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.”

Dr Nicholl was speaking after an extraordinary general meeting (EGM) of the Royal College of Physicians (RCP) held to debate issues related to PAs.

The debate was on five motions covering scope of practice, accountability, evaluation, the impact on training opportunities, and the pace and scale of the roll-out of PAs.

Dr Nicholl, RCP fellow and consultant neurologist, spoke in the debate and pointed out governance issues relating to the motions and what will be done if they pass.

“We’re pushing for all five motions to be passed and I don’t think the officers were reading the room,” he said.

“Everyone agreed with the first four motions, which is precisely why we need all five motions to pass.

“It’s illogical for the college to support motions one to four, but oppose motion five to limit the pace and scale of the roll-out until the issues of regulation, standards, and scope of practice are addressed.

“It really is time to take the foot off the accelerator.”

Dr Nicholl added: “I pointed out governance issue after governance issue with regard to what’s happening now in relation to motions one to four, that they agree with.

“But no-one said what we’re going to do about it, and what’s going to happen if motion five passes. Is anyone actually going to do anything?

“It’s a challenge.”

Dr Nicholl thanked DAUK members for completing a survey about PAs last year, which has formed the basis for a lot of campaigning and media work.

And he thanked RCP fellows who contributed to his talk during the EGM.

He said: “I’m immensely proud of what we’ve done but equally I’m extremely anxious about what happens next.

“I was neutral on this until last summer and it was only when DAUK did a survey of our members across the country alerted me that, Houston, we have a problem.

“So a huge thank you to every DAUK member that completed that survey.

“I’ve had nearly 50 FRCPs who inputted into my slides.

“I only had a 12 minute talk to cover five motions and there was a real breadth of expertise in that.”

The vote closes at 7.30pm on Wednesday 20 March and results of the fellows’ vote will be announced on 25 March.

The RCP said: “They will then be discussed by RCP Council at an additional meeting in April and the Board of Trustees in June, where any necessary action plans will be developed. We will update RCP fellows and members on the next steps as soon as we can.”

Ms Helen Fernandes said PAs had a part to play in the NHS but said they had ‘mushroomed’ and taken on doctors’ roles and that patients were not aware.

She was interviewed on the Iain Dale programme on LBC.

Ms Fernandes said: “Any criticism we have of physician associate roles is not personal to those that are currently in that role.

“It’s rather the way that role has morphed over time, mushroomed somewhat out of control, and developed now into a situation where PAs are being substituted into roles traditionally only populated by a doctor.

“The medical profession feels that this is a significant risk to patient safety.

“Patients are seeing individuals they think are qualified and trained doctors. They’re not. They’re PAs.

“The new BMA publication is the first time ever, despite law being passed that the GMC will be their regulator in the future, that we’ve actually begun to ask what can a PA safely do for our patients?”

Ms Fernandes also spoke about the training and experience needed to be a PA compared to that of a doctor.

“Currently, if you want to do a PA course you have to have an undergraduate degree that has some sort of science background,” she told LBC listeners.

“You will then spend two years in a master’s degree. Some would question whether it’s equivalent to what we would normally think of as a master’s degree.

“Then you are a qualified PA.

“With that qualification you can be appointed to a role where you will see patients in a GP practice by yourself for the first time, for which a doctor would have to undergo a five year medical degree and 10 years of post-graduate education – 10 years altogether before you can independently see the patients.

“The qualifications, the training, the experience doesn’t match up.

“It doesn’t mean that PAs don’t have a role in general practice, but they don’t as a substitute to a fully qualified and trained GP.”

And she said that there was no shortage of doctors ready and willing to go into general practice but that roles were going to PAs.

She added that neither patients nor doctors want the changes that are being pushed through to general practice.

“The powers that be would have it that these roles are really needed because there’s a shortage of doctors and a shortage of GPs and that somebody needs to see patients, address their problems and move their treatment and care forward,” she said.

“There is not a shortage of doctors.

“In the recent recruitment round, more than 11,000 doctors applied for a GP training post and 4,000 were accepted into these posts.

“There were only 4,000 available posts to train our future GPs, so 7,000 doctors who wanted to be a GP in the future have not got a job to train as a GP.

“The blockage or shortage of GPs for patients is not a shortage of doctors. It may be the way the Department of Health or other decision makers have decided to fund and structure general practice but it’s not what patients want and it’s not what doctors and GPs want for their patients.”

Listen to the interview again. It starts at around one hour 37 minutes and 50 seconds.

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.”

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 Dr Matt Kneale said it was imperative that the recruitment and integration of medical associate professionals (MAPs) – in particular physical associates (PAs) – be paused.

It came in a letter to the BMJ, responding to an opinion column by Dr David Nicholl, consultant neurologist and DAUK spokesperson, in which he argued for the recruitment of MAPs to be paused for problems around regulation, scope of practice, and supervision to be resolved.

In his letter, Dr Kneale said: “This position stems from a growing body of evidence, including our own recent survey, highlighting grave concerns about the integration, regulation, and supervision of these roles within the NHS.

“In less than 72 hours, our survey garnered responses from over 650 frontline doctors, with some truly alarming insights.

“Many reported instances where PAs, operating beyond their competence, have been implicated in significant patient harm and, tragically, in some cases, fatalities.

“These incidents, while not exclusive to PAs and acknowledged as also occurring within the medical profession, are particularly concerning given the current regulatory vacuum and the relatively limited training and experience PAs possess compared to the gold standard of fully trained doctors.”

DAUK recently wrote to the General Medical Council (GMC), supported by more than 2,800 frontline doctors, calling for the GMC to urge the Government to reopen the 2017 consultation into MAP regulation. As yet, the GMC hasn’t responded to that letter.

Dr Kneale said the 2017 consultation was “an outdated snapshot”, coming at a time when only 60 PAs were in general practice. That figure now stands at well over 1,000.

“We are further concerned about the ambition to ‘grandfather’ over registrants in good standing on the PA Managed Voluntary Register at the Royal College of Physicians (RCP), as we doubt the robustness of its safety mechanisms at present,” his letter continued.

“The RCP say that employers bear responsibility for disciplinary matters, but we believe reliance on local employers for disciplinary actions presents significant risks, as seen in cases like Emily Chesterton’s, where systemic failures contributed to her untimely death.

“These instances highlight the urgent need for a comprehensive regulatory framework, away from the medical register for doctors, that encompasses not just guidelines and supervision but also clear pathways for accountability and patient safety.

“Royal Colleges need to wake up and take on this responsibility alongside the future regulator, in whichever form it takes.”

Dr Kneale said that DAUK recognised the potential value of PAs in “augmenting provision of care” but called for their recruitment and integration to be paused.

He said: “This will allow for a thorough root cause analysis of the highlighted issues, ensuring that patient safety remains paramount.

“We propose exploring alternatives, including a possible pathway for PAs into medical practice or re-evaluating their roles entirely.

“It is only through such measures that we can safeguard the integrity of our healthcare system and prevent the MAP experiment from causing further harm.”

Read Dr Kneale’s letter in full.

Co-chair Dr Matt Kneale described the increasing integration of MAPs – including physician associates (PAs) and anaesthesia associates (AAs) – in the healthcare system as “an experiment with our nation’s health”.

DAUK has been working closely with multiple stakeholders, not least the BMA, to address regulatory and safety concerns around MAPs.

It has supported a statement released by the BMA calling for an immediate halt to the recruitment of MAPs and has pledged to continue working with stakeholders on the issue.

Dr Kneale said: “The BMA is the latest stakeholder to call for a halt in the recruitment of MAPs in the UK, and we welcome and agree with their stance.

“We’re working with them on a number of aspects of the regulation and scope of PAs and will continue to do so.

“We’ve long supported an immediate pause on the recruitment of PAs until safeguards and proper regulation are in place – and it’s clear we’re not alone.

“More than 2,800 doctors signed our letter to the General Medical Council (GMC) over fears the proposed regulation of PAs will undermine standards and put patients’ safety at risk. 

“It’s evident there’s a pressing need for clear guidelines and proper supervision of PAs if we want to protect patients from danger.

“We need to halt this experiment with our nation’s health.”

DAUK will continue to work closely with people at the BMA and other stakeholders.

It is also working its way through the findings of a recent survey of frontline doctors and their concerns about the role and integration of PAs into the healthcare system.

The survey was completed by more than 650 doctors and highlighted significant worries about PAs operating beyond their competence and affecting the quality of medical training.

Dr Kneale said: “We’re using the data we collected from the survey, and other work we’re doing, to take this issue directly to MPs in Parliament.

“We want to have those conversations with the people who are able to stop this legislation going through and reopen the discussions around it.”

DAUK will also raise the issue with the GMC at a series of upcoming engagements.

Dr Kneale added: “We’re urging the GMC to work with us to address the concerns of doctors and maintain the high healthcare standards the public quite rightly demands.”