Last month the BMA’s junior doctors conference passed a motion to “actively oppose” medical associate professionals (MAPs) being treated equally to them when it comes to medical staffing. I proposed the motion. It was comprised of various sections from regional junior doctor committees across the country. It was a very split debate and some people felt that it demonstrated a disregard or even disrespect for our colleagues, but this was most certainly not the intention.
Medical associate professionals encompass a wide variety of groups and skills. Since 2015 there has been an increase in the number of degree places for training to become a physician associate and this group is expanding the quickest. Other groups such as advanced critical care practitioners, surgical care practitioners, and physicians associate (anaesthesia) are more specific roles. These are more often entered into by existing NHS workers including nurses, operating department practitioners, physiotherapists, and others. PAs originated in the USA in the 1960’s and the role was created in the UK in 2005. In 2015, 200 were recruited from the USA at the same time as the first new two year graduate entry degree programmes were set-up.
There are now 36 university courses for training to become a PA listed on the NHS health careers website. This sudden upsurge in numbers follows the government’s suggestion that MAPs, and in particular PAs, could solve the medical staff numbers crisis. The biggest problem so far has been that there is no standardised job description for these graduates and recruitment has been on a trust by trust basis where roles, and most importantly funding, have been identified. In many departments PAs are working 9-5 Monday to Friday as an extra member of daytime staff. This is being used as an excuse to reduce the normal working days of junior doctors because it increases ward staffing. There are places where PAs are becoming part of the on-call team. This is a logical step, however there is currently no nationally agreed position on how this should be done. Filling gaps in junior doctor rotas by using both groups interchangeably is not a safe option, but it is the easy one for medical staffing. Where rotas exist, slotting a PA into an on call gap provides minimal disruption and minimal administrative work. This is a dangerous precedent as it suggests equivalence and devalues both professions. In situations where it is felt that a PA may be appropriate for out of hours work there should be a separate rota whereby a PA is an integral part of the on-call team present in all teams. This may lead to a reduction in the number of doctors required out of hours while maintaining, or even increasing, the physical numbers of staff on the ground. This may reduce the trust’s locum bills and increase the number of normal hour days that junior doctors can work and the training opportunities that go with them such as clinics and theatre lists.
The other question is about regulation A voluntary register has existed since 2010 which requires MAPs to revalidate every five years. There is an ongoing consultation regarding a mandatory regulation system and the GMC are keen to bring PAs under their sight. Again this is the easy option and again not in my opinion the correct one. This would further blur the lines between MAPs and doctors, and confuse the public. Currently a GMC number is one of the key identifiers of a medical degree and license to practice.
MAPs can become a key part of the NHS workforce, but they must not be treated as cheap, quickly trained junior doctors. It is not good for them and it is not good for junior doctors either. Maintaining a separation of rotas and a separation of regulators would allow both groups to work together to provide the best NHS we can for world class patient care and world class medical training.
James Warwick is an ST2 in Obstetrics and Gynecology in the north west and deputy chair of the Mersey BMA junior doctors committee.
Competing interests: none declared