The doctor will see you now?

If you don’t know the differences between a doctor and a Physician Associate or Anaesthesia Associate, you’re not alone – and this confusion is putting patient safety at risk

About our campaign

PAs and AAs can play an important role within the wider healthcare system, but they should be regulated by the Health and Care Professions Council (HCPC), not by the GMC. They are not a substitute for a doctor who undergoes years of medical training so they can provide complex, highly skilled care to their patients.

We would also like to see a return of the job title Physician Assistant, which is what Physician Associates were called until 2014. We believe it’s a clearer title that better reflects the role, and crucially, reduces any confusion for patients.

We also believe AAs should be called Physician Assistants (Anaesthesia) or Anaesthesia Assistants.

MAPs (Medical Associate Professions) survey

In response to concerns raised across the profession, the BMA conducted a comprehensive survey to inform its position on physician and anaesthesia associates. The survey findings have been used in our ongoing engagement with central and devolved nation governments, NHS England and devolved nation health departments, the GMC and other key stakeholders.

Amongst its findings, the survey found that:

  • 55% of doctors have found that PAs increase their workloads, even though they were sold as a way of reducing them.
  • 87% of doctors who took part said the way PAs and AAs currently work in the NHS was always or sometimes a risk to patient safety.
  • Nearly 80% of doctors stated that they were occasionally or frequently concerned that a PA or AA they worked alongside was working beyond their competence.
  • 86% of doctors reported that they felt patients were not aware of the difference between these roles and those of fully qualified doctors, showing the immense scope for patient confusion about the level of care they are receiving.
  • 72% of doctors do not support the future regulation of PAs and AAs by the GMC.
  • 80% of doctors felt that PAs and AAs would be more appropriately named ‘assistants’ than ‘associates’, as they were in the past.

The background: uncertain is unsafe

To patients, Physician Associates, Anaesthesia Associates, and doctors usually look the same. They might all be wearing scrubs or their own clothing. They might be working in a GP surgery or a hospital. They might talk to you about your medical history, they might perform a physical examination. But the fact is Physician Associates and Anaesthesia Associates do not have the same qualifications or expertise as doctors. If you have a medical issue, you have a right to fully understand what the medical professional you’re speaking to can and cannot offer. Too many patients believe they have been seen by a doctor when they haven’t, and this can lead to cases of poor care, and sometimes tragic consequences.

We’re calling on the Government to abandon its plans to introduce legislation which would regulate Physician Associates (PAs) and Anaesthesia Associate (AAs) by the General Medical Council (GMC) - a move that will only add to patient confusion. PAs and AAs are not doctors, are not medically qualified and should not be registered by the doctors’ regulator, the GMC.

 

So what are the key differences?

Doctors, uniquely, are the healthcare professionals who hold ultimate responsibility for the patients under their care, obtaining and analysing information about the patient’s condition. They diagnose and decide, along with patients, what is the best course of treatment to follow: prevention, cure, long-term control, palliation or none.

In many situations uncertainty will exist and it’s the role of the doctor to understand this. Doctors make decisions on care based on sound ethical principles using knowledge and skills, evidence and scientific training. They will consult with colleagues where necessary, bearing in mind that the right course of action might be to differ from the standard pathway. Sometimes the right course of action might be to develop or trial new therapies, sometimes it’s to do nothing but offer explanation and support.

Doctors can order scans for patients; PAs and AAs can’t. Doctors can prescribe medication for patients; PAs and AAs can’t.

Medical training

Doctors must complete a five-year medical degree, but their training doesn’t stop the second they graduate from medical school. For example, your GP will have undertaken a further five years postgraduate and specialist training to work as a GP in the NHS (so 10 years of training overall).

PAs and AAs usually complete two years of clinical training following completion of a non-medical degree course.

Regulation

Doctors are heavily regulated by strict laws and standards. PAs and AAs are not currently regulated, but should be by the right statutory body.

Interaction with patients

Doctors supervise PAs and AAs. PAs and AAs cannot work without this supervision. PAs must make it clear to patients that they are a physician associate, taking time to explain their role, including their training, qualifications, and that they are not a doctor.

If you are not sure whether you’re talking to a PA, AA or a doctor, always ask. You have a right to see a doctor.