Government wants to regulate NHS non-doctor associate roles

The government is beginning a legal process to set new rules around the NHS roles of physician associates (PA) and anaesthesia associates (AA).

There have been calls for regulation of the non-doctor jobs for patient safety.

People in these roles are fully trained, but do not currently undergo the types of mandatory checks that doctors and nurses do.

With no obligatory register, any who malpractice cannot formally be struck off, for example.

PAs can already join a voluntary register with the Royal College of Physicians.

The future plan though is for PAs and AAs to be regulated by the General Medical Council, which also oversees doctors, to set standards of practice, education and training, and operate fitness-to-practise procedures.

The government will lay legislation this week so the change can be brought in by the end of 2024.

What do PAs do?

There are about 1,500 full-time equivalent PAs working in hospitals and 1,700 in GP practices, seeing patients and helping doctors with their work. The government plans a big expansion of this workforce, with 10,000 more in the next decade or so.

They are usually science graduates who have two years of intense training for the role.

PAs can ask patients about their symptoms, carry out physical examinations, order and look at test results and discuss treatments - but they should always be supervised by doctors.

AAs - there are about 73 full-time equivalent of them - similarly help anaesthetists, but, again, should be fully supervised.

Health and Social Care Secretary Victoria Atkins said: "Physician associates and anaesthesia associates are already making a great contribution to the NHS, supporting doctors to provide faster high-quality care for patients.

"This new legislation paves the way for these professionals to be held to the same strict standards as doctors, boosting patient safety.

"This is part of our Long Term Workforce Plan to reform the NHS to ensure it has a workforce fit for the future."

Not everyone is happy about the roles though.

In July, members of the doctors' union the British Medical Association (BMA) called for the PA role to be renamed as "physician assistant" and for more efforts to ensure that they were not confused with doctors.

The mother of a woman who died after a misdiagnosis by an NHS worker she mistakenly believed was a GP has called for better patient protection.

Emily Chesterton died three weeks after she first sought medical advice

Emily Chesterton, from Salford, died in 2022 after being seen twice by a PA.

The 30-year-old, who lived in London, was told her calf pain was a sprain, when she actually had a blood clot.

Ms Chesterton's mother Marion previously told the BBC: "If I had known earlier that she had not seen a doctor, I would have marched back to the surgery or gone straight to hospital.

"Physician associate sounds grander than a GP," she added.

The Doctors' Association has written an open letter to the GMC with concerns about PA and AA regulation.

It says:

• If the regulation of PAs by the GMC goes ahead, distinct GMC numbers should be allocated to PAs to distinguish them from medical doctors

• All PAs transferring from the voluntary Royal College of Physicians register to the GMC's statutory register must undergo thorough verification and checks, especially with regard to fitness-to-practise procedures

• The GMC must establish a clearly defined scope of practice for PAs and AAs, eliminating the option for these to be set locally

Prof Kamila Hawthorne, from the Royal College of GPs, said: "PAs can only work under the supervision of a doctor, and in general practice that should be a fully qualified GP.

"However, there have been some recent notable cases where patients have been unaware that the medical professional treating them was a Physician Associate and not a GP. This legislation must recognise the distinction between PAs and GPs, making it clear that these are 'additional' roles, not 'substitute' GPs."