Majority of doctors say the way PAs and AAs work is a risk to patient safety

by Ben Ireland

Hundreds write to their MPs as government set to legislate for GMC regulation of roles

Location: UK
Published: Wednesday 13 December 2023
hospital corridor

A majority of doctors say that the way in which PAs (physician associates) and AAs (anaesthesia associates) work presents a significant risk to patient safety.

A major new BMA survey, with more than 18,000 responses from UK doctors, found overwhelming concern about patient safety in the NHS owing to the current ways of employing the medical associate professions.

Some 87 per cent of doctors who took part said the way AAs and PAs currently work in the NHS ‘always’ or ‘sometimes’ poses a risk to patient safety.  

A further 86 per cent reported that they felt patients were not aware of the difference between these roles and those of doctors.

And in a separate survey of the public, 29 per cent of patients said they did not know whether or not they had been seen by a PA.  

It comes as the government is set to legislate to begin process of regulating physician associates and anaesthesia associates through the doctors’ regulator, the GMC. 

The BMA says its survey results are ‘more evidence’ that government plans to regulate PAs and AAs by the GMC ‘are ill-thought-through and will likely further blur the lines between doctors and other roles in patients’ minds’.

Earlier this year, the association voted to campaign for PAs to instead be regulated by The Health and Care Professions Council – which regulates biomedical scientists, clinical scientists, radiographers, physiotherapists, and paramedics among other professions – to help distinguish the role from that of a doctor.

The motion at the BMA’s annual representative meeting also called for PAs to be renamed ‘physician assistants’ and ‘must take personal responsibility for their professional actions’.

Last month, the BMA called for an ‘immediate halt’ on the recruitment of PAs and AAs until they secured guarantees from government that MAPs will be ‘properly regulated’.


MPs contacted

Encouraged by the BMA, more than 10,000 doctors have now written to their MP urging them to oppose this GMC regulation for PAs and AAs.

Philip Banfield, BMA council chair, 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.’

Prof Banfield added: ‘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.’


Professional warning

The Government’s NHS long-term workforce plan, published earlier this year, includes a proposed expansion to up to 10,000 roles for PAs and 2,000 for AAs. There are currently about 1,500 PAs working in hospitals and 1,700 in primary care settings, and about 320 AAs.

‘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,’ said Prof Banfield.

‘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.’

Health secretary Victoria Atkins, who took up her role last month, said the long-term workforce plan will ensure the NHS ‘has a workforce fit for the future’.

She added: ‘This new legislation paves the way for these professionals to be held to the same strict standards as doctors, boosting patient safety.’

Charlie Massey, chief executive of the GMC, said: ‘Regulation will help increase the contribution PAs and AAs can make to UK healthcare while keeping patients safe.

‘We are working hard to design and deliver detailed regulatory processes for registration, education, standards and fitness to practise for both professions.’