Physician and Anaesthetist Associate Roles: Review

Lord Scriven Excerpts

Thursday 5th December 2024 Lords Chamber

[Lord Scriven (LD)]

My Lords, this has been a short but useful debate introduced by the noble Baroness, Lady Bennett. The Question that she laid before the House underlines the lack of balance that she opened with. She asked

“what the review, announced by the Secretary of State for Health and Social Care on 20 November, of the physician associate and anaesthetist associate roles will cover, and what actions they plan to take in advance of the outcome”.

I would hope that if a review of this controversial issue was taking place, it would be considered wise to wait for the evidence and recommendations, not just do something on instinct or limited evidence. Therefore, it is welcome that the Government have opened the Leng review into how physician associates and anaesthetic associates are deployed as part of a team to improve patient outcomes working under the supervision of doctors to support the delivery of medical care.

I thank the approximately 5,000 physician associates and 300 anaesthetist associates who are registered or practising for the professional and dedicated work they do, and the thousands of doctors, nurses and other allied medical professionals of all levels who quietly but professionally and supportively work alongside PAs and AAs as part of the medical team to improve the health of patients.

If I were to think back to when other health professional roles were introduced into healthcare settings when I was managing in the NHS, the issues raised about the work that these healthcare professionals do, and the potential issues that arise, are no different. This is not anything new. What is new is the level of unprofessionalism and hostility that has been shown to these roles.

The lack of respect and the bullying behaviour that some medical leaders within the BMA have decided to adopt when dealing with the issues around the use and deployment of these professionals are not only unacceptable but go against the very GMC regulations that govern you as a doctor. On collaborative working, the regulations say:

“Work effectively … with colleagues in the multidisciplinary team”


and

“respect the skills and contributions”

of all healthcare professionals. Some of the examples of ostracisation, making false claims and bullying at work fall far below what doctors are expected to do and the standards that they are expected to uphold. To that small minority of doctors, I say, “Stop”.

It is clear that PAs and AAs have not had the introduction or supervision that has led to some care being optimal. However, to quote individual cases and then equate the lack of patient safety with all PAs or AAs is neither useful nor correct. The very nature of healthcare is that risk is there and can and does lead to problems. This happens across all professional groups involved in healthcare provision. The issue at hand is whether PAs and AAs have more never events or near misses than other medical and healthcare professionals. Surely, that should be a key line of inquiry to work out the safety of these professions.

Physician associates are mid-level healthcare professionals trained under a medical model to support doctors in diagnosis, treatment planning and patient care. They have a science degree, predominantly, and two years of postgraduate training. PAs can enter the workforce sooner than fully qualified doctors, and, as some evidence suggests, they can make a real difference in relieving pressure on overstretched health services.

The NHS has been using a model of PAs since 2003, and their role has expanded over the years. Yet, despite 20 years of valuable contributions, their integration remains controversial. Some doctors have rightly voiced concerns about their short training period, lack of regulatory authority and potential competition for roles. These concerns deserve thoughtful consideration, which is why the investigation will take place, but they should not overshadow the evidence demonstrating the benefits that PAs and AAs can bring to our healthcare system.

Research led by Professor Vari Drennan and colleagues has provided compelling insights into the effectiveness of PAs across various settings. For instance, an observational study comparing PAs and GPs in primary care found that consultations with PAs resulted in no significant differences in re-consultation rates, diagnostic testing, referrals or patient satisfaction, while maintaining comparable patient outcomes. In secondary care, a BMJ Open study evaluated PAs working in emergency departments alongside doctors in training. It concluded that PAs were equally effective and safe, with no significant differences in clinical adequacy or unplanned re-attendances. What is more, PAs were praised for improving team continuity and efficiency, allowing doctors to focus on more complex cases. These findings demonstrate that PAs can provide high-quality care while addressing staffing mix issues in primary and secondary care settings.

To address the concerns, the new GMC regulation regime will help to deal with some of the genuine issues raised around the scope of practice. I need to be clear, as people keep talking about a national scope of practice. The scope of practice—that people are working within their competence—is down to the individual. That is exactly what the GMC does now with individual doctors. Individuals have to work within their scope of practice, and standards will be laid down by the GMC, which then allows the scope of practice and revalidation to take place. We need to be clear what we are talking about. Along with this new regulatory scheme, there will be professional accountability for education, training and conduct, and it will ensure that individuals undertaking these roles are safe to practise.

Secondly, it would be useful for the NHS to undertake a refreshed national public campaign to raise awareness of PAs and what they do. Some patients still mistake PAs for doctors or nurses, which can lead to confusion and undermine trust and satisfaction. Research conducted in 2021 revealed that a simple information leaflet, co-designed with patients, significantly improved patient understanding of and confidence in PAs. Expanding such initiatives across the NHS would enhance public confidence and empower patients to make informed decisions about their care.

As we move forward, and when the Leng review reports, we must ensure that PAs and AAs are regulated to the highest standards and adequately equipped to perform their roles. Furthermore, improving public understanding of PAs will help their role to be understood more widely by the public.

With these measures in place and other recommendations that will emanate from the review, PAs and AAs will not only help, as part of a modern medical team, to address the future demands of patients but, if the review identifies the key changes required and the Government act on them, become a vital part of a resilient NHS. I hope we can all embrace the opportunity to support our health service and improve patient care.