Further position statement on Physician Associates

The Royal College of Physicians of Edinburgh ( “the College”) has members and fellows in all four nations of the UK and around the world.

Its prime charitable purpose is to protect, maintain and develop standards of patient care, wherever our members and fellows work.

This statement reflects that purpose.

We have previously commented[i] [ii] on the planned regulation, deployment and supervision of Medical Associate Professionals (MAPs) in the UK, calling for a halt in deployment until issues relating to patient safety, scope of practice, supervision and the impact on training of doctors are more clearly resolved. This statement updates and re-emphasises our position, specifically with regard to Physician Associates (PAs).

We acknowledge and do not underestimate the complex challenges that Royal Colleges, the BMA, employers, Statutory Education Bodies, MAP representative groups and the GMC have faced with regard to this agenda.

We also recognise the clearly expressed views of multiple medical professionals, in large surveys conducted by Royal Colleges and others, that hasty and wide deployment of PAs may undermine patient safety and compromise the training of doctors. Those views are reflected in the position statements released by an increasing number of Royal Colleges in recent months.

Our current position is as follows:

1. We are deeply concerned that multiple different organisations, including Royal Colleges, are now generating separate scope of practice documents for PAs working in different specialties, in different geographical locations and with different employers.

We predict that the existence of multiple scope documents will cause confusion in the workplace and risk harm to patients.

These documents must be unified into a single core scope document, ideally covering all four nations of the UK, ideally covering all surgical and medical specialties, and ideally indicating a clear “ceiling of practice” for PAs.

2. We are also concerned that multiple different organisations are now generating separate documents relating to the supervision of PAs.

We predict that this will lead to further confusion for both PAs and doctors, again compromising patient safety and again we ask that these are unified.

3. We do not believe that the uncertainty surrounding scope and ceiling of practice and of the supervision of PAs will be resolved before the planned date of GMC regulation in December 2024.

In that regard, it is noteworthy that GMC regulation will effectively enable a system to licence PAs, analogous to the licensing of doctors, primarily based on approval and assurance of undergraduate curricula and assessments by the GMC.

However, there is at present no indication of any structures or processes that will be mandated post-registration of PAs, that would ensure ongoing structured training or experience, with appropriate assessment of capability, such as the prospective structured competency-based training curricula that doctors undertake.

Without greater clarity regarding these matters, we predict that the quality assurance of post-registration capability of PAs across the wide range of areas where they are deployed will be insufficiently robust or consistent to guarantee patient safety.

4. As such we recommend that the legislation regarding regulation is delayed in its implementation - that is, that the GMC does not take over regulation until clear nationally agreed scope and ceiling of practice protocols are in place and clear plans regarding post-registration training and assessment of PAs are defined.

5. In the interim, and whether or not GMC regulation is delayed, this College

a. again calls for a suspension of any further recruitment or deployment of PAs in the NHS in all four nations.

b. will not produce a separate scope or supervision document for PAs.

6. Finally, we sincerely believe that the professional acrimony and discord generated by this extremely divisive debate must cease. We again condemn the hostile and abusive exchanges occurring on social media and in the workplace. These represent unacceptable behaviour and must cease.

The medical community of Royal Colleges, specialist societies and the BMA must now come together to resolve any differences in professional perspective that exist.

A united professional position is the best way to ensure that patient safety is protected, and we call upon senior representatives of the Colleges and the BMA to come together to determine a means by which such unity can be achieved.

[i] Position Statement on Physician Associates in the UK January 2024

[ii] College publishes new statement on Medical Associate Professions April 2024