The majority of doctors who took part in a UK-wide BMA survey believe that the way in which physician associates (PAs) or anaesthesia associates (AAs) work present a significant risk to patient safety.
In what is thought to be the first survey of its kind, with over 18,000 responses, UK doctors are reporting overwhelming concern about patient safety in the NHS due to the current ways of employing physician associates and anaesthesia associates.
87% of doctors who took part said the way AAs and PAs currently work in the NHS was always or sometimes a risk to patient safety.
In addition, 86% 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. In a separate survey of the public, 29% of patients said they did not know whether or not they had been seen by a PA.
The results of these surveys are more evidence that the Government’s plan to regulate PAs and AAs by the GMC – the doctors’ regulator - are ill-thought-through and will likely further blur the lines between doctors and other roles in patients’ minds.
Encouraged by the BMA, over 10,000 doctors have so far written to their MP to urge them to oppose this damaging change.
Prof Philip Banfield, BMA chair of council, said:
“Doctors in the UK have been growing more and more worried about the consequences of the Government’s plan to expand the number of PAs and AAs in England. Here, at last, are numbers that show the shocking scale of that concern.
“If well-defined, associate roles can play an important part in NHS teams, but the Government has refused to give associate roles that definition. Patients deserve to know who is treating them and the standard of care they are going to receive. By blurring the lines and allowing a situation where PAs can act beyond their competence without the public understanding what they are qualified to do, both professions are demeaned and risk losing crucial public trust.
“This week Government has continued to press ahead with plans to regulate PAs as if they are doctors - using the GMC. At every stage we have been clear that the GMC is the wrong regulator for medical associate professionals: it is the body for regulating doctors, which these staff are not.
“The Government is encouraging a false representation. Patients being told that the people seeing them are regulated by the same body that regulates doctors will make them think they are receiving a doctor’s standard of care. Indistinguishable GMC numbers will make it difficult to tell if you have seen a doctor, even when patients ask. But there is no comparison between the two years of a PA’s training and the four to six of a qualified doctor. And by giving the impression that PAs can do what doctors can do, the Government is risking yet more patient safety incidents along the lines we have already seen.
“The creeping expansion of these roles and their central part in the Government’s workforce plan for the NHS has been undertaken against the advice and warnings of an entire profession. To change the nature of medical care in this country without the consent of the medical profession is utter folly and will be revealed as such.
“There is still time for the Government to reverse course and finally listen to the medical professionals who know what they are talking about. The BMA will continue to oppose this dangerous path every step of the way.”
Notes to editors
On Wednesday, 13 December, the government will lay legislation to begin the process of regulating Physician Associates and Anaesthesia Associates by the General Medical Council. This legislation will be an Order in Council (the Anaesthesia Associate and Physician Associates Order (AAPAO)) amending the 1999 Health Act. This is secondary legislation which will receive far reduced parliamentary scrutiny than primary legislation. The regulations will come into force at the end of 2024
Anonymous quotes from doctors about their experiences with PAs
I have frequently seen miscommunication from PAs as a result of their lack of clinical expertise relative to that of a doctor, and delays in patient care. I have also seen this result in incorrect prescriptions as a result of inaccurate assessments from PAs, but there is a pressure/expectation on doctors to prescribe on behalf of the PAs based solely on their assessment.
Have witnessed physician associate advising an F1 doctor to give the incorrect course length of antibiotics then berating them when it was questioned. Only when 2 more senior doctors advised it was wrong did they admit the formulary should be checked.
My work load is doubled when I am supervising them as I have to watch everything they do. I have real safety concerns for patients as they do not possess the baseline medical knowledge to manage any complication or recognise when they are out their depth.
I have come across multiple episodes of substandard or even unsafe care from PAs in the last year or so. Encompassing all aspects of clinical care: prescribing, mental health assessment, suicide risk assessment, general clinical assessments etc.
I work as a long term locum in a GP practice. Part of my role is to supervise [the PA] [They} are without doubt the most worrying person I have ever had to supervise in over 30 years as a GP. Their basic knowledge is poor, they are unable to present a coherent history and examination, unable to formulate a differential diagnosis. Patients frequently believe they have seen a doctor. I will no longer sign off on any prescription for the PA without reassessing the patient myself. It is only a matter of time before a patient comes to serious harm at their hands.
The survey questions were as follows.
Doctors’ survey - conducted 9th-27th November 2023
Do you believe the way that PAs and AAs currently work in the NHS is a risk to patient safety?
Always 31.6% 5,975
Sometimes 55.2% 10,425
Never 4.6% 865
Don't know 8.6% 1,631
Do you think the public understand the difference between PAs/AAsand doctors?
Yes - fully understand 0.7% (131)
To some extent 10.9% (2,047)
No - not at all 86.1% (16,23)
Public survey – conducted 18th- 19th November
Have you ever received NHS healthcare or treatment by any of the following professionals?
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.