Within the UK, the pressing debate surrounding the roles of physician associates (PAs) and anaesthesia associates (AAs) has reached a boiling point, prompting action from government officials. Recent developments have seen Health and Social Care Secretary Wes Streeting launching a comprehensive independent review, aiming to address the concerns arising from these role expansions within the NHS.
Julia, who has spent nearly four years as a physician associate, initially found her new role rewarding. After working for nearly ten years behind the scenes, she felt fulfilled by the patient interaction and the ability to play a direct role in the healthcare team. "I loved the contact I had with patients, assessing them and playing a part in their care. I felt supported and part of a team," she reminisced.
Unfortunately, this supportive environment has shifted drastically over the past year. Julia faced hostility from some doctors who began refusing to collaborate with her on patient care. "Suddenly we came under attack. Doctors in the radiology department started refusing to talk to me about scans and others have been saying we don’t deserve to get paid what we do. The atmosphere has totally changed. We’ve even stopped going to the canteen as we were being made to feel uncomfortable," she shared, reflecting the broader issues faced by her peers.
According to the United Medical Associate Professionals (UMAPs), many practitioners are encountering similar bullying and exclusion. A recent statement from the Academy of Medical Royal Colleges highlighted the damaging impact this has had on teamwork across various healthcare facilities. They cited social media, where members of the medical profession have openly criticized the pay and professionalism of PHEs and AAE.
This week, Streeting responded to the crisis by announcing the new review focused on both PHEs and AAEs, calling the current state "toxic".
'Blurring the Lines'
So, what has led to such animosity among colleagues? While the physician associate role is not new—it has existed within the NHS for around two decades—the recent surge in recruitment has raised concerns among doctors. Over the last seven years, the number of PHEs has risen to 3,500, with ambitions to expand to 12,000 by 2036. This rapid increase has blurred the lines between the responsibilities of doctors and associates.
Sam, who works alongside PHEs, voiced his worries, asserting, "They are more of a hindrance than a help. They’re being placed on rotas instead of doctors—but there are things they cannot do so doctors end up having to double up. For those doctors at the very start of training, having PHEs on wards can limit their exposure to some of the medical tasks integral to their learning. We’ve had enough." His sentiments echo the medical community's growing concerns about the adequacy of PHE training.
The British Medical Association (BMA) has taken these concerns seriously and has called for the rollout of PHEs to be paused pending the review. The association posits, supported by its own members' survey, alleged issues concerning patient safety and suggests there’s been instances of PHEs taking on tasks beyond their qualifications, including ordering scans and prescribing medications.
To spotlight its concerns, the BMA referenced two tragic cases where patients—Emily Chesterton and Susan Pollitt—died after being seen by PHEs. Following these incidents, Dr. Emma Runswick, BMA deputy council leader, underscored the dangers, stating: “We’re seeing PHEs doing things such as ordering scans they are not qualified to order and prescribing drugs they aren't qualified to prescribe. It’s dangerous and has got to stop.”
The BMA is advocating for stringent regulations to define and restrict the roles of PHEs and AAE, aiming to limit their responsibilities purely to assistive tasks.
A Contrasting Perspective
UMAPs chief Stephen Nash offers a different perspective, indicating the BMA's stance derives not from patient safety but from protecting the interests of doctors. He expresses concern about the systematic targeting of the PA profession. "When mistakes are made, there are often multiple contributing factors at play, but the current campaign unfairly singles out PHEs and AAE professionals," he declared.
With the independent review led by Professor Gillian Leng —a respected figure—more scrutiny will be placed on the NHS England database concerning patient safety incidents. A senior NHS source highlighted, "The key here is not whether PHEs are making mistakes—everyone, including doctors, does—but whether they are involved in more incidents than statistically anticipated. Reports tend to be complex, often lacking immediate alarm signals.”
Beyond the healthcare settings, tensions have aroused among medical subscriber groups. The Royal College of Physicians and the Royal College of GPs have started leaning toward opposition against the expansion of PHEs and AAE roles, creating noticeable rifts.
The rumbles of this upheaval have reached legal battle grounds, with the BMA beginning proceedings against the General Medical Council, questioning the regulation of PHEs and AAE roles under the same umbrella governing doctors, concerned it will continue blurring professional lines.
A Graduate Perspective
Adding another layer to this narrative are the graduates entering this contentious workforce. Many are finding it tough to secure jobs. For example, Ulster University graduates hope the government review will help dispel the "toxic debate" hindering their employment opportunities. PHEs undergo rigorous training, and with many securing qualifications, they are left dismayed at the prospect of unemployment.
Conor Finnerty, one such graduate, reflects, "It's disappointing, but it could be worse, and there is hope. The review is good to outline the correct scope. Most of my class haven't managed to get positions as PHEs either. We may have found employment elsewhere, but it’s not what we initially envisioned. It was marketed as almost guaranteed.” Finnerty emphasized the importance of transparency about their qualifications, stating, "PHEs should make it blatantly obvious they’re not doctors."
This sentiment strikes at the heart of the matter, as both practitioners and patients express uncertainties about their qualifications and capabilities. Cuing the government review provides not just hope for the future direction of PHE roles but also the necessary clarity for the healthcare workforce and patients.
Streeting indicated, “Many PHEs provide great care and alleviate pressure off doctors, but legitimate concerns about transparency cannot be overlooked. These issues have persisted too long, resulting in frustrations for physicians and demoralization among PHEs.”
This statement reflects the urgency of establishing clear frameworks and mutual respect among the healthcare professions for the efficacy of patient care and safety.
The pathway forward seems laden with challenges, and only time will tell if the independent review can successfully address the concerns raised and bolster the healthcare system for years to come.
