Wales to halt the further expansion of these roles in light of the serious concerns raised by doctors in Wales and the absence of any robust evidence as to their effectiveness.”  

Notes to editors

Survey content in more detail:

Doctors’ survey - conducted 9th-27th November 2023, with 935 doctors in Wales taking part.

The survey questions were:

1. Do you believe the way that PAs and AAs currently work in the NHS is a risk to patient safety?

Always 25.1% (235)
Sometimes 55.3% (517)
Never 6.7% (63)
Don’t know 12.8% (120)

2. Do you think the public understand the difference between PAs/AAs and doctors?

Yes fully understand 0.8% (7)
To some extent 13.6% (127)
No – not at all 82.7% (772)
Don’t know 2.9% (27)

3. The Welsh Government’s National Workforce Implementation Plan proposes further development of new roles in Wales, including PAs and AAs. There are currently 57 training places each year for PAs, with plans to commission placements for AAs in future years. To what extent do you approve of the planned expansion of PA and AA roles in the NHS workforce?

Strongly approve 6.2% (58)
Approve 8.6% (80)
Neither approve nor disapprove 12.5% (117)
Disapprove 28.1% (262)
Strongly disapprove 44.6% (417)