Leading doctors to launch legal action over physician associates

The British Medical Association said it needed to take action before the “uncontrolled experiment” of the use of medical associate professions (MAPs) “before it leads to more unintended patient harm”.

The union said it plans to bring legal action against the General Medical Council (GMC) over the way it plans to regulate MAPs.

It said that there is a “dangerous blurring of lines” for patients between doctors and assistant roles.

MAPs have been under increased scrutiny following the death of Emily Chesterton in November 2022.

The 30-year-old had been under the impression that she was seeing a GP, but was actually seen twice by a PA who failed on both occasions to spot that her leg pain and breathlessness was a blood clot, which ultimately travelled to her lungs.

Leading medics, including the Royal College of GPs and the BMA, have called for a halt of the recruitment of physician associates while concerns are addressed.

From December 2024, the GMC will become the regulator for physician associates and anaesthesia associates – known as Medical Associate Professions (MAPs).

Professor Philip Banfield, chairman of the council at the BMA, told the union’s annual meeting in Belfast: “Today I want to announce that we are taking legal action against the GMC.

“We’re taking this action because of the dangerous blurring of the lines between doctors and MAPs specifically with challenging their frankly unsafe use of the term ‘medical professionals’ when they’re referring to people who are not doctors.

“This legal action is supported by our colleagues, the grassroots movement Anaesthetists United who will be pursuing a complimentary legal challenge.

“We have had enough of the Government and the NHS leadership eroding our profession.

“We are standing up for both doctors and patients to block this ill thought through project before it leads to more unintended patient harm.

“It’s not too late to row back from this uncontrolled experiment in dumbing down the medical skills and expertise available to our patients.”

The BMA has previously argued that the GMC is not the right regulator for MAPs, arguing that the move will “undermine and devalue” the medical profession while confusing patients.

The BMA’s letter before action says it is seeking to challenge the GMC’s decision to apply its central guidance for doctors – Good Medical Practice – equally to physician associates and anaesthesia associates once they are regulated by the council.

The BMA is also contesting the GMC’s use of the term “medical professionals” as a collective description for doctors, physician associates and anaesthesia associates.

The association is seeking to bring the legal claim against the GMC over its use of this term which it says should only be used to refer to qualified doctors.

Once the legal challenge is filed at the High Court, the BMA will need to be given the go-ahead by a judge for the claim to be considered at a full hearing.

Professor Banfield later added: “PAs are not doctors, and we have seen the tragic consequences of what happens when this is not made clear to patients.

“Everyone has the right to know who the healthcare professional they are seeing is and what they are qualified to do – and crucially, not to do.

“Doctors are ‘the medical profession’. To describe any other staff as medical professionals not only undermines doctors and the rigorous training journey they have been on, but also confuses patients, who rightly associate the two terms as one and the same.

“The central and solemn responsibility of the GMC is to protect the public from those who are not registered qualified doctors, pretending to be doctors.

“It has become increasingly clear that broadening the term ‘medical professionals’ to include those without medical degrees has had the effect of making this task far harder, when recent experience has now shown that this represents a dangerous blurring of this critical distinction.”

Dr Richard Marks, co-founder of Anaesthetists United, added: “Doctors and their patients are united over their opposition to the outgoing Government’s plans for replacing doctors with Associates. Taking legal action seems to be the only way forward.”

A GMC spokesperson said: “In 2019 the General Medical Council was asked by the four UK governments to take on regulation of physician associates (PAs) and anaesthesia associates (AAs).

“Earlier this year legislation introducing the regulation of PAs and AAs was passed by the UK and Scottish Parliaments. This means that we will start to regulate PAs and AAs from the end of the year.

“Regulation will help to assure patients, colleagues and employers that PAs and AAs are safe to practise and can be held to account if serious concerns are raised.

“As a multi-professional regulator, we will recognise and regulate doctors, PAs and AAs as three distinct professions.

“PAs and AAs don’t have the same knowledge, skills and expertise as doctors. They are not doctors but they can, and do, play important roles within multidisciplinary teams when appropriate and effective clinical governance and supervision are in place.

“We know from several years of ongoing engagement with patients and the public, doctors and stakeholders that they do expect PAs and AAs will, like doctors, work to high professional standards.

“We will continue to work with patients, professionals, royal colleges, the BMA and others towards the delivery of safe and effective regulation for these groups.

“We note the BMA’s correspondence on a range of issues and further note that no legal proceedings have been issued at this stage.”

Meanwhile, delegates at the BMA annual representative meeting also passed a motion which called for a public enquiry into reports that MAPs have “worked outside of their competence”.

They also said that MAPs working in GP surgeries or hospitals “must not prescribe or see undifferentiated patients” and that the union should demand that “MAPS are not used as a substitute for doctors and insists on a pause in recruitment and deployment of PAs”.

Presenting the motion, Dr Samuel Parker told delegates: “Tragically, patients have died.

“It takes 10 years to fully train a GP, in contrast it takes two years for a PA.

“No one would board a plane flown by a pilot who (had) 20% training, so why push under-qualified MAPs on to NHS patients.”

He highlighted a job advert for a locum PA in general practice offering a salary of £90,000 per annum.

Dr Parker added: “Doctors are not luddites, trying to prevent progress, MAPs is simply no replacement for qualified medical professionals and you must not be complicit in this patient safety scandal.”

Responding to the passing of the motion, Prof Banfield, said: “We have made clear that PAs should never be a substitute for doctors and have demanded a pause in their recruitment until it can be made clear that they can be integrated into medical teams safely. Today the conference clearly backed that position.

“There is a clear call for more transparency and accountability about the way MAPs are working. The new government, NHSE, and Royal Colleges are all going to have to step up and show how they will deal with the dangers of employing MAPs unsafely.”

An NHS England spokesperson said: “The NHS has been clear that medical associate professions are not a substitute for doctors but are trained roles to support doctors to do their jobs with appropriate supervision.

“Last month, the NHS issued guidance on the appropriate deployment of these roles.”