The Government will not put in place interim safety measures regarding physician associates (PAs) ahead of the independent review into their safety, a health minister has said.
Yesterday, the House of Lords held a debate on the upcoming PA review, with the Green Party’s Baroness Bennett calling on the Government to take ‘interim action’ to address the ‘clearly untenable situation’ before its findings are published and implemented.
In response, health minister Baroness Merron said ‘NHS guidance remains in place’ on PA deployment in the meantime, while seeking to provide assurance that the review would move ‘quickly’.
Following the debate, the BMA said it was ‘disappointing’ that the Government could not commit to ‘much-needed interim measures’ to protect patients, and called for ‘immediate adoption’ of the union’s own PA scope of practice.
Last month, health secretary Wes Streeting launched an independent review into the scope and safety of PAs in order to ‘establish the facts’ and ‘take the heat out of the issue’.
It will be led by Professor Gillian Leng, a former consultant in public health medicine who is now president of the Royal Society of Medicine, and it is due to be published in spring 2025.
Baroness Bennett called the debate yesterday to ask the Government what the review will cover and ‘what actions they plan to take in advance of the outcome’.
She pointed to ‘disturbing, localised reports’ about how PAs have been deployed in both hospital settings and GP practices, as well as ‘considerable concerns about the impact of PAs on doctors’ training’.
In light of the spring 2025 deadline, Baroness Bennett said: ‘Your Lordships’ House knows that government definitions of seasons means that that could extend well into the year.
‘By the time report is absorbed and action decided, realistically, we are talking about a year of a clearly untenable situation. Does the Minister agree that interim action is surely needed?’
On interim action, the health minister Baroness Merron responded: ‘NHS guidance remains in place on PA and AA deployment while the review is ongoing. Furthermore, NHS England continues to engage with NHS organisations to ensure that this guidance is adhered to.
‘On the pace of the review, we are committed to it moving quickly to provide clarity, while ensuring that it has sufficient time to consider all available evidence.’
The health minister was also asked about a ‘national scope’ or ‘ceiling of practice for PAs’, and whether they should work to the BMA’s own guidance.
Baroness Merron recognised that there has been ‘significant debate’ on this issue, and confirmed that the independent review will cover scope, but refused to provide any more details.
She continued: ‘The issue will therefore be considered as part of the review, and I will not pre-empt its outcome on this or any other aspect.
‘Many questions were rightly asked about what happens in the meantime. NHS England’s guidance on the deployment of PAs and AAs should continue to be followed.’
BMA council chair Professor Philip Banfield said it is the Government’s ‘responsibility to ensure NHS England puts in place safety measures while the situation undergoes urgent review’.
‘We would not keep prescribing a drug while there were outstanding questions about its safe use,’ he said.
Professor Banfield added: ‘While the Leng review is undertaken we must see the immediate adoption of the BMA’s safe scope of practice, a pause on recruitment and expansion of these roles, and a guaranteed stop to the substitution of doctors with PAs, plus clearly agreed supervision of those already in place.
‘These are common-sense measures that we will be pursuing with NHS England and employers.’
He also said the upcoming review ‘must have the confidence of the medical profession’, claiming that so far doctors’ voices ‘have been inexplicably ignored, which is to the detriment of all’.
Just two hours before the start of the debate, the GMC published its long-awaited report on its consultation on PA regulation, which made only minor amendments to its plans in response to the number of concerns raised by doctors and others.
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It’s not enough to look at evidence of harms found by PA/AA care; we need to look at potential risk and knowing that their training is minimal-2 years an no post qualification structures training, and their supervision is also not standardised the evidence is already in place that there is risk-the very existence of these two stated facts evidences risk.
The review is looking for evidence of patient harm ie significant events.
This is a much higher bar for evidence. Who knows how much harms are never reported or identified.
The frames of reference for the government review are wrong.
The review should look for risk not evidenced harm and we already have evidence of risk by the very nature of their training, job role and perpetual requirement for supervision which will never be possible to fulfil adequately in an overstretched system.
They are a chocolate teapot.
Another import form US health systems by Simon Stevens who worked for so many years for the US private healthcare systems.
Phase them out.
It’s such a victorian arrogance that our representatives think only doctors have the answers for patients. They dont. The NHS is full of those who heal including receptionists, nurses, pharmacists, social prescribers, mental health practitioners , PAs and others. I think the ‘ we never make a mistake’ attitude of the BMA and RCGP is damaging our reputation and so are their targeted attacks. Do experienced PAs make the same number of mistakes as experienced doctors and experienced nurses? We all make mistakes but only those who deny this are dangerous. PAs are frightened enough and need doctors to back off and let them do their job whilst someone looks at the evidence not the propaganda.