BMA Threatens Legal Action Over Physician Associates ‘Experiment’

Dr. Judah Eastwell, a GP at St. Johns Medical Centre, consults a patient in the outdoor consultation tent in Altrincham, England, on April 13, 2020. Christopher Furlong/Getty Images

The British Medical Association (BMA) has threatened legal action against the General Medical Council (GMC), over what it terms its “dangerous blurring of the lines” for NHS patients between qualified doctors and physician associates (PAs).

The BMA, the trade union for British doctors, believes the GMC is not the right body to regulate PAs and anaesthesia associates (AAs), who usually complete a two-year course rather than a five year medical degree, although they may also have a degree in a bio-science field.

Following recent legislation, the GMC, which is responsible for maintaining the register of those allowed to practise medicine, will also become the regulator of PAs and AAs from December this year.

The BMA said in a statement it agrees PAs should be regulated, but believes that in appointing the GMC to the task, “the Government is undermining and devaluing the medical profession, and confusing patients.”

Solicitors for the union have written a letter before action to the GMC over its use of the term “medical professionals,” which the BMA insists should only be used to refer to qualified doctors.

The BMA said: “The GMC has been using the term ’medical professionals’ in its materials to describe all of its future registrants – both doctors and associates. This includes in Good Medical Practice, the key GMC guidance document for doctors, defining the standards of care and behaviour that are expected, which is used as a reference to determine fitness to practise.”

‘Worrying’ Expansion of Physician Associates

The BMA said the legal action will highlight the “worrying” expansion of PAs, who numbered just over 1,500 as of June 2023, amid concerns that the government is looking to save money because associates are paid less than doctors, with salaries starting at just over £32,000. An experienced PA can earn just over £53,000 after at least five years.

There were 93 full-time equivalent people working as AAs as of last year, but the government is keen to recruit more individuals to these roles, offering training routes for nurses and other health care professionals as well as to graduates with relevant degrees.

The union said its concern is illustrated by a number of tragic cases, pointing to the death of 30-year-old Emily Chesterton, who an inquest ruled died from a blood clot in 2022 after she was repeatedly misdiagnosed with anxiety coupled with the effects of “long COVID” by a PA at her GP’s surgery in London. Ms. Chesterton was under the impression she had seen a doctor.

BMA Council Chair Philip Banfield announced the launch of the judicial review claim at the BMA’s Annual Representative Meeting in Belfast earlier this week.

In its letter before action to the GMC, the BMA said the NHS had confused patients—and even itself—over which staff were doctors and which were PAs in a recent marketing campaign, “It’s a GP Practice Thing.” One integrated medical board in Bradford apologised for the campaign and removed it, following complaints.

Misuse of Title ‘Physician’ Can Be Criminal

The letter points out that use of the professional title “physician” is among those protected by the 1983 Medical Act, and its misuse can constitute a criminal offence.

Undated family handout photo of Emily Chesterton, who died from a pulmonary embolism after being misdiagnosed on two occasions by a physician associate. PA

Mr. Banfield said in a statement: “[PAs] are not doctors, and we have seen the tragic consequences of what happens when this is not made clear to patients. Everyone has the right to know who the healthcare professional they are seeing is and what they are qualified to do—and crucially, not to do.

“The central and solemn responsibility of the GMC is to protect the public from those who are not registered qualified doctors, pretending to be doctors. It has become increasingly clear that broadening the term ‘medical professionals’ to include those without medical degrees has had the effect of making this task far harder, when recent experience has now shown that this represents a dangerous blurring of this critical distinction.”

“It’s not too late to row back from this uncontrolled and ill-thought out experiment in dumbing down the medical skills and expertise available to patients.”

Anaesthetists United, a group independent from the BMA, is planning a “separate but complementary” legal action, relating to what the BMA terms the “lack of any national regulation of scope of practice” for AAs.

Dr. Richard Marks, co-founder of Anaesthetists United, said in a statement: “Doctors and their patients are united over their opposition to the outgoing government’s plans for replacing doctors with Associates. Taking legal action seems to be the only way forward.”

The GMC told The Epoch Times in an emailed statement: “As a multi-professional regulator, we will recognise and regulate doctors, PAs, and AAs as three distinct professions.

“PAs and AAs don’t have the same knowledge, skills, and expertise as doctors. They are not doctors but they can, and do, play important roles within multidisciplinary teams when appropriate and effective clinical governance and supervision are in place.

“We know from several years of ongoing engagement with patients and the public, doctors, and stakeholders that they do expect PAs and AAs will, like doctors, work to high professional standards. We will continue to work with patients, professionals, Royal Colleges, the BMA, and others towards the delivery of safe and effective regulation for these groups.”

The letter before action from the BMA gave the GMC until June 28 to respond.