Draft Anaesthesia Associates and Physician Associates Order 2024

Margaret Greenwood Excerpts

Wednesday 17th January 2024 General Committees

[Margaret Greenwood (Wirral West) (Lab)]

It is a pleasure to serve under your chairmanship, Dame Caroline. Regulation of the roles of physician associates and anaesthesia associates is long overdue. Let me say first that physician associates and anaesthesia associates have a valuable contribution to make to the NHS workforce.

I want to highlight some concerns that doctors in my constituency have raised with me about the fact that the responsibility for regulation will rest with the General Medical Council, the same body that regulates doctors. Their concern is that patients often do not understand that physician associates are not actually doctors and do not have the same medical training as them. The British Medical Association is among those that have highlighted that the deployment of those roles can be problematic, and that when patients have been seen by a physician associate, they are

“often unaware they have not been seen or assessed by a doctor”.

That is extremely important because, in the treatment of illness, diagnosis is key. We have heard some harrowing examples this afternoon showing why this is so important.

A recent survey by the BMA found that 86% of the doctors who took part felt that patients were not aware of the difference between these roles and the roles of fully qualified doctors. They are concerned that the General Medical Council regulating responsibilities with a single register for doctors, physician associates and anaesthesia associates will only exacerbate the confusion. Further cause for concern is that 87% of doctors who took part in the same survey revealed that the way that physician associates and anaesthesia associates currently work in the NHS is always or sometimes a risk to patient safety. That is a matter of extreme concern.

A number of my constituents, many of whom are medical professionals, have contacted me about this legislation. A consultant wrote to me to say that

“the professional titles used for these roles—‘physician associate’ and ‘anaesthesia associate’—are highly misleading and only add to patient confusion, because it is clear that patients often think they are being treated by a doctor, when they are not.”

My constituent suggested that the titles revert to what they were—namely, “physician assistant” and “physician assistant (anaesthesia)” or “anaesthesia assistant”. I would go further and suggest that the name “doctor’s assistant” be used. That is much clearer and everybody would be able to understand it.

Another Wirral West resident, a retired consultant, said that doctors are

“increasingly concerned about the expansion of medical associate roles in the NHS while significant confusion remains about the scope of the roles, supervision and expertise.”

They also suggest clearly defining the roles of physician associates and anaesthesia associates because there is currently such little definition of what the roles entail and what their limits are.

It is vital that the scope and limits of the roles of physician associates and anaesthesia associates are clearly set out, not just for people taking up those roles, but for their patients. That needs to be clearly communicated. Many constituents have also suggested, as has the BMA, that these roles would be better regulated by the Health and Care Professions Council. Will the Minister share with us what consideration has been given to whether that body might be better as a regulator?

This SI concerns regulation. It comes about following the Health and Care Act 2022, which made provision for taking health professions out of regulation. This SI shows the need for the exact opposite. It is important that the high standards that we enjoy in the NHS are protected, so it is vital that the roles are clearly defined, as well as regulated.

I hope the Minister will take on board and respond to the concerns that have been raised in this debate. Concerns are likely to persist that the Government see the training and deployment of medical associate professionals as simply a cheaper alternative to training doctors. To take GPs, for instance, as of November 2023, there were 2.3% fewer fully qualified full-time equivalent GPs in England than in 2019 and 6.8% less than in 2015. In 2023, there were 7% fewer GP practices than in 2019.

Meanwhile, the number of patients per GP has increased considerably. There are now 2,290 patients per GP, an increase of 6.9% since 2019. We can see that our GPs are doing more work than they had been required to do and they are clearly working under increased pressure. Added to that, those who have physician associates in their practice also have to oversee them. The expansion of the number of physician associates and anaesthesia associates should not be used as a solution to the shortage of hospital doctors and GPs.