Julia’s first four years as a physician assistant were everything she hoped for. Having worked in the NHS in a non-patient-facing role for the best part of a decade, she was delighted to be on the wards supporting doctors and wider health care teams.

“I loved contacting patients, assessing them and playing a role in their care. I felt supported and part of a team.”

That all changed about a year ago.

“Suddenly we were attacked. Doctors in the radiology department started refusing to talk to me about the scans and others were saying we don’t deserve to be paid for what we do.

‘The atmosphere has completely changed. We have also stopped going to the canteen because we were made to feel uncomfortable.”

Julia is not alone. The United Medical Associate Professionals (UMAP), an organization that represents physician assistants (PAs) and anesthesia associates (AAs), says there are countless examples where employees have faced bullying and been sidelined.

The Academy of Medical Royal Colleges, which represents senior doctors in the NHS, has warned that the whole situation has become so “disastrous” that it is damaging teamwork in hospitals and GP surgeries where PAs and AAs work. Are.

This has led to particularly heated debate on social media, which has seen regular attacks about the pay and professionalism of PAs and AAs as well as discussions about how they might be undermined in the workplace. .

this week Health Secretary Wes Streeting decided he needed to take action, and ordered a review. in PA and AA in England to resolve what he said had become a “toxic” dispute.

So how did it come to a point that doctors turned against the very people they were brought in to help?

The PA role in the NHS is hardly new – it has been around for 20 years, helping doctors by carrying out tasks such as taking medical histories and conducting examinations.

What has changed is the speed at which they are being recruited – numbers have increased from a few hundred over the past seven years to 3,500 currently, with a target of 12,000 including AAs by 2036.

As the numbers rise, doctors have become concerned that the lines between professions are blurring.

Sam is five years into his training and works with PAs in a hospital in the South West. “They are more of a hindrance than a help,” he says. “They are being put on the rota instead of doctors – but there are things they can’t do so doctors have to work twice as hard.

“And for those doctors, having a PA on the ward early in their training can really limit their exposure to some of the medical tasks that should be part of their learning. we have a lot.”

The doctors’ union, the British Medical Association (BMA), is so concerned that it now wants the rollout to be halted until a review can take place.

It says PAs and AAs, who are required to complete a two-year master’s degree after a first degree, typically bioscience-related, are being asked to do jobs they should not do. More doctors are needed and the places are being filled. His argument is that this is putting patients at risk.

To support its claims, it points to two high-profile cases where patients – Emily Chesterton And susan pollit – Died after being attended to by PA.

As well, the BMA also cites a survey published last year of its 18,000 members, which found that almost nine in 10 of those who responded felt that the way AAs and PAs currently work in the NHS He or she always or sometimes poses a risk to the patient’s safety.

Dr Emma Runswick, deputy council leader of the BMA, says: “We are seeing PAs doing things such as ordering scans they are not qualified for and prescribing medicines they are not qualified for.

“And when they see patients it is not always clear to the patient that they are not being seen by a doctor. This is dangerous and has to stop.”

The union is demanding that a strict set of rules be drawn up to limit what they can and cannot do. The BMA’s plan would essentially limit their role to that of assistants – helping with ward rounds, taking blood and scan results and arranging discharges.

But Stephen Nash, head of UMAP, says: “This is not about patient safety, but about protecting their interests. They want us to be under them.”

He says the reported deaths are “absolute tragedies”, but he is concerned about how they are being used to attack the profession as a whole.

“Taking a blame-free approach means learning lessons from failures.”

He says that when mistakes are made there are often a number of factors at play, but the campaign against PAs and AAs means their role has been highlighted. He further said, “It misleads the public.”

Ultimately it will be up to the independent review to establish the truth, which is being led by Professor Gillian Leng, President of the Royal Society of Medicine.

The key will be the NHS England database on patient safety incidents, which services across the country report.

Data from last year is not publicly available, but a senior NHS source told me: “What is important here is not whether PAs are making mistakes – everyone in the NHS does, including doctors – but whether They are making more mistakes and causing more security incidents than you would expect.

“The reports are often complex and nuanced, but there is nothing in them that should immediately raise alarm bells.”

This is not just a controversy that has played out in hospital wards and consulting rooms of GP surgeries, it has spread to the highest echelons of the world of medicine.

While the Academy of Medical Royal Colleges has been broadly supportive of the rollout of PAs and AAs, many of the 23 individual colleges it represents have been beset by infighting over the issue, which has led to resignations.

The Royal College of Physicians, the Royal College of GPs (RCGP) and the Royal College of Anaesthetists have all recently moved in opposition.

A source close to what is happening at the royal colleges says: “There have been some major disputes – I fear relationships have been permanently damaged. As royal colleges we were traditionally always above the politics of trade unionism.

“There is a group of doctors who see PAs and AAs as a threat – we saw the same thing when nurses took on additional responsibility years ago.”

Lawyers have also brought in UMAP to consider action against the RCGP, believing that its protests have caused some PAs to lose their jobs.

And the BMA has already started a legal case against the General Medical Council, which is due to start regulating PAs and AAs next month. The union does not want the same body responsible for regulating doctors to do the same for PAs and AAs, believing it would blur the lines even further.

It is clear that resolving this dispute will not be easy.

And meanwhile, frontline workers are being left to flounder.

“PAs and AAs are anxious every time they go to work,” says Mr. Nash. “A very powerful lobby within the medical profession has turned against him. “This is a really terrible time.”