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Confirm there is no plan to ‘replace doctors’, NHSE told

Published on: 25 Oct 2023

The medical regulator has told NHS England to ‘directly tackle’ a perception there is a plan to replace doctors with physician associates amid an ‘intense’ debate about their future.

General Medical Council chief executive Charlie Massey wants NHS England and health systems in the devolved nations to address several issues surrounding the expansion of medical associate roles.

This follows intense debate over recent weeks, including multiple media reports of safety incidents where the involvement of physicians and anaesthesia associates has been questioned. The debate has been partially prompted by ambitions in the long-term workforce plan to increase their numbers, and the impact this would have on post-graduate medical training.

Last week almost 90 per cent of Royal College of Anaesthetists members voted to pause the rollout of anaesthesia associates, after an extraordinary general meeting. This prompted NHSE leaders to stress to trusts that associates should be working within established guidelines and have appropriate supervision.

In response, Mr Massey has written to NHSE, calling for it to: “Directly tackle the perception that there is a plan for the health services to ‘replace’ doctors with PAs or AAs by convening and leading a system-wide discussion on an agreed vision for these roles.”

He said there must be frameworks for associates to work safely; that NHSE should be more explicit about plans to safeguard medical training as the roles are expanded; and should set out how they fit into multi-disciplinary teams.

He told HSJ: “I am worried that the discourse about medical associates on some social media could impact on the health service’s ability to attract and retain people in these roles and thereby affect the delivery of the long-term workforce plan.”

“I’ve heard unfortunate accounts of PA/AAs not feeling safe in the workplace, and students being concerned about what will happen when they graduate. These conversations are creating inevitable tensions within some multidisciplinary teams. This is obviously not good news for anyone, and must be addressed.”

He also stressed that “regulation will go a long way to make sure that patients have the necessary trust and confidence in these professions”.

However, because new legislation is needed before regulation can start, the timeline sits with the Department of Health and Social Care. Mr Massey said he hoped legislation would be laid before Parliament before the end of the year, which would enable a consultation process to begin by the end of 2024.

The long-term workforce plan set out plans to increase the number of AAs to 2,000 by 2036-37 and establish a PA workforce of 10,000.

Mr Massey said the centre must also set out in a more granular way how it will generate the necessary growth of training opportunities and capacity across the system, including increasing the trainer workforce.

Physician associates were introduced in 2003 and work alongside doctors and surgeons to provide medical care as part of the MDT, including taking histories and carrying out examinations. They work under supervision of a medic. Anaesthesia associates were introduced in 2004 and designed to “enhance the working lives of other members of the perioperative team”.

Steve Powis, national medical director at NHSE, said in response to the GMC’s letter: “There is emphatically no plan to replace doctors in the NHS, with the NHS long term workforce plan setting out a doubling in the number of medical degree school places to 15,000 by 2031, compared to 1,500 Physician Associate places - this in turn will mean a major expansion of specialty training which we are committed to working with the Royal Colleges on.”*