Tripling of physician associates leaves doctors 'concerned and frightened'

The number of people recruited into the Welsh NHS as physician associates in secondary care has increased by more than 200% in three years, an investigation by ITV Cymru Wales has found.

The British Medical Association (BMA) Cymru, which represents thousands of doctors in Wales, says its members are already reporting incidents where they say they witnessed the safety of patients being put at risk.

NHS Wales says physician associates (PAs) are clinically trained, generalist healthcare professionals, who work alongside doctors and provide medical care as an integral part of the multidisciplinary team.

But the BMA says patients who come to hospital do not always know whether they are speaking to a qualified doctor when they are seeking advice or diagnosis, and the confusion can lead to patients not getting the correct care.

Using Freedom of Information (FOI) laws, ITV Cymru Wales has found that 105 physician associates have been recruited into secondary care in health boards across Wales.

The total number of people working in the role now stands at 156. That represents an increase of at least 207%. We cannot be certain that is an exact figure because we do not know how many PAs have left the Welsh NHS in that time.

The FOI responses show that 67% of all the physician associates employed in secondary care in Wales have been employed in just the last 3 years.

Becoming a physician associate requires a two year course on top of a degree qualification.

The Chair of the BMA's Welsh Council, Dr Iona Collins, told ITV Cymru Wales: "The problem is if you have people who have graduated from a variety of other degrees who are under the impression that they are being fast-tracked to become associated with doctors.

"And instead of training to become doctors, they can train to be like doctors. The two year course is really intensive and it facilitates them to feel like a doctor, but not a doctor, so they are associated with doctors. That is the problem.

"Simply put, the two year training does not equate them at all with what a doctor has to go through in order to qualify to call themselves a doctor. They are not doctors associates, they are doctors assistants".

In response to our investigation, a Welsh Government spokesperson said: “Physician associates play an important role in the NHS in Wales, but we are clear they are there to support the work of doctors, not replace them.

Whilst these roles can work autonomously, they must always work under the supervision of a named, fully trained and experienced doctor.”

The Welsh Conservatives health spokesperson in the Senedd, Sam Rowlands MS said the increase in the number of physician associates is "really significant".

"It perhaps points to a direction of travel which for many people may be a concerned. When people go to hospital they expect to see a doctor, not perhaps someone with a lesser qualification.

"That's not to underplay the role of physician associates, who play an important role but that needs to be put in the right context."

Mabon ap Gwynfor MS, Plaid Cymru said: "There’s a role for physician associates, absolutely. But that’s not at the expense of GPs and doctors.

"So, we need to see the government ensure that they have a programme to recruit more GPs in Wales and to retain the GPs that we have got."

Maxine Hanson-Nortey is one of the physician associates recruited in the last three years in Wales. She works in acute care in Withybush Hospital in Haverfordwest and is very passionate about her role.

"My role as a physician associate is actually working alongside doctors, supporting them with decision making, diagnosing patients and managing patients".

But Maxine accepts that members of the public often do not understand the limitations of her role in secondary care.

"You always have to explain to them that this is what I do and my role is this. Some of them don't get it. They keep on describing us as doctors, but we just have to be stressing that we're not doctors".

Maxine says she doesn't listen to the general criticism about the role of physician assistants being increasingly used in Welsh healthcare settings.

"I'm not trying to put my head under the sand, but I don't follow it, because following is going to bring you down. I've done the course. I've been trained.

"I treat every patient as they're my relative, and I know my limits. I'm not a doctor".

The Welsh Conservatives says clarity around the role is important and they would support a conversation about renaming the role as physician assistants, rather than associates, which is a call from the BMA.

"Sadly", Dr Collins says, "we have the situation where people believe they have been training to a level they have not been trained to attain, and they believe they are safe enough to deliver a certain type of care that doctors who have been trained to deliver that care are quite concerned and frightened".

"On top of that, there is an assumption that whoever is working with that physician associate as a doctor has assumed the responsibility of supervising that physician associate so if they make a clinical error then the blame lies with the doctor who allowed that clinical error to take place, and that is very concerning for doctors.

Dr Collins says she has been told about incidents where patients have experienced a delay to seeing the correct level of medical professional when a physician associate was mistaken for a doctor by hospital staff.

She says doctors have reported to her occasions where a patient believed they have had treatment from a doctor and then retrospectively found out it was in fact a physician ssociate, and that had led to the wrong clinical management.

Doctors have already reported to the BMA in Wales about occasions when PAs have proscribed medication and ordered X-Rays without doctor approval, which would be illegal.

"I want to emphasise that this is not about people", Dr Collins told me, "This is about the role.

Do you feel like a major incident is around the corner, with regards to this blurred line between what is a doctor and what is a physician associate?", I asked her.

"It is, I'm sorry to say that these incidents are already happening in Wales".

From December this year, the General Medical Council (GMC) is set to begin regulating Physician Associates and Anaesthesia associates. The BMA says this will reinforce confusion.

It believes the Health and Care Professions Council, who regulate other health professions such as physiotherapists, paramedics and radiographers, would be a more appropriate regulatory body for PAs, given the GMC has previously only regulated medical practitioners like doctors only.

A survey last year carried out by the BMA, which had more than 900 respondents in Wales, found that 83% of doctors who gave their opinion do not understand the difference between a doctor and a medical associate professional.

When asked if the way MAPs work within the Welsh NHS poses a risk to patient safety, 25.1% responded always, with 55.3% responding sometimes.

The Welsh Government says a tripartite group has recently been established by NHS Wales Employers, including BMA, Health Education and Improvement Wales and Welsh Government.

This group is tasked with developing a framework for the safe and effective deployment of physician associates in Wales.

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