‘Wes Streeting on Physician Associates (PAs) following RCGP vote and public statement’
Wes Streeting was asked to respond to a recent vote and statement on physician associates (PAs) from the Royal College of General Practitioners (RCGP) during a fringe meeting hosted by the Institute for Public Policy Research (IPPR), ‘Health Equals Wealth – Labour’s Plan for Health and Care’ at the Labour Party Conference in Liverpool on 23rd of September.
A journalist for GPOnline prompted Streeting, “Last week the RCGP made an announcement regarding PA, voting to oppose the role of PA’s in general practice after concerns about patient safety – What is your view on this and do you think that PA’s have a role to play in general practice?”
Streeting responded that he believes PAs “do have a role to pay in a modern NHS, and in our country, they are [already] providing great care and contributions – not just to patients and their colleagues.” He continued, “where I think we’ve had a challenge is the legitimate concerns expressed by doctors about substitutions and patient safety and ignored by the previous government and feel gaslit – this has been quite a toxic debate especially online – PAs feeling quite demoralized, and physicians feeling unheard – now led to [a] number of parts of the profession – now the RCGP [are moving] to throw the bathwater out and the baby with it – and I think to throw the baby out with the bathwater would be a mistake…”
RCGP issued its statement, which can be read in full below, following a vote of its governing UK council which saw a change in its position on PAs working in general practice. Professor Kamila Hawthorn, Chair of the Royal college of GPs, said: “The role of PAs in general practice has dominated the medical agenda for well over a year now and we understand the strength of feeling amongst our members and their concerns for the safety of their patients.” RCGP membership is a collective 54,000 GPs.
Hawthorn continued, “It became very clear at today’s Council discussion that we needed to speak out in opposition to the PA role within a general practice setting and I am pleased that our processes have enabled us to do this in a collegiate and democratic way. We recognise that this new policy position may be unsettling for Physician Associates who are already working in general practice and for their employers, and we hope that our upcoming documents to be published in the coming weeks will provide some clarity on how these roles could be managed where they are in place.” (RCGP.org, 2024).
As the RCGP recognises that “around 2,000 PAs” are already working in general practice, the council also approved three sets of guidance to support GP practices that are already employing PAs. This comes off the back of the BMA issuing national guidance and writing an open letter to the House of Lords last February, staging a “major intervention for patient safety” regarding the use of PAs and their regulation through the General Medical Council (GMC) from December 2024. The GMC is the regulating body exclusively for doctors. BMA’s chairman Professor Phil Banfield stated in the letter, “PAs are not doctors. They do not hold a medical degree and are not medically trained, despite misleading statements made by some. We know that patients are already confused about telling the difference between PAs and doctors, and this legislation will make this problem worse. Keeping the GMC as the regulator exclusively of doctors would mean we retain the clear distinction between doctors and PAs” (BBC.co.uk, 2024).
The BMA, who issued the first national guidance for the PA role, did so following the death of patient Emily Chesterton who died age 30 after two appointments with a PA she believed was a GP who misdiagnosed her symptoms of a pulmonary embolism. This incident alongside a build-up of “serious patient safety incidents involving PAs, together with mounting concern from the medical profession” prompted the intervention (BMA.org.uk, 2024).
Streeting went on to conclude his thoughts that the concerns of professionals and patient safety needed to be taken seriously, “are being taken seriously” alongside “physician’s anxiety about substitutions”, looking to work through the situation in a “thoughtful, considered and evidenced based way to approach this issue”.
The BMA issued its guidance on the scope of responsibilities for Medical Associates Professionals (MAPS) including PAs and anaesthesia associates (AAs), stating that the BMA has “drawn on doctors’ expertise and experiences to draft this crucial guide for safe practice”, with first time recommendations that are “designed to work at a national level across all medical practices, and are very different from the more piecemeal or fragmented approach seen in reality whereby individual organisations or medical bodies set their own guidelines and scope.”
The Academy of the Medical Royal Colleges (AOMRC), which represents 24 medical royal colleges, has since called for the institute of a “rapid review of the role of MAPS” including PAs and AAs, in a letter to the Secretary of Health and Social Care, and the Chief Executive of the NHS England, Amanda Pritchard – looking at these roles from three important perspectives:
- Patient safety. In short, do the PAs and AAs that have been working in the NHS since 2003 show any greater propensity than doctors to work in a way that is unsafe to patients?
- Are they cost-effective? In other words, can they do what is required of them without increasing the cost to the taxpayer?
- And do they really free up scarce resource such as a doctor’s time so that it can be used more effectively? Are they efficient? Can they work without close supervision? And do they improve the overall quality of care for patients?
(AOMRC.org.uk, 2024)
“As this date [of GMC regulation] approaches it has been clear to leaders of the medical profession and in particular our member colleges and faculties that there is mounting concern and adverse commentary by doctors at all levels of their career around NHS England’s plans to increase the current MAP workforce from the current 3,000 to 10,000 by 2036/7” said Dr Jeanette Dickson, chair of council for AOMRC – who went on to conclude, “Only if these last three criteria are met do we think we will be able to support their continued roll-out – provided, of course, that’s what the evidence tells us. If the evidence tells us that the whirlwind of anecdotes and claims on social media are in fact correct, I am sure you will agree, it will give us all cause for thought.”
Sources:
Academy of Medical Royal Colleges Letter to Wes Streeting and Amanda Pritchard
BMA sets out first national guidance for the role and responsibilities of physician associates in major intervention for patient safety
Physician associate law may confuse patients, says BMA
https://www.bbc.co.uk/news/health-68384747
RCGP changes position on Physician Associates working in general practice
https://www.rcgp.org.uk/news/physician-associates-council-update
Streeting backs role for physician associates in NHS despite RCGP vote