The results are in: Physician and Anaesthetic Associates pose "a significant risk to patient safety" according to latest BMA opinion poll

A British Medical Association ('BMA') survey completed by over 18,000 UK doctors has flagged significant concerns regarding the way Physician Associates (PAs) and Anaesthetic Associates (AAs) work within the NHS.

The news comes as the Government implements plans to roll out a rapid medical associate recruitment plan and regulate those associates through the General Medical Council (GMC), the doctors' regulator.

PAs and AAs are unregulated healthcare professionals who work under the supervision of GMC registered doctors and surgeons to provide medical care as part of a multidisciplinary team. PAs and AAs currently have direct contact with patients and are expected to undertake key tasks, which include performing diagnostic and therapeutic procedures, analysing test results and developing management plans.

PAs and AAs usually undergo a three-year undergraduate degree followed by two years post-graduate training (to include 1,600 hours of on-the-job clinical hours) and are not required to specialise in any specific field of medicine.  The PA and AA qualification route is significantly less onerous compared with the five years of medical school training and two years of NHS placements undertaken by registered doctors.

At present there are circa 1,500 PAs working in hospitals and 1,700 in primary care settings in the UK. However, the Government's NHS Long Term Workforce Plan (published in June 2023), includes a proposed expansion of up to 10,000 roles by 2036/37 for PAs and AAs to help fill record NHS vacancies.

In addition, the Government has set in motion its plan to regulate PAs as if they were doctors – under the auspices of the GMC.

In strong support of the strategy, Victoria Atkins, the current Health and Social Care Secretary, has said that "PAs and AAs are already making a great contribution to the NHS, supporting doctors to provide faster high-quality care for patients. This new legislation paves the way for these professionals to be held to the same strict standards as doctors, boosting patient safety".

The backlash to the Government's long-term plan has however been significant with the Doctors Association (DAUK) calling it "hazardous". DAUK say that although PAs and AAs hold an important support role within the make-up of the NHS, they do not undergo the "extensive rigorous training" of a doctor or develop the "depth of experience that defines a doctor's professional capacity".

In response to the Government's plans, the BMA circulated an anonymous UK wide survey (said to be the first of its kind) asking for their members' (primarily registered doctors) and the public's views on the role of PAs and AAs in healthcare.

87% of doctors participating in the poll reported that the way PAs currently work in the NHS is either "always" or "sometimes" a safety risk to patients. A further 86% of participants felt patients were not aware of the difference between PAs/AAs and those of registered doctors. Worryingly, such confusion was said to stem from an increase in PAs and AAs holding themselves out as doctors on social media or during patient consultations.

Doctors participating in the survey were also asked to describe their experience of working with PAs. One concerned GP stated their workload was "doubled" when supervising PAs, since "they do not possess the requisite knowledge to manage any complication" or "recognise when they are out of depth".  Another GP described their clinic PA as "the most worrying person I have ever had to supervise in over 30 years as a GP. Their basic knowledge is poor, they are unable to present a coherent history and examination, unable to formulate a differential diagnosis".

Responding to the survey results, Philip Banfield, BMA Chair, stated "here at last are numbers that show the shocking scale of concern from medics".

The BMA has called for the regulation of PAs and AAs to be by the Health and Care Professions Council (HCPC), the regulator for non-doctor healthcare practitioners (such as physiotherapists, dieticians and paramedics) to avoid blurring the lines between the roles of doctors and other healthcare professionals. Encouraged by the BMA, over 10,000 UK doctors have written to their MPs, urging them to oppose the proposed changes to expand PA and AA numbers and to regulate them under the GMC.

The BMA is also calling for 'Physician Associates' to be renamed 'Physician Assistants', as well as an immediate moratorium on the employment on PAs (and other medical associates) until there is clarity about their role and scope of practice.

What's Next?

Currently there is no suggestion that the Government is slowing down its plans. In November 2023 a draft Order providing regulatory powers to the GMC (the draft "Anaesthesia Associates and Physician Associates Order 2024") was laid down before Parliament for consultation. PA and AA recruitment drives have also been set in motion.

The concerns highlighted by the BMA poll serve as an important reminder to all healthcare organisations which employ PAs and AAs to ensure that they are appropriately supervised and demonstrate the correct skills, without straying beyond their remit or role. Of paramount importance is to ensure that patients being attended to by PAs and AAs understand who is treating them and the standard of care they are going to receive.

Insurers can play a key role in risk management by checking that their healthcare insureds have protocols in place to support and monitor medical associates, and that there are pathways to facilitate the escalation of a patient's care to a qualified doctor when appropriate.

A failure to take these precautions may result in an increase in patient safety incidents, bringing with it an increased risk of claims. It follows that healthcare organisations need to ensure that appropriate indemnity provision is in place for any PAs and AAs and that their healthcare insureds' risk management systems and policies are fully up to date and sufficiently robust.