Welsh council position statement on MAPs

At a recent meeting of BMA Welsh council, an important motion was passed articulating the growing concerns with the expansion of MAP (medical associate professional) roles in Wales

Location: Wales
Published: Friday 1 December 2023
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The Welsh Council motion in full: Welsh council recognises and applauds the recent actions by Scottish and UK councils in addressing the growing concerns around MAPs. It notes the continued expansion of both the numbers in these roles and their scope of practice in Wales, and the issues this poses to both the public and the medical profession here. Therefore, it resolves to:

  1. Immediately inform the BMA membership in Wales publicly that work is under way on formalising a BMA Cymru Wales position on MAPs
  2. Urgently formulate and publish a Welsh council position statement on MAPs that minimally proposes either abolishing the roles or modifying them to ensure their scope of practice maintains patient safety and does not negatively infringe on doctors of any grade, and that any medical workforce strategy in Wales should prioritise increasing the number of specialty training, SAS and consultant posts over continued expansion of MAPs
  3. Lobby HEIW, Welsh Government, NHS Wales, Royal Colleges in Wales and other relevant bodies against the planned further expansion of the numbers of and scope of practice of MAPs here in the absence of any robust evidence or evaluation
  4. Coordinate with work being undertaken by other BMA committees and councils on this matter wherever possible, including forthcoming surveys, media campaigns and reports.


Anyone working in the front line of NHS delivery knows how vital multidisciplinary team working is: care provision and patient safety is compromised without each member of the team playing their part. MAPs were intended to be an addition to multidisciplinary teams, assistants to medically qualified doctors, freeing up doctors’ capacity and enabling doctors to do what only they can do.   

However, alongside the proliferation of MAP roles across the UK, there has unhelpfully been a blurring in the distinction between doctors and these non-medically qualified professionals. This is evidenced by reports of significant confusion where patients and their families are unaware they have not been seen or assessed by a doctor.   

Wales has not been immune to this shift, with almost 200 PA (physician associate) roles in Wales and training places for more than 50 more each year.   

MAPs are not regulated and they cannot work independently – therefore a significant level of senior medical supervision is needed to ensure patient safety.  

The GMC expects newly qualified PAs and AAs (anaesthetic assistants), following their two years of clinical training, to be able to give immediate care in clinical emergencies and seek support from their supervising doctor or healthcare professional or other colleagues if necessary*.  

PAs cannot order certain investigations independently and doctors are not able to countersign either prescriptions or radiology requests without assuring themselves that the responsibilities they carry legally and under the GMC’s Good Medical Practice have been fulfilled. This can cause unnecessary duplication and added pressure for the supervising doctor.  

It is important consultants and GPs, as senior supervisors, understand that they remain responsible for the overall management of the patient, decisions around transfer of care, and the processes in place to ensure patient safety. BMA Cymru Wales, reiterates the national guidance regarding the requirement of senior supervision in order to safeguard patient safety. If there is no immediate patient safety concern, we urge junior doctors to direct MAPs to the named consultant doctor or GP doctor supervising the MAP.  

Doctors in training are also reporting reduced training opportunities and that, after completing several years of medical education, they feel demoralised and betrayed for being put in a position where they have to compete alongside MAPs for educational opportunities.   

There are 537 vacant senior medical posts in Wales, meaning more than 10 per cent of positions are unfilled. Only by training, recruiting and retaining more doctors can we plug these huge gaps. We do not believe MAPs are a workforce solution for the shortage of doctors.   

The BMA will be working across the UK to explore public and profession attitudes and understanding of MAP roles. You will have already received a link to our survey on this – please do take the time to share your views. We have also launched a portal for members to share their experiences of working with MAPs, please share your experiences here.  

We have already been clear that expanding the GMC’s remit to regulate MAPs is inappropriate and this function should instead be undertaken by the Health and Care Professions Council to avoid increasing patient confusion.  

We have also called, on patient safety grounds, for a change to the professional titles of PAs and AAs to physician assistant and physician assistant (anaesthesia) or anaesthetic assistant to stop ongoing confusion for the public.  

In the meantime, the Welsh Government and NHS in Wales must halt the further expansion of MAP roles in light of the serious concerns raised by doctors in Wales and the absence of any robust evidence as to the effectiveness of these roles.   


* https://www.gmc-uk.org/-/media/documents/pa-and-aa-generic-and-shared-learning-outcomes_pdf-87633490.pdf