Draft Anaesthesia Associates and Physician Associates Order 2024

Karin Smyth Excerpts

Wednesday 17th January 2024 General Committees

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship, Dame Caroline. I thank the Minister and his officials for meeting me in advance of today’s sitting, and for the courtesy they showed to the Opposition in doing so.

When we are in need of care from the NHS, we are usually at our most vulnerable. We expect to be seen and treated by a professional who is competent in their role and regulated. It is vital that patients know who is undertaking their care, and can be confident in their competence. It is paramount to patient safety that those treating patients in the NHS are regulated. There has clearly been a delay in getting to that point with physician associates and anaesthesia associates, and regulation is long overdue. Those positions play an important role as part of a flexible and diverse workforce, but should never be seen as a replacement for doctors. I am pleased that the Minister has made that clear.

PAs and AAs were first introduced as assistants by the previous Labour Government because they are important in bringing people with different skills into the NHS and providing opportunities for those who do not take the traditional route into clinical roles. They exist in many systems around the world, and we thank them for their service. As part of a multidisciplinary team, they can provide much-needed capacity by supporting doctors and other frontline staff. So important are they that, as we have heard, their numbers are going to be increased as part of the Government’s workforce plan.

However, we must be clear that associates are not a panacea to 14 years of Conservative mismanagement of the NHS. The current crisis on the frontline, the workforce crisis, and record high waiting lists will not be solved by increasing the number of associates. The Government have cut 2,000 GPs, and many people now find it impossible to get an appointment when they need one. The failure to recruit, and particularly to retain, enough fully qualified staff should not be papered over by using alternatives. The Government’s inability to maintain relationships with frontline staff, including both junior doctors and GPs, is exacerbating worries about this legislation. The Government have already shattered morale among the health workforce. Many of us, as MPs, have heard from the people concerned most specifically in the run-up to this legislation. My first question for the Minister is: will he reassure me that the expansion of PAs and AAs will not impinge on medical specialty training expansion and, crucially, opportunities?

A number of concerns have been raised with me and other colleagues about the detail of this order and its implications for safety—concerns that really should have been addressed earlier if the Government had better relationships with key stakeholders. It is important for a Government to listen to and work with patients and professionals, and address their concerns. I ask the Minister to do that today, as this legislation goes through, and throughout the consultation process. That is my second question to the Minister: can he provide assurance that, going forward, all stakeholders will be fully consulted by the GMC on the details of the draft order? Patients need clarity about who is treating them and why. What measures will the Minister take to ensure that patients have that clarity, and improved awareness of who they could be speaking to in a GP surgery or other medical setting?

It is vital that people who are looking to become associates are properly supported and supervised to work within a defined scope in those roles. Addressing the workforce crisis in the NHS, so that staff have the time and, crucially, the capacity to support PAs and AAs, is crucial to ensure that those roles are successful. Can the Minister indicate what support would be available to PAs and AAs, what level of supervision will be suitable, and how the Government will ensure that that is in place, given that we all know how stretched the frontline already is? Has he had discussion with the GMC about defining the scope of PAs and AAs?

It will also be helpful to hear the Minister’s thoughts on how the draft order may impact on career progression in the NHS and help with retention, which we all want. Are there plans to define the core capabilities expected of PAs and AAs? What assurances can the Minster give us that the GMC is the best regulator to undertake that work? That point has been raised with many Members. Will the Minister explain how the order fits in with wider regulation reform, which is to be undertaken over the next year or so? Patient safety is and must always be our No. 1 priority. Can the Minister provide any assurances about the measures in place to review this legislation over the two-year transition period, particularly given the expansion of the role of PAs and AAs in the NHS?

Finally, some have expressed concern about the safeguards around the fitness-to-practice decisions taken by regulators, including decisions to remove or reduce regulatory restrictions on a registrant who has been found to present a possibly serious risk to the public. What assurances can the Minister give on that point? If the legislation is deemed not suitable to improve patient safety, what measures will the Government take to remedy that and keep on top of the situation?

The draft order provides a framework for the regulation of associates. It is vital that all those treating patients in the NHS are regulated and safe, and for that reason we will not oppose the statutory instrument. We support regulation. However, I hope that my concerns and those of others—I know that other right hon. and hon. colleagues wish to speak—will be monitored closely. I look forward to hearing further assurances from the Minister as he works to ensure that the change is successful.

[Several hon. Members rose —]