GP concerns around PAs need to be ‘seriously addressed’, says Streeting

GP concerns around the role of physician associates (PAs) need to be ‘seriously’ addressed, according to the shadow health secretary.

However, PAs do ‘have a role to play’ in primary care, and should not be ‘thrown out with the bathwater’, Wes Streeting added.

Speaking at a Medical Journalists’ Association (MJA) event on Monday evening, he also suggested the debate about the role of PAs has become ‘toxic’.

Last week’s Labour Party manifesto promised to ‘deliver the NHS long-term workforce plan’. This had pledged to increase PA training places in a bid to establish a workforce of over 10,000 PAs by 2036, and with a need to target more PAs towards primary care.

Responding to a question from Pulse on whether Labour would continue this expansion, Mr Streeting said: ‘I’ve been really depressed by the state of the debate and discussion around the future of physician associates.

‘Depressed because I think that physician associates do have a role to play, and that it will be wrong to throw the baby out with the bathwater, and just say “because of some legitimate concerns that doctors have, we’re just going to kind of slam the brakes on and end physician associates in the NHS”.’

He added that he met ‘quite a lot of PAs’ who are doing ‘really valuable’ and ‘appropriate’ work, but that they are feeling ‘increasingly pessimistic and browbeaten’ about their roles and ‘devalued’ by colleagues.

He said: ‘Because of legitimate concerns from doctors about substitution of doctors, and PAs sometimes being asked to work beyond their scope of practice, because of the workforce constraints, and because those doctors’ concerns haven’t been listened to, we’ve ended up with a far more toxic conversation that we might otherwise have had.

‘And I think it is important that we address seriously the concerns that doctors are raising, that we make sure that physician associates are deployed appropriately. That they work within their scope of practice, that they are complementing the role of doctors not replacing them or substituting them inappropriately.’

‘That’s important for patient safety. I also think it’s important for a much better workplace culture,’ he added.

According to Mr Streeting, the debate has got out of hand because of the current leadership, and doctors not being taken seriously.

He said: ‘I think there’s been a failure of leadership and not listening to doctors and allowing this toxic culture to erupt with barely any public commentary whatsoever from the leaders of this system.

‘I’ve been genuinely shocked by the extent to which any number of organisations, whether political or not, could have gotten a grip on this and could have shown leadership and instead ran for the hills. And that doesn’t bode so well for the future of the NHS.’

Last week, NHS England said that PAs are a ‘small but important’ part of the NHS workforce plan and ‘crucially’ need to be ‘well-supported as colleagues’

Last week, Pulse’s major investigation on the rise of PAs found evidence that practices are in part recruiting PAs instead of GPs, with cost being the driving factor. The investigation found that in those practices in the lowest decile in terms of payments per patient, a higher proportion of clinical staff are PAs.

As of April this year, there were around 1,950 full-time equivalent PAs working across primary care in England, according to NHS Digital.

Pulse has looked at how effective they are and if they reduce GP workload, with some GP partners arguing that ‘heavy’ supervision is ‘the biggest downside’ of the role.

Pulse also looked at what clinical responsibilities they are being given, and the potential risks in their practice, including a lack of guidance and regulations, meaning that GPs are having to decide themselves how to use PAs in general practice.

Photo credit: Sam Mellish