BMA publishes first guidance for doctors supervising physician associates

The BMA has published the first guidance for doctors supervising physician associates (PAs) and other medical associate professionals (MAPs), representing a ‘major change’ in practice.

Professor Phil Banfield, BMA chair of council, says doctors have been left “without clear guidance” on how to supervise these staff, and these new recommendations will help to prevent “catastrophic mistakes” and improve patient safety.

Majority of doctors believe physician associates put patient safety at risk

Medical Associate Professionals include physician associates (PAs), surgical care practitioners and anaesthesia associates (AAs).

MAPs receive considerably less training than fully qualified doctors, and a survey of BMA members found that many doctors believe MAPs add to doctors’ workloads and negatively affect patient care.

In total, 55% of doctors said physician associates increase their workloads, while 87% said the way PAs and AAs currently work in the NHS was always or sometimes a risk to patient safety.

MAPs must always work under the supervision of doctors, but the BMA says existing practices mean that, in some cases, the named supervisors are unreachable, which puts patient safety at risk.

The guidance therefore sets out to clearly explain the key responsibilities of MAPs and how their supervision should be managed to ensure they contribute to high quality patient care.

Guidance states junior doctors cannot supervise physician associates

The guidance includes specific recommendations for both supervising doctors and employers. It states that Consultants, GPs and autonomously practising SAS doctors are all suitable as MAP supervisors, but not junior doctors, locally employed doctors and specialty doctors who do not practise autonomously.

It also emphasises the importance of supervising doctors having allotted time for discussions with PAs and to review patients. This must occur on each working day and the supervisor must double check patient symptoms, clinical signs and test results before agreeing to any management plan of a MAP they have agreed to supervise.

Practical recommendations for doctors supervising physician associates and other MAPs are also included, and the BMA says supervising doctors must have a clear understanding of the specific work MAPs can undertake while under their supervision. This is clearly highlighted in ‘traffic light’ tables which indicate which activities and behaviours MAPs are competent to perform and expected to do, and which they are not.

Finally, the guidance includes recommendations for doctors who are not supervising MAPs. This includes treating physician associates and other MAPs with respect and learning who their supervisor is so they can be contacted if needed.

Guidance will ensure patients are treated “by the right healthcare professionals at the right time”

Professor Banfield says the guidance will provide clarity, thus giving all staff and the public the confidence that patients are being treated “by the right healthcare professionals at the right time.”

“Unfortunately, doctors have been left without clear guidance on how to supervise these staff placed under their care,” he said. “PAs have been asked to work above their training and competencies without direct access to their named supervisor who would be able to double check clinical findings and plans of management.

“Nor can that responsibility for supervision just be passed over to those unable to undertake it safely because of their own workloads or those untrained to carry the risk of responsibility for others’ actions. This is where critical patient safety incidents become more likely and catastrophic mistakes happen.”

“This is the first time such clear guidance has been produced for the NHS and for doctors, and the BMA is once again filling the void left by others by providing a straightforward set of recommendations that can be implemented locally so that doctors and employers are clear about their responsibilities,” he added.