Family doctors fear they are being replaced by cheaper ‘physician associates’ as bitter dispute intensifies – as NHS data shows most GP appointments now with a non-doctor
Doctors have taken their regulator to the High Court over its decision to call their more junior NHS colleagues “medics”.
The doctors union says referring to physician associates (PAs) as “medical professionals” risks confusing the public who may assume they are being treated by a doctor. It comes after the death of a woman whose fatal blood clot was missed twice by a PA who she had assumed was a doctor.
During an NHS staffing crisis, PAs – who do not have to undergo the same lengthy medical training – are being increasingly recruited to GP surgeries. They are supposed to work under the supervision of a doctor and are not allowed to prescribe drugs. However doctors suspect they are being replaced by PAs because they are cheaper as NHS England plans to recruit thousands more.
Previously it was a universally accepted truism within the NHS that it needed to recruit more doctors. Tory governments repeatedly promised to increase their number by several thousand but numbers actually fell because of an exodus of more experienced family doctors – many going part time or retiring early because of excessive workloads.
However in the last 12 months, family doctors have actually reported being unable to find work. NHS England insists PAs are not replacing doctors but it is hard not to suspect GP practice budgets going towards hiring a PA or two could be at the expense of an additional doctor.
The two-day High Court hearing started on Wednesday and comes in the week NHS data revealed most consultations in general practice were with non-doctor staff for the first time last year. The British Medical Association is suing the General Medical Council over its use of the term “medical professionals” – arguing it deliberately confuses physician associates with doctors.
Critics say the BMA’s action speaks to the arrogance of a profession that is more interested in protecting its status within the NHS, than helping it treat more patients. But the BMA insists PAs are unsafe and should be phased out of primary care and only used in limited roles in hospitals.
Last year the BMA published “guidance” on what it believes should be the scope of the PA role – limiting it to being an “assistant role to doctors helping with simple practical procedures and admin tasks”. In a sign of the bitterness between the two staffing groups, the United Medical Associate Professionals responded by saying the doctors’ union had published “their dream job for another group of NHS staff”, adding: “This mainly looks like being servants to doctors.”
However the BMA says it is taking the legal action to protect patients, insisting that the GMC “was established so that the public could be confident they were being treated by a qualified, competent doctor”.
Professor Phil Banfield, BMA chair of council, said: “Put simply, associates are not medical professionals. Doctors are. The NHS is a complex enough system as it is and if the GMC’s regulatory approach is to further confuse patients by blurring the lines between the two, it only undermines public confidence in the healthcare they receive.”
Emily Chesterton, a 30-year-old actress, died in 2022 after she was misdiagnosed twice by a PA whom she thought was a GP. She was diagnosed as having an ankle sprain when she actually had a blood clot that then travelled from her leg to her lung and killed her.
Dr Helen Salisbury, a GP in Oxford and member of the BMA’s council, said: “I’ll introduce myself to patients at my practice as a doctor, and I would make sure that any PA who worked here would introduce themselves as a PA. But if PAs can describe themselves as medical professionals, patients are going to be confused about who is treating them and what skills and training they have.
“Doctors are medical professionals. PAs are not. Patients going into GP practices across the country deserve to know who is treating them and what their training is.”
GPs are now outnumbered by other primary care colleagues such as nurses, pharmacists and physician associates by almost three to one. A decade ago there were as many of them as other clinical staff in surgeries. There were a record 329 million GP appointments in England last year in which the role of the healthcare professional was known. Only 49.39% were conducted by an actual GP.
The Physician Associate role was first established in 2003 and now there are thought to be around 4,000 in the NHS, working mainly in England. NHS England plans to increase the number of PA to 10,000 by 2036/37.
PAs complete a three-year undergraduate degree, then a two-year postgraduate qualification. In contrast doctors’ medical degrees usually take five years to complete and postgraduate training can take five to ten years depending on what field they choose to specialise in.
The GMC has been the doctors’ regulator since 1858 but has now had its remit expanded to include physician associates (PAs) and anaesthesia associates (AAs). AAs assist with anaesthetic care during surgery, including pre-op assessments, under the supervision of a hospital doctor. The BMA insists PAs and AAs should be banned from diagnosing patients.
Total full time equivalent (FTE) GPs has been falling in England since 2015 . A study published in the journal BMJ Open last year found there were 15% fewer GPs than a decade ago per 1,000 patients. It also found the average practice patient list size has increased by 40%. It concluded the NHS in England is heading towards a “tipping point” after which GPs will no longer provide the majority of appointments.
Professor Banfield added: “There is currently an ongoing government review into the safety of the PA and AA roles while evidence of patient harms mounts. The GMC should be taking stock of the situation and concluding that instead of defending the indefensible it should concentrate on giving patients the reassurance that they are being treated by a doctor, with all the training and skill that go with that title.”