Call for alternative regulator of – and to rename – physician associates

by Ben Ireland

BMA motion calls for PAs to work under consenting doctors and ‘take personal responsibility’

Location: UK
Published: Thursday 6 July 2023
Peter holden

‘I’ve had patients explain to me with surprise, and some anger, that they never saw a registered medical practitioner at hospital but another healthcare professional who – however dedicated – was not a registered medical practitioner.

‘The patient felt cheated, deceived and misled, and so did I.’

Derbyshire GP Peter Holden explained the frustration among many doctors with the role of physician associates, widely known as ‘PAs’, in the NHS.

The motion demanded that the public was not ‘misled, deceived or confused’ by the titles of 'PAs'. It called for a renaming of physician associates to physician assistants, and that PAs ‘never be called “doctor” in a healthcare setting, even if they have a PhD’.

To differentiate the roles, the motion asked for PAs to hold their registration through the Health and Care Professions Council – which regulates biomedical scientists, clinical scientists, radiographers, physiotherapists, and paramedics among other professions – rather than through the GMC, which regulates doctors and was asked in 2019 to prepare to regulate PAs.

Further, it asked that PAs ‘must only be appointed to work under a named responsible registered medical practitioner… who is immediately available, appropriately indemnified and specifically consents in writing to supervise a physician assistant’ and that PAs ‘must take personal responsibility for their professional actions’.


Patient understanding

He was supported by Tal Ellenbogen, a junior doctor in Nottingham, who said: ‘Being a patient at hospital can be confusing, tiring and scary. Patients in their most vulnerable moments deserve clarity, not confusion.

‘Even if every single PA introduced themselves as a physician associate, how many patients could explain to you what that title means? Do patients understand the difference between a physician associate and an associate specialist?

‘I do. I know the immense expertise, experience and skill that our often-overlooked associate specialists bring to the NHS. I do not want to see them devalued.

‘Patients have the right to know who is treating them and whether they hold a medical degree.’

While all four parts of the motion passed comfortably, some speaking against it urged doctors to treat PAs ‘with respect’.

Vicky Theakston, a GP trainee, noted the role of PAs was a ‘contentious issue’ and accepted ‘it is vital we protect and defend our expertise and professional standing and conditions’.


Great opportunity

But she said renaming physician associates as physician assistants and regulating them outside the GMC would not solve the issues doctors currently have and noted how preparations for GMC regulation are ‘already well-under way’.

‘This motion is firmly slamming shut the stable door after the horse has bolted,’ she said. ‘Making potentially inflammatory demands about other health professionals might make us all feel a little better briefly about the state of the NHS, but it does not encourage a collaborative approach to fix the healthcare system currently – that is an issue we need to take up with government.’

Dr Theakston urged doctors to consider the ‘positive action we can take now to look after professional interests rather than engage in a futile attempt to turn back time'.

William Ashwell, a medical student whose mother is a physician associate having retrained from being a speech and language therapist because of a lack of opportunities when returning to work after bringing up children, said the role ‘came across as a great opportunity’ for her.

They began their courses in the same year, so Mr Ashwell has ‘seen how her learning and development can be compared to what I’ve been taught in a traditional medical school capacity’.


Regulation concerns

He accepted ‘clear differences in the training and scope of physician associates from medical students and doctors’ but said PAs’ regulation by the GMC ‘should be considered separately’.

Mr Ashwell also warned changing “associate” to “assistant” doesn’t alter the word physician, and believes PAs are more likely to be confused for “personal assistants” than a doctor.

He added that ‘behind each of these roles there are people who are also being exploited in the same healthcare system as us’ and urged doctors not to take their ‘frustration at the government’ out on PAs. He challenged doctors to ‘think more critically’ about PAs’ role in the NHS and ‘treat them with respect’.

Dr Holden, who proposed the motion, said separate regulation was ‘crucial’ and that passing the motion would draw ‘a line in the sand’.

He warned ‘the threat has been magnified’ by the recently-announced NHS long term workforce plan, which explicitly mentions physician associates in a section about expanding the training of new roles.


Staff crisis

‘This is about our profession, this is about our future,’ he said. ‘It’s time to say, “I worked bloody hard for my MB ChB and nobody is taking that away from me”.’

‘We are here because of 20 years of failed workforce planning. The government, belatedly, is in a panic about how to staff the NHS. Their solution is the most massive passing off in history, of physician associates as some kind of doctor through a confusion of titles and grading structures.

‘The solution has been designed to deliberately confuse the public but appear to be staffing the NHS at a record level of capacity and competence not borne out in reality.’

He added: ‘On this topic, the time for inclusivity and woolly thinking is over. This is about the survival of our profession, the maintenance of professional standards.’