A survey report published today by the BMA of almost 19,000 doctors shows that far more doctors are finding working with Physician Associates (PAs) and Anaesthesia Associates (AAs) is increasing their workloads rather than decreasing them, despite the promise that they would free up time to focus on patient care. 

 

Only 21% of respondents reported a decreased workload since the employment of MAPs, with more than half (55%) reporting that their workload had increased instead. 

Prof Phil Banfield, BMA chair of council, said: 

“NHS England tells us that ‘Physician Associates support doctors in the diagnosis and management of patients,’ supposedly giving doctors more time to deliver the high-quality care only they can give.  

“But the reality appears to be the exact opposite – too many doctors are telling us that working with PAs is instead draining their time and energy. The responsibility for signing off prescriptions and ensuring the PAs are working within their proper scope of practice quite rightly falls on the supervising doctor, but also those doctors working alongside them; as scope has inappropriately crept ever further it has made far more work for doctors than it has saved. 

“The House of Lords will soon have a chance to oppose damaging legislation that aids that blurring of lines by regulating PAs under the GMC, the doctors’ regulator rather than the more appropriate Health and Care Professions Council.  

“The Government and NHSE should be instead ensuring that PAs return to their original purpose of supporting, not replacing doctors, so that doctors can get on with utilising the diagnostic and treatment skills they have spent so long at medical school gaining their expertise in.  Their scope should be strictly defined and, to ensure patients are not confused, the title returned to the more accurate “physician assistant” – then they can play their valuable role in supporting the delivery of NHS care safely.” 

The BMA has made the following recommendations.   

• There should be an immediate halt to the recruitment of Medical Associate Professionals (MAPs) in the UK, including PAs and AAs on the grounds of patient safety (as called for by the BMA in November 2023). Long term expansion plans for the roles must be paused.  

• All legislators must oppose the Anaesthesia Associates and Physicians Associate Order 2024. The House of the Lords must vote against it in the days ahead. MAPs should be regulated by the Health Care and Professions Council, as called for by the BMA in​ response to the original DHSC consultation on regulation in 2017. 

• The titles should revert​ to physician assistant and​ physician assistant (anaesthesia) ​​/ anaesthesia assistant to avoid public confusion.  

• The scope of the roles should be​ strictly​ limited to ​the​​​ original intention of supporting doctors with administration tasks and​ a defined range of low-risk​ clinical​ tasks​​  

• ​​The UK has a severe shortage of doctors​​. This should be urgently addressed by ​fully funding​ increased specialty training ​places ​ and opening Additional Roles Reimbursement Scheme (ARRS) funding to ​​GP​​ recruitment​. ​ 

• ​​T​​raining opportunities for doctors must be protected. Doctors and medical students should be prioritised for all clinical and training opportunities. This means that within a department/practice any procedure​, clinic opportunity, or other structured learning event must be offered to ​doctors first​ before being​​ offered to non-doctor staff.  The training of physician associates and anaesthesia associates must not compromise the training of current or future doctors 

• MAPs should not be utilised on any level of doctor rota ​or​​ perform, train in, or consent ​to​​​ invasive or life-threatening procedures. They should not be receiving any specialty referrals ​or​​ be in roles​ requiring them to give specialty advice. They should not make ​unsupervised ​treatment decisions or management plans. They must work under direct on-site supervision ​​at a level commensurate with their qualification and not​ be​ ​using​​ ​ on-the-job experience​ to work beyond their formal level of qualification.​ 

Also in the survey: 

• 87% of doctors said the way PAs and AAs currently work in the NHS was always or sometimes a risk to patient safety, as reported last year. 

• 86% of doctors reported that they felt patients were not aware of the difference between these roles and those of fully qualified doctors, showing the immense scope for patient confusion about the level of care they are receiving. 

• Nearly 80% of doctors stated that they were occasionally or frequently concerned that a PA or AA they worked alongside was working beyond their competence. 

• 72% of doctors do not support the future regulation of PAs and AAs by the GMC. 

• 80% of doctors felt that PAs and AAs would be more appropriately names ‘assistants’ than ‘associates’, as they were in the past. 

 

Notes to editors

The survey questions were as follows. 

Doctors’ survey - conducted  9th-27th November 2023 

Q. In general, has the employment of PAs or AAs in places you have worked reduced or increased your workload?  

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.