The BMA has threatened to move towards industrial action over the lack of a scope of practice for physician associates (PAs).
In a letter to NHS England today, the union said that ‘many’ of the concerns that doctors have raised around PAs relate to the ‘continued lack of nationally agreed safe scopes of practice’, and has asked the commissioner to ‘take action’ now to stop the ‘unsafe substitution of doctors’.
The letter, signed by BMA council chair Professor Phil Banfield, pointed out that despite calls to halt the recruitment of PAs from both the union and royal colleges including the RCGP, ‘the medical profession continues to be ignored’.
Professor Banfield said that the union is ‘concerned’ that NHS England has yet to act on any of the concerns raised regarding PA recruitment and expansion, and that BMA members are asking to move towards industrial action over these issues.
It comes after the BMA published its own scope of practice for PAs, and recently the RCGP also set out a clear scope for PAs which severely limits their current practice.
Earlier this year, the GMC ran a public consultation on the proposed rules and standards for PA regulation, but stressed that it will not determine a scope of practice for how PAs work beyond initial qualification competencies.
Professor Banfield said: ‘The BMA acted to fill the void by publishing a safe scope of practice and supervision guidance to better protect patients and those doctors working with PAs.
‘Our members are now asking the BMA to move towards industrial dispute and collective action over this issue, which we will fully support where this is necessary to protect patient safety.
‘It is not too late for NHS England to prevent this if it acts urgently to address the concerns we and others have outlined.’
He also mentioned a call from the Academy of Medical Royal Colleges (AoMRC), urging the health secretary to order a ‘rapid review’ of the safety and efficiency of PAs, but said that this review could only delay action.
He said: ‘We believe it would be a serious mistake to ignore the wealth of information already available by undertaking further work to determine if the concerns raised by doctors are valid.
‘What is needed now is action. Action to stop the unsafe substitution of doctors, action to halt the expansion of these roles while safety concerns exist, and action to implement the BMA’s safe scope guidance in place of unsafe locally agreed parameters.’
Pulse has approached NHS England for comment.
Meanwhile, the Doctors’ Association UK has written to the GMC to express concerns over the regulator’s ‘refusal’ to release full consultation responses regarding the regulation of PAs and anaesthesia associates (AAs).
The DAUK argued that ‘withholding’ the data ‘limits scrutiny and undermines trust’ in the process.
It is calling on the GMC to ‘immediate release’ of the quantitative data and full consultation responses to ensure that the final regulatory framework ‘reflects a diverse range of expert views’.
Should the GMC proceed to regulation without providing an opportunity for respondents to review and address submissions, the DAUK said that it ‘reserves the right to pursue legal action’.
DAUK past chair Dr Matt Kneale said: ‘Those who took part in this consultation have the right to know that their views are being seriously considered.
‘Transparency is essential to maintaining trust in this process, and the GMC must demonstrate that its decisions are based on all the feedback received.’
A GMC spokesperson told Pulse: ‘We have received a letter from the Doctors’ Association UK and will respond in due course.
‘At the end of the year, we’ll publish a detailed report on our consultation, which will include quantitative data for each question we asked, showing the range of responses to our proposals. It will also set out how the feedback from the consultation has shaped the final rules, standards, and guidance for PA and AA regulation.
‘We’ll continue to provide updates as our work towards regulation progresses, and we remain committed to listening to all perspectives during this process.’
PAs and AAs will come under GMC regulation at the end of this year, despite challenges from doctors’ groups.
The GMC has confirmed that regulation will begin on 13 December, but registration will not be legally required for another two years.
The regulator is currently facing the threat of legal challenge from doctors’ groups over the regulation, with Anaesthetists United fundraising for a case which calls for ‘clear and enforceable guidance’ on what PAs ‘can and cannot do’.
And the BMA – which is also bringing a separate judicial review claim against the GMC over PAs – confirmed that it will financially support Anaesthetists United’s legal case.
NHS England is planning to expand the number of PAs working in the NHS to 10,000 by 2036/7, up from the current 3,000.
Pulse’s major investigation into PAs in June explored issues around their recruitment and role in general practice, with an analysis of the safety of PAs and their cost-effectiveness.
Cheap and unskilled is the way forward for the NHSE now. They should not harp on about patient safety and system failures when they are letting this happen. At the end of the day, sadly, only the doctor who was supposedly supervising the PA will lose his livelihood (god forbid if they are BAME but inevitably they will be and we all know how that end) as the responsibility for the harm will be down to them. Not the hospital. Not the system. Not NHSE. Just the doctor who is properly trained but over regulated and has zero say in who else is employed or working along side them.
The intentional chronic defunding and fragmenting (PAs, paramedics, Pharmacy First etc) of general practice may soon lead to a fully salaried service led by political and management interests, rather than clinical.
This Govt’s flagship healthcare policy for the next 10 years at least, it seems to me, is about selling off extraordinarily lucrative patient data to its rent-seeking associates in Big Pharma and Tech. It cannot afford for this flagship policy to sink their credibility.
I wonder if the BMA realises that the leverage we currently have as data controllers is our most potent weapon to fight for what the profession wants. The threat of mass undated resignations, taking all this patient data with us, would be a disaster for the Govt and must force them into real negotiations. I hope..
Agree with access to date is pot of gold government looking to sell off.. but is the data really ours?
Yes each practice has a Data Controller, and for now in current BMA GP industrial dispute we are be advised not to sign up to new data access agreements (or at least to defer doing that for now). But with patients having access to their records, government might view their benevolent help in oversighting records could use same access.
In last week reported a new system coming in to share all records across the NHS without restriction and that appropriate safe-guards would be put in place. Yet do any GPs have trust in the NHS to do this after debacle of patient access meant that locked records on transfer to another practice do not carry over the restricted viewing rights (so an abusive partner or parent only need change registered GP and they they can view past entries long before new practice might spot some controversial entry from a few years past.
Other than very fragile Data Control permissions, I don’t own the patient data (that belongs I believe to The Crown as granted to the Minister for Health), I don’t own our computers (provided by local ICB GPIT department) and I don’t have a proper service contract with EMIS (as that provided by the ICB). Other than myself as a GP getting angry, I suspect government could decide to take the data, so getting public opinion to stage that this would be seen as a very very bad move / infringement on personal data etc is what profession and BMA need to ensure.