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.’
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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’.
To quote Alan Partridge – “That sounds disconcertingly vague?”.
What exactly are these people ‘trained practitioners’ of, if they are not Medical Practitioners (which they are not, because it has a different meaning) ?
This is the question that we precisely need th eanswer to, in the form of a ‘scope of practice’.
Either they are assistants to Physicians, or they are something else, and there is growing suspicion that their deployment is an insidious manipulation by NHSE to destabilise and cause confusion and disarry and misunderstanding, without any care for the wellbeing of these trained people.
PAs, Doctors, Nurses, Allied Health Professionals, and Patients, all need to know more clearly what it is that a PA is and what they can do.
In the absence of such a quality standard, they are not equivalent to any grade of trained health professional in any other UK region, let alone any other Country, as there is no standard and no comparator training level; They are not made ready for any substantive role within the NHS, nor elsewhere ,and the training establishments and regulator is misleading them about what training and qualifications they are investing in for their future careers.
This is dishonest, and needs to be sorted out, by GMC, BMA, the RCP that started training supervision, and the NHS. Before any of them or us is damaged by this failure of joined-up thinking!
Like the BMA survey this latest pronouncement bullies and scapegoats PAs again. The research quoted found no evidence of safety concerns but the studies were small and I quote ‘ the absence of evidence is not evidence of absence’. So better research is needed with PAs involved as partners not pilloried unfairly- I suspect their main concern will be lack of supportive supervision in initial years. Also don’t you think we need to look at newly qualified doctors , new nurse practitioners and other clinicians to make sure they are safe too- or does BMA believe all doctors and nurse practitioners make no mistakes ever?
I can understand the wish of some to argue, quite rightly on behalf of PAs until there is clearer understanding of the positions to be adopted, but to extrapolate the need to investigate the roles of PAs further to the additional need to investigate newly qualified doctors who are part of a long established profession with rigorous training, monitoring, appraisals and oversight is frankly unhelpful and ridiculous.
Dr Centreground etc..
PAs have been professionals internationally for 50 years now and their training is more rigorous than nurse practitioners( 2 years post graduate after three years biomedical degree with then two rigorous examinations, one nationally appraised.) Have you actually worked with one? The debate needs to move toward who will help GPs manage the demographic calamity ahead- its nurse practitioners, PAs and others in close supportive teams. Any alternatives given extra resources need to improve patient contacts and continuity?
Is this the same BMA who in 2021 produced a report in which they said “clearly our health services do not only need more doctors; we also need other clinical professionals, including nurses and MAPs (medical associate professions), to deliver high quality care to the population and manage growing patient need.”
Why the sudden change of heart? Surely they had done their due diligence already?