The BMA has demanded that NHS England introduce ‘interim safety measures’ and a mandated national scope of practice for physician associates (PAs) in light of new research on the role.
Last month, GP and primary care academic Professor Trish Greenhalgh published a ‘rapid review’ of UK-based research on PAs which found that there is ‘no evidence’ they add value in GP practices and highlighted the need for more evidence regarding safety incidents.
The BMA has said the review, which was intended to inform the ongoing Government-commissioned review of the profession and has now been published in the BMJ, ‘concludes there is a lack of evidence these roles are safe’.
BMA council chair Professor Phil Banfield wrote to NHS England yesterday to say it is ‘imperative’ that the national commissioner ‘acts immediately to prevent more harm’.
He said: ‘I am asking that interim safety measures are implemented immediately including mandating a national scope of practice until the Leng Review is able to report later this year.
‘It is wholly unacceptable for NHS England to continue its current course of inaction relying on evidence that cannot be provided and which this systematic review has shown does not exist.’
The BMA cited a particular conclusion in Professor Greenhalgh’s review which argued that the ‘absence of evidence of safety incidents in a small number of studies appears to have been misinterpreted by policymakers to mean that there are no safety concerns with the substitution of doctors with PAs’.
Professor Greenhalgh had warned that this ‘error of logic’ is ‘likely to cost lives’ if it is not corrected.
The BMA suggested that NHS England had previously followed this ‘error of logic’, by asserting in 2023 that the ‘evidence tells us [medical associate professionals] are safe’.
According to the union, NHS England failed to provide any evidence of this claim at the time.
Professor Banfield also wrote: ‘It is deeply concerning that NHS England continues to ignore concerns raised by patients, doctors and now an increasing number of coroners.
‘By maintaining a postcode lottery in which different hospitals can decide what physician and anaesthesia associates can and can’t do in the absence of any agreed scope of practice, I fear that the NHS has created a patient safety scandal.’
A recent coroner’s report raised concerns about the physician associate title ‘misleading’ patients as well as a lack of national guidelines on their scope of practice, after a PA had misdiagnosed a patient with a nosebleed when she had a strangulated hernia.
In December, the Government refused calls to implement interim safety measures around PAs ahead of the independent review into their safety.
The upcoming Government-commissioned review, chaired by Professor Gillian Leng, will consider the scope of practice for PAs ‘at the start of their working career’, and if and when an ‘enhanced’ scope of practice might be appropriate.
GPs have this week been invited to share their experiences of working with PAs as part of the Leng review, which is expected to report this spring.
In response to the BMA’s letter yesterday, NHS England said physician associates are ‘trained practitioners that play an important role’ but that they should always have ‘appropriate supervision’ and work ‘within the scope of their practice’.
A spokesperson continued: ‘The Leng Review will gather insight from across the NHS to ensure that these roles are being used appropriately to deliver safe care for patients and we are listening carefully to legitimate concerns about these roles and we are taking action to address this.’
