Physician and Anaesthetist Associate Roles: Review

Lord Bishop of London Excerpts

Thursday 5th December 2024 Lords Chamber

[The Lord Bishop of London]

My Lords, it is good to participate in this important debate and I am grateful to the noble Baroness, Lady Bennett, for having secured it. I declare my entry in the register of interests, specifically that I was formerly the Government’s Chief Nursing Officer.

This is clearly a complex issue, and I join other noble Lords in welcoming the Government’s recently announced review of the physician associates and anaesthetist associates. In building an NHS fit for the future, it is right that the right people with the right training and the right competence undertake the right roles. Over the last 20 years, we have seen an expanding of roles to release medical staff to do what only they can do; for example, the development of nurse-led assessment, advanced nurse practitioners and nurse prescribing, and the expansion of the role of pharmacists. In some sense, the development of physician associates and anaesthetist associates is part of this change. However, any change in role and the healthcare workforce needs to be carefully implemented and regulated. Therefore, I welcome the regulation of physician associates and anaesthetist associates, but I too question whether their regulation should take into account the outcome of this review, rather than moving ahead at present.

The main points I will make are around clarity and trust. Noble Lords will often hear me speak in this place about the essential commodity of trust in healthcare and the health of the nation. Research carried out by Healthwatch found that the public awareness of physician associate roles is mixed, particularly among older people, who are less likely to know the difference between a PA and a GP. Clear information needs to be given to people about the healthcare worker they are seeing, and they need to be reassured that they are competent and working to clear standards.

I am encouraged to hear that both roles and standards will be examined in the review, but can the Minister tell us whether what and how information is given to the public will be part of the scope? I also wonder whether we can learn from past changes, such as the introduction of nurse prescribing, to help us understand how we bring about this type of change.

Giving clarity is a vital step towards ensuring trust, particularly in primary care. We must ensure that we are transparent and that we focus on building trust as a priority. I also speak from a London perspective, where the memory is fresh of the great losses during Covid that were disproportionate in some communities, especially those that still struggle to reach the health service—their trust in primary care is low. Will the Government assess the distribution of physician associates as part of the review and examine how patients might have greater clarity about who they are seeing at an appointment? This is especially important where communication might be difficult, such as when English is a second language. According to the Royal College of General Practitioners, GPs in more deprived areas are responsible for caring for more patients than those in affluent areas. It would be helpful to know how physician associates fit into that picture.

Looking more generally at the workforce and the long-term workforce plan, which accelerates the expansion of physician associate and anaesthetist associate roles, do the Government plan to change the projections of this expansion based on the outcome of the review? What impact will this have not just on the plan but on the wider workforce?

The issue of supervision has already been raised in the debate. While I welcome the diversification of roles in the multidisciplinary team to ease pressure where it is appropriate, it is absolutely clear that the supervision of those roles is important. Who is supervising them? Who are they accountable to? That is particularly the case when there is pressure already on our health service.

When the long-term workforce plan was first published, I am not sure that it answered the question related to supervision. On apprenticeship schemes for roles such as this, what progress has been made to ensure that in hospital settings and primary care, funding is given for backfilling? When apprentices are paid and have time for study, is the hospital or the primary care setting able to backfill with staff? If the Minister has any insight into how this has progressed since the plan was published, I would be grateful to know.

The role of the physician associate is a controversial topic, as has been highlighted in this debate. It is having a very clear impact on team dynamics. Within some of those teams, staff are reporting bullying. Staff morale is low, including that of the physician associates and anaesthetist associates. I wonder whether this should be a high priority for the Government and a dimension of the review.

Finally, I hope that the Government will learn from this review and that the learning they undertake will be transferred to other areas of health. As the Government shift from sickness to prevention, from hospital to community, as part of their 10-year plan, it is likely that diversification—in primary care but also elsewhere—will be required and will need to grow. Therefore, there is an opportunity to learn from this review and to roll that learning out. I look forward to hearing from other noble Lords on this important issue and from the Minister when she responds.