A rebellion by senior medics threatens to disrupt the NHS’s plans to address workforce shortages by hiring junior staff. Doctors have expressed concern that the health service is increasingly turning to physician associates (PAs) because they are quicker and cheaper to train. However, they have warned that patients are often unaware that they are being treated by PAs, rather than qualified doctors. Physician associates undergo two years of post-graduate training in addition to a biomedical sciences degree, as opposed to attending medical school. Despite these concerns, the government intends to expand the role of PAs in the NHS.
In June, the NHS published a workforce plan aiming to increase its permanent workforce by nearly a million by 2036/2037, raising the number of employees from 1.4 million to between 2.2 and 2.3 million. As part of this plan, ministers also seek to quadruple the number of physician associates to 12,000 by 2036/37. The plan even suggests that PAs may be permitted to prescribe medication in the future.
The role of physician associates was introduced in 2003, allowing them to take medical histories, perform physical examinations, and analyze test results with supervision. However, they are not authorized to prescribe drugs or refer patients for procedures. Concerns have arisen regarding the extent of their role, confusion among the public regarding their level of expertise, and the lack of regulation. Senior anaesthetists, under the group “Anaesthetics United,” have convened a general meeting of the Royal College of Anaesthetists to oppose the expansion of anaesthesia associates, who can administer anaesthesia under the supervision of a consultant.
Dr. Richard Marks, a semi-retired anaesthetist in London, has raised doubts about the necessity of anaesthesia associates in light of a national shortage of anaesthetists. Dr. Marks, who previously served as a regional director of training and vice-president of the Royal College of Anaesthetists, has also questioned the supervision and scope of practice for associates. An attempt to halt associate recruitment and ensure that patients are informed when they are being treated by an associate will be made during the scheduled meeting of Anaesthetics United on October 17.
The use of physician associates is becoming more prevalent in other medical specialties as well, prompting early-stage efforts to address concerns in those areas. The General Medical Council and the government have been discussing the regulation of associates; however, the GMC has stated that regulations will not be implemented until at least the second half of 2024.
These concerns surrounding physician associates have been further amplified by the tragic death of actress Emily Chesterton, who died at the age of 30. Ms. Chesterton had been seen twice by the same PA who failed to identify symptoms of blood clotting and instead diagnosed her with anxiety and long Covid. Her parents have asserted that at no point during the appointments was it made clear to Ms. Chesterton that the person treating her was not a fully qualified GP. A coroner determined that her life could have been saved if she had gone to A&E and received treatment for a pulmonary embolism. Following this incident, the Vale Practice in Crouch End, London, where Ms. Chesterton was treated, has ceased employing PAs.
In response to these concerns, members of the British Medical Association (BMA), a doctors’ union, have called for the role of physician associates to be renamed as “physician assistant.” They have also advocated for efforts to ensure that PAs are not mistaken for doctors. Consequently, a motion was passed at the BMA’s annual representative meeting in Liverpool, demanding the renaming of physician associates and clarifying their role and responsibilities in medical settings. The BMA has suggested that PAs should be regulated by the Health Professions Council rather than the GMC, and that they should be accountable for their actions. Health minister Will Quince has pledged to investigate the renaming suggestion and stressed the importance of clear communication between PAs and patients.
While the Royal College surveys its members and awaits the results, Dr. Fiona Donald, the college’s president, notes the immense pressure on anaesthesia services due to a shortage of anaesthetists, soaring demand, and a lack of training opportunities for anaesthesia specialists. The NHS defends the use of anaesthetist associates, emphasizing that they are highly trained and work under consultant supervision, thus allowing clinicians to spend more time with patients.
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