NHS crisis won't be solved by hiring 'physician associates' instead of real doctors – Dr Iain Kennedy

Many doctors are worried that the use of physician associates and anaesthesia associates is putting patients at risk

The NHS needs more doctors, not 'physician associates' (Picture: Christopher Furlong/Getty Images)

One of the key issues being debated in Scotland’s NHS at the moment is the role and deployment of a group of professionals known as physician associates (PAs) and anaesthesia associates (AAs). I suspect readers might not know what roles these terms refer to – and that is really the core of the problem.

The first PAs were introduced in the UK in 2003, under the name ‘physician assistant’, with the name changing to associate in 2014. Originally, the idea was that these roles would support doctors and maybe free up our time – but this is not happening. Instead, members of the British Medical Association (BMA) have serious concerns about how PAs and AAs now work.

For example – our members are highlighting the patient safety implications of these roles – and the potential confusion among patients who may believe they have seen a doctor, but instead have seen a professional not trained to the same standards. Doctors must complete a five-year medical degree. PAs/AAs typically have to complete two years of clinical training. There just isn’t any comparison to be made between the levels of qualification and the work required to achieve them.

Our junior doctors are worried about the impact of these roles on doctors in training, who lose out on vital opportunities to gain experience that is instead provided to PAs/AAs. We also fear the numbers of these roles may be expanded to plug medical vacancies and compensate for poor medical workforce planning with a cheaper and less effective and safe alternative.

An issue that can’t be ducked

And all this is being compounded by PAs or AAs at times undertaking work beyond their competence. Some 69 per cent of doctors who responded to our recent survey on this said they were occasionally or frequently concerned this was happening with a PA/AA they worked with.

At BMA Scotland, we are clear this isn’t an issue that can be ducked. This is not about individuals in these roles – it is about patient safety, the scope and supervision of these roles, and the impact on doctors’ training. But it is a debate that that must be conducted respectfully for patients and PAs/AAs.

We believe there are some urgent steps needed. Currently, the Scottish Parliament is pushing forward with plans for AAs/PAs to be covered by the doctors’ regulator, the General Medical Council – which would only add to the dangerous blurring of lines between the medical profession and these new professions. I would urge the government and MSPs to rethink these plans – a suitable alternative can be found.

We have also called for a return to ‘assistants’ as the name for these jobs and a moratorium on recruitment while this worrying uncertainty is ongoing, at the very least. Indeed, long term we need to give serious consideration to what part AAs and PAs will play in NHS Scotland. There simply isn’t any shortcut out of the medical workforce crisis we face, which will only be solved by investing in the retention and recruitment of doctors.

Dr Iain Kennedy is chair of the British Medical Association Scotland