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Parliament prepares to approve the regulation of physician associates

Parliament looks set to approve the regulation of physician associates (PAs) by the GMC today, a move many fear will “blur the lines” between doctors and PAs.

Parliament looks set to approve the regulation of physician associates (PAs) by the General Medical Council (GMC) today, a move many doctors fear will present a significant risk to patient safety.

The British Medical Association (BMA) says if this is approved, it will blur the lines between medically qualified doctors and other professionals who are not doctors and have fewer years of training and experience.

In response, it has taken out an advert asking MPs to act on doctors’ very clear warnings and not wave through the “ill-thought through plans”. It wants MPs to lodge their opposition and commit to a GMC that remains the sole regulator of doctors.

A BMA survey in December found that 86% of doctors felt patients were not aware of the difference between these roles and those of doctors, showing the immense scope for patient confusion about the level of care they are receiving.

Physician associates need supervision to practice safely

A consultation was launched by the Government in December, which sought views on the legislative provisions that will give the GMC the necessary powers to regulate anaesthesia associates and physician associates in the UK.

The legislation provides a high-level regulatory framework and gives the GMC more autonomy to set out the details of its regulatory procedures in its rules. The draft legislation will also pave the way for full scale reform of the regulatory frameworks of all the healthcare professional regulators by providing a template upon which the GMC can build.

Professor Phil Banfield, chair of council of the British Medical Association, said: “Doctors have been raising their voices in protest at this potentially dangerous move for a long time. The BMA has heard 87% of its members report in a survey that the way PAs are currently used in the NHS is a danger to patient safety. Given how understaffed and intensely pressurised the clinical environment can be, it is not always possible to offer the support and supervision that PAs need to practice safely, which is not right for the PAs as well as patients.

“Last year saw stories in the media showing the grave consequences to patient safety when members of the public think they have seen a doctor when they haven’t.

“Changing the nature of the medical profession by diluting it rather than boosting it with a strengthened workforce with better recruitment and retention of doctors, and doing so against the best advice of nearly the entire profession itself, is a terrible failure of government. MPs must halt that failure today for the good of the patients they represent.”

Role should be renamed physician assistant to avoid confusion

It was initially welcomed by the Royal College of Physicians who said the news is a positive step towards regulation of the physician associate profession, something they have long called for. It added that PAs are a valuable part of a multi-disciplinary team, and regulation will give a welcome assurance of patient safety.

The Royal College of Physicians of Edinburgh, however, released a statement this week saying that it recognises the invaluable contributions of all members of the multi-professional healthcare team in providing high quality and safe patient care and it believes that with appropriate education, training, regulation and support, physician associates can contribute to such care.

It added that clinical medicine is increasingly complex and the unique role of the doctor as the clinician – with the breadth and depth of knowledge and skills to allow highly skilled clinical reasoning, complex decision making and the management of uncertainty – must be preserved and strengthened.

It recommended renaming of the profession to the internationally recognised term “physician assistant” to avoid confusion for the public with existing medical roles such as Associate Specialist.

The statement also said: “Physician associates are not doctors and must not be regarded as substitutes for doctors, but as supplementary members of the multiprofessional team. Statutory and meaningful regulation of physician associates is essential to enable the quality management, training and career framework and possible future career progression for this group to be more clearly defined. This regulation must include standards of practice and formal mechanisms to investigate and sanction malpractice.

“If the GMC becomes the regulator, the register they hold must clearly and simply differentiate doctors from physician associates. Supervision of the clinical practice of physician associates is vital if standards of patient care and patient safety are to be assured. We recommend that physician associates always have direct in-person medical supervision available to them.”

Physician associates (PAs) are healthcare professionals with a generalist medical education who work alongside doctors and surgeons providing medical care as an integral part of the multidisciplinary team. PAs work under the supervision of a doctor but can work autonomously with appropriate support. The first PAs were formally introduced in 2003.

There are approximately 4,000 PAs already working in the NHS across the UK but there are plans to increase the number working in hospitals and GP surgeries to 10,000 by 2038 to help with staff shortages.

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