Review of streeting orders to end ‘toxic’ NHS staff row
The government has ordered a review of Physician Associates (PA) and Anesthesia Associates (AA) in England following growing concern about their use in the NHS.
The number of PAs and AAs assisting doctors is in the process of increasing rapidly.
But the British Medical Association has expressed concerns that they are being asked to do things they should not do and that relationships with doctors are becoming strained.
Announcing the review, Health Secretary Wes Streeting said there were some legitimate concerns that needed to be addressed, but he also criticized the “toxic nature of the debate”, and said it was leaving PAs feeling demoralized.
The review will look at how they are being deployed and what further safeguards are needed.
Streeting said: “Many physician associates are providing good care and freeing up doctors to do things that only doctors can do.
“But there are legitimate concerns over transparency for patients, scope of practice and replacement of doctors.
“These concerns have been ignored for too long, leading to a toxic debate where physicians feel ignored and PAs feel discouraged.”
He said he hoped the review would “take down the heat” and ensure “we get the right people, in the right places, doing the right things”.
The review will be led by Professor Gillian Leng, former chief executive of the National Institute for Health and Care Excellence, the NHS medicines advisory body.
It will report early next year to inform the government’s new 10-year plan for the NHS.
role confusion
Current NHS workforce planning sees PAs and AAs as an important part of the staffing mix in the health service.
Numbers have been rising slowly in recent years, but a plan published last year called for a rapid expansion from 3,000 to 12,000 by 2036.
PAs can work in GP surgeries and hospitals. They are not authorized to prescribe medications, but they can order certain scans, take a medical history, and perform a physical examination.
AAs, who support surgery teams, are a very small group – there are only about 100 in the NHS.
Both PAs and AAs must complete a two-year master’s degree. They usually require a first degree related to bioscience, but this is not a prerequisite.
Dr Phil Banfield, leader of the British Medical Association, called for the rollout of new PAs to be halted until a review is carried out.
And he added: “The NHS must tell us how they will keep patients safe during this review.
“You don’t fly a plane under safety review, you ground it.”
last week BBC reports death of Susan Pollitt, 77 Who died in 2023 at the Royal Oldham Hospital after accidentally leaving a drain in his stomach for too long.
The inquest into his death concluded that it was caused by “unnecessary medical procedure neglect”. She received treatment from other staff as well as a PA.
Following Mrs Pollitt’s inquest, North Manchester coroner Joan Kearsley warned about the use of PAs.
They said there was a lack of regulation and national framework covering training, supervision and qualifications, and understanding and awareness of the role among both patients and other NHS staff was limited.
He also said that the lack of a distinct uniform and the title “physician” is leading to confusion as to whether a physician is a doctor.
‘Disastrous debate’
The issue of regulation should be addressed next month when the General Medical Council begins regulation of PAs and AAs.
In September, the Academy of Medical Royal Colleges, which has been widely supportive of expanding the role, Acknowledged that a review is required in view of the concerns being expressed,
But the academy was critical of the “increasingly acrimonious and destructive debate”, which it said was fueled by baseless comments on social media and was damaging teamwork in the health service.
Stephen Nash, head of the United Medical Associate Professionals, which represents PAs, said the review would be a chance to “shed a real light” on what is going on and provide much-needed evidence in a “one-sided debate”.
Louise Ansari, head of patient watchdog Healthwatch England, said she also welcomed the review.
She said that patients reported “very positive” interactions with PAs, but she had particular concerns about the fact that patients were not always told or made aware that they were being seen by PAs. Is.
