The health secretary must order a ‘rapid review’ of the safety and efficiency of physician associates (PAs), the Academy of Medical Royal Colleges (AoMRC) has argued.
In a letter to Wes Streeting yesterday, the group of colleges said there is ‘mounting concern and adverse commentary’ by doctors around the expansion of PAs, and that the current conversation is ‘almost devoid of factual information’.
The AoMRC called on Mr Streeting to commission a review into the role of medical associate professionals (MAPs) in GP practices as well as secondary and community care, in order to establish an evidence base.
It comes as the RCGP voted to completely oppose the role of PAs in general practice last month, following a call to halt recruitment earlier in the year.
AoMRC chair of council Dr Jeanette Dickson said the review should provide clarity on whether PAs are more likely to work in a way which is ‘unsafe to patients’, whether they ‘really free up’ a doctor’s time, and whether they ‘improve the overall quality of care for patients’.
She said the academy will only be ‘able to support’ the continued rollout of PAs if the review finds in favour of PAs across these three criteria.
But if the review corroborates the ‘whirlwind of anecdotes and claims on social media’, Dr Dickson said this ‘will give us all cause for thought’.
AoMRC criteria for PA review
- Patient safety. In short, do the PAs and AAs that have been working in the NHS since 2003 show any greater propensity than doctors to work in a way that is unsafe to patients?
- Are they cost-effective? In other words, can they do what is required of them without increasing the cost to the taxpayer? And do they really free up scarce resource such as a doctor’s time so that it can be used more effectively?
- Are they efficient? Can they work without close supervision? And do they improve the overall quality of care for patients?
Source: AoMRC letter
She also warned that the negative discourse around PAs is ‘driven by information circulating across social media platforms’, and that these claims – which tend to focus on patient safety issues and diminished training opportunities for junior doctors – are ‘becoming part of a wider accepted narrative’.
Dr Dickson continued: ‘However, the degree to which these statements and resulting counterstatements are based on sound evidence is unclear. As a result, this conversation is almost devoid of factual information.
‘As doctors, we must always be evidence-led, and we believe that it is essential that we establish and assert the evidence base in this case.’
The AoMRC has urged the health secretary to appoint an individual or organisation with ‘impeccable credentials for impartiality and neutrality’ to carry out the review.
Dr Dickson also stressed the importance of completing the review ‘at pace with great thoroughness and academic rigour’.
In its response to news of this letter, the Department of Health and Social Care (DHSC) highlighted that the GMC – which will regulate PAs and anaesthesia associates (AAs) from the end of this year – will be responsible for setting standards of practice, education and training.
DHSC also said that NHS trusts and GP practices should have robust clinical governance processes in place to ensure PAs are working with the appropriate level of oversight and supervision.
A spokesperson said: ‘Physician associates have played an important role in the NHS for over two decades, but we are clear they should be supporting, not replacing, doctors and should receive the appropriate level of supervision by healthcare organisations.
‘The NHS has issued clear guidance on the deployment of PAs in the NHS and we expect trusts to follow this.’
BMA Council chair Professor Philip Banfield said: ‘The Academy has finally acknowledged the mounting worries of the medical profession about the expansion of the role of PAs and AAs, who cannot and should never replace the role of a fully qualified doctor. In survey after survey, thousands of doctors tell us of severe worries about the use of lesser-qualified staff in place of appropriately trained medical professionals. What is troubling is that it has taken so long for it to acknowledge that concern.
‘We called for an independent inquiry investigation into the unsafe use of PAs on rotas in place of doctors six months ago, and given recent revelations the need for this is even greater today. It is imperative that Wes Streeting acts to address the concerns his predecessor ignored.
‘Until we get a commitment of a full and frank investigation, and NHSE can ensure that PAs are working to a strict scope of practice such as the one BMA has produced, we need the recruitment and expansion of PAs to be paused.’
PAs and anaesthesia associates (AAs) will come under GMC regulation at the end of this year, despite challenges from doctors’ groups.
And 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 the same issues highlighted by the AoMRC yesterday, with analysis of the safety of PAs in general practice and their cost-effectiveness.
‘Efficiency’ assessment needs to include training and experience opportunities lost to trainee Doctors – especially given the dire statistics as to availability of tutors and educators in General Practice with room to take on expanded roles in teaching and training of both GP VTS Registrars, and also undergraduate Medical Students and Pre-Registration House Officers (F1/F2 doctors and increasing number, for some unknowable reason of F3 and F4, which really should not exist!)
Does “commissioning a review” involve shovelling yet more money in the direction of the gong seekers?
“Dr Dickson continued: ‘However, the degree to which these statements and resulting counterstatements are based on sound evidence is unclear. As a result, this conversation is almost devoid of factual information”
As opposed to the font of all truth – the AoRMC?
Be honest now, which one of you GPs could confidently diagnose the difference between a D.V.T. and a strained calf muscle without the aid of an ultrasound?
If I’d made the same, repeated, errors as the PA that resulted in Emily Chesterton’s death, I’d have quit. That PA simply moved to another practice.
No doctor, or airline pilot, is infallible; therefore medical errors will always occur to some degree. However, a medical education, training and experience facilitate a role which minimises such errors. Assuming equivalence from PAs’ largely unrelated undergraduate degree and 2yr postgraduate studies is deeply disingenuous. Such errors become inherent in the underqualified PA role. Despite AoMRC’s assertion: ‘almost devoid of factual information’, there is already incontrovertible evidence of Trusts’ substitutions of medical posts by PAs, requesting ionising diagnostics, illegal prescribing, and surgical techniques. What is genuinely shocking and unforgivable is that this fiasco has taken so long to surface or be properly evaluated. Is John Graham Munro suggesting that PA training and skills are equivalent to that of a doctor?
JGM, is that an attempt at sarcasm or a genuine question? The point is that a competent GP would not guess at the answer and would arrange an ultrasound. The question is would a non-GP do the same? I’m not sure from what angle you are approaching this, and perhaps you are in fact suggesting that not ordering an ultrasound is negligent. If that is the case then we are in agreement. It is a basic differential and diagnosis in general and acute medicine. Am I missing the obvious?