The Minister for Health and Secondary Care (Will Quince)
Let me start by thanking the hon. Member for Worsley and Eccles South (Barbara Keeley) for securing this important debate and for her very powerful speech. It was very difficult to hear her recite Marion’s words.
First, on behalf of the House, may I pass on my sincere condolences and sympathies to the hon. Lady’s constituents, Marion and Brendan Chesterton, in relation to their daughter Emily. No family should have to suffer the loss of a child, and my heart goes out to them and, of course, to Emily’s friends and wider family. Having personal experience, I know that no words from me could ever take away the pain or the suffering of losing a child, but I certainly understand the need to understand why and how this happened, and the need for an assurance that any lessons that can be learnt will be learnt, that necessary changes are made and that all steps are explored, so that any future families will not go through a similar tragic loss.
I have had sight of the hon. Lady’s recent letter to the Secretary of State for Health and Social Care. Although I will not be able to answer all the specific questions she raised today—not least because I have not yet had a chance to read the coroner’s report or had specific information from NHS England—I will ensure that she receives a full response to the letter and the points and questions contained therein.
Improved patient safety and care lay at the heart of the NHS long-term workforce plan, which, backed by significant Government investment, shows our determination to support and grow the healthcare work- force. As set out in the plan, roles such as physician associate play an important role in NHS provision, but critically, healthcare teams remain supervised and led by clinical experts. It is right that we include a range of roles and skills in our multidisciplinary teams that can offer personalised, responsive care to patients. Giving staff access to continuing development, supportive supervision and, importantly, protected time for training is a core responsibility for all employers in ensuring patient safety.
As set out in National Institute for Health and Care Excellence guidelines, we are clear that the onus is on the individual professionals to properly explain their role to patients, especially if there is a likelihood of this not being automatically understood. I know that NHS England has produced patient-facing materials that have been shared widely with GP practices to support patient awareness and the understanding of roles.
Physician associates are healthcare professionals but with a generalist medical education, who work alongside doctors, providing medical care as an integral part of a multidisciplinary team. Physician associates can work autonomously but, importantly, always under the supervision of a fully trained and experienced doctor. They add new talent to the skill mix within teams, providing a stable generalist section of the workforce that can help ease the workforce pressures that the NHS currently faces.
As the hon. Lady rightly said, across the UK there are currently approximately 1,500 PAs working in hospitals and a further 1,700 PAs working in primary care settings. Physician associates are qualified and trained health professionals, and people will usually need a bioscience-related undergraduate degree to get on to one of the training programmes available, which typically last for two years. The training involves at least 1,600 hours of clinical training, including 350 hours in general hospital medicine and a minimum of 90 hours in other settings, including mental health, surgery and paediatrics. Some become physician associates after working in another healthcare role, such as a nurse, allied health professional or midwife.
As the hon. Lady will be aware, physician associates are not currently subject to statutory regulation, and I heard her call in that regard. It is important to note that, as an unregulated role, physician associates are not able to prescribe. In order to prescribe, as she rightly pointed out, a role needs to be added to the Human Medicines Regulations 2012. Any prescribing decisions must be made by a regulated professional such as a doctor. Work is ongoing to bring this role into regulation under the General Medical Council in an appropriate way.
The Faculty of Physician Associates at the Royal College of Physicians provides professional support to PAs across the United Kingdom. In terms of standards, the faculty reviews and sets standards for the education, training and national certification of physician associates. The faculty also oversees and administers the running of a managed voluntary register, which is a register of fully qualified PAs who have been declared fit to practise in the United Kingdom. I understand that the majority of qualified physician associates are on this register.
When complaints are received and upheld in line with the faculty’s code of conduct processes, it can suspend a physician associate from the voluntary register. We would strongly recommend that employers only consider recruiting PAs who are on the voluntary register. It enables supervisors and employers to check whether a physician associate is qualified and safe to work in the United Kingdom.
Barbara Keeley
I take what the Minister has said about the training and voluntary registration aspects, which I did speak to, but could he comment on the situation we seem to have been in? The GP practice had concerns about the physician associate’s knowledge and understanding of what investigations she should perform, her ability to recognise an unwell patient, and her overconfidence and lack of insight into the limitations of her own knowledge. Those are the issues that the GP practice itself reported. Does the Minister share my concern that it is a very serious thing to have had a system like that, and, surrounding that, to have the fact that the reception function in that practice did not realise that it should not refer an unwell patient to a physician associate twice within a short period of time? If these are meant to be safety measures, they are not working, are they?
Will Quince
I hear what the hon. Lady says. In response to her questions, we very much need to look into the exact details, and I hope I will be able to respond to her with full answers when I have received both the coroner’s report and further information from NHS England regarding the practice itself. On the face of what she has just said, the situation is concerning and it certainly adds weight to her calls for the register to be non-voluntary and for regulation and legislation in this space. I will come on to that issue in a moment, because it is a case well made.
The physician associate role is in no way a replacement for any other member of the general practice team—that is an important point to make. They work in conjunction with the existing team, and are complementary to it. Physician associates can help broaden the capacity and skill mix within the practice team to help address the needs of patients in response to the growing and ageing population faced by constituencies up and down the country, including the hon. Lady’s constituency and, indeed, mine. However, let me be clear: the employment of a physician associate does not in any way mitigate the need to address the shortage of GPs, nor does it reduce the need for other practice staff.
I will talk, not about the specific case that the hon. Lady described—I do not have those details—but about the generalities of the responsibilities of a supervising doctor, which may be relevant in this case. Physician associates are dependent practitioners: they are working with a dedicated consultant or GP supervisor. They are able to work autonomously but, vitally, with appropriate support, and the General Medical Council has published guidance for doctors who supervise physician associates. The supervision of a qualified physician associate is similar to that of a doctor in training or a trust-grade doctor, in that the physician associate is responsible for their actions and decisions. However, the medical consultant or GP supervisor ultimately retains responsibility for the patient.
The hon. Lady has called for regulation. As she alluded to, the General Medical Council is well advanced in developing regulatory processes for physician associates once the necessary legislation is in place, and regulation will give the GMC responsibility for, and oversight of, physician associates and anaesthesia associates in addition to doctors. That will enable a more coherent and co-ordinated approach to regulation and make it easier for employers, patients, and of course the public to understand the relationship between the roles. The hon. Lady asked specifically when that legislation will come forward. We intend to lay legislation before the House at the end of this year, which will allow the GMC to commence the regulation of physician associates by the end of 2024—legislation by the end of this year, and then a year for it to be put in place.
The General Medical Council has published future professional standards for physician associates. Among other things, that includes working within the bounds of professional competence and knowing when to refer, or indeed to escalate, to a colleague within the practice. Those standards also cover communication with patients, including the importance of physician associates explaining what they do and how their role fits in with other members of the medical team. Once regulation commences, the GMC will be able to investigate concerns raised about physician associates, and in serious cases will be able to prevent a physician associate from practising, either on a temporary or a permanent basis.
Barbara Keeley
I want to go back to the point I made to the Minister about the title of physician associate, which I have used a lot and so has he. The point is that it does sound rather grandiose as the name of a role in clinical practice for a person who has trained for only two years, and it is confusing. I have been steeped in health and social care matters in this place—I have been a member of the Health Committee and had Front-Bench responsibility for it—and I had never heard of physician associates, so it does seem confusing. The title itself is confusing.
Will Quince
I thank the hon. Lady for her intervention, and I gave careful thought to the point she raised in her speech. Although the terms she used were doctors in training or trainee doctors, physician associates are not doctors in training and they are not doctors. They are very different, but they are a part of a multidisciplinary team. I will take away what she says. She is right that they have been in place for well in excess of 10 years, but nevertheless there is still a relatively small number of them. However, there are plans to significantly grow their number, so I will take that away.
Personally, as part of my own experience of the NHS, I have never seen a physician associate, but when I have been in general practice, I have often seen a paramedic, a physiotherapist or a pharmacist and they have made their position very clear at the outset of the appointment. I think we need to ensure that, regardless of the title— I will take that away and look in some detail at whether it needs to be changed—they are properly introducing themselves and their role, making it very clear to patients that they are not a doctor but are working under the close supervision of one, and making it very clear that they are not able to prescribe but a doctor can. I think that is the most important point, but the hon. Lady raises a very good point about the title and I will consider that very carefully.
Barbara Keeley
I think this is actually related to the confidence one has or does not have. The Minister says he takes advice from pharmacists, as do most of us, but we tend to know in that circumstance that it is a pharmacist we are talking to. There are receptionists, physios and all these types of people working in GP practices, but this was a person who to all intents and purposes looked like a doctor. That knowledge of the short period of their training, and of what they can actually do and not do, really ought to be more visible.
Will Quince
I hear what the hon. Lady says, and I will certainly take that away and give it considerable thought. If she has any particular ideas in this regard, given her experience on this matter, I would of course be very happy to meet her to discuss this further. It is really important, certainly ahead of legislation, that we get this right.
Before I close, I would again like to reiterate my deepest condolences to the family of Emily, and I thank the hon. Lady once again for bringing this debate to the House. As we develop and progress with changes to the NHS workforce, it is absolutely vital that robust governance and supervision sit at the heart of the multidisciplinary model, because at the heart of everything we do must be patient safety.
Question put and agreed to.