Letter to Secretary of State for Health and Social Care on PAs (Updated 20.11.24)

UPDATE 20.11.24. The College welcomes the announcement today, 20th November 2024, from Health and Social Care Secretary, Wes Streeting MP of an independent review into PAs and AAs which will be led by Professor Gillian Leng CBE. This is something we have called for and we are pleased that the concerns of physicians and the medical community have been listened to in this regard.

As the first Medical Royal College to call for a pause to the rollout of PA workforce expansion, we look forward to engaging with Professor Leng’s work in this important independent review.

We also urge the Scottish Government to commission a similar independent review in Scotland and recently our President, Professor Andrew Elder, wrote to the Cabinet Secretary for Health & Care, Neil Gray MSP, urging him to do so.

More details of Wes Streeting’s announcement of the independent review: https://www.gov.uk/government/news/new-review-of-physician-and-anaesthesia-associates-launched

14.11.24

Dear Mr Streeting,

Deployment of physician associates

I note your recent comments in the media regarding the deployment of physician associates (PAs) in the UK, where you have indicated “there are legitimate concerns” that you wish to examine. The Royal College of Physicians of Edinburgh, which has over 4000 Fellows and Members in England, has continually raised a number of concerns in relation to this. Indeed, we were the first Medical Royal College in the UK to call for a pause to the rollout of PA workforce expansion. In April 2024, we said:

The College believes no further expansion of the PA workforce should occur in the UK, and specifically that there should be a suspension of the recruitment to new PA posts in Internal Medicine and its specialties across the NHS, until the implications of such expansion for the following can be more clearly defined:

• patient safety, in turn related to PA scope of practice;
• medical training in internal medicine and its associated specialties; 
• medical recruitment, at all levels, across training and service posts;
• health service costs.

For a more detailed explanation of why the College is calling for a pause to the expansion of the PA workforce, please read our explainer here. 

A further complication to note is that multiple different organisations, including some Medical 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 are concerned that the existence of multiple scope documents could 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 and all surgical and medical specialties, and indicating a clear “ceiling of practice” for PAs. Many of those same organisation are also generating separate documents relating to the supervision of PAs. We predict that this could lead to further confusion for both PAs and doctors, again compromising patient safety and again we ask that these are unified.

The College recognises the invaluable contributions of all members of the multiprofessional healthcare team in providing high quality and safe patient care, and we believe that with appropriate education, training, regulation and support, PAs can contribute to such care. However, clinical medicine is increasingly complex and the unique role of the doctor as the clinician - with the breadth and depth of knowledge and skills to allow highly skilled clinical reasoning, complex decision making and the management of uncertainty - must be preserved and strengthened. We have outlined the differences in the education and training of doctors and physician associates here.

It is vital that the government takes some time to consider the concerns that this College and others have raised in relation to the deployment of PAs. I would therefore urge a pause in the expansion of the PA workforce until patient safety, scope of practice, supervision and the impact on training of doctors are more clearly resolved - through a process of independent review. 

Kind regards,

Professor Andrew Elder, President