At Scottish Council this week, there was an important update and resolution on the role of “Physician Associates (PAs)” and “Anaesthetic Associates (AAs)” within Scotland’s NHS.
This is an issue that I know is of serious concern to many members across all parts of the medical profession.
It resulted in the bringing forward of a motion that highlighted how these roles have changed significantly since being introduced to the UK as “Physician Assistants”, but yet remain poorly defined. To quote the motion directly: “This threatens to encroach on junior doctors’ training opportunities. Senior physicians are increasingly burdened with the uncertainty of taking on liability for their actions. Moreover, there is a risk of the public being unsure when they are or are not being treated by a physician.”
These are all serious concerns, that members described clearly to Scottish Council based on their own experiences – which I am sure reflect those of members across Scotland. It has also been thrown into sharp focus by the recent NHS staffing plan in England.
In response, the motion quoted above was passed and commits BMA Scotland to “immediately begin work on formalising a stance on PAs and AAs that either proposes abolishing the roles or modifying them to ensure their scope of practice does not negatively infringe on doctors of any grade and maintains that any medical workforce strategy should prioritise increasing the number of speciality training and consultant posts.”
Of course, across the whole of the BMA we were already aware of the issues these roles are causing prior to the discussion, so we will urgently build on that to finalise our stance. Given the work underway at UK level, the motion committed us to coordinating with other BMA committees on this wherever possible. That is crucial, as I am very hopeful that we can take a strong united stance on this across the whole profession.
Practically it means we will be paying close attention to and inputting into discussions at a BMA UK level, while equally encouraging contributions and perspectives from branch of practice committees in Scotland. I very much hope that will allow us to publish our stance as soon as we can – and make sure that policy makers are fully aware of Scotland’s doctors’ full range of concerns.
While we do need to do some work to finalise our complete position, and the evidence to support it – the principles we are approaching this with are abundantly clear. They are based on the value and indeed necessity of the medical training needed to become a doctor – which must not be put at risk by the pursual of cheaper options which might – as seems to be the case in England at least – be used to paper over the cracks of abysmally poor workforce planning. Furthermore, patients must know if they are actually speaking to a doctor or another healthcare professional.
While our work will establish whether we believe there is a role for PAs and AAs – the way to get out of the workforce crisis we face (just look at our vacancy heatmaps if you doubt the seriousness of this), is by investment in the recruitment, training and then retention of doctors. There are no shortcuts or neat ways to avoid that. It means valuing doctors, focussing on our training, improving our pay and conditions and finally ensuring there are enough of us to care effectively for the people of Scotland. I’ll update you further as this work progresses.
Dr Iain Kennedy is Chair of BMA Scotland Council
FULL MOTION PASSED BY SCOTTISH COUNCIL:
Scottish Council recognises that the role of “Physician Associate (PA)” and “Anaesthetic Associate (AA)” has changed significantly since being introduced to the UK as “Physician Assistants” yet remain poorly defined. This threatens to encroach on junior doctors’ training opportunities. Senior physicians are increasingly burdened with the uncertainty of taking on liability for their actions. Moreover, there is a risk of the public being unsure when they are or are not being treated by a physician. Scottish Council will:
- Immediately begin work on formalising a stance on PAs and AAs that either proposes abolishing the roles or modifying them to ensure their scope of practice does not negatively infringe on doctors of any grade and maintains that any medical workforce strategy should prioritise increasing the number of speciality training and consultant posts.
- Coordinate with other BMA committees on this wherever possible.
- Now inform the membership publicly that work is underway on formalising a BMA Scotland position on PAs and AAs
bmascotland.home.blog 
I agree that the role of PA should be formalised.
I strongly disagree that their role should be abolished.
As a g.p. and previously as a hospital doctor I have worked alongside other health professionals who practice within their defined roles , just as I do as a general practitioner.
The main problem is lack of experienced Doctors who have the time to monitor those practising under their responsibility such as other Doctors in training, PA, anp, np, pharmacists, opticians, nurses, physiotherapists, paramedics, call handlers , receptionists.
So rather than targeting PA`S PERHAPS you should continue working to wards better workload control and role definitions.
In my job dealing directly with patients I welcome all the help I can get. I suggest a better way would be making all health professionals trained in the NHS to commit to at least 5 years NHS service in return.
LikeLike
I think we need to be very cautious in reviewing the stance we should take on Physician Associates. These are medically trained professionals who can play a hugely beneficial role in a modern health service.. It is important to be able to identify how and where their role differs from doctors, but I think it would ultimately be counter-productive to suggest that we should recommend the abolishment of another group of medical professionals or that their role should be modified to protect doctors. We are all under huge workload pressures, which I believe have much greater impacts on recruitment and retention than the raw pay problem, and any group of appropriately trained and experienced professionals who can have a positive impact on these workload pressures should be welcomed and supported, not isolated and criticised. Would we also seek to abolish Advanced Nurse Practitioners or prescribing Pharmacists or a wide range of other professions allied to medicine? That would be a dangerous path which I think would make us look elitist and protectionist. Not what I consider our profession to be about.
LikeLike
The BMA’s interest in anaesthesia associates is about 15 years late. We set up a coarse to train them at the University of Edinburgh which was successful in training them across Scotland. All the same concerns about their roles and training impacting medical trainees were raised at that time and proved for the most part ill founded. They became valuable members of the anaesthesia team. Unwisely, the government withdrew funding after about four years so the course closed.
LikeLike
As a Physician Associate who takes great pride in caring for my patients, whilst of course working under the supervision of my consultants, this is deeply upsetting and difficult to read.
Since day one I have carefully and thoughtfully done my job and on many occasions I have gone above and beyond to ensure that all of my patients problems have been dealt with appropriately and in a timely fashion. Where necessary I asked for further support and feedback from my consultants. I have received nothing but positive feedback from many patients that were under my care.
By abolishing our role it will only make the NHS worse. Why must we focus on the negatives? Why can’t we all work together and help PAs get regulated so that we can have more defined roles between PAs and doctors? Ultimately, we all work in one NHS to provide the best care possible for our patients. I take great pride in my role, I treat each one of my patients the same way I’d like my family members to be treated.
It is a real shame that regulation is taking so long. PAs aren’t to blame for the lack of training opportunities for doctors within the NHS but rather nor do we take away training opportunities from them. There is a well recognised shortage of training posts and doctors. The government must simply tackle this by paying what the doctors deserve and increase their training opportunities.
Yours sincerely,
A PA that is trying to do their part in the NHS.
LikeLike