Operating theatres
Controversies surrounding PA and AA roles
Kate Woodhead RGN DMS discusses the ongoing debate around the roles of Physician and Anaesthesia Associates, in the lead up to the GMC’s plans for regulation.
The roles of medical associate professions (MAPs) are once again under the spotlight. There have been a number of consultations carried out by the Department of Health and Social Care together with consequent communications and agreement with the devolved nations regarding the regulation of health and social care professions. A law was passed earlier this year identifying two specific professional groups, the Physician Associates (PAs) and the Anaesthesia Associates (AAs), citing plans for their imminent formal regulation. Currently, they are only required to be on
an appropriate voluntary register managed by the Royal College of Physicians or the Royal College of Anaesthetists respectively. This is set to change in December 2024 and the General Medical Council (GMC) will take the lead setting up a new registration process for both specialist groups, which will become mandatory after a two-year transition period. This debate and new parliamentary order have set the cat among the pigeons, although everyone seems to agree that, in the interests of patient safety, formal regulation is necessary and indeed long overdue. The most vocal groups dissenting, have been the BMA and the Royal College of General Practitioners (RCoGP) who state that the GMC is not the appropriate body to be regulating the groups, but it should rather be the Health and Care Professions Council. The RCoGP recently raised significant concerns that Physician Associate regulation by the GMC could increase the confusion among patients about the differences between doctors and Physician Associates.1
They also are concerned about the
capacity of senior GPs to supervise the learning of new and potential Physician Associates, as well as the resources to fund their training, induction and supervision overall. The British Medical Association is equally concerned, not only about the possible confusion by patients about whom they have been seen by, but also their use and planned expansion, which they believe “challenges what it means to be a doctor”. They say that
this reflects how the medical profession has been devalued and undermined in favour of colleagues with less training and skill.2
The BMA
have recently reported on a survey in which the respondents said that the employment of Physician Associates and Anaesthetic Associates had increased their workloads. Many also thought that the way in which Physician Associates were being employed in the NHS was a risk to patient safety and that Physician Associates were working frequently or often beyond their competence.3 The irony of the findings in the survey is that the scope of practice, training and supervision of the Physician Associates’ work is undertaken by a senior medical professional. It certainly confirms the opinion of many that the roles require formal regulation as soon as possible. The order passed into law in early 2024, and the GMC is now tasked with formal regulation, which will cover the scope of practise, education, standards and fitness to practise.
Roles So, it appears that the new roles within the multi-disciplinary team are not understood by
the public. This is completely understandable as many of the public will have had no interaction with them either in acute care or in general practice. If the individual undertaking the role does not explain themselves on first meeting, the public will probably not question by whom they have been seen. Physician Associates have undertaken post graduate medical training in Physician Associate studies. This is a general medicine education course spread over two years with equal time in theoretical learning and in clinical placement. Anaesthetic Associates spend more time in clinical placement than in theory learning. The preparation and examinations they undertake are to provide them with skills and knowledge to be employed as supplementary members of the multidisciplinary team in a wide range of clinical areas under the supervision of a named senior doctor. The roles vary according to the hospital and the clinical area worked in. Generally, the Physician Associates are
trained to undertake clinical duties including taking medical histories, carrying out physical examinations, and developing and delivering treatment and management plans.4
Anaesthesia May 2024 I
www.clinicalservicesjournal.com 15
t
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68
