Physician associates – letter to the editor

Photo by Alex Proimos
This image, which was originally posted to Flickr, was uploaded to Commons using Flickr upload bot on 30 May 2012, 08:03 by High Contrast. On that date, it was confirmed to be licensed under the terms of the license indicated.

Dear Editor

Re: Physician Associates

I am writing to give my perspective on the role of physician associates( PAs).  I am a recently retired Consultant Physician who was  involved in the initiation of a PA programme in Devon over 10 years ago.

Workforce planning in the NHS is notoriously difficult and an issue that central government has continually put in the “too difficult” box.  

Workforce planning in medicine has been confounded by many factors.  Some of these  include a programme labelled ‘Modernising Medical Careers’ ( re-organisation of postgraduate medical training in 2005) , demographic shifts, (with an increasingly elderly population with higher health care needs), Brexit ( loss of European doctors working in the NHS), extended roles of other professions ( nurses, pharmacists, physiotherapists  etc. ), progress in healthcare research (changing public expectations and novel roles and treatments) and, not least, underfunding of the NHS since 2010.

PAs have been introduced into the workforce at a time of increasingly low morale amongst medics as a result of cultural shifts and financial pressures in the NHS.  

PAs do not function within the same regulatory framework as qualified doctors and arguably have better terms and conditions of work.  This understandably has led to resentment.

The lack of regulatory framework and transparency/ambiguity of the role has led to confusion and anxiety with the general public who have an expectation “to see the doctor”.

The historical workload of junior doctors (postgraduate doctors undergoing specialty training) was either covered by large numbers of doctors (often from overseas) with little prospect of career progression to substantive specialist or GP posts, or by reducing the numbers of doctors in training to match expected substantive workforce requirements.  

There is more than enough work to do, and PAs can help deliver this.  However, in the absence of a regulatory framework and a clear communication strategy, mission creep would appear to be occurring.   Examples of PAs working without clear lines of accountability are being cited in social media and linking medical mishaps to PAs are adding to adverse publicity.  

Doctors have always made mistakes and some have been known to work outside their competence, but they arguably have a robust regulatory framework and a long historical legacy of trust that both supports them,  their patients and can hold them to account where necessary.

PAs were introduced into the workforce in order to improve patient care by increasing the number of workers who were competent  and capable of providing basic clinical skills whilst maintaining ensuring that such care was supervised and the responsibility of senior clinicians.

An appropriate regulatory framework and communication programme is urgently required to allay concerns on all sides.

Sincerely yours,

John Lowes MA MD Cert Clin Ed FRCP