Call for independent review into physician associates

There needs to be an independent review of physician and anaesthesia associates (PAs and AAs) in England, the Academy of Medical Royal Colleges says.

The group, which brings together leading doctors and surgeons, has been broadly supportive of the rollout of these roles which assist health care teams.

But it said given the “increasingly acrimonious and destructive debate”, fuelled by some unsubstantiated comments on social media, it was important to look into claims around safety as the campaign against them was damaging teamwork.

The British Medical Association has voiced concerns PAs and AAs are being asked to do tasks they are not meant to and the lines with doctors are getting blurred.

The number of PAs and AAs have been gradually increasing since 2016. There are now more than 3,000 in England, but the NHS workforce plan has called for them to be increased to 12,000 by 2036.

PAs are not authorised to prescribe, but they can order some scans, take medical histories and conduct physical examinations.

Both PAs and AAs have to complete a two-year master’s degree. They usually need a bioscience-related first degree, but that is not a pre-requisite.

The academy, which represents 24 medical royal colleges, said there has been a growing campaign against their use “potentially fuelled by unsubstantiated claims of social media”.

Chair Dr Jeanette Dickson said: “We want an independent, evidence-based, rapid review to help us make a decision about how best to delineate their roles and where they might best fit into the system.

“What’s important is that we can objectively assess the data around safety, efficiency and cost effectiveness and make a judgement about what precise roles in healthcare may be suitable for them and what levels of responsibility they might be safely given based on the actual evidence.”

The academy said it was not its job to say how and who should set up the inquiry, but added it needed to be robust and independent in the way the ones by Lord Ara Darzi, into NHS performance, and Dr Hilary Cass, into gender care for children, were. They were set up by the government and NHS England respectively.

BMA leader Prof Philip Banfield said it was “troubling” that it had taken the academy so long to reach this point.

“We called for an inquiry six months ago. It is imperative the government acts to address the concerns.

“Until we can ensure PAs are working to a strict scope of practice we need the recruitment and expansion to be paused.”

But NHS England indicated there would be no review, pointing out it had produced updated guidance making clear what the role of PAs and AAs were.

“The NHS has always been clear about the role they play – they are not replacements for doctors, but support teams with specific tasks they are trained to do under supervision.”