The Doctors\u2019 Association UK (DAUK) has today called for the re-evaluation of the roles of non-doctors in the NHS to \u201csafeguard the integrity of our healthcare system\u201d.<\/p>\n\n\n\n
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.<\/p>\n\n\n\n
It came in a letter to the BMJ, responding to an op<\/a>inion column by Dr David Nicholl,<\/a> 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.<\/p>\n\n\n\n In his letter, Dr Kneale said: \u201cThis 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.<\/p>\n\n\n\n \u201cIn less than 72 hours, our survey garnered responses from over 650 frontline doctors, with some truly alarming insights.<\/p>\n\n\n\n \u201cMany reported instances where PAs, operating beyond their competence, have been implicated in significant patient harm and, tragically, in some cases, fatalities.<\/p>\n\n\n\n \u201cThese 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.\u201d<\/p>\n\n\n\n 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\u2019t responded to that letter.<\/p>\n\n\n\n Dr Kneale said the 2017 consultation was \u201can outdated snapshot\u201d, coming at a time when only 60 PAs were in general practice. That figure now stands at well over 1,000.<\/p>\n\n\n\n \u201cWe 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,\u201d his letter continued.<\/p>\n\n\n\n \u201cThe 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.<\/p>\n\n\n\n \u201cThese 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.<\/p>\n\n\n\n \u201cRoyal Colleges need to wake up and take on this responsibility alongside the future regulator, in whichever form it takes.\u201d<\/p>\n\n\n\n Dr Kneale said that DAUK recognised the potential value of PAs in \u201caugmenting provision of care\u201d but called for their recruitment and integration to be paused.<\/p>\n\n\n\n He said: \u201cThis will allow for a thorough root cause analysis of the highlighted issues, ensuring that patient safety remains paramount.<\/p>\n\n\n\n \u201cWe propose exploring alternatives, including a possible pathway for PAs into medical practice or re-evaluating their roles entirely.<\/p>\n\n\n\n \u201cIt is only through such measures that we can safeguard the integrity of our healthcare system and prevent the MAP experiment from causing further harm.\u201d<\/p>\n\n\n\n