Health Secretary Wes Streeting Initiates Review Amid “Toxic” Debate on NHS Associate Roles

The government in England has commissioned an examination into physician associates (PAs) and anaesthesia associates (AAs) following increasing apprehension regarding their deployment within the National Health Service (NHS). The count of PAs and AAs, who assist medical practitioners, is currently undergoing swift expansion. However, the British Medical Association has expressed worries that these professionals are being assigned duties beyond their intended scope, leading to an unclear distinction from doctors’ roles. Upon announcing the inquiry, Health Secretary Wes Streeting acknowledged valid concerns requiring investigation, but he also condemned the “toxic nature of the debate,” stating it had caused PAs to feel disheartened. The examination will investigate their current deployment methods and identify necessary future safeguards. Streeting commented: “Many physician associates are providing great care and freeing up doctors to do the things only doctors can do.” He continued: “But there are legitimate concerns over transparency for patients, scope of practice, and the substituting of doctors. “These concerns have been ignored for too long, leading to a toxic debate where physicians feel ignored and PAs feel demoralised.” He expressed his hope that the review would “take the heat out of the issue” and ensure “we get the right people, in the right place, doing the right thing”. Prof Gillian Leng, previously the chief executive of the National Institute for Health and Care Excellence, an NHS drugs advisory body, will spearhead the review. Its findings are expected early next year, intended to inform the government’s forthcoming 10-year strategy for the NHS. The existing NHS workforce strategy considers PAs and AAs to be an essential component of the healthcare service’s staffing composition. Their numbers have steadily risen in recent years, yet the plan, released last year, advocated for a swift increase from slightly over 3,000 to 12,000 by the year 2036. PAs are qualified to work in general practitioner practices and hospitals. While they lack prescribing authority, they are permitted to request certain scans, compile medical histories, and perform physical assessments. AAs, who assist surgical teams, constitute a considerably smaller cohort, with approximately 100 currently employed within the NHS. Both PAs and AAs are required to complete a master’s degree spanning two years. Typically, a foundational degree in a bioscience-related field is expected, though it is not a mandatory prerequisite. Dr Phil Banfield, leader of the British Medical Association, urged a halt to the introduction of new PAs during the review period. He further stated: “The NHS must tell us how they are going to keep patients safe while this review is carried out.“You do not fly a plane under safety review, you ground it.” The BBC reported last week on the passing of Susan Pollitt, aged 77, who died in 2023 at Royal Oldham Hospital following the erroneous prolonged retention of a drain in her abdomen. The official inquiry into her demise determined it resulted from an “unnecessary medical procedure contributed to by neglect.” She had received care from a PA among other personnel. Subsequent to Mrs Pollitt’s inquest, Joanne Kearsley, the North Manchester coroner, issued a caution regarding the deployment of PAs. She highlighted an absence of regulatory oversight and a national framework for training, supervision, and competency, alongside restricted comprehension and recognition of the role among both patients and other NHS employees. She additionally noted that the absence of a unique uniform and the designation “physician” were causing ambiguity regarding whether the practitioner was a medical doctor. The matter of regulation is anticipated to be addressed next month, coinciding with the General Medical Council commencing its oversight of PAs and AAs. In September, the Academy of Medical Royal Colleges, which has generally endorsed the expansion of this role, acknowledged the necessity of a review in light of the concerns articulated. Nevertheless, the academy criticized the “increasingly acrimonious and destructive debate,” which it attributed to unsubstantiated remarks on social media, asserting it was detrimental to collaborative efforts throughout the health service. Stephen Nash, who leads United Medical Associate Professionals, an organization representing PAs, stated that the review would offer an opportunity to “shine a real light” on current circumstances and furnish crucial evidence in a “very one-sided debate.” Louise Ansari, who heads the patient advocacy group Healthwatch England, also expressed her approval of the review. She mentioned that patients had reported “very positive” interactions with PAs, but she harbored specific reservations regarding patients not consistently being informed or made conscious that they were being attended to by a PA.