BMA publishes new guidance for physician associates

The British Medical Association (BMA) has published new guidance setting out the scope of responsibilities for Medical Associate Professionals (MAPs), including physician associates (PAs) and anaesthesia associates (AAs).

The recommendations are designed to work at a national level across all medical practices and use a simple ‘traffic lights’ system identifying what MAPs might be expected to do on their own (green), what they might do under supervision (orange) and what they must not do (red).

The BMA is now calling on NHS employers to adopt it immediately and hopes that the Medical Royal Colleges will use it as the basis for their own work on scope of practice for MAPs in the NHS workforce.

Key concepts that are covered in the document include MAPs following, and not giving, medical directives, MAPs not seeing undifferentiated patients, and national standards for supervision of MAPs being set and adhered to.

The BMA has long voiced concerns about MAPs being increasingly employed in the NHS in roles that had previously been reserved for doctors despite not being regulated and only completing a two-year
postgraduate course (1,600 hours of clinical experience and teaching).

Safe scope of practice for physician associates

Professor Phil Banfield, BMA chair of council, said: “Our guide has been written by doctors, for doctors, to explain to the medical profession what MAPs should and should not do alongside their doctor colleagues. But it is also to help patients, to improve patient safety. With the Government’s clear intent to expand the numbers of MAPs in the medical workforce, but without the clarity on the scope of their skills and responsibilities, it is even more important that patients must know who is treating them and the skills and abilities that clinician has.

“We know that MAPs are working in roles that increasingly cross the line into situations more appropriately requiring the expertise of a doctor, so our report sets out what the Association considers a safe scope of practice that will keep patients protected and allow the NHS to effectively employ MAPs to assist medical teams – which was their original purpose.

“By setting out clear parameters for the distinction between doctors and MAPs, ensuring proper in-person supervision by qualified doctors, and ending the creeping substitution of PAs for doctors on rotas, this safe scope guide sets out a clear explanation of how MAPs can be employed to maintain the provision of high-quality patient care in the NHS.”

The government in England plans to increase the number of PAs by 2036/37 from approximately 3,250 to 10,000 (an increase of over 300%); and AAs from approximately 180 to 2,000 as part of their NHS Long Term Workforce Plan.