Review announcement comes amid growing concerns about use of roles within the NHS
An independent review of the controversial use of the roles of physician associates within the NHS has been launched today by the Health Secretary. Wes Streeting wants the review to look at how both physician associates and anaesthesia associates are being used across the health system.
The launch of the review comes amid growing concern of how people in these positions are used in hospitals and primary care settings. The ECHO has reported extensively on the controversy, with local doctors labelling the situation as ‘irresponsible.’
The NHS first began using physician associates (PAs) more than twenty years ago. Anaesthesia associates (AAs) were introduced shortly afterwards. The idea is that these staff members work alongside doctors to support them in hospitals and GP surgeries. They are trained to take medical histories, carry out physical examinations and to develop and deliver treatment and management plans.
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Physician associates train for just two years before being deployed into the health service, whereas doctors train for between four and six years. The Department of Health states that while PAs can work autonomously, they must always be under the supervision of a fully trained and experienced doctor. PAs cannot prescribe medication but they can diagnose.
At present there are around 4,000 PAs working in the health service, but there are plans to increase that number to 10,000 in the coming years as part of an NHS workforce plan. For many doctors and others working in the NHS, there are increasing concerns about the direction of travel when it comes to these positions and how these roles are being used at present.
Both the Royal College of GPs and the British Medical Association (BMA), have called for a halt of the recruitment of physician associates while rising concerns are addressed around safety and clarity of roles. Doctors who spoke to the ECHO told of a huge reliance on PAs in local Accident and Emergency departments and confusion amongst parents about who they are speaking to when being treated.
The government review will now look into the safety of these roles, how they support wider health teams, and their place in providing patients with good quality and efficient care. It will also look at how effectively these roles are deployed in the NHS, while offering recommendations on how new roles should work in the future.
The review will seek evidence from a range of voices – including patients, employers within the NHS, professional bodies, and academics. Professor Gillian Leng CBE will independently lead the review. She is a described as an “experienced leader in the UK health care system who has championed patient safety and has a deep understanding of the British medical system.”
Health and Social Care Secretary, Wes Streeting, said: “Many physician associates are providing great care and freeing up doctors to do the things only doctors can do.
“But there are legitimate concerns over transparency for patients, scope of practice, and the substituting of doctors. These concerns have been ignored for too long, leading to a toxic debate where physicians feel ignored and PAs feel demoralised.
“This independent review, led by one of the UK’s most experienced healthcare leaders will establish the facts, take the heat out of the issue, and make sure that we get the right people, in the right place, doing the right thing.”
The review will consider the scope of PA and AA roles, which currently include gathering medical histories, performing initial examinations, organising tests to support doctors and reviewing patients before surgery. To increase transparency in these roles, the review will also look into measures to ensure patients know when they are interacting with PAs or AAs, so they are clear on the type of clinician they are seeing and for what reason.
Professor Gillian Leng CBE said: “To promote patient safety and strengthen the NHS workforce, it’s crucial that we have a comprehensive review of the role of PAs and AAs. This will cover recruitment and training, scope of practice, supervision and professional regulation.
“As I conduct this review, I am looking forward to speaking to a broad range of stakeholders and to gathering evidence from the UK and abroad so that we can reach a shared understanding of these roles and their place in wider healthcare teams.”
Amanda Pritchard, chief executive of NHS England, said: “Physician associates and anaesthesia associates are important members of NHS staff – they come to work every day to help care for patients and so they deserve to be treated with the same respect as anyone else coming to work in the NHS.
“While we have always been clear that they are not replacements for doctors, there are clear and ongoing concerns which we are listening to carefully and taking action to address – this independent review marks our pledge, together with the government, to getting this right.
“The review will gather insight from across the NHS, hearing from hospital teams, patients, professional bodies and academics so that we have the evidence we need to tackle this head on and find a way forward that is the right one for patients and our staff.”
The review and next steps will be published in the Spring.