Tensions are escalating in the NHS between doctors and Physician Associates (PAs) and Anaesthesia Associates (AAs), creating a toxic work environment that has prompted Health Secretary Wes Streeting to order an independent review.
The conflict stems from the rapid expansion of PAs and AAs in the healthcare system. Over the past seven years, their numbers have grown from a few hundred to 3,500, with a target of 12,000 by 2036. While PAs have been part of the NHS for 20 years, helping doctors with tasks like taking medical histories and conducting examinations, the recent surge in recruitment has raised concerns among doctors.
Many physicians argue that PAs and AAs are being placed on rotas instead of doctors, creating potential patient safety risks. The British Medical Association (BMA) claims that these associates are performing tasks they are not qualified to do, such as ordering scans and prescribing medications. The union points to two high-profile cases involving patient deaths and a survey where nearly 90% of its members believed PAs and AAs pose a risk to patient safety.
The workplace atmosphere has become increasingly hostile. Julia, a PA with four years of experience, reports a dramatic shift in her work environment. Doctors in her department have started refusing to communicate with her, and she and her colleagues feel uncomfortable and unwelcome.
The conflict has extended to professional medical organizations. The Academy of Medical Royal Colleges warns that the situation is becoming “destructive” and damaging teamwork across hospitals and GP surgeries. Several royal colleges, including the Royal College of Physicians and Royal College of GPs, have moved towards opposing the expansion of PAs and AAs.
Stephen Nash, chief of United Medical Associate Professionals (UMAPs), argues that the opposition is more about protecting doctors’ interests than genuine patient safety concerns. He believes the criticism unfairly targets the entire profession and misrepresents the complexity of medical errors.
The upcoming independent review, led by Royal Society of Medicine president Prof Gillian Leng, will be crucial in addressing these tensions. A senior NHS source suggests that preliminary data does not immediately indicate alarm bells regarding patient safety incidents involving PAs and AAs.
Legal battles are also emerging, with UMAPs considering action against the Royal College of GPs and the BMA launching a legal case against the General Medical Council over the regulation of PAs and AAs.
The dispute has created a challenging work environment for PAs and AAs. Nash describes it as “a really horrible time” where these healthcare professionals are worried every time they go to work, facing significant professional hostility.
As the review approaches, the future of PAs and AAs in the NHS remains uncertain, with both sides presenting compelling arguments about their role, qualifications, and potential impact on patient care.
