If you continue without changing your settings, we’ll assume you’re happy to receive all cookies from the BMA website. Find out more about cookies
When you visit any web site, it may store or retrieve information on your browser, mostly in the form of cookies. This information might be about you, your preferences or your device and is mostly used to make the site work as you expect it to. The information does not usually directly identify you, but it can give you a more personalised web experience.
Because we respect your right to privacy, you can choose not to allow some types of cookies. Click on the different category headings to find out more and change our default settings. However, blocking some types of cookies may impact your experience of the site and the services we are able to offer.
These cookies are necessary for the website to function and cannot be switched off in our systems. They are usually only set in response to actions made by you which amount to a request for services, such as setting your privacy preferences, logging in or filling in forms.
You can set your browser to block or alert you about these cookies, but some parts of the site will not then work. These cookies do not store any personally identifiable information.
These cookies are required
These cookies allow us to know which pages are the most and least popular and see how visitors move around the site. All information we collect is anonymous unless you actively provide personal information to us.
If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance.
These cookies allow a website to remember choices you make (such as your user name, language or the region you're in) and tailor the website to provide enhanced features and content for you.
For example, they can be used to remember certain log-in details, changes you've made to text size, font and other parts of pages that you can customise. They may also be used to provide services you've asked for such as watching a video or commenting on a blog. These cookies may be used to ensure that all our services and communications are relevant to you. The information these cookies collect cannot track your browsing activity on other websites.
Without these cookies, a website cannot remember choices you've previously made or personalise your browsing experience meaning you would have to reset these for every visit. In addition, some functionality may not be available if this category is switched off.
Our websites sometimes integrate with other companies’ sites. For example, we integrate with social networking sites such as Twitter and Facebook, to make it easier for you to share what you have read. These sites place their own cookies on your browser as a result of us including their icons and ‘like’ or ‘share’ buttons on our sites.
As doctors working and training in the NHS, we are no strangers to the challenge of adapting and thriving in an ever-changing landscape of healthcare. As reorganisations both top-down and bottom-up come and go, we remain ever at the coal face, and ever mindful of the effects that organisational changes may have on our training.
One of the more recent changes has been the expansion of a workforce that has been termed the Medical Associate Professions (MAPs for short), incorporating Physicians Associates (PA), Surgical Care Practitioners (SCP), Advanced Critical Care Practitioners (ACCP) and Physicians Assistants in Anaesthesia (PA(A)). The effects of this expansion have been most keenly seen in England in direct response to the NHS Five-Year Forward View.
In late 2018, the UK Government announced it would move to regulate in statute PAs and PA(A)s, omitting SCPs and ACCPs from this framework.
Over the last few years, the BMA has heard numerous accounts from members across the UK about their experiences of working and training alongside MAPs. We have heard that introduction of new roles in departments has at times been rushed, poorly planned and not properly scoped, and that the quality of training posts has been put at risk. Others have told us about the improvements that MAPs have brought about in their teams, allowing doctors in training to focus more on their own development as consultants of the future.
It has become clear that doctors’ experiences of working and training alongside MAPs is widely varied across the UK, and we want to understand why.
With greater understanding comes an opportunity to highlight best practice in new role development, advising training providers and employers how to retain high quality working and training experiences for all health care professionals in the NHS. It would also help us challenge the bad practice that is undeniably existent today.
This is where we need your help to give us clear understanding of how the new roles are affecting your training opportunities, progression, work patterns, rota gaps and so much more.
Where these roles have been introduced with benefit to the medical staff and service, we want to know how this has been achieved with specific mention to their interface with doctors. We also want to know what the pitfalls are and how to avoid medical training being put at risk.
As of today, we are inviting all doctors who have direct experience of working alongside MAPs to volunteer to participate in focus groups or telephone interviews that will form the basis of our response and guidance to training providers and employers. If you are interested in taking part, please complete this expression of interest form.
Professionally, the skills mix porfolio was initially intended 20 years ago to address the lack of doctors , however increasing concerns have emerged about the observation that the non medical roles are being prioritized to replace medical roles either via duress( threats) or on the grounds that it's more cost effective?!
I do not know how many doctors are willing to raise their hands that they have been forced out of medical job via bullying via skill mix practitioners and a lot of us who did study medicine do this as a vocation , so I'm sure there are quite a few who work at Band 5/6 levels doing a medical job more effectively than skills mix counterparts.
there is the real issue that trainee doctors are not receiving adequate training/medical experience due to the skill mix composition of the "medical " workforce.
Alarmingly, more patients are noting they go into hospital, have a variety of" consults" and never get a bona fide medical opinion because they've never seen a a doctor?
when is medicine going back to medicine and not an episode of " Friends", " st elsewhere's" or some other TV program where people are pretending to do doctors roles? te patient is not an ausci model on stretcher. they're real people who need medical treatment, not a "culture"?
- PAs are paid more hour-for-hour than FY2s yet can do less (no prescribing, no ordering ionising radiology) and are trained less (2 years is less than 4 no matter what their first degree was)
- Pseudo-favouritism. Every surgical department I have worked in, PAs are being taken to clinics and theatres by consultant surgeons 'as part of their development'; Foundation doctors are expected to get on with ward work and have to fight to get the scraps of non-ward time & opportunities.
- Out of Hours. Most PAs can't work independently OOHs because they don't have full range skill sets (eg. prescribing) (exception being working alongside doctors where this is viable such as in A&E) as a result again Foundation doctors are carrying the vast of OOH work which is largely service provision not training.
I'm all for the Profession 'managing the change' as these new staff groups become more prevalent, but from the juniors perspective it currently feels like our seniors are largely abandoning the next generation of doctors, rather than taking the opportunities to restructure services to rejuvenate the doctor's training opportunities that have been lost as the NHS has got busier.
My experience? Paid more than doctors for less responsibilities, less hours, way less forced ooh, and oh, access to a degree of SPA time we mere medical trainees can only dream of. In short, yay great for them, but how about getting similar deals for actual doctors.
And it gets worse.
One of the Royal Medical colleges actually did a workplace census and there are decreasing numbers of consultants due to the number of MAPS sucking up all the training opportunities so for people on CCT training schemes, there is no guarantee to being an NHS consultant.
I've seen staff grade posts dismantled to redistribute to MAPS with greater loss financially to the system and the patients have less homogeneous care
"Benefiting medical staff" is actually a horrendous fraudulent myth.
I think PA’S are excellent. But I have no doubt that they have hampered my training. When working on ITU PA’s were able to do transfers all procedures etc. Like us they were trying to get their log book filled. I found that because the department had a workforce capable of lines and transfers there was less inclination to spend time ensuring the trainee doctors were capable of doing this. I feel in 6 months the amount I learned and the i exposure I had to procedures was significantly less than what it would have been had they not been part of the department.
I think PA’s are a good addition to workforce. But I often feel the PA’S do the procedures ( echo’s, lines, clinics, theatre time) and doctors end up left to do the donkey work ( prescribing and paper work etc). I have found this to particularly be the case when they are unable to prescribe.
I've worked with 3.all have been excellent. As long as the professions don't get blurred together, then they're a good way to boost a struggling nhs
The physician associate we have on our ward is excellent as she has been on the same ward for over a year and knows how things run and it certainly helps to ease the staffing pressures. That being said, there are definitely times where she has been prioritised for training opportunities (e.g. practical procedures) over doctors such as myself as she is seen as a long-term investment in the ward whereas we are only there for several months. This is understandable but also pretty frustrating. I also resent the fact that PAs get paid more than us for ultimately doing less work (no evening cover, no weekend work and no nights). I think they should be paid the same amount as an F1 until either they do further training or work out of hours.
During A&E placement in large teaching hospital; MAPs did all the front door screening, and were in resus quite a lot, and completely ran minors. us ACCS SHOs were almost permanently in Majors doing the same stuff over and over, with all the main decisions already made. Essentially clerking monkeys. Lead to difficulties getting ARCP signed off.
During Intensive care; MAPS were excellent for very inexperienced junior doctors, as were able to supervise procedures, but they also tended to go to A&E more than the SHOs for emergencies, and did almost all of the transfer work, which again, was problematic for gaining competencies.
It's pretty clear in the states and other 1st world countries. If you do not have a medical licence you should not be doing a medical job.
The MIT's get truckloads of doctors from overseas to boost vacancies.