David Oliver: The current stand-off may leave physician associates stranded

Abstract

This year has seen much controversy around plans to expand the numbers of medical associate professionals (MAPs) in the NHS—mainly physician associates (PAs) but also surgical care practitioners and anaesthesia associates. On 20 November the government announced a commissioned review into PA and anaesthesia associate professions,1 focusing on safety and their appropriate roles within services and wider health teams. The health secretary, Wes Streeting, said that he aimed to end “toxic debate” over the issue.2 In my view the current impasse could leave MAPs, especially PAs not already in post, stuck with limited employment prospects, while those already in post face far greater scrutiny over their scope of practice. The NHS workforce plan,3 published in June 2023, was explicitly structured around training and retaining more staff and “reforming” how staff work, the mix of skills in teams, and a proposed shift towards more community models and digitally enabled care. Delegation or expansion of clinical professional roles, role substitution, and the creation and expansion of newer roles were all part of the thinking. Meanwhile, the long expected General Medical Council …