In the first of its kind, the BMA is today publishing a guide setting out how physician associates should work safely - the scope of responsibilities for Medical Associate Professionals (MAPs), including physician associates (PAs) and anaesthesia associates (AAs).

The BMA believes this is the first time such clear recommendations have been made – laying out what MAPs should and should not do for patients under the careful supervision of a doctor.

After the death of Emily Chesterton and other serious patient safety incidents involving PAs, together with mounting concern from the medical profession about the risk to patients across the NHS posed by employing individuals with only a two-year qualification, the BMA has drawn on doctors’ expertise and experiences to draft this crucial guide for safe practice.

Using a simple ‘traffic lights’ system, the report clearly identifies what MAPs might be expected to do on their own (green), what they might do under supervision (orange) and what they must not do (red). This covers both the general field of medicine and specialties from anaesthetics to psychiatry.

Four years ago, the BMA published a report which looked at how to improve the ways that doctors and MAPs work together and identified possible solutions to some of the common problems that had arisen with the introduction of MAPs. Since then, due to the expansion of PAs and AAs, the experience of doctors has become more negative and patient safety concerns have dramatically increased. The BMA believes today is the first time recommendations, designed to work at a national level across all medical practices, have been published. They are very different from the more piecemeal or fragmented approach being seen in reality whereby individual organisations or medical bodies set their own guidelines and scope.

The BMA believes, in writing and publishing this report, it is addressing the crux of the problem – filling a void that has lasted for over 20 years – that of defining the scope and responsibility of MAPs.

Professor Phil Banfield, BMA chair of council, said:

“The need for guidance, implemented at a national level, about what a physician or anaesthesia associate can do safely and to be a valued member of a medical team, is paramount. Our guide has been written by doctors, for doctors, to explain to the medical profession what MAPs should and should not do alongside their doctor colleagues. But it is also to help patients, to improve patient safety. With the Government’s clear intent to expand the numbers of MAPs in the medical workforce, but without the clarity on the scope of their skills and responsibilities, it is even more important that patients must know who is treating them and the skills and abilities that clinician has.

“We know that MAPs are working in roles that increasingly cross the line into situations more appropriately requiring the expertise of a doctor, so our report sets out what the Association considers a safe scope of practice that will keep patients protected and allow the NHS to effectively employ MAPs to assist medical teams – which was their original purpose.

“By setting out clear parameters for the distinction between doctors and MAPs, ensuring proper in-person supervision by qualified doctors, and ending the creeping substitution of PAs for doctors on rotas, this safe scope guide sets out a clear explanation of how MAPs can be employed to maintain the provision of high-quality patient care in the NHS.”

NHS employers are encouraged to adopt this safe scope of practice immediately.

The guide has been distributed to the Medical Royal Colleges who are also urged to agree to it as the basis for their own work on scope of practice for MAPs in the NHS workforce.

ENDS

Notes to editors

The full scope of practice includes the following General Principles:

General principles for MAPs:

1. This is an assistant role to doctors helping with simple practical procedures, administrative tasks, and working with patients in a supportive and specified role.
2. This does not extend to seeing undifferentiated patients in any situation.
3. When seeing differentiated patients (those already triaged by a doctor as appropriate, or already assessed, diagnosed, and on a treatment plan by a doctor), MAPs must be directly and closely supervised.
4. PAs/AAs/SCPs must not make independent management decisions for patients nor be responsible for initial assessments of patients and diagnosis.
5. MAPs must make it clear in all communication to patients and to other staff members that they are not doctors and be clear about their specific role.
6. Statements such as ‘I am one of the medical team’ must not be used unless also stating their own title.

Safe parameters have been set to describe what a PA/AA/SCP can do independently and what they must not do. These have been chosen to have a safe level of working that will allow MAPs to contribute to high quality patient care.

MAPs should not be seeing ‘undifferentiated’ patients. This means that all patients should be seen by a doctor first who then decides that it is appropriate for a PA/AA/SCP to do some limited and protocolised care.

• In a hospital setting, this means that they should not work in an ED setting unless a supervisor reviews each patient in person
• In a GP setting, a GP should first triage all the patients and decide which ones a PA can see for some protocolised reviews in stable patients

In general they should be assisting the medical team by helping with tasks like taking bloods and ECGs, helping to prepare discharge notes, helping with ward round documentation, and organizing appointments. This is consistent with their level of formal qualifications.

To overview their work, they need close, in person, supervision by a consultant or GP who consents in writing to supervise them.

They should not be performing any complex tasks nor life-threatening procedures. They are not doctor substitutes and therefore should not be on a doctor’s rota nor be in charge of giving any specialist advice.

In order to be clear for patients about who is treating them, they must always give their full titles and correct any misconception that they are doctors.

The full scope of practice is here.

The BMA is a professional association and trade union representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.

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