Stephen Nash, general secretary of United Medical Associate Professionals (UMAPs), urges PCNs to recognise and support the role of ARRS employed physician associates.
Three months ago, a bomb exploded in the lives of Britain’s physician associates (PAs). Professor Gillian Leng's independent review into the safety and effectiveness of PAs and anaesthesia associates found no compelling case that PAs are unsafe. It acknowledged that the debate around our profession had grown so toxic that it tainted all evidence and that many associates are routinely subject to bullying and harassment. Nevertheless, its recommendations, and the government's acceptance of them have shattered the very core of our practice.
For the roughly 50% of PAs who work in primary care, the changes are practically existential. Many have been barred from treating undifferentiated patients – entirely undermining the benefit of having such highly trained medical professionals on the frontline of the NHS.
PAs who have spent years building their competency under the careful supervision of senior doctors are being prevented from treating all but the simplest cases. Colleagues who have earned the trust and respect of their medical peers have been demoted to ‘assistants’, with the goalposts of their clinical processes constantly shifted.
This uncertainty has taken a serious toll on PAs’ wellbeing. In a recent survey of our members, 95% said the Leng Review had negatively affected their mental health and more than a quarter reported feeling ‘better off dead’.
It doesn’t have to be this way. Following legal intervention by UMAPs, NHS England has maintained the Network Contract DES specifications for PAs, although they have not confirmed or denied our legal action was the reason for this. This means their role descriptions are unchanged and additional roles reimbursement scheme (ARRS) funding for PCNs is unaffected at present. The health service has also confirmed that it is up to individual practices to decide how and when to implement the recommendations.
Our judicial review against the recommendations of the Leng Review is gathering pace. Led by Patrick Green KC – formerly of the subpostmasters IT scandal – we are confident in proving that the government was irresponsible to adopt these without assessing the havoc it would inflict on patients’ access to care.
Our advice to employers is clear: don’t make any changes to PAs’ scope of practice before the judicial review is complete. Those who do will have to defend legal action from UMAPs.
The vast majority of PCNs have been incredibly supportive in this regard, allowing associates to keep seeing patients in a meaningful way and regularly checking in on their wellbeing. I am grateful to the many GPs who have stepped forward to speak up for their PAs’ work and defend them from abuse, knowing that they themselves might be targeted as a result.
We urge all employers who have restricted their associates’ practice to allow them to once again work to the full extent of their medical competency. It’s also vital that PCNs explain to doctors the legal status of the Leng Review and insist that all staff treat PAs with respect.
As our legal challenge continues to take shape, UMAPs is preparing for a future beyond the Leng Review. We want PAs to again play a key role in PCNs' core mission: increasing patients’ access to quality care. By developing close partnerships with GPs, we can significantly improve their quality of life at work and help them grapple with pressures from the public, government, and their own institutions.
PAs are regularly deployed to the most deprived parts of the country, treating patients who might otherwise not be seen for weeks or months. Associates' training was designed to support the full scope of a GP’s work, expanding their capacity and allowing them to confidently delegate to highly trained professionals. By working hand-in-nitrile-glove with doctors, we can help PCNs to manage the complicated workload that comes with our ageing and increasingly unwell population.
To date, much of the debate around PAs has been driven by minority groups, who preach a protectionist agenda behind a thin veil of patient safety concerns that even the Leng Review couldn’t hold up. We want to reframe this discussion so that it gives voice to the majority of NHS employers and patients, who prioritise swift, reliable access to quality care.
We want to work closely with PCNs, the royal colleges and wider stakeholders on issues such as credentialling, professional development and career progression for PAs. We will also hold consultations to provide a constructive way forward on sticking points like name changes. But this should crucially be led by the medical associate profession, rather than dictated by bullies who would want to push PAs out of the health service altogether.
Times are tough for PAs and I am full of admiration for all the associates who are doggedly doing their best for patients in a limited scope of practice. Once the rubble of the Leng Review has been cleared away, we are determined to restore a path ahead for physician associates. Once again, physicians, surgeons and GPs will delegate tasks to their associates, as colleagues and friends, so we can help them shoulder the burden together.