The Minister for Health and Secondary Care (Andrew Stephenson)
I congratulate my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) on securing this debate. He spoke knowledgeably, both as a serving NHS medic and as a former Health Minister.
Let me begin by making a very important point. I addressed it in the Delegated Legislation Committee on 17 January, but it is worth repeating. The role of a physician associate is to work with doctors, not to replace them. Improved patient safety and care is at the heart of the NHS long-term workforce plan, which, backed by significant Government investment, shows our determination to support and grow the workforce. As set out in the plan, roles such as physician associates, who remain supervised by doctors, play an important part in NHS provision, and it is therefore right that we include a range of roles and skills in our multi-disciplinary teams that can offer personalised, responsive care to patients.
It is important to note that the NHS long-term workforce plan commits to doubling medical school degree places to 15,000 a year by 2031-32. That compares with 1,500 physician associate places. In turn, this will mean a major expansion of specialty training, on which we are committed to working with the royal colleges. We have accelerated this expansion by allocating 205 additional medical school places for the 2024-25 academic year, with the process for allocating 350 additional places for the 2025-26 academic year already under way. This demonstrates our commitment to the medical profession, and reaffirms that we absolutely do not see physician associates as replacements for doctors. There are currently 139,200 full-time equivalent doctors working in the NHS in England, which is over 42,100, or 43.4%, more than in 2010. Patient safety remains of the utmost importance, and regulation will help bring further clarity to patients and healthcare professionals on the nature of these roles and their remits.
Physician associates are qualified and trained health professionals. They undergo a three-year undergraduate degree in a health, biomedical science or life sciences subject, followed by two years of postgraduate training, gaining significant clinical experience. Alternatively, some universities now offer an undergraduate degree PA course that includes an integrated master’s degree in physician associate studies. Those courses take four years to complete. Training involves supervised practice with real patients, with at least 1,600 hours of clinical training. It also includes 350 hours in general hospital medicine, and a minimum 90 hours in other settings, including mental health, surgery, and paediatrics. The dedicated medical supervisor is responsible for the supervision and management of a student’s educational process throughout the clinical placement of the course.
Dr Poulter
Earlier, in response to the hon. Member for York Central (Rachael Maskell), I made the point about the variability of biomedical science degrees from different institutions. The GMC would not recognise a biomedical science degree as being adequate for a doctor in training as part of their preclinical studies, because of that variability. Will my right hon. Friend raise that issue directly with NHS England, with regard to putting in place a standardised training pathway for physician assistants?
Andrew Stephenson
My hon. Friend makes a valid point, and that is one reason why regulation is so important. The GMC has assured me that although draft regulations are out there, it will be consulting further on them later this year, so my hon. Friend, the BMA and various others can make strong representations about how the training framework should be provided. With that introductory regulation, the GMC will be responsible for setting, owning and maintaining a shared outcomes framework for physician associates, which will set a combination of professional and clinical outcomes. The outcomes framework will help to establish and maintain consistency, embed flexibility, and establish principles and expectations to support career development and lifelong learning. While at the moment there is significant variability in the system, I hope that the regulations we passed in this House on 17 January will help to provide that clarity and give the GMC the powers it needs to ensure that the training provided to physician associates is of the appropriate quality for the roles we are expecting them to undertake in our NHS.
Physician associates can work autonomously with appropriate support, but always under the supervision of a fully trained and experienced doctor. As with any regulated profession, an individual’s scope of practice is determined by their experience and training, and will normally expand as they spend longer in the role. That must be coupled with appropriate local governance arrangements to ensure that healthcare professionals only carry out tasks that they have received the necessary training to perform. Statutory regulation is an important part of ensuring patient safety, but that is also achieved through robust clinical governance processes within healthcare organisations, which are required to have systems of oversight and supervision for their staff.
NHS England is working with the relevant professional colleges and regulators, to ensure that the use of associate roles is expanded safely and effectively. That includes working with the GMC, royal colleges and other stakeholders to develop appropriate curriculums, core capabilities and career frameworks, standards for continual professional development, assessment and appraisal, and supervision guidance for anaesthetist and physician associates. NHS England will also work with colleges, doctors’ representative organisations, AAs and PAs to identify areas of concern. Specifically, the NHS has committed to working with the Academy of Medical Royal Colleges and individual professional bodies to develop and implement recommendations as a result.
Regulation will give the GMC responsibility and oversight of AAs and PAs, in addition to doctors, allowing it to take a holistic approach to education, training and standards. That will enable a more coherent and co-ordinated approach to regulation and, by making it easier for employers, patients and the public to understand the relationship between the roles of associates and doctors, help to embed such roles in the workforce. Indeed, regulation addresses many of the concerns that we have heard in the debate last month and today. The GMC will set standards of practice, education and training and operate the fitness to practice procedures, ensuring that PAs meet the right standards and can be held to account if serious concerns are raised. GMC guidance sets out the principles and standards expected of all its registrants, and that will apply to PAs once regulation commences. Those standards will give assurance that PA students have demonstrated the core knowledge, skills and professional and ethical behaviours necessary to work safely and competently in their areas of practice and in a care context as newly qualified practitioners.
Rachael Maskell
On that point, can the Minister clarify where the liability will sit if error does occur? Will it sit with the clinician or the consultant who is supervising them? I am not clear on that particular issue.
Andrew Stephenson
In many ways, it will be the same as with many medical professionals. Once we have the situation clarified in regulation, it will not be any different from the personal liability of a doctor or others working in an organisation. Those are the kind of things that the GMC will be consulting on and discussing with stakeholders in the coming months, and is important that all these points are clarified. The hon. Lady was in the debate we had in January, where the tragic case of Emily Chesterton was raised. In that case, unfortunately we saw a PA move from one practice to work in another, and we need to ensure that there is a proper, robust fitness-to-practice regime so that any medical professional can be held to account in such cases for what has happened and, if necessary, struck off the register and no longer able to practice.
Dr Poulter
The Minister is being generous in giving, and we are taking advantage of the slightly extended time we have for this Adjournment debate, but it is an important issue, because it is about patient safety. On that point, he is putting a lot of faith in the GMC doing things quickly, when we know there are existing patient safety issues. Would it not be more sensible to wait for the GMC to put in place the proper regulatory framework, the proper scope of practice and the other pieces of work that are being done before we commit to an expansion of a workforce when we know there is variability and patient safety concerns?
Andrew Stephenson
I feel that I am being criticised from both angles on this point. Some people are saying we are going too fast, and other people are saying we are going far too slow. A number of years ago, we consulted on regulating these professions. We are now moving forward. Those regulations have passed through the UK Parliament and the Scottish Parliament. The GMC has had a long time to prepare. In my meetings with the GMC, it has reassured me that it is ready to go. It will want to consult to ensure that any further concerns that people wish to raise are reflected in the regulations. It wants to ensure that it gets the regulations right, but it has known that they have been coming for some time. We consulted on who was best placed to regulate physician associates and anaesthetist associates back in 2019, so the GMC has had some time to lay the groundwork.
Under the long-term workforce plan, there is a much more significant expansion of doctors, as opposed to physician associates or anaesthetist associates. The number of extra doctors we are bringing in to the health service, as compared with physician associates, is of a magnitude of five to one. I hope I can reassure hon. Members that this is not in any way about replacing doctors. Doctors are still absolutely pivotal to patient care and will be heavily involved in overseeing physician associates, who are not doctors and need to be overseen in clinical practice.
The role of physician associates is in no way a replacement for that of any other member of the general practice team. They work in conjunction with and are complementary to an existing team. Physician associates can help to broaden the capacity and skills mix within a practice team by helping to address the needs of patients in response to the growing and ageing population, but let me be clear that the employment of PAs does not mitigate the need for more GPs, nor does it remove the need for other practice staff.
There will be a wide range of clinicians, such as PAs, who are well suited to providing care in general practice as part of a multidisciplinary team, but GPs remain at the heart of general practice and primary care, and that is not going to change. As we develop and progress with changes to the NHS workforce, it is vital that the expansion of physician associates and their role is delivered safely. GMC regulation is a positive step forward in the safe expansion and further integration of AAs’ and PAs’ roles within the NHS.
I thank my hon. Friend the Member for Central Suffolk and North Ipswich for once again bringing the House’s attention to this important issue. I look forward to continuing to work with him and other right hon. and hon. Members to ensure that we get this right.
Question put and agreed to.