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Permission to Visit - Goldilocks and the Three Bank Statements
Robert Houchill
The role of Physician Associates (PAs) and Anaesthesia Associates (AAs) are still considered to be relatively new, but they have been practising in the NHS since 2002 and 2004 respectively. As of June 2023, there were 73 Full Time Equivalent (FTE) AAs and 1,508 FTE PAs working in NHS Trusts and other core organisations. A further 1,707 FTE PAs were working in GP practices and primary care networks. The NHS Long Term Workforce Plan aims by 2036/37 to have established a workforce of 10,000 PAs and 2,000 AAs.
Given the aforementioned, why has there been such debate about the plans for these roles to be regulated by the General Medical Council (GMC)?
Scope of practice
The role of PAs includes the taking of medical histories from patients, carrying out physical examinations, performing diagnostic and therapeutic procedures and interpreting diagnostic studies. AAs conduct pre-operative assessments for anaesthesia and can administer anaesthesia under the supervision of a medically qualified anaesthetist. Neither can currently prescribe medication or request ionising radiation (which is used in medicine for diagnostic radiology, nuclear medicine and radiotherapy).
At present AAs and PAs are subject to voluntary regulation but they are due to come under the regulation of the GMC in December 2024. Prior to this point, the GMC has only regulated doctors who:
- Have an acceptable primary medical qualification;
- Can provide evidence of their fitness to practise with details of all their postgraduate medical and non-medical experience for the five years since graduation (including accounting for any gaps); and
- Are able to demonstrate a sufficient command of English to be able to practice safely.
Response from the medical profession
The role and regulation of PAs and AAs has not been without controversy. A survey report published by the British Medical Association (BMA) in February 2024, showed that of almost 19,000 doctors surveyed, 87% were concerned that the way PAs and AAs currently work in the NHS was always or sometimes a risk to patient safety and 72% of doctors did not support the future regulation of PAs and AAs by the GMC. The BMA recommended that all legislators must oppose the Anaesthesia Associates and Physician Associates Order 2024 (currently in draft) and Medical Associate Professionals (MAPs) should be regulated by the Health and Care Professions Council (HCPC), as called for by the BMA in response to the original consultation on regulation in 2017.
So thorny is this issue that in June 2024, the BMA announced that it was launching legal action against the GMC over what they called the dangerous blurring of lines between doctors and PAs and AAs, in particular the use of the term “medical professionals” in GMC material, which the BMA said should only ever be used to refer to qualified doctors. The GMC issued a statement in response on 2 July 2024, confirming they had responded to the BMA strongly rejecting the basis of their threatened legal proceedings, stating that ‘The term ‘medical professionals’, which we have adopted to describe all the professional groups we will regulate, is not a protected title, and our use of it is both lawful and appropriate.’ Anaesthetists United also served a judicial review pre-action protocol letter upon the GMC on 26 July 2024, raising concerns about a lack of scope of practice in respect of AAs and PAs.
Commentary
With the date for GMC registration for PAs and AAs getting ever closer, there remain unanswered questions on how these roles will fit into the existing medical workforce both from an employment and regulatory perspective. It is without doubt that the medical sector requires skilled healthcare workers, but in this case, it is clear that there are many medical professionals who are concerned about the safe and effective practice of MAPs. It is important that the Department of Health and the GMC address the concerns head-on, and find a way to make the transitionary period as smooth as possible.
We shall be watching the developments of this issue with keen eyes.
further information
If you have any questions regarding this blog, please contact Louise Murphy-King or Shannett Thompson in our Regulatory team.
about the authors
Louise is a Senior Associate in the Regulatory Team. She re-joined Kingsley Napley as a solicitor in 2016, having previously worked as a Legal Assistant at the firm between 2010 and 2012.
Shannett is a Partner in the Regulatory Team and is the firm’s Training Principal. She trained in the NHS and commenced her career exclusively defending doctors. She provides regulatory advice predominantly in the health and social care and education sectors.
We welcome views and opinions about the issues raised in this blog. Should you require specific advice in relation to personal circumstances, please use the form on the contact page.
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