Senior doctors are urging MPs to reject government plans to regulate “physician associates”, whose growing use in the NHS has divided the medical profession.
The British Medical Association has said that allowing the General Medical Council (GMC) to regulate physician associates (PAs) would “blur the lines” between doctors and non-doctors.
Many medics are opposed to the increased use of PAs, who they fear patients will wrongly see as doctors, even though they do not have a medical degree. They have expressed concern that letting the GMC – which regulates doctors – regulate PAs from April, as ministers plan, is “potentially dangerous” because it could confuse the public, diminish the status of doctors, and leave patients at risk of being treated by someone without the appropriate skills.
The BMA is running advertisements in the Guardian and on social media asking MPs on a Commons committee examining the plan to vote against it when they consider it on Thursday. “PAs are not the same as doctors, and blurring the lines can have tragic consequences for patients who think they have seen a doctor when they have not,” the adverts say.
Almost nine out of ten (87%) doctors believe the way PAs are used in the NHS threatens patient safety, Prof Philip Banfield, the BMA’s chair of council, said.
“Now MPs have the chance to listen and act on doctors’ very clear warnings. They don’t have to wave through the government’s ill-thought-through plans, plans that have taken shape largely outside of the public’s knowledge or control.”
Concern about the potential risk posed by physician associates intensified after the death of Emily Chesterton, a 30-year-old actor, in 2022. She had a blood clot, but a physician associate at her GP surgery, twice misdiagnosed her symptoms as a sprain, long Covid and anxiety. A coroner later said she would probably have survived if she had been referred to A&E.
There are about 4,000 PAs already working in the NHS across the UK but a major expansion is planned. For example, the NHS in England intends to increase the number working in hospitals and GP surgeries to 10,000 by 2038 to help plug gaps in its workforce.
The BMA’s campaign highlights the simmering tensions over PAs within the medical profession. PAs are graduates, but not in medicine, who have done a two-year masters course in physician associate studies. They have been used in the NHS since 2004. They are put in place to support doctors and are allowed to take a patient’s medical history, perform examinations and diagnose illnesses, though they are meant to be supervised by a doctor.
The BMA has said that while PAs can be useful, their job title should be renamed “physician assistants”, as they were until 2014, to reduce the risk of patients confusing them with doctors. In addition, the union added, it is “manifestly unjust” that a PA is paid £11,000 more than a newly qualified doctor, despite their lack of medical training.
Two of the UK’s medical royal colleges, the organisations that represent different types of doctors professionally, are facing a grassroots revolt from members unhappy at their support for medical associate professionals, a group of positions that include physician associates, anaesthesia associates and surgical care practitioners.
Discontent among members of the Royal College of Physicians, which represents hospital doctors mainly in England, has forced it to hold an emergency general meeting to discuss the issue on 25 January. The Royal College of Anaesthetists held a general meeting on the issue last October at which critics aired their unease about the deployment of “anaesthesia associates”.
The Royal College of Physicians of Edinburgh released a detailed statement on Tuesday outlining its “significant ongoing concerns” about physician associates. Their use and expansion could undermine “the unique role of the doctor as the clinician [who has] the breadth and depth of knowledge and skills to allow highly skilled clinical reasoning, complex decision-making and the management of uncertainty”, it said.
Physician associates “must not be regarded as substitutes for doctors”, their title must be changed back to “physician assistants”, and their role in the NHS must not be allowed to undergo “scope creep”, such that they were undertaking tasks for which they were not medically qualified, the college added.
A GMC spokesperson said: “We’re pleased to support the development of these valuable professionals, recognising the important role they play in the medical workforce. Regulation will help to increase the contribution physician associates and anaesthesia associates can make to UK healthcare, while keeping patients safe.”
Physician associates and anaesthesia associates will have to explain to patients who they are and what their role is and to work only within the limits of their competence, the GMC added.
