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President's view: Associate professionals - valid concerns are not protectionist
Dr Naru Narayanan

HCSA President

It’s not clear whether the GMC’s latest statement on plans to regulate physician and anaesthesia associates was meant to address doctors’ concerns. If anything it has made things worse.

Take, for example, its acknowledgement that it should no longer use the term “medical professional” to describe both doctors and PAs/AAs. This is something which HCSA and others have long opposed. In our view the term “medical” should be reserved for doctors.

Not the GMC, though. The term “medical professional” must be reserved for doctors, it tells us earnestly. But both doctors and PAs/AAs, it continues, are “medical practitioners”. It’s a contortion worthy of a Civil Service sitcom, but there will be no amusement among those concerned at the way the regulator is implementing its plans.

Let me be clear: HCSA does not oppose PAs and AAs being deployed within defined parameters. As colleagues they have an important role to play within multi-disciplinary teams. What we oppose in the strongest terms is a budget-driven rush to create a tier of “doctors-lite”, blurring the lines around patient care, deployed unsuitably by employers seeking to plug staffing gaps, and squeezing training for the pipeline of future doctors.

So while HCSA agrees that PAs and AAs must be properly regulated, we have opposed current GMC plans to place associate professionals under the existing Good Medical Practice, rather than a distinct code, and to add them to the same register as doctors. We have long warned that this would cross a red line and erode the boundaries between doctors and less qualified clinical staff.

These concerns are not rooted in medical protectionism, as proponents of the plans to increase associate numbers to 12,000 suggest, but in patient safety and the quality of training for doctors. Current plans should also be of concern to associate professionals themselves.

We are told by the GMC that while it will regulate associates - and bring them into the disciplinary regime all too many doctors are dragged through - it hasn’t got the funding to regulate or set standards for their training as it does with doctors.

It also ducks entirely the reasonable demand of HCSA and others to set boundaries for their scope of practice, stating: “This will be for employers and medical royal colleges and faculties to define.”

Given the collective experience of HCSA members over 75 years, we can say with some confidence that mission creep will happen. That certain employers, if left to define the scope of roles, will push the boundaries or will allow them to blur for expediency - placing patients at risk of harm and associates at risk of GMC action. More so if the prescribing powers which are mooted within a matter of years come into force.

Associates cannot be expected to have the full range of knowledge required when simpler procedures go wrong, or to assess cases where wider medical factors may be involved.

Aside from the risks to patient safety, a significant influx of associates and junior doctors will increase pressure on trainers and scant teaching time. There is already an incentive to invest time into a permanent PA or AA within a team over a junior doctor who is “passing through” for a few months on rotation.

Unless these tensions are addressed then a rapid increase in numbers of both groups will only heighten it. And this is a concern which, as I write, has elicited no satisfactory answer. The Long Term Workforce Plan merely opines that expanding associate numbers “will release time for more experienced clinical professionals to provide … training.”

HCSA is clear. We remain supportive of associate professionals, but they are not doctors. Nor should they be expected to be. The GMC’s current proposals are wrong on key issues, and risk blurring professional boundaries in a way that can only be detrimental to patients and staff.

We’ll continue to push back on the profession’s concerns. We’ll be pressing, too, for the architects of planned workforce expansion to answer the crucial question: how will we train them all?