Blurred lines: The expansion of MAPs and the effect on patient safety and the profession

BMA Welsh junior doctors committee co-chairs Oba Babs-Osibodu and Peter Fahey reflect on the experiences of doctors in Wales and how the committee plans to take action to halt the expansion of MAPs

Location: Wales
Published: Thursday 21 December 2023
fahey - babs

The UK’s medical landscape has been somewhat turbulent as of late, to put it mildly. One of its latest stressors is the growing presence of and increasing scope of practice of MAPs (medical associate professionals), such as PAs (physician associates) and AA (anaesthesia associates).

As the Welsh junior doctors committee, we feel it's important to express our views on this trend and explore the consequences it has for our profession and for the safety of our patients.

In Wales, there is an escalating healthcare crisis, which is characterised by increasing patient needs and dwindling resources. As a result, waiting lists are at an all-time high, burnout rates are worse than ever, and doctors are continuing to leave the NHS in Wales for greener pastures.

Meanwhile, those at the helm seem to be in a desperate search for miraculous, fix-all solutions. One option, which likely seems attractive on the surface, is to further embed MAPs throughout our healthcare system. However, unless we address existing widespread concerns, we believe that further MAP recruitment represents a reckless shortcut, which sacrifices long-term stability and sustainability in favour of short-term relief. Below, we’ve outlined a few reasons why.

A recent UK-wide survey capturing doctors’ experiences found that 80% of respondents in Wales believe the way PAs and AAs currently work in the NHS is always, or sometimes, a risk to patient safety. 83% stated they felt patients were not aware of the difference between these roles and those of doctors. It’s little wonder then that almost three quarters of those surveyed disapproved of the Welsh Government’s plans to expand PA and AA roles in the Welsh NHS workforce.

Colleagues regularly tell us about the negative impact on the quality of their medical training. Unlike doctors, who rotate constantly, MAPs are afforded the freedom to remain in their chosen department indefinitely. This privilege enables them to establish strong relationships within their local teams, which often results in preferential treatment, leading to doctors being sidelined and deprived of hands-on experiences which are critical for our professional development. Essentially, this reliance on MAPs inadvertently weakens the training doctors receive, directly affecting the quality of patient care we can provide. This needs to change – systems must begin to protect doctors’ training.

There is also a highly concerning trend in which doctors are being heavily pressured to rely solely on the assessments of MAPs before prescribing medications or ordering ionising radiation for patients. This pressure, often falsely sold as a means to enhance system efficiency, is placing doctors in an uncomfortable position. It asks them to bypass their direct patient evaluations, a fundamental aspect of safe medical practice.

This trend not only threatens to endanger patients, but also threatens doctors' professional integrity. Despite the pressure, it's crucial for doctors to remember that the final responsibility for medical decisions lies with them. We strongly encourage doctors to resist this pressure and adhere to the highest standards of patient care and we call on employers to do more to tackle these inappropriate requests.

Perhaps most alarmingly, there is an ongoing mission creep, as MAPs are increasingly filling roles and undertaking tasks traditionally designated to doctors. This erosion of role clarity by employing organisations is disturbing. The highly misleading titles of PAs and AAs, combined with their ill-defined scope of practice, is leading to widespread confusion and miscommunication, putting patient safety and informed decision-making at risk.

We fear these problems will only be exacerbated by the GMC’s planned regulation of PAs and AAs. Whilst we were mildly encouraged by their recent announcement to add an alphabetical prefix to the seven-digit registration number of PAs and AAs, we believe that GMC regulation will further blur lines between roles that must remain distinct.

Essentially, we see this trend towards filling more clinical roles with MAPs as a misstep in addressing the deep-seated issues of chronic understaffing in Wales. While there is a possibility that these plans are well-intentioned, this approach fails to address the root of the problem and could very well lead us down a path which leads to the quality of patient care and the calibre of medical training in Wales being permanently compromised. This persistent rollout of MAPs, despite widespread concerns, is reckless and raises serious doubts about the priorities of our nations’ leaders.

We don’t need short-term solutions. We need a healthcare system based on well-considered, sustainable and safe policies. We need doctors.

Our concerns regarding this issue are serious. That's why, echoing our colleagues on UK and Scottish Council, we're calling for an immediate moratorium on the recruitment of MAPs in Wales. The Welsh Government needs to take a moment to ensure we’re moving in the right direction before the damage becomes irreparable.

We are also joining forces with BMA councils and committees across the UK, to offer clear guidance and advocate for the maintenance of high-quality medical training. We will continue to engage in robust discussions with HEIW, Welsh Government, and NHS Wales employers to ensure that patient safety and the quality of training for doctors remain uncompromised.


WJDC recognises concerns from Welsh members about the potential threat to patient safety, doctors’ training, and the medical profession that the increasing number of MAPs, and their increasing scope of practice, presents in Wales. This is not the solution to the Welsh medical workforce crisis. It notes the actions being undertaken by BMA Welsh and UK Councils on this issue and resolves to:

  • Support the work of relevant BMA Councils and Committees on this matter, including the provision of guidance to members
  • Lobby HEIW and training providers in Wales to ensure that doctors’ training and work is never negatively impacted by MAPs
  • Lobby HEIW, Welsh Government, and NHS Wales employers against expansion of the scope of practice of MAPs in Wales
  • Push for a moratorium on any further training or recruitment of MAPs in NHS Wales pending either their abolition, or reforms that satisfy the concerns of BMA Cymru Wales members.
  • Lobby the DHSC against the planned regulation of physician associates and anaesthesia associates by the GMC.