The government is pushing on with a flawed plan to roll out associate professionals that compromises patient safety and puts doctors at risk.

We know employers are stretched on staffing and have rotas to fill. But without a clear scope of practice, physician associates (PAs) and associate anaesthetists (AAs) are being inappropriately substituted for doctors and carrying out procedures far beyond their expertise. Meanwhile, misleading job titles and ambiguity prevent patients from giving informed consent.

PAs and AAs are dependent practitioners, yet doctors tell us they have no idea whether or not they are responsible for a Medical Associate Professional (MAP) when working alongside them on the wards. This puts our registration at risk for other peoples mistakes. Consultants and SAS doctors must be safeguarded as supervisors, and junior doctors not inappropriately expected to assume this responsibility.

Training has been stretched for years. Junior doctors know only too well that opportunities to learn from senior doctors, simulation time, clinical laboratory rooms and basic resources are all hard to come by, and this will only get worse with another staff group competing for the same opportunities.

WHAT WE ARE CALLING FOR

No grey areas

• A new regulator for MAPs, with a separate code of practice.
• The regulator should take the lead in producing one single universally agreed scope for MAPs.
• Renaming of the roles to “assistant” rather than “associate" and the term “medical professionals" reserved for doctors.
• All work on developing standards and rules halted until a commonly agreed scope is reached.
• MAPs to be required to submit competencies nationally.
• A separate department within the regulator to handle MAP registration and clearer labelling to differentiate from doctors.

Safe supervision

• Employers should only start a recruitment process for MAPs once supervisory capacity has been determined and halt the process where this is not possible.
• Supervisors must be appropriately senior ie consultant or SAS doctors who have willingly agreed through a job planning process, with time ring-fenced and appropriate renumeration for supervision.
• There must be clearly defined limits on the number of MAPs and junior doctors under an individual supervisor and clarity on what happens on a day-to-day basis including when the named supervisor is not available.
• MAPs should be required to provide the name of supervisor when asked.

Gold standard training for doctors

• A defined scope of practice for MAPs which identifies training needs as those appropriate to their role in the team, and not beyond this – leaving complex invasive procedures for doctors.
• Training opportunities for junior doctors ring-fenced, with investment in facilities and resources to enable this.

The role of the doctor is essential 

• As MAPs are dependent practitioners, doctors must be involved at every stage in developing their education and assessment pathways.
• Doctors must sit on Fitness to Practice tribunals and appeal panels for MAPs.

It is time for doctors' concerns to be heard. This is not about protectionism, but protecting patients.