Dr Steve Taylor was speaking to GP Online on the findings of the latest Health Survey for England.

GP Online reported that the survey reveals rising pressure on general practice as a growing proportion of the population lives with poor health and long-term illness.

He said: “The lack of investment in health has created this.

“We are reaping what we sowed over 15 years of austerity.

“There’s also an element of an ageing population, more long-term issues because of the huge waiting list, more people who are ill and overstretched GPs with not enough time to spend on prevention, so the problems increase again.”

DAUK in the media

Read the GP Online article on what the Health Survey for England shows about pressure on GPs.

Meanwhile, Dr Taylor spoke to Pulse on a survey by United Medical Associate Professionals (UMAPs).

The survey found that 76% of PAs said their scope of practice has been restricted since the publication of the Leng review.

Dr Taylor said: ‘I would say their scope has been reduced rightly, because I think there was significant risk for patients with somebody that’s had such limited training to be seeing undifferentiated patients.”

Read the Pulse article in full.

DAUK’s committee members are all volunteers. They campaign and speak in the media about issues facing doctors in their own time. Please support our work by joining DAUK or donating to our GoFundMe.

Physician associates

Ms Fernandes said there had been a failure to address the ‘scope and limitation’ of PAs. She added: “That leaves the PAs themselves, the doctors supervising them and, more importantly, the patients they care for in unsafe and uncharted territory. “The proposal that the scope will be determined locally, by the employer, seems ridiculous given that is not what trusts are for in being able to define what a professional can do.” Ms Fernandes also questioned whether there was actually a role for PAs in the NHS.

What do PAs bring to medical teams?

She said: “If they work with the more admin side of patient care and carried out limited amount of patient care, like blood pressure checks and blood tests… but there are already people who do these things all of whom are trained in these things, so what does a PA bring to a medical team? “What unique skills do they bring? Well, the answer is none. There is no single college that supports the role.” Read the article in full on the i News website. Please support our work by contributing to our crowd funder or by becoming a member.

Judicial review

In seeking a judicial review, Anaesthetists United argued in the High Court that PAs and AAs, who are not doctors, are performing roles beyond their competence and training. It was also argued that by not setting their scope of practice, the GMC was putting patients at risk. The case has been heard by Mr Justice Chamberlain, the lead High Court Judge dealing with judicial review cases. It has passed its first legal hurdle and has been granted permission to proceed to a full High Court hearing, which is set to be held before Easter. In reaching his decision, Mr Justice Chamberlain, said: “The claim raises serious issues of importance to the relevant professions and to patients which should be determined on a reasonably expedited basis.”

Legal ruling welcomed

The ruling was today welcomed by our chair Ms Helen Fernandes. She said: “We have been consistent supporters of this crucial legal challenge and provided substantial financial backing. “We are delighted with the ruling and that it will now go to a full judicial review. “With this ruling, as well as the independent Leng Review, we feel even more strongly that the roll out of PAs and AAs now needs to be paused. “Questions around the appropriate regulation, scope of practice, supervision, and ultimately patient safety need to be answered. It’s too important to blindly carry on. “It’s also unsettling for the many PAs and AAs who are already in post, and their teams and their patients.

Patient safety

“We recognise PAs and AAs need to be regulated. However, it must be done by the most appropriate body, which is not the GMC. “GMC regulation only blurs the lines between doctors and non-doctors, confuses the public, and risks patient safety.” Anaesthetists United is aiming to raise another £150,000 to cover its costs in the next stage of the case. For more information on how to support this crucial legal challenge, please visit the Anaesthetists United donations page. And please support the work of DAUK.

DAUK has long-standing concerns that GMC regulation will confuse the roles of doctors and non-doctors in the eyes of the public, creating a misunderstanding of the role of PAs and presenting a risk to patient safety.

We’ve also voiced concerns about the scope of practice, that doctors are responsible in law for PA care, and concerns that tasks and procedures that doctors in training need to practice repeatedly are being reallocated to PAs and AAs.

Announcing its legal action, the BMA said it had consistently made clear that physician and anaesthesia associates – who complete a two-year course rather than a five-year medical degree – need regulating, but that the GMC is not the right organisation to do this.

Physician associates

By choosing the GMC as the regulator for PAs and AAs, the BMA says the Government was undermining and devaluing the medical profession, and confusing patients.

The GMC has been using the term ‘medical professionals’ in its materials to describe all of its future registrants – both doctors and associates, the BMA says. This includes in Good Medical Practice, the key GMC guidance document for doctors, defining the standards of care and behaviour that are expected, which is used as a reference to determine fitness to practise.

The BMA is now launching a judicial review claim against the GMC over its use of this term, which the Association says should only ever be used to refer to qualified doctors.

Anaesthetists United, an independent group of grassroots anaesthetists, are planning separate but complementary legal action, which relates to the lack of any national regulation of scope of practice for PAs and AAs, a vital issue which the GMC has studiously avoided.

The BMA says it is liaising with Anaesthetists United, and the DAUK offers both our support.

Dr Ellen Welch, DAUK vice chair, said: “We do need to stand up and make people aware of the deskilling of medicine.

“I do feel for PAs within this debate, but this is not about individual clinicians. It’s about systemic flaws which are normalising doctors being replaced by staff members who haven’t done the same training and this is simply a patient safety issue.”

Open letter

The BMA has also written an open letter to party leaders ahead of the general election to try to put the issue of PAs at the top of their agendas.

In summary, it is asking for:

1.    Implementation of a national safe scope of practice for MAPs underpinned by robust evidence and regulation. 

2.    Amending the Anaesthesia Associates and Physician Associates Order 2024 so that MAPs are regulated by a more suitable regulator using titles that protect patients from being misled. 

3.    An end to widespread doctor replacement and unemployment. 

4.    An urgent review of the long-term workforce plan to determine how MAPs can be safely utilised to the benefit of patients and healthcare systems, as well as the numbers required, underpinned by evidence.  

5.    A halt to any current plans to provide MAPs with prescribing responsibilities. 

6.    An independent inquiry to determine how widespread doctor substitution has become, and how this scandal has been allowed to develop without sufficient regard for patient safety.

Sign the open letter.

DAUK is encouraging as many doctors and GPs as possible to take part in the consultation before it closes at 11.59pm on 20 May.

The consultation covers the regulation of PAs and anaesthesia associates (AAs) as well as education and training, registration, fees, and dealing with concerns.

DAUK remains opposed to regulation of PAs and AAs by the GMC over concerns about patient safety, the scope of practice, that doctors are responsible in law for PA care, and concerns that tasks and procedures that doctors in training need to practice repeatedly are being reallocated to PAs and AAs.

Ms Helen Fernandes, DAUK’s co-chair, said: “What is most alarming about this process, which is set down now in law, is that the GMC states it will not determine what tasks PAs and AAs can safely carry out once they are registered because that depends on their individual skills and competence, which develop over time.

“But it also says regulation will help assure patients, colleagues and employers that AAs and PAs are appropriately educated and qualified, can contribute safely and appropriately to the care of patients, and can be held to account if serious concerns are raised. These two statements seem contradictory at best.”

The GMC is following the instructions laid down by the Anaesthesia Associates and Physician Associates Order 2023 which says the GMC 3(1)(a) must determine standards for the purposes of registration but only 3(1)(b) may determine other standards in relation to associates.

However, it 3(2)(a) must consult such persons as the regulator considers appropriate before determining a standard.

Ms Fernandes said: “For the GMC the word ‘may’ we now know means ‘won’t’. It won’t be setting  standards of performance or scope for AA and PAs beyond their point of qualification.

“From the conversations DAUK has had with the GMC, it is clear it is looking to the royal colleges and the employers to determine scope and competence for AAs and PAs.

“While we are not privy to what may be published by the colleges, we do know that none, save for maxillofacial surgery and ophthalmology have gone anywhere near this as yet.

“Job descriptions for PA and AAs look remarkably similar to that of middle grade doctors, even consultant-level responsibility.

“While PAs and AAs undoubtedly have skills and expertise to assist in the care of patients, their current deployment in historically doctors’ roles, affecting employment of doctors and their training is clear.”

Ms Fernandes added: “The GMC will expect AAs and PAs, however, to follow good medical practice, which states that medical professionals should provide a good standard of practice and care, work within their competence, and when providing that care, base it on their assessment, their clinical judgement, and the likely effectiveness of the treatment options.

“Doctors are trained to do this, PAs and AAs are not.

“We at DAUK state in the strongest terms that this needs to be relooked at. What also needs to be addressed in regulation is how the GMC will hold the doctor supervising the PA or AA responsible when patient care goes wrong. “

The GMC is asking doctors to read its consultation document Regulating Anaesthesia Associates and Physician Associates: consultation on our proposed rules, standards and guidance and take part in the consultation 

Click here to take part in the consultation.

It is putting PAs at risk of being placed in positions they have limited training for and this is less safe for patients, he said.

Dr Taylor, GP spokesperson for the Doctors’ Association UK (DAUK), was contributing to an article on why trained GPs are unable to get a job.

The reason, the article on iNews said, was because surgeries are employing pharmacists, physios and PAs.

Dr Taylor said: “People like pharmacists, physios and mental health workers have been proven to be effective in primary care.

“The role that is causing a lot of consternation is the physician associate (PA). This isn’t the fault of PAs, because I think they’ve been thrown to the wolves, but they’re effectively being used to get healthcare done cheaper.”

DAUK’s GP spokesperson Dr Steve Taylor

DAUK acknowledges that PAs have a part to play in the NHS. However, DAUK’s co-chair Ms Helen Fernandes said the Association was concerned that their roles have ‘morphed over time’ and are being ‘substituted into roles traditionally populated by a doctor’.

Dr Taylor questioned that, as well as the patient safety risk of being seen by a PA, whether the tax-payer was getting value for money.

He told iNews: “A GP has 10 years of training, whereas a PA has two. They can’t know what they don’t know, and I don’t think they’re necessarily getting the supervision a GP trainee would get.

“We’re effectively paying someone who’s a little bit cheaper, but nowhere near as qualified, [instead of] people who are more expensive but will do twice as much work and not make as many mistakes.”

He added: “There has been a good push from the government to recruit extra GP trainees. We’ve seen a lot more trainees coming through the system. That would be fine if there was funding to employ them at the other end, but the funding per patient that practices receive has fallen 20 per cent in real terms since 2016.”

Dr Taylor also contributed to an article in the Daily Mail exploring the lack of work opportunities for qualified GPs.

The article said that a GP had been working as a taxi driver in the Midlands for the past two or three months because they had struggled to secure work as a locum or salaried GP.

Dr Taylor said it was not an isolated case. 

“There are increasing reports of doctors not getting the work they want,” he said. ‘I did a little poll recently – at least 50 per cent of GPs were struggling to get the work they wanted.

“Some were locums not getting as much work as they wanted, some were partners not getting the hours they wanted, and some salaried. In summary it’s a lack of funding within core GP services.”

GPs, he said, were increasingly taking shifts in roles outside general practice including in urgent treatment centres and A&E.

“It’s ridiculous,” Dr Taylor said. “I was getting emails daily offering locum work last year – but I’ve not had a single email for four months.”

DAUK views the NHS England guidance as a positive step towards patient safety and effective multidisciplinary teams – but believes more still must be done.

Dr Matt Kneale, DAUK co-chair, said: “The focus on clear roles, appropriate supervision, and limits to the scope of practice for PAs aligns with our long-standing position on the safe integration of non-medical professionals into healthcare.

“We particularly welcome the emphasis on PAs not replacing doctors and the clarification of prescribing rights, both of which are critical for maintaining high-quality patient care.

“However, while welcoming this guidance, we maintain that significant work remains to ensure patient safety.

“We continue to call for an immediate pause on the recruitment of MAPs, including PAs and Anaesthesia Associates (AAs), until robust safeguards are fully established.”

This position reflects a recent DAUK member survey, which revealed substantial concerns among frontline doctors about PAs potentially operating beyond their competence. This raises the possibility of risks to both medical training quality and patient safety.

To ensure that MAP integration doesn’t compromise healthcare or training standards, DAUK calls for more stringent regulatory measures and governance frameworks.

DAUK urges the General Medical Council (GMC), in collaboration with stakeholders, to accelerate the development of comprehensive curricula, core capability frameworks, and standards for continuous professional development, assessment, and appraisal for MAPs.

DAUK also encourages NHS England and healthcare leaders to maintain open dialogue with medical professionals.
These conversations should address concerns and actively incorporate frontline staff input into the policymaking process.

Dr Kneale said: “Collaboration is essential for an NHS that is both inclusive and safe, enabling all team members to work to their full potential.

“DAUK remains committed to working with NHS England, the GMC, and other partners. This cooperation will support the development of a well-regulated, integrated, and safe NHS workforce that upholds the highest standards of patient care.”

The move follows pressure from DAUK and other organisations to oppose the legislation for the regulation of physician associates (PAs) and anaesthesia associates (AAs) by the General Medical Council (GMC).

DAUK yesterday called for a motion of regret when the Draft Anaesthesia Associates and Physician Associates Order 2024 next goes before the House of Lords.

Now the Order is being drawn to the special attention of the House of Lords, ‘on the ground that it is politically or legally important or gives rise to issues of public policy likely to be of interest to the House’.

Dr Kneale said: “We welcome and are grateful for the intervention, which means this legislation will no longer pass quickly in a small chamber and will have a full debate in the House of Lords.

“We’ve been saying all along that legislation that will fundamentally change patient care in the NHS to the detriment of the public should be properly debated and scrutinised and not rushed through on the nod.

“There are so many issues to be discussed around PAs and AAs, but the fundamental one is patient safety and they deserve to know who is treating them.”

Dr Kneale added: “The focus on PA/AA regulation highlights the need for clarity and proper oversight in healthcare roles. DAUK’s concerns about the GMC’s regulation model underline the importance of this debate for patient care and professional standards.”

He also welcomed a fatal motion brought by Baroness Bennett, who said the Order ‘represents a significant constitutional change in regulation of healthcare professionals by omitting parliamentary oversight and approval for regulating AAs and PAs; and fails to address concerns within the medical profession about the supervision and titles of the roles.

“Credit to the BMA as well on this,” Dr Kneale said. “If successful it will stop the statutory instrument.”

Dr Kneale also welcomed motions of regret by Baroness Finlay and Baroness Brinton.

Baroness Finlay moved ‘that this House regrets that the draft Anaesthesia Associates and Physician Associates Order 2024 refers to “associates” rather than “assistants”, which would more properly reflect the role, scope and responsibilities of such staff and reduce patient confusion’.

Baroness Brinton, meanwhile, moved ‘that this House regrets that the Government has failed to respond adequately to concerns over provisions in the draft Anaesthesia Associates and Physician Associates Order 2024 about (1) the regulation of physician associates and anaesthesia associates by the General Medical Council instead of another regulator, and (2) the use of these professional titles, which risks confusion for patients over the difference between doctors and other healthcare professionals, with potential implications for patient safety’.

Dr Kneale said: “The motions reflect the broader unease about the draft order, from the titles used for associates to the choice of regulator. 

“We’ll continue to share concerns with Peers in the build up to this in order that they may effectively hold the Government to account on vital issues of regulation, scope and standards of practise for PAs and AAs.”

DAUK co-chair Ms Helen Fernandes has highlighted a significant disparity between the GMC’s stringent curricula requirements for doctors and the generic proposals for non-doctors.

The association questions the fitness of the GMC model of regulation for non-doctor roles, given the absence of detailed standards or competencies for PAs and AAs. 

Ms Fernandes said: ”Our doctors meet high standards through rigorous exams, assessments, and reviews. The GMC adopts these from the colleges for each specialty, ensuring a high bar for patient care.

“However, for PAs and AAs there are no such standards set, raising the question of how their competency will be measured and regulated.”

Ms Fernandes pointed to an independent review of advanced practise nursing commissioned by the Nursing and Midwifery Council (NMC), which revealed inconsistencies in entry and practice across the UK, with no clear definition or consistent education standards for advanced practice roles. This parallels the issues DAUK foresees with the GMC’s proposed regulation of PAs and AAs.

“There is a pressing need to address the root of safe patient care,” Ms Fernandes said, emphasising the public’s assumption of being treated by fully trained doctors when seen by PAs.

“Regulation is more than just a GMC number. It’s about safeguarding the public.”

The GMC’s recent announcement that PAs and AAs will be registered under a unique seven-digit reference number, while a step forward in identification, does not alleviate DAUK’s concerns about the scope and competencies of these roles.

“The reference number is a start, but it doesn’t differentiate the expertise doctors bring to patient care from that of PAs and AAs,” Ms. Fernandes said.

“It also doesn’t address the urgent need for detailed regulation of their scope and practice.”

Dr. Matt Kneale, DAUK co-chair, expressed concern about the “blurring of lines” between doctors and non-doctor roles, calling into question the suitability of the GMC as the regulator for medical associate professions (MAPs).

DAUK is scheduled to meet with GMC chair Dame Carrie MacEwen, chief executive Charlie Massey, and Professor Colin Melville, the medical director and director of education and standards, in early January to discuss these critical issues further.

“We intend to bring to the GMC’s attention the unprecedented concern among doctors about the imminent legislation,” Dr. Kneale said. “Patient safety must be the priority, and we believe that the GMC regulating MAPs could compromise that safety.”

DAUK remains steadfast in its commitment to improving NHS policies and will continue to voice the concerns of frontline doctors to ensure a better health service for all.

DAUK co-chair Ms Helen Fernandes has written to the GMC to emphasise members’ concerns about the proposed regulation of physician associates (PAs) and anaesthesia associates (AAs).

The Government is seeking to pass legislation for PAs and AAs to be regulated by the GMC which, Ms Fernandes, said was creating “unprecedented concern” in the medical profession.

“A major theme is alarm over the apparent lack of any detail within the proposed legislation to address the competency and scope of these health professionals,” she said.

DAUK has long campaigned against the expansion of non-doctor roles in the NHS.

According to the Department of Health and Social Care, there are currently 1,500 PAs in hospitals and 1,700 in primary care settings. There are approximately 320 AAs.

The NHS Long Term Workforce Plan sets out plans to increase the PA workforce to 10,000 by 2036/37 and the AA workforce to 2,000 in the same period.

Legislation was due to be laid this week to allow the GMC to begin the process of regulating PAs and AAs.

But Ms Fernandes said there were still fundamental issues to be resolved including the huge difference between the training and education requirements that the GMC demands of doctors for registration, and the proposals for PAs.

She said: “It seems illogical that legislation will be passed to approve GMC regulation of PAs and AAs when we have no structure in place against which to regulate them.”

DAUK is currently exploring all avenues to address the concerns of members and the wider profession with this bill, including legal redress if necessary.

In her letter to the GMC, Ms Fernandes said: “DAUK feels very strongly that these fundamental issues that go to the root of safe patient care need to be urgently addressed.

“There is much more to regulation than a GMC number and the safety and protection of the public who, most often, think they are being seen by a fully trained doctor is paramount.”