Achi news desk-
It was given little fanfare – but it attracted plenty of interest among doctors on social media.
On April 19, the Royal College of Physicists of Edinburgh (RCPE) drew a clear line in the sand with an updated position statement declaring “no further expansion of the [Physician Associate] workforce should happen in the UK”.
This contradicts the Scottish Government’s plans to “gradually increase” their numbers; a projected expansion of around 3,000 to 10,000 in NHS England by 2036; and – most notably – the position taken by its counterpart, the Royal College of Physicians in London, which has faced a backlash from doctors over its apparently pro-PA stance.
What are Personal Assistants?
Associate physicians (PAs) are not doctors – although one of the criticisms was that the job title could be misleading to patients (they were previously known as Physician Assistants).
In most cases they are bioscience graduates or nurses who have gone on to complete a two-year master’s degree, although some are arts graduates.
They can take medical histories, perform physical examinations, order ultrasound or MRI scans, and develop treatment plans for patients.
Read more:
Inside the NHS | Medical associates: Workforce solution – or risk to patients?
However, they cannot prescribe drugs or order ionizing radiation (X-ray, CT) scans and should be supervised by a consultant or GP who will triage low-risk, “simple” patients for PAs.
However, critics argue that the shortage of senior clinicians means that some PAs go beyond their remit and work without proper supervision, putting patients at risk.
There have been some highly publicized cases of misdiagnosis, and also anger from junior doctors who say they already struggle to get the training time they need with consultants – something that will get worse if consultants must spend more time supervising an increasing number of PAs.
A change of heart?
Back in January, the RCPE was lukewarm rather than hostile to PA expansion. He warned that “the unique role of the doctor as the clinician… must be preserved and strengthened” and that Personal Assistants “should not be considered a substitute for doctors”.
It recommended a return to ‘physician assistant’ terminology “to avoid public confusion” and stressed that the “scope and limits” of PA clinical practice must be clearly defined in the interests of patient safety and standards of care.
Three months later, the College’s position has hardened: the process of recruiting new Personal Assistants should be frozen until there is more clarity about how they are used, and how they can be used, in the NHS.
For example, the College is “concerned that the supervision of PAs, in real-life, day-to-day, contemporary NHS practice, will not match the theoretical levels described in published protocols”.
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He argues that the supervision of medical students and trainee doctors should be a priority for senior medical staff, adding: “We are concerned that it is not possible, within the terms of current consultant post schemes, to supervise additional PAs without compromise on the training. of doctors and medical students.”
It is “increasingly illogical” to expand the numbers of PAs at a time when an increasing number of early career doctors in the UK NHS “cannot access training posts”, and there is “concern there is a lack of evidence to suggest… that an expansion will PA reduces care costs, without compromising outcomes”.
Reaction
Doctors online have welcomed the statement as “clear and logical”, “excellent”, “true leadership”, and Scotland “leading the way” (although its membership is UK-wide and international).
It remains to be seen how the Scottish Government will respond.
The College itself also emphasizes that PAs are “very well integrated” in some NHS units, providing “excellent support” to doctors and contributing to “high quality patient care”.
It condemns “abusive and often bullying behaviour” – some of it directed via social media at PAs, in a sign of how bitter and polarized the issue has become.
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In Scotland, their numbers remain relatively small – 154 according to the number of staff at the end of December, compared to 7,101 trainee doctors – but the College notes that in some regions the NHS has employed PAs “because it has been difficult to attract doctors to training and [health] service jobs”.
That will be harder to fix.
