'Serious concern' for patient safety in Scotland's NHS amid use of non-doctor associates

Doctors across Scotland are expressing “serious concerns” about patient safety amid the use of certain health workers in the NHS.

Some 80% of doctors believe the way physician associates (PAs) and anaesthesia associates (AAs) work puts those accessing health services at risk, according to a BMA survey.

PAs are health workers who support doctors while AAs work within anaesthetic teams.

PAs can work in GP practices and hospitals and can ask about symptoms, carry out physical examinations and even diagnose illnesses.

But they are meant to work under the supervision of a medically qualified professional.

Typically a PA has a science degree and two years of training at a master’s level.

The BMA Scotland survey of 1,700 doctors found more than four in five (82%) feel their patients do not understand the difference between PAs and the role of doctors.

More than 80% of those who responded believe the way PAs and AAs currently work in the NHS in Scotland is always, or sometimes, a risk to patient safety. And 82.8% reported they feel patients are not aware of the difference between the roles of PAs & AAs and the roles of doctors. pic.twitter.com/aIzIZlGjO3
— BMA Scotland (@BMAScotland) December 13, 2023

Dr Ronald McDonald, a rep for BMA Scotland, said doctors aren’t against PAs or AAs but are concerned about the way the professionals are being used in the healthcare service.

He told STV News: “PAs are not new in Scotland. They’ve been in place for the past 20 years but we are concerned that the way they are being used is changing.

“Certainly the last couple of years we feel they’re being used as a stopgap rather than as part of a solution.”

Dr Iain Kennedy, chair of the BMA’s Scottish Council, said: “There is absolutely no doubt that doctors across Scotland have serious concerns about the confusion, and resulting impact on patient safety, caused by the use of physician associates and anaesthesia associates in our NHS.

“We have a duty of care to our patients and their families – and they need to know who they are being treated by, and the level of their experience and skills.”

He said it is becoming “worryingly clear” that this isn’t always happening, adding that he is “deeply concerned about the implications this has on the level of care that is being delivered”.

The BMA is also worried about the impact PAs and AAs are having on junior doctors who Dr Kennedy said are occasionally being “placed behind AAs and PAs in the queue for access to key training opportunities”.

He continued: “Senior doctors simply do not have the time to effectively train two separate professions and unfortunately it is often the junior doctors who are being impacted by this, which is unacceptable, since it is our younger colleagues who will one day step into our shoes – not PAs or AAs.

“This is an extremely important and urgent matter, and one that BMA Scotland has already raised with the Scottish Government, including directly with the cabinet secretary for health.

“While the Scottish Government has only set out vague plans for a gradual increase in the numbers of PAs and AAs, we remain very concerned that this is not the right time – while doubts about scope, impact on doctor training and confusion with the public are far from resolved.”

BMA Scotland is calling for the roles to be regulated but is against that being done by the General Medical Council (GMC).

The watchdog stepping in may “only further increase the risk of confusion”, Kennedy said.

A Scottish Government spokesperson said: “Physician associates and anaesthesia associates are an important and valued part of the NHS Scotland workforce.

“Today, legislation was laid in both the Scottish and UK Parliaments to bring the roles into regulation by the General Medical Council.

“Statutory regulation is the strongest form of professional assurance, establishing, for the first time, consistent UK-wide professional standards and expectations, together with individual professional accountability to an independent regulator.

“It will also provide patients and supervising doctors with more consistent expectations of the standards and skills for these roles.”

“The Scottish Government is supportive of a gradual and carefully managed expansion of the AA and PA workforce, underpinned by robust evidence of the benefit that can be derived from these roles in specific settings and contexts.”