Physician and Anaesthetist Associate Roles: Review

Baroness Merron Excerpts

Thursday 5th December 2024 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, I congratulate the noble Baroness, Lady Bennett, on securing this debate. This is an important issue, as we have heard today. I thank all noble Lords for their invaluable and varied contributions.

I shall start with the toxicity of the debate. I emphasise this Government’s support of and gratitude to all staff. That absolutely includes physician and anaesthetist associates who work hard to treat and care for patients in the NHS. As the noble Lord, Lord Kamall, said, the debate has been not just toxic but polarised. As the noble Lord, Lord Scriven, acknowledged, we have seen bullying, which is unacceptable; as the noble Lord, Lord Kamall, said, we need to look at the toxic culture as well as the toxic debate. I absolutely associate myself with the comments made by the noble Lords from their respective Front Benches. At times, not just the debate but the activity around the subject has been deeply abusive, not just in words or on social media, and has been aimed at PAs and AAs. There is no excuse for this and it will not be tolerated. They are valued team members, as is everybody who works in the National Health Service, and deserve our respect and support.

Let me assure noble Lords that this review—I am glad that it has been welcomed—will be an independent, end-to-end review. It will cover training, recruitment, day-to-day work, oversight, supervision and professional regulation. It will assess the safety of the PA and AA roles relative to existing professions, the contribution that the roles can make to more productive use of professional time in multidisciplinary teams and whether the roles deliver good-quality and efficient patient care in a range of settings. All these matters, among others that noble Lords have rightly flagged today, will be considered.

The noble Baroness, Lady Bennett, asked about resources, support and co-operation for the review. I can assure her that this review is properly resourced and, importantly, that stakeholders across the health and social care system have already indicated that they will actively support its work. I agree that this is vital to Professor Leng’s work. As the noble Lord, Lord Kamall, identified, Professor Leng is a champion for patient safety who brings a thorough understanding of healthcare in this country. She is one of the UK’s most experienced leaders in it and I am most grateful to her for her work. I will draw key points from this debate to her attention, including the matter that the right reverend Prelate and the noble Lord, Lord Scriven, raised about getting information to the public. I take that point and will draw these aspects of the debate to the attention of my ministerial colleagues and Professor Leng.

As the Secretary of State highlighted when he announced it on 20 November, the review will gather available evidence and data on the PA and AA professions. It will also engage with relevant professions, the public, employers and researchers. In response to a number of questions raised today, I am committed to ensuring that noble Lords are kept informed as the review progresses. As has been identified, it will report in spring 2025 and we will publish our findings and update your Lordships’ House on the next steps.

I will address the concerns of the noble Baroness, Lady Bennett, and other noble Lords on interim action. NHS guidance remains in place on PA and AA deployment while the review is ongoing. Furthermore, NHS England continues to engage with NHS organisations to ensure that this guidance is adhered to. On the pace of the review, we are committed to it moving quickly to provide clarity, while ensuring that it has sufficient time to consider all available evidence.

The right reverend Prelate spoke of the value of a skills mix and the need for it in providing the kind of healthcare that we need into the future. My belief is that it is recognised—the noble Lord, Lord Scriven, also spoke to this—that the mix of professions required to deliver the right kind of care has evolved continually since the birth of the NHS. As the right reverend Prelate said, on previous occasions there have been many other criticisms and concerns; it is the nature of change. However, I want to be clear that the premise behind the use of PAs and AAs as part of the multidisciplinary team is absolutely sound. To give some context, PAs and AAs have been practising in the NHS for over 20 years, as the noble Lord, Lord Scriven, said. It is not a recent development.

The numbers we are speaking about are small. I will give some context to your Lordships’ House. There are 14,000 full-time equivalent doctors in anaesthetics in England and 170 AAs in the whole of the UK. There are 146,000 full-time equivalent doctors in England and 1,600 PAs. There are 38,420 full-time equivalent GPs and 2,105 PAs. I would not want your Lordships’ House to labour under any misunderstandings.

PAs support doctors to diagnose and manage patients —“support” is the operative word. They are not and should never be used to replace doctors. Similarly, AAs are qualified to administer anaesthesia but only under the supervision of a medically qualified anaesthetist. These roles always have to work under the right supervision. Concerns have been raised by medical professionals about blurred lines of responsibility and whether, in some cases, PAs and AAs are being used to replace doctors. So I understand the need for a comprehensive view of how these roles are being deployed and how effectively. I am confident that the review will address this.

I am acutely aware of the rare but deeply tragic incidences where patients have lost their lives following treatment by an associate. I offer sincere condolences—I know other noble Lords will too—to family and friends. They deserve answers and the assurance that we are listening—and indeed we are. My noble friend Lady Keeley spoke so movingly about the cases of Emily Chesterton and Susan Pollitt, which are deeply tragic. As the noble Lord, Lord Scriven, said, it is so important not to lump every PA and AA together, just as it is not right to do that for any other group. The noble Lord, Lord Kamall, rightly observed that tragic death happens when care is provided by other health professionals. Our job is to reduce that as far as we possibly can, which is what we are working to do.

The noble Baroness, Lady Bennett, highlighted a reference to legal action and redundancies, as well as the systematic impact that uncertainty has created for employers, GP practices, NHS services and individuals. That is why this review is so vital. It enables us to take stock of the evidence, establish the facts and provide absolute clarity for patients, professionals and employers.

As the noble Baroness, Lady Bennett, acknowledged, there has been significant debate on the scope of practice, especially for PAs. The review will cover all aspects of PA and AA roles, including their deployment and scope of practice. The issue will therefore be considered as part of the review, and I will not pre-empt its outcome on this or any other aspect. Many questions were rightly asked about what happens in the meantime. NHS England’s guidance on the deployment of PAs and AAs should continue to be followed.

On the important points about patient confusion, the GMC has published interim standards for AAs and PAs in advance of regulation. That will make clear that professionals should always introduce their roles to patients and set out their responsibilities in the team. The Faculty of Physician Associates has produced guidance, which includes an example of what a good initial introduction should look like. The review will also consider the professional regulation of these roles, which, as was set out, the GMC will commence next week.

The noble Lord, Lord Kamall, and the noble Baroness, Lady Bennett, asked about the action that will be taken in advance of the review concluding. It is important to note, as the noble Lord, Lord Scriven, did, that regulation by the GMC will begin in a very short while. As the noble Baroness, Lady Bennett, set out, I am aware that concerns have been raised about the GMC as the regulatory body for the roles. But we can be assured of the benefit of statutory regulation in helping to ensure that all PAs and AAs meet the very high standards expected of—and I emphasise this—every healthcare professional. Where these standards are not met, action can be taken.

This has been a challenging period for the PA and AA workforce, and it is vital that, like all NHS staff, they are treated with respect. It is therefore incumbent on all to do this. I look forward to the review, and I wish Professor Leng well. I thank noble Lords for their valued contributions to this debate. I look forward to PAs and AAs playing their part in providing improved healthcare in this country.