The BMA welcomes the RCP (Edinburgh) statement and expression of concern over the ways in which Medical Associate Professions (MAPs) are being integrated into healthcare services[1]. We recognise the contribution to healthcare by all members of the multiprofessional team, as well as the unique role that doctors provide in leading those teams.

The training of a doctor typically takes 4-6 years for the initial degree and 5-10 years more to become a GP or consultant, reflecting the depth and breadth of the knowledge required to practice medicine safely. The BMA is deeply concerned to see increasing evidence of Physician Associates (PAs) and other MAPs, whose training lasts only two years, being utilised as direct substitutes for doctors (for example, by working on doctors’ rotas), including in very senior positions that usually require many years of further training to allow doctors to practice safely in these roles.

The BMA survey of our members highlighted widespread professional concerns amongst our members. 87% of the 18,182 doctors who took part in our survey told us that the way Anaesthesia Associates (AAs) and PAs currently work in the NHS was always or sometimes a risk to patient safety. 86% reported that they felt patients were not aware of the difference between MAPs and doctors[2]. Our public survey demonstrated that 57% of the general public have never heard of Physician Associates, and that 50% of patients erroneously rank them higher than junior doctors in terms of medical training and knowledge. The Association of Surgeons in Training demonstrated similar overwhelming levels of professional concern in their own survey[3].

It is vital that patients understand the professional qualifications of those treating them. A number of recent tragedies have demonstrated the grave consequences of patients mistaking these relatively new healthcare providers for doctors, including the case of Emily Chesterton, whose pulmonary embolism (clot on the lung) was misdiagnosed twice by the same PA as anxiety, and later as long covid. Emily’s parents stated that had they known the PA was not a doctor they would have taken her to A+E, where her life would likely have been saved[4]. We agree with Emily’s parents that to many patients, titles such as ‘Physician Associate’ are profoundly misleading.

The BMA has called for the title to be changed back to the original ‘Physician Assistant’ which is the internationally preferred title, in order to aid public understanding in the hope of preventing further tragedies[4]. We are reassured that the RCP (Edinburgh) has come to the same conclusion.

There is now widespread concern about unsafe practice and a call by the medical profession to limit how MAPs are employed in the NHS. Resolutions have been passed by the Royal College of Anaesthetists calling for an immediate pause in the expansion of Anaesthesia Associates and for tighter controls on the scope of practice of those already working in the NHS, and the Royal College of Physicians (London) is in the process of organising an Extraordinary General Meeting to discuss widespread concerns among their members[5].

Despite clear evidence of patient safety concerns among the UK's doctors, the government has decided to push ahead with legislating for the regulation of MAPs under the General Medical Council (the doctors’ regulator) via a Statutory Instrument. While a delegated committee meeting on the 17th of January discussed the changes, it was quickly approved and is now unlikely to undergo the full parliamentary scrutiny we have called for and will move to the final stage of the legislative process. We believe this furthers entrenches attempts by the government to deliberately mislead the public by blurring boundaries and distinctions between doctors and non-doctors.

The BMA continues to call for an immediate pause in the recruitment of Medical Associate Professionals until title clarity and safe scopes of practice and supervision have been properly determined. We will continue to advocate for all patients' rights to know who delivers their healthcare.

We encourage our members to persuade their respective professional bodies and colleges to adopt a similar position and to represent their members’ concerns.

References

[1] Royal College of Physicians of Edinburgh. Position statement on physician associates in the UK. 16 Jan 2024. Accessed 17 January 2024.

[2] BMA. New survey shows “shocking scale” of concern from doctors over use of physician associates. 12 December 2023. Accessed 17 January 2024.

[3] Association of Surgeons in Training. The Physician Associate Role and its Impact on Surgical Training and Patient Care. Accessed 17 January 2024.

[4] House of Commons debate (6th July 2023) Vol 735 Col 2023. Accessed 17 January 2024.

[5] RCP. Extraordinary general meeting request and RCP council. 16 Jan 2024. Accessed 17 January 2024