‘Blurring of roles’ between doctors and less qualified staff must end – BMA

The union has called for the recruitment of less qualified staff to be paused.

Less qualified staff are “encroaching” on the role of doctors and their recruitment in the NHS should be paused until their roles are clarified, the British Medical Association (BMA) has said.

Medical associate professionals (MAPs), such as physician associates (PAs), are set to play a larger role in the health service in England under workforce plans for the next 15 years, but there are concerns that they do not have to complete the same medical training as doctors.

The BMA’s UK council has passed a motion calling for recruitment to be paused on the grounds of patient safety.

The union also called on the Government and the NHS to ensure MAPs are properly regulated and supervised.

MAPs roles and responsibilities are not clearly defined. We are seeing increased instances of MAPs encroaching on the role of doctors

Professor Phil Banfield

BMA’s chair of council Professor Phil Banfield said: “Doctors across the UK are getting more and more worried about the relentless expansion of the medical associate professions, brought into sharp focus by terrible cases of patients suffering serious harm after getting the wrong care from MAPs.

“Now is the time for the Government to listen before it is too late. We are clear – until there is clarity and material assurances about the role of MAPs, they should not be recruited in the NHS.”

There are more than 3,500 PAs registered in the UK, as well as 150 anaesthesia associates (AAs) and 6,800 nursing associates.

PAs and AAs usually undergo a three-year undergraduate degree followed by two years post-graduate training.

“We have always been clear that MAPs can play an important part in NHS teams, and doctors will continue to value, respect and support individual staff they work with,” Prof Banfield added.

“But MAPs roles and responsibilities are not clearly defined. We are seeing increased instances of MAPs encroaching on the role of doctors; they are not doctors, do not have a medical degree and do not have the extensive training and depth of knowledge that doctors do.

“As doctors, we are worried that patients and public do not understand what this could mean in respect of the level of experience and expertise in care they receive.”

Last month, NHS England’s national medical director, Professor Sir Stephen Powis, said that there is “emphatically no plan to replace doctors in the NHS”.

His comments came after Charlie Massey, chief executive of the the General Medical Council (GMC), wrote to NHS leaders urging them to “directly tackle the perception that there is a plan for the health services to ‘replace’ doctors with PAs or AAs by convening and leading a system-wide discussion on an agreed vision for these roles”.

There was also an extraordinary general meeting of the Royal College of Anaesthetists in October, during which the majority of members voted to pause the recruitment of AAs until further work has been completed.

Prof Banfield said: “The General Medical Council is the exclusive regulator of doctors in the UK.

“Adding staff who are not doctors and do not have a medical degree to the GMC register brings into question the competence and qualification of the whole medical profession.”

He also claimed “patients want doctors to remain doctors, regulated by a dedicated body, and they have a right to have confidence in the expert medical care they receive”.

“There must be no doubt that when a patient goes to see a doctor, they are going to see a doctor,” Prof Banfield added.

“This blurring of roles and the confusion caused to patients must stop now.”

The Department of Health and Social Care has been approached for comment.