The BMA has urged the Government-commissioned review of physician associates to rename the role and set a national scope of practice.
In its official evidence to be submitted this week, the doctors’ union will make more than 30 recommendations to Professor Gillian Leng’s national review of PAs and anaesthesia associates.
The submission will also include results from a new survey of over 16,000 doctors and medical students which showed that 95% want a national scope of practice ‘to clarify what PAs can and can’t do’.
Over three-quarters of respondents (77%) also said they think ‘NHS leaders can’t make the PA role safe’ while 83% do not think PAs should ‘provide initial care to patients in general practice’.
The BMA has argued that using the title ‘physician’s assistant’, rather than ‘associate’, is ‘much more effective for patients in setting out where in a healthcare team’ the role sits.
Renaming the role and introducing a scope of practice will ‘help avoid patient confusion and prevent further tragic safety incidents in which patients thought they were being treated by a doctor when they were not’, the union will tell Professor Leng.
The BMA highlighted the ‘tragic cases’ of Emily Chesterton, who died after being seen by a PA at a GP practice, and Pamela Marking, who died following a misdiagnosis by a PA in an emergency department.
On scope of practice, the union urged Professor Leng to ‘set ceilings of practice for these dependent non-medical roles’.
Last week, the union demanded that NHS England introduce a mandated scope in light of new research on the role which had highlighted the need for more evidence regarding PA safety incidents.
Other BMA recommendations to Leng review
- Associates must not be described as medical practitioners, medical professionals or being medically trained.
- Training opportunities of medical students and doctors must be prioritised over the provision of training opportunities of doctor’s assistants.
- Regular monitoring and enforcement of nationally agreed safe working parameters must be undertaken by healthcare regulators.
- In each healthcare setting (private or public), PAs and AAs must have an immediately available senior doctor as their named supervisor.
- Employers must ensure that where associates are employed there is adequate time allocated each working day for every patient to be fully discussed with the supervising senior doctor and reviewed in person if necessary.
- An investigation into the unsafe substitution of doctors by associates must be instigated to examine the full extent of the problem across the NHS.
- Staff rostering systems must ensure the complete separation of doctor and non-doctor roles with dedicated doctor-only rosters, which prevent non-doctors being assigned to duties that can only be undertaken by doctors.
- All NHS hospitals and trusts must undertake an urgent review of all electronic prescribing systems, and ionising radiation requesting systems, to ensure associates are prevented from accessing them.
Source: BMA
BMA council chair Professor Philip Banfield urged Professor Leng to ‘think carefully’ about the union’s evidence, arguing that the deployment of PAs ‘has been a total system failure where the stakes for the future safety of the health service could not be higher’.
He said: ‘We are presenting evidence today representing the clear settled opinion of the medical profession: we need a scope of practice for PAs and AAs, a proper regulatory system that draws the line between them and doctors, and the clear naming of the roles so that patients can be in no doubt of their relative responsibilities in comparison to the expertise of doctors.’
The Government has said that the Leng review, which is expected to report this spring, 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.
In December, the Government refused calls to implement interim safety measures around PAs ahead of the independent review into their safety.
GPs were last week invited to share their experiences of working with PAs as part of the review.
