Asked by: Virginia Crosbie (Conservative - Ynys Môn)
Question to the Wales Office:
To ask the Secretary of State for Wales, whether he has had recent discussions with representatives of the Welsh Government on the levels of public awareness of (a) the role and (b) competencies of physician associates in the NHS in Wales.
Answered by David T C Davies - Secretary of State for Wales
I have regular discussions with Welsh Government Ministers on a wide range of issues. As a devolved matter, it is for the Welsh Government to consider the operational deployment of the role of physician associates (PAs) within the NHS workforce in Wales.
The UK Government greatly values the work of physician associates (PAs) and is introducing regulation as part of our commitment to the roles and to their place in the multi-disciplinary workforce.
The regulation of PAs which is a reserved matter has been subject to extensive public consultation over several years. Throughout the project, UK Government officials have engaged thoroughly with stakeholders including regulators, the devolved administrations, the Professional Standards Authority for Health and Social Care, representative bodies and service users in developing the policy behind this legislation. This engagement has been crucial in shaping both UK Government policy intention and the resultant legislation, to ensure that it remains a practical piece of legislation for the benefit of patient safety and registrants.
Regulation will give the GMC responsibility and oversight of PAs, allowing it to take a holistic approach to education, training, and standards. Once regulation commences, GMC guidance will apply to PAs.
Asked by: Lord Bishop of Chelmsford (Bishops - Bishops)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what steps they are taking to ensure that there is clarity for patients about different roles within clinical teams in healthcare settings, including regarding anaesthesia and physician associates.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
Anaesthesia Associates (AAs) and Physician Associates (PAs) are supervised by a designated senior doctor, in the role of a consultant, registrar, or general practitioner. The NHS Long Term Workforce Plan sets out plans to increase the PA workforce to 10,000 by 2036/37, and the AA workforce to 2,000 over the same period. The plan also calls for 60,000 more doctors, for a factor of five to one in favour of more doctors, which will contribute to the sustainable implementation of this multidisciplinary model and deliver increased capacity to supervise and support new associate staff.
NHS England is working with the relevant professional colleges and regulators to ensure the use of associate roles is expanded safely and effectively, and that they are appropriately supported, supervised, and integrated into multidisciplinary teams.
The introduction of regulation by the General Medical Council (GMC) will provide a standardised framework of governance and assurance for the clinical practice and professional conduct of AAs and PAs, and make it easier for employers, patients, and the public to understand the relationship between these roles and that of doctors.
As set out in National Institute for Health and Care Excellence’s guidelines, all healthcare professionals should introduce themselves and explain their role to the patient regardless of their job title. In addition, the GMC has published interim standards for AAs and PAs in advance of regulation which makes it clear that professionals should always introduce their role to patients, and set out their responsibilities in the team.
Asked by: Preet Kaur Gill (Labour (Co-op) - Birmingham, Edgbaston)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what guidance her Department issues to GP surgeries on (a) the scope of practice and (b) supervision protocols for employed physician associates; and whether she has made an assessment of the quality of different working arrangements for physician associates in GP surgeries across England.
Answered by Andrea Leadsom - Parliamentary Under-Secretary (Department of Health and Social Care)
Physician associates (PA) and anaesthesia associates (AA) play an important role in multidisciplinary teams and complement the work of doctors. On 13 December 2023, the Department laid draft legislation in both Houses and in the Scottish Parliament that will empower the General Medical Council (GMC) to commence regulation for the two roles by the end of 2024.
Regulation will provide a standardised framework of governance and assurance for clinical practice and professional conduct, to enable these roles to make a greater contribution to patient care. Ahead of regulation, the GMC has published advice for PAs, AAs and doctors who supervise them.
The Faculty of Physician Associates (PFAs) and the Royal College of Anaesthetists have developed guidance setting out the processes and considerations required for employers and supervisors of PAs and AAs respectively. In addition, NHS England has produced patient-facing materials that have been shared widely with general practices (GPs) to support patient awareness and understanding of the PA role.
PAs work within a defined scope of practice and limits of competence. The FPA provides professional support to PAs across the United Kingdom and review and set standards for the education and training of PAs.
The FPA will be able to give further information on scope of practice and supervision requirements.
NHS England has committed to a review of the Additional Roles Reimbursement Scheme (ARRS). This work will cover the performance of the scheme to date and inform the Government’s approach to any future support for additional clinical roles in general practice.
In addition, the Department has funded, via the National Institute of Health and Care Research a project to look at the impact of non-GP staff in practices on patient care.
Asked by: Lord Hunt of Kings Heath (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what assessment they have made of whether the adoption of the British Medical Association’s report Safe Scope of Practice for Medical Associate Professionals (MAPs) would undermine established governance and frameworks.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
The Government considers scope of practice guidance for Anaesthesia Associates (AAs) and Physician Associates (PAs) to be a matter for the Royal College of Anaesthetists (RCoA) and the Royal College of Physicians (RCP) respectively, in conjunction with key stakeholders including other medical royal colleges, the Faculty of Physician Associates (FPA), and the Association of Anaesthesia Associates.
The current scope of practice guidance for AAs, which is applicable across the United Kingdom, is published on the RCoA website. The FPA, which is hosted by the RCP, has also published guidance documents relating to the PA curriculum, code of conduct, and supervision. We understand that both the RCoA and the RCP are currently developing further guidance in collaboration with stakeholders, in relation to supervision and scope of practice.
Once regulation begins, the General Medical Council’s published learning outcomes for AAs and PAs will also apply. This sets out a pre-qualification education framework and the outcomes expected of newly qualified AAs and PAs, including professional behaviours and capabilities and minimum expectations for the knowledge and skills required. In addition, employers of AAs and PAs are responsible for ensuring that appropriate governance and supervision are in place, and that individuals within their employment are practicing within their competence.
Asked by: Rachael Maskell (Labour (Co-op) - York Central)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, if she will take legislative steps to align (a) standards and (b) fitness to practice processes across all healthcare profession regulators.
Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)
Between 24 March and 16 June 2021, the Government consulted on proposals to reform the regulation of healthcare professionals, and on the introduction of anaesthesia associates (AAs) and physician associates (PAs) into statutory regulation by the General Medical Council (GMC). The consultation was entitled Regulating healthcare professionals, protecting the public, and proposed that all regulators should have broadly consistent powers in relation to standard setting and fitness to practise.
The Government’s response to the consultation was published in February 2023 and detailed our proposed reforms to the regulators’ standard setting powers. It also set out a new fitness to practise process for all regulators.
A modernised regulatory framework is being introduced firstly for AAs and PAs. The Anaesthesia Associates and Physician Associates Order 2024, laid on 13 December 2023, allows for the statutory regulation of AAs and PAs by the GMC under the new framework. The reformed regulatory framework will be rolled out to all regulated healthcare professionals, beginning with doctors, and the professions regulated by the Nursing and Midwifery Council and the Health and Care Professions Council, over the next couple of years.
Asked by: Tanmanjeet Singh Dhesi (Labour - Slough)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what recent steps her Department has taken to integrate physician associates into multidisciplinary teams in the NHS; and whether she has made a recent assessment of the potential impact of this process on (a) team dynamics and (b) the delivery of patient care.
Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)
Physician associates (PAs) are already a valued and integral part of the multi-disciplinary healthcare team. The NHS Long Term Workforce Plan commits to expanding the role further whilst upholding the highest levels of patient safety and welfare.
On 13 December 2023, the Department laid draft legislation in both Houses and in the Scottish Parliament that will empower the General Medical Council (GMC) to commence regulation of PAs by the end of 2024. Regulation will provide a standardised framework of governance and assurance for clinical practice and professional conduct which will enable PAs to make a greater contribution to clinical teams and patient care. Ahead of regulation, the GMC and the Faculty of PAs at the Royal College of Physicians have issued guidance for supervisors, employers and organisations to help provide a structured and standardised way of using the PA role.
Health Education England, now NHS England, has previously explored the value and potential of PAs as members of the multidisciplinary medical team through impact case studies, which are available at the following link:
There is ongoing work by NHS England to further integrate medical associate profession roles, which include PAs and also anaesthesia associates and surgical care practitioners.
NHS England will continue to seek feedback from employers, regulators, royal colleges and professional bodies regarding the PA role and will work to develop and implement any recommendations.
Asked by: Smyth, Colin (Scottish Labour - South Scotland)
Question
To ask the Scottish Government what its response is to the concerns of BMA Scotland regarding the proposal that the General Medical Council rather than the Health and Care Professions Council should regulate anaesthesia associates and physician associates.
Answered by Gray, Neil - Cabinet Secretary for NHS Recovery, Health and Social Care
The Scottish Government is aware of the BMA Scotland’s views that anaesthesia associates (AA) and physician associates (PA) should be regulated by the Health and Care Professions Council (HCPC) rather than the General Medical Council (GMC).
The Scottish Government is satisfied with the suitability of the GMC as the regulator. AAs and PAs are educated in curricula aligned to the medical model and work complementary to and under the supervision of doctors, a common regulator ensures consistent standards, providing doctors with better assurance when delegating clinical tasks. It also ensures a consistent approach across professional groups in relation to adverse events, particularly where fitness to practise concerns arise.
Furthermore, the Department of Health and Social Care published a UK-wide consultation in 2017 which clearly demonstrated a majority preference for the GMC as the regulator (59% in comparison to 20% for the HCPC).
With regard to the BMA Scotland’s concerns that GMC regulation will confuse patients as to a practitioner’s professional status, current guidance issued to Health Boards by the Scottish Government stipulates that patients should always be told when they are being treated by an AA or PA, rather than a doctor. Once regulated, the roles will also become subject to the principles in Good Medical Practice to always be open and honest about their role and ensure that they are working within the limits of their qualifications and experience.
Asked by: Rachael Maskell (Labour (Co-op) - York Central)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, if she will conduct a review of the competencies of (a) anaesthesia associates and (b) physician associates, in the context of the clarification of the different competencies of registered doctors.
Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)
Anaesthesia associates (AA) and physician associates (PA) play an important role in multidisciplinary teams and complement the work of doctors. On 13 December 2023, the Department laid draft legislation in both Houses and in the Scottish Parliament that, subject to parliamentary scrutiny, will empower the General Medical Council (GMC) to commence regulation for the two roles from December 2024.
Regulation will provide a standardised framework of governance and assurance for clinical practice and professional conduct, to enable these roles to make a greater contribution to patient care. NHS England has worked with royal colleges and the GMC to develop appropriate curricula, core capability and career frameworks, standards for continued professional development, assessment and appraisal and supervision guidance for the AA and PA roles.
NHS England continues to work with partners, including the GMC and medical royal colleges, to ensure that AAs and PAs can be effectively trained and integrated into teams across a range of specialties through the ongoing development of national standards, a defined scope of practice, and assessment of educational capacity.
Correspondence Jan. 09 2024
Committee: Health, Social Care and Sport CommitteeFound: Anaesthesia Associates and Physician Associates Order Letter from BMA Scotland to the HSCS Convener concerning
Asked by: Rachael Maskell (Labour (Co-op) - York Central)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, whether she is taking steps to increase public awareness of the (a) roles and (b) competencies of (i) anaesthesia and (ii) physician associates in the NHS.
Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)
Anaesthesia associates (AAs) and physician associates (PAs) are integral parts of the multi-disciplinary healthcare team. The Government greatly values the work of AAs and PAs and is introducing regulation as part of our commitment to the roles, and to their place in the multi-disciplinary workforce.
The NHS Long Term Workforce Plan sets out significant expansion of the roles over the coming years, as part of plans to grow the multi-disciplinary workforce. The Government and NHS England are undertaking extensive engagement around this expansion to increase public and patient understanding of the roles and how they contribute to safe, effective patient care.
In primary care, NHS England has produced patient-facing materials that have been shared widely with general practices to support patient awareness and understanding of the PA role.
The National Institute for Health and Care Excellence guidelines set out that all healthcare professionals directly involved in a patient's care should introduce themselves and explain to the patient the roles and responsibilities of the different members of the healthcare team.
In advance of their regulation by the General Medical Council (GMC) later this year, the GMC has published interim standards for AAs and PAs which make it clear that professionals should always introduce their role to patients and set out their responsibilities in the team.