THE British Medical Association (BMA) has condemned the use of physician associates warning of serious risks to patients.
Responding to revelations from Channel 4 News that over 109 doctors’ shifts in hospital trusts had still been covered by physician associates (PAs) between April and September, Professor Phil Banfield, chair of the British Medical Association (BMA) council, said: ‘This is an appalling situation.
‘PAs do not have the clinical expertise, experience, or training to cover doctors’ shifts and should never, ever be asked to do so.
‘The fact that so many NHS trusts continue to flagrantly disregard NHS England’s specific instruction earlier this year that PAs should never replace doctors, leaves patients at risk, with no organisation taking responsibility or accountability.
‘The implications for patient safety cannot be ignored given that hospital bosses continue to blur the lines between doctors and less qualified staff. This is unacceptable.
‘Trusts should not need to be told that there are medical tasks that only a fully trained doctor can do. From our own surveys and feedback from thousands of doctors, we know these findings by Channel 4 News are the tip of a very big iceberg.
‘Not all Trusts in England replied to their investigative questions, and we hear daily of PAs working far beyond their competency.
‘We need government to hold a full and frank inquiry, without delay, into how often doctors’ shifts or clinical work are being covered by medical associate professionals, what harms may have come about as a result, and how often staff are being asked to work beyond their competencies without support or supervision.
‘We also need an immediate pause in recruitment of PAs until we can be assured that the practices described here are no longer being taken.
‘The Channel 4 investigation demonstrates exactly why we must have a nationally agreed scope of practice – what PAs can do and what they can’t do – so that hospitals cannot ignore safe standards of care or blur the lines putting both PAs and patients at risk of avoidable harm.
‘The failure to train, fund and retain enough doctors for rising numbers of patients is not an excuse to take short cuts with patient safety.
‘We’ll be writing again to NHS England making clear that if the concerns that have been raised not just by Channel 4 News and the BMA, but now by numerous Royal Colleges, are not addressed, the serious risk to patients will continue.
‘The suggestion from the government of a rapid review will hopefully provide some clarity on how PAs can assist doctors, however, a review alone is not enough.
‘We need action now to end the practice of organisations using PAs in situations where a doctor’s skills and expertise would deliver safer care.
‘Have no doubt, if the government and the NHS won’t act, doctors will.’
The continued use of PAs comes despite the BMA’s General Practitioners Committee for the UK (GPC UK) voting in favour of stopping hiring PAs in general practice, and for existing roles to be phased out.
Their view was made clear at a meeting of GPC UK on 17th October, where an overwhelming majority of members voted in favour of the following motion:
‘This meeting believes that the role of physician associates in general practice is fundamentally unsafe and:
‘1. There should be no new appointments of physician associates in general practice;
‘2. The role of physician associates in general practice should be phased out;
‘3. The role of a physician associate is inadequately trained to manage undifferentiated patients, and there should be an immediate moratorium on such sessions.’
The motion comes as the Royal College of General Practitioners recently changed its position on PAs, voting against them working in general practice.
The BMA says that those in existing PA roles should be retrained into more suitable ancillary NHS roles.
Dr Katie Bramall-Stainer, chair of GPC UK at the BMA, said: ‘We are aware that this is a challenging and politically heightened issue. At the heart of it is patient safety, which needs to be prioritised, alongside acknowledging the responsibilities of employing practices and welfare of existing employees.
‘It’s no secret that we desperately need more staff in general practice, but we need be sure that staff who see patients are suitably trained and competent to see them unsupervised.
‘Workload is inextricably linked to the recruitment and retention of the workforce, so additional roles should not generate more work for already-stretched GPs.
‘We’d like to see PAs being given opportunities to retrain and take up other roles in the NHS, but the bottom line is getting more GPs into the workforce.
‘We want to be able to give patients the care and services they need, when they need them, with the most appropriate clinician for their needs. To do that, the government must urgently invest in practice staff such as GPs and general practice nurses.’
- Last week, the BMA warned that negative changes to pensions taxation in Labour’s Budget would ‘derail the government’s chances of meeting its pledge to cut NHS waiting lists.’
In a letter to the Chancellor, the chair of the BMA’s pensions committee said that punitive changes would prevent doctors from taking on additional work, force them to reduce their workload, or, in the worst case, leave the NHS entirely.
The BMA called on assurances from the government that it will:
- Not reduce tax-free pension lump sum allowances;
- Not reintroduce the lifetime allowance;
- Not introduce a flat rate tax relief on pension contributions;
- At least index the annual allowance threshold in line with inflation and provide a solution for the poorly designed annual allowance taper2.
The BMA says that reducing the tax-free pension lump sum allowance would cause a large number of doctors to retire immediately in order to not be hit by huge tax bills that they had not planned for.
According to NHS data, more than 22% of the consultant workforce in England are between the ages of 55-64, many of whom are able to take early retirement.
The tapered annual allowance, which dictates how much a person’s pension can hypothetically grow before it is subject to more tax, can trigger additional charges of up to £22,500 as a result of just £1 of further earnings.
In his letter to Chancellor Rachel Reeves, BMA pensions committee chair Dr Vishal Sharma, said: ‘The government has committed to bringing down record waiting lists via 40,000 additional appointments a week, but the wrong changes to pension taxation could completely derail these plans before they have even started.
‘As we have already highlighted, the tapered annual allowance is already impairing senior doctors’ ability to take on additional work but some of the potential changes that are being suggested could result in doctors retiring on an unprecedented scale.
‘After many years of doctors being left with little option but to take action, such as reducing their workload or leaving the NHS entirely, to mitigate the disproportionate impact of pension tax policy, the last thing that the NHS needs is further detrimental changes.’
Dr Sharma also warned of unintended consequences of national insurance rises on the NHS as an employer, whether these are increases to the rate of employers’ national insurance, or subjecting employers’ pension contributions to national insurance charges.
He said that the Treasury would need to meet these costs or the NHS – including GP practices – would need to be exempt.
‘GP practices are already under immense financial pressures – levying further costs could likely cause the closure of even more practices,’ he warned, adding:
‘I would again urge you to consider these points, alongside our wider BMA submission to the Budget consultation as you finalise the coming Budget.
‘The wrong changes could have irreparable damage for the NHS and the government’s ambitions to improve waiting times for patients.’
