Physician associates who “deliberately” mislead patients into thinking they are doctors could be investigated for serious misconduct under new guidelines from the medical regulator.
Its chief executive said regulation—which will come into force on Dec. 13—is a “vital step towards strengthening patient safety and public trust” in the roles, which have come under scrutiny following concerns raised by the public as well as from the British Medical Association (BMA.)
Numbers Set to Triple
Under current plans, the number of PAs in England could increase from 3,500 to 10,000 by 2036-2037, along with 2,000 more AAs, with the aim of getting more patients seen and treated quickly.These staff are graduates—generally with a health or life sciences degree, but not a medicine degree—who have undertaken two years of postgraduate training.
The role of a PA is to “support doctors in the diagnosis and management of patients” and they can be deployed across GP surgeries and hospitals.
AA duties include reviewing patients before surgery and taking medical history, as well as inducing, maintaining and waking up patients under supervision.
The new report by the GMC includes a number of changes to its initial proposals for PA and AA regulation, including the expansion of behaviours indicating “a high level of seriousness.”
‘Fitness to Practise’ Cases
More case examiners will be needed for fitness to practise cases involving PAs and AAs.The process, which assesses a professional’s ability to practise safely and effectively, will now need two examiners rather than the one that was initially proposed by the GMC.
Course providers must also ensure that student PAs or AAs make it clear to patients that they are involved in their care.
Charlie Massey, GMC chief executive, said: “Regulation is a vital step towards strengthening patient safety and public trust.
“It will provide assurance to patients, employers and colleagues that physician associates and anaesthesia associates have the right level of education and training, meet the standards we expect, and can be held to account if serious concerns are raised.”
PAs have come under increased scrutiny in recent years due to a number of cases where patients were given inappropriate treatment.
In 2022, Emily Chesterton suffered a fatal pulmonary embolism at the age of 30 after being misdiagnosed by a PA on two occasions, when she believed she was seeing a doctor.
Legal Threats From BMA
Last month, the government launched a review into the role of PAs and AAs, led by Professor Gillian Leng, president of the Royal Society of Medicine.It is expected to report in the spring and will recommend how new roles should work in the future.
In October, the Royal College of General Practitioners (RCGP) published guidance which said PAs should not see patients who have not been assessed by a GP first.
RCGP Chairwoman Professor Kamila Hawthorne said: “It is the college’s position, following consultation with members and discussion amongst our governing council, to oppose a role for physician associates in a general practice setting.
“However, acknowledging that there are around 2,000 PAs already working in general practice, one of our red lines has always been that the profession must be regulated as soon as possible.
“We do not believe the GMC is the most appropriate body to do this but we recognise they have been given this responsibility and that regulation will commence later this month, so we will continue to work with the GMC to ensure regulation of PAs can be implemented as smoothly as possible to protect patient safety.”
The BMA, which is the trade union for doctors, has threatened to take legal action against the GMC as it does not believe it is the right body to regulate PAs and AAs, known collectively as Medical Associate Practitioners (MAPs).
In June, the BMA wrote a letter to the GMC, accusing it of playing a role in the “dangerous blurring of the lines” for NHS patients between qualified doctors and MAPs.
Solicitors for the union wrote 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.”
‘Cavalier Approach’
Professor Phil Banfield, chair of BMA Council said that the GMC has not gone far enough with the regulation, as it has failed to specify exactly which tasks are allowed to be carried out by MAPs.Banfield said in a statement: “The GMC, the medical regulator, should never have been made the regulator of non-medical occupations like PAs. Nevertheless, it had the opportunity with this consultation and in the months since to show both patients and doctors it could carry out this role responsibly. It has not taken that opportunity.
“A regulator should be able to set out what these associate roles can and cannot do. However, in direct opposition to the views of doctors and patients, the GMC continues to believe that those decisions—how and what PAs can do—should be determined locally by each hospital trust.
“This will continue the postcode lottery of local variation that has already led to tragic patient safety incidents, including deaths.”
He added: “Patients deserve better than this cavalier approach to regulation. They deserve a medical regulator that listens to the medical profession. Professor Leng will have much to consider in her review which demands unsparing scrutiny of government, NHS England and the GMC for their role in this debacle.”
